Abstract
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that is associated with significant difficulties in the executive control of behaviour and emotions. Risk for depression in ADHD youth is a logical concern. This narrative review examines what is known regarding sources of risk for depression in youth with ADHD in the areas of epidemiology, genetics, neuroanatomy, neuropsychological functioning, social functioning, maltreatment and the effects of psychopharmacologic treatments. Emphasis is placed on longitudinal studies across childhood to maximize relevance to the research question. Findings suggest that comorbidity between ADHD and depression is less than chance would predict in community studies, and shared risk for oppositional defiant disorder accounts for the association that is seen in clinical studies. ADHD and depression share few if any similarities in brain morphology and function. The risk of maltreatment, difficulties in parenting ADHD children and social functioning deficits likely account for substantial risk for depression and should be targets for interventions.
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References
Meinzer MC, Pettit JW, Viswesvaran C. The co-occurrence of attention-deficit/hyperactivity disorder and unipolar depression in children and adolescents: a meta-analytic review. Clin Psychol Rev. 2014;34(8):595–607.
Bloom B, Cohen RA, Freeman G. Summary health statistics for US Children. National Health Interview Survey 2009. Vital Health Stat. 2009; 20101–82.
Taurines R, Schmitt J, Renner T, Conner AC, Warnke A, Romanos M. Developmental comorbidity in attention-deficit/hyperactivity disorder. ADHD. 2010;2(4):267–89.
Diagnostic and statistical manual of mental disorders, fifth edition. American Psychiatric Association Press. Washington DC. 2013.
Jeste SS. Neurodevelopmental behavioural and cognitive disorders: review. Am Acad Neurol. 2015;21(3):690–714.
Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602.
Cullen K, Klimes-Dougan B, Kumra S, Schulz SC. Paediatric major depressive disorder: neurobiology and implications for early intervention. Early Interven Psych. 2009;3:178–88.
Wade TJ, Cairney J, Pevalin DJ. Emergence of gender differences in depressing during adolescence: national panel results from 3 countries. J Am Acad Child Adolesc Psychiatry. 2002;41(2):190–8.
Angold A, Costello EJ, Erkanli A, Worthman CM. Pubertal changes in hormone levels and depression in girls. Psychol Med. 1999;29(5):1043–53.
Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163(4):716–23.
Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A. Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry. 2003;60(8):837–44.
Copeland WE, Shanahan L, Erkanli A, Costello EJ, Angold A. Indirect comorbidity in childhood and adolescence. Front Psychiatry. 2013; (4):144.
Shaw P, Stringaris A, Nigg J, Leibenluft E. Emotion dysregulation in ADHD. Am J Psychiatry. 2014;171:276–93.
Chen MH, Su TP, Chen YS, Hsu JW, Huang KL, Chang WH, et al. Higher risk of developing mood disorders among adolescents with comorbidity of attention deficit hyperactivity disorder and disruptive behavior disorder: a nationwide prospective study. J Psychiatr Res. 2013;47(8):1019–23.
Chronis-Tuscano A, Molina BS, Pelham WE, Applegate B, Dahlke A, Overmyer M, et al. Very early predictors of adolescent depression and suicide attempts in children with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 2010;67(10):1044–51.
Lahey BB, Hartung CM, Loney J, Pelham WE, Chronis AM, Lee SS. Are there sex differences in the predictive validity of DSM–IV ADHD among younger children? J Clin Child Adolesc Psychol. 2007;36(2):113–26.
Lee SS, Lahey BB, Owens EB, Hinshaw SP. Few preschool boys and girls with ADHD are well-adjusted during adolescence. J Abnorm Child Psychol. 2008;36(3):373–83.
Biederman J, Faraone S, Milberger S, Guite J, Mick E, Chenv L, et al. A prospective 4-year follow-up study of attention-deficit hyperactivity and related disorders. Arch Gen Psychiatry. 1996;53(5):437–46.
Hinshaw SP, Owens EB, Zalecki C, Huggins SP, Montenegro-Nevado AJ, Schrodek E, et al. Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. J Consult Clin Psychol. 2012;80(6):1041.
