Co-Existing Mood Disorders In Children With ADHD

Introduction

Two-thirds of people with Attention Deficit and Hyperactivity Disorder (ADHD) will be diagnosed with a co-existing condition. Most children diagnosed with such a condition will have a behavioral disorder, but around 18% of them will have mood disorders. Anxiety and depression are the most frequently diagnosed mood disorders in children with ADHD. These conditions can be caused by the frustrations of having to live with the symptoms of ADHD or they could be a coexisting mood disorder. Other common mood disorders include bipolar disorder, learning disorders, obsessive-compulsive disorder, Tourette Syndrome and substance abuse.

Anxiety

Present in up to 30% of children with ADHD, anxiety is characterized by constant worrying, tiredness, and stress. Children suffering from anxiety may make excuses not to go to school, complaining of illness rather than face the stress of going to school. Anxiety can also result from social stresses, but some forms of anxiety may not be a direct result of ADHD. It may be a co-existing disorder. If anxiety is not diagnosed and treated alongside the ADHD, stimulants may increase the child’s feelings of anxiety.

Learning Disorders

Learning disorders will be experienced by 20-30% of children with ADHD, compared to 5% of children without ADHD. 12% will have speech problems. The most common disorders are dyslexia, difficulties learning to read and dyscalculia, difficulties with mathematics. ADHD is in itself not a learning disorder, but it can make it difficult for children to learn and they may need educational intervention. Treating ADHD alone will not solve the learning disabilities. The treatment of learning disabilities generally requires a team approach involving school, medication, and tutoring.

“If you have a learning disability along with ADHD (as is the case with 50% of people with ADHD) and you meet the criteria for a learning disorder such as dyslexia, you may be able to have your tests read to you or you may be able to dictate the answers. Keep in mind that standardized tests for graduate school may not allow these options,” write Stephanie A. Sarkis Ph.D.

Substance abuse

Adults with ADHD are much more likely to become addicted to substances. Research has shown that they will start using substances at an earlier age, will continue the abuse for longer and will have less chance of recovering. The reasons for this are likely to be that the individual with ADHD is tempted to self-medicate, has a tendency to impulsive behavior and starts mixing with other children who have problems acquiring academic and social skills.

“People with ADHD are more impulsive, making them more vulnerable to the temptation to use drugs. This temptation is typically greater among people with untreated ADHD,” writes Joel L. Young M.D.

A recent study has shown that children and adolescents treated with stimulants are less likely to abuse substances. Parents should start speaking to their children about drugs and risky behavior from an early age and ensure that the communication lines are kept open.

Depression

People with ADHD can suffer from one of two types of depression.

Dysthymic Disorder

Dysthymic Disorder is a low-grade depressive state featuring irritability and low morale. It is a chronic condition that persists for years. This and major depressive disorder (MDD) are the two mood disorders most likely to be experienced by children and adults with ADHD.

For a diagnosis of DD, a child must have at least two of the symptoms listed below. The symptoms must have been present for a year or more, and should not have been caused by another condition.

The symptoms are:

Over or under eating
Oversleeping or the inability to fall asleep
Lack of energy
Low self-esteem
Feeling hopeless
Indecisive or inability to concentrate

These symptoms must have had a major negative impact on the child’s home, school or social life

Major Depressive Disorder

MDD is a more severe form of depression and is more likely to afflict adults with ADHD. Children who have had ADHD for a while and children with untreated ADHD may also suffer from MDD. This is a serious condition in which people feel a sense of hopelessness, loss of interest in things that they previously found interesting, tearfulness, inability to sleep, fatigue, anxiety. The symptoms can range from mild to severe, but should always be taken seriously.

Bipolar Disorder

Only recently has bipolar disorder been recognized as a problem from which children can suffer, as it was previously thought to be an adult-onset condition. Whilst adult bipolar sufferers swing from euphoria to depressive moods on a cyclical basis, in children it is more complicated. They have unstable emotions, behavioral problems, and social difficulties. Many children with bipolar disorder also have ADHD.

“Bipolar disorder and ADHD do have a higher rate of occurring together; however, more often than not, people with ADHD who say they have mood swings mean ‘ADHD swings’ not manic swings,” writes Scott Shapiro M.D.

Conclusion

The demoralizing effect of being unable to perform to the expectation of teachers and parents along with the detrimental effects of constant criticism can have an even more damaging effect on the child than the symptoms of ADHD. In children, depression and anxiety can result from demoralization and negative self-esteem brought on by negative feedback. This can be avoided when parents are trained to build a home environment that is ADHD friendly, offering positive reinforcements rather than unnecessary criticisms or harsh punishment. Parents should be taught to find the child’s strengths and then to create an environment where she can flourish.