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ADHD and Depression, Anxiety Disorders or Bipolar Disorder

Margaret V. Austin, Ph.D., edited by C. E. Zupanick, Psy.D.

skeletonsimage by Liz (lic)ADHD and Depression

It is estimated that 10 to 30% of children with ADHD have a co-occurring mood disorder such as Depression. Although many depressed adults move, think and talk slowly, children often demonstrate different symptoms when depressed. For example, depressed children be extremely impulsive. They may demonstrate hyperactive behavior, as well as irritability.

Depression may be a reaction to the everyday stress associated with living with ADHD. It is hard to remain hopeful and optimistic when the world seems so unpredictable. Peers seem unfriendly, and school is one drudgery after another. In such cases, a separate depression diagnosis is unnecessary because the depression is occurring in response to ADHD. This is called situational depression. The symptoms will abate once the ADHD symptoms improve.

In other instances, both diagnoses are warranted. When depression runs in the family it may be more directly rooted in biological/genetic causes, rather than situational ones. In such cases, a separate diagnosis and specific treatment for symptoms of depression might be more appropriate. Distinguishing between the emotional complications of ADHD and a separate depressive disorder can be very difficult. A therapist charged with this task would try to determine which came first. If depression preceded the ADHD, it is less likely to be situational depression. Likewise, if there is a family history of depression, it may warrant a separate diagnosis. The clinician would also conduct an evaluation of the severity of symptoms. It is very important to take depressive symptoms seriously, regardless of their cause. Children with ADHD and depression can have suicidal thoughts. Any suicidal comments, jokes, or thoughts should be monitored and immediately addressed by a mental health professional.

ADHD and Anxiety Disorders

Approximately 25% of individuals with ADHD also have anxiety disorders. Common symptoms of anxiety in children include: unpredictable mood swings (i.e., someone is happy one minute and miserable the next); excessive irritability; frequent angry outbursts; a noticeable lack of energy; and, low self-esteem. Low self-esteem becomes particularly problematic during puberty and adolescence. This is then when children begin to compare themselves to their peers. During this time, children with ADHD can become painfully aware of their own limitations.

Other anxiety symptoms include frequent school absenteeism; somatic (physical) complaints; unwillingness to attempt new tasks; and, a sense of resignation regarding their decreased ability to perform various tasks. Children with ADHD and anxiety disorders seem to lack motivation. This is often termed, learned helplessness. Because their efforts to improve do not produce fruitful results, they begin to feel that nothing they do will matter anyway. So, why try? Of course, this sets up a vicious cycle. The lack of effort ensures a lack of improvement, further solidifying the idea, "nothing I do matters anyway."

It is very important to distinguish between an actual anxiety disorder versus children that are experiencing anxiety in response to ADHD. This distinction is important because treatment options are very different. Stimulant medications, while helpful for ADHD symptoms, may actually worsen the symptoms of an anxiety disorder. Medication treatment becomes more complex for those with ADHD and an anxiety disorder.

ADHD and Bipolar Disorder

Bipolar Disorder is a condition that mimics ADHD. Both disorders have symptoms of impulsivity, mood instability, and hyperactivity. Research shows that about 50% of boys and 25% of girls with bipolar disorder also meet the criteria for ADHD. Children and adolescents with bipolar disorder often show impulsive inattention and hyperactive behavior. They may express extremely strong feelings and carry an overbearing or irritable manner. They may find it difficult to wake up in the morning. Children and adolescents with severe bipolar symptoms may have excessive and lengthy temper tantrums that are destructive. These tantrums are often prompted by gross distortions of real events. For example, when a friend wants to play a different game, the bipolar child may think that his friend is trying to purposefully be mean. The child's anger and indignation at such mistreatment may result in an extreme temper tantrum.

As with other disorders already discussed, it is critically important to reach an accurate diagnosis. The stimulant medication used to treat ADHD is not usually helpful for bipolar disorder. It may even worsen symptoms. Lithium is one of the most frequently used medications to treat Bipolar Disorder. Lithium seems best for children who are truly bipolar.