Children with ADHD at increased risk for depression and suicidal thoughts as adolescents

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ScienceDaily (Oct. 4, 2010) — Children diagnosed with attention deficit/hyperactivity disorder (ADHD) at ages 4 to 6 are more likely to suffer from depression as adolescents than those who did not have ADHD at that age, according to a long-term study published in the October issue of the Archives of General Psychiatry. Although it was an uncommon occurrence, the children with ADHD also were somewhat more likely to think about or attempt suicide as adolescents.

"This study is important in demonstrating that, even during early childhood, ADHD in is seldom transient or unimportant" said study director Benjamin Lahey, Ph.D., a professor of health studies and psychiatry at the University of Chicago. "It reinforces our belief that parents of young children with ADHD should pay close attention to their child's behavior and its consequences and seek treatment to prevent possible long-term problems."

Children with ADHD have trouble paying attention and controlling impulsive behaviors and are often overly active. This can cause poor performance in school, difficulties in social situations, and a loss of confidence and self esteem. The Centers for Disease Control and Prevention estimate that about 4.4 million children, including about four percent of those aged 4 to 6, have ADHD. While many of us hear that there is an "over-diagnosis" of ADHD, in reality there is an under-diagnosis, and many children, adolescents and adults go untreated, either with medications or cognitive therapy.

Most of the earlier studies of the long-term connections between ADHD, depression and suicidal thoughts produced mixed results. The current study benefited from a more comprehensive assessment of depression taking place over a decade, a focus on specific child and family factors that predict which children are most at risk, and consideration of other factors associated with suicidal ideation - suicidal thoughts.

The study was performed by researchers at the University of Chicago and the University of Pittsburgh. It followed 123 children diagnosed with ADHD at age 4 to 6 for up to 14 years, until they reached ages 18 to 20. It compared these diagnosed children with 119 other children from similar neighborhoods and schools, matched for age, sex, and ethnicity. The children were assessed annually in study years 1 through 4, 6 through 9, and 12 through 14. During the course of the study researchers found that 18 percent of children diagnosed early with ADHD suffered from depression as adolescents. That's about 10 times the rate among those without ADHD. They found that children with early ADHD were five times more likely to have considered suicide at least once, and were twice as likely to have made an attempt.

"Suicide attempts were relatively rare, even in the study group," cautioned Lahey. "Parents should keep in mind that more than 80 percent of the children with ADHD did not attempt suicide and no one in this study committed suicide."

"Although the subtypes of ADHD--based on whether they had attention deficit or hyperactivity or both--predict subsequent depression and suicidal thoughts, distinct forms of the disease at age 4 to 6 were moderately predictive for specific problems later on. Children with inattention or combined subtype were at greater risk for depression. Those with combined type or hyperactivity were at greater risk for suicidal thoughts."

"Far more boys that girls suffer from ADHD, but being female increased the risk of depression. Children whose mothers suffered from depression were also at increased risk. Children with more complicated ADHD were most at risk, the authors conclude. Greater numbers of depression, anxiety, oppositional defiant disorder, and conduct disorder symptoms at ages 4 to 6 among children with ADHD robustly predicted risk for depression during adolescence. Children with uncomplicated ADHD with few concurrent symptoms of other disorders were at low risk for depression, but children with many concurrent symptoms were at very high risk."

What does this mean for you and your child or adolescent who you suspect has ADHD? For one thing it means if you suspect ADHD, attention Deficit Hyperactivity Disorder, you need to do more than complete a simple form or self report and obtain a diagnosis and medication. Often, regretfully, that is all that takes place in an MD's office. A "SNAP-4" is given to the parents and the teacher, and after a brief and cursory history 9"Has he been like this for a long time?") a diagnosis is made. I often tell parents we don't "do a diagnosis" but instead engage in a "differential diagnostic process." That means gathering basic information, looking at how the child, adolescent or adult with suspected ADHD presents during the interview (a Mental Status Exam is often the formal means of doing this), collect an extensive history and whenever possible information and observations from a number of people and settings, and complete a battery of tests, self reports and other assessments that RULE OUT other possible causes of the behaviours that are of concern. Remember, there are actually many different possible causes for the behaviours that concern you, and we need to rule out other possible causes and not just jump to a conclusion that ADHD is the cause. Finally, we need to look at a full range of cognitive and academic or workplace results of the behaviour to see exactly how it is affecting the child or yourself. Part of this more in-depth diagnositic procedure includes assessments for depression, mood disorders, neurological disorders, anxiety, autism...all other possible causes and co-morbid (at the same time) conditions. One thing we don't want is to treat ADHD with a medication or treatment that would make another condition w that was masked by the ADHD worse!

So, if your child has ADHD (attention Deficit Hyperactivity Disorder) you also need to be asking yourself, is he or she also depressed? Does he or she have anxiety? Are there specific learning disabilities that also make school difficult? And if my child or adolescent has ADHD what skills did they not learn properly that either I should re-teach or the school should re-teach?

What do we learn from this on-going research? Get a complete evaluation to start.

This study was funded by The National Institutes of Health.

This blog is not offered as medical advice or as a means of diagnosing or treating ADHD or any other disorder. Don't go on line and take an ADHD "test." The diagnosis is complex, and it involves not just looking for symptoms of ADHD, but also ruling out other disorders that might look just like ADHD. So avoid these on line "tests" which are nothing more than a collection of symptoms. You need to see a licensed or registered professional for that. Medical doctors can diagnose ADHD, but the diagnosis is complex and often they will make a referral to a Registered Psychologist. You can obtain a referral from the British Columbia Psychological Association for a psychologist near you.

My web page lists a number of resources you can make use of yourself in dealing with Attention Deficit Hyperactivity Disorder (ADHD). Please visit it at or one of my other sites at either Psychology Today, AAMFT, PSYRIS or my professional site.

Attention Deficit Hyperactivity Disorder (ADHD) assessment and treatment services are offered for individuals, couples, families, children and adolescents in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.

Dr. Jim Roche
Registered Psychologist, British Columbia 01610