Abram KM, Zwecker NA, Welty LJ, Hershfield JA, Dulcan MK, Teplin LA. Comorbidity and continuity of pychiatric disorders in youth after detention: a prospective longitudinal study. JAMA Psychiatry. 2015;72(1):84–93.
Ohan JL, Visser TA. Why is there a gender gap in children presenting for attention deficit/hyperactivity disorder services? J Clin Child Adolesc Psychol. 2009;38(5):650–60.
Davies W. Review: Sex differences in attention deficit hyperactivity disorder: candidate genetic and endocrine mechanisms. Front Neuroendocrinol. 2014;35:331–46.
Scerif G, Baker K. Annual research review: rare genotypes and childhood psychopathology—uncovering diverse developmental mechanisms of ADHD risk. J Child Psychol Psychiatry. 2015;56(3):251–73.
Lau JYF, Belli SR, Gregory AM, Eley TC. Interpersonal cognitive biases as genetic markers for pediatric depressive symptoms: twin data from the emotions, cognition, heredity and outcome (ECHO) study. Dev Psychopathol. 2014;26:1267–76.
Cubillo A, Halari R, Smith A, Taylor E, Rubia K. A review of fronto striatal and fronto cortical brain abnormalities in children and adults with attention deficit hyperactivity disorder and new evidence for dysfunction in adults with ADHD during motivation and attention. Cortex. 2012;48:194–215.
Hulvershorn LA, Cullen K, Anand A. Toward dysfunctional connectivity: a review of neuroimaging findings in pediatric major depressive disorder. Brain Imaging Behav. 2011;5:307–28.
Gaffrey MC, Barch DM, Singer J, Shenoy R, Luby JL. Disrupted amygdala reactivity in depressed 4 to 6 year old children. J Am Acad Child Adolesc Psychiatry. 2013;52(7):737–46.
Nigg JT, Casey BJ. An integrative theory of attention-deficit/hyperactivity disorder based on the cognitive and affective neurosciences. Dev Psychopathol. 2005;17:785–806.
Nikolas M, Nigg JT. Moderators of neuropsychological mechanism in attention deficit hyperactivity disorder. J Abnorm Child Psychol. 2015;43:271–81.
Vilgis V, Silk TJ, Vance A. Executive function and attention in children and adolescents with depressive disorders: a systematic review. Eur Child Adolesc Psychiatry. 2015;24:365–84.
Wagner S, Müller C, Helmreich I, Huss M, Tadić A. A meta-analysis of cognitive functions in children and adolescents with major depressive disorder. Eur Child Adolesc Psychiatry. 2015;24:5–19.
Cortese S, Keely C, Chabernaud C, Proal E, Di Martin A, Milhyam M, et al. Toward systems neuroscience of ADHD. A meta analysis of 55 fMRI studies. Am J Psychiatry. 2012;169:1038–55.
Gershon J. A meta-analytic review of gender differences in ADHD. J Atten Disord. 2002;5:143–54.
Martel M, Klump K, Nigg JT, Breedlove AM, Sisk CL. Potential hormonal mechanisms of ADHD and major depressive disorder: a new perspective. Horm Behav. 2009;55:465–79.
Gammon GD, Brown TE. Fluoxetine and methylphenidate in combination for treatment of attention deficit disorder and comorbid depressive disorder. J Child Adolesc Psychopharmacol. 1993;3(1):1–10.
Kratochvil CJ, Newcorn JH, Arnold LE, Duesenberg D, Emslie GJ, Quintana H, et al. Atomoxetine alone or combined with fluoxetine for treating ADHD with comorbid depressive or anxiety symptoms. J Am Acad Child Adolesc Psychiatry. 2005;44(9):915–24.
Martsenkovsky I, Martsenkovska II, Bikshaeva YB. P. 2. g. 001 Milnacipran and atomoxetine: treatment of depressive disorder with co-morbid hyperactivity disorder. Euro Neuropsychopharmacol. 2008;18:S373–4.
Bangs ME, Emslie GJ, Spencer TJ, Ramsey JL, Carlson C, Bartky EJ, et al. Efficacy and safety of atomoxetine in adolescents with attention-deficit/hyperactivity disorder and major depression. J Child Adolesc Psychopharmacol. 2007;17(4):407–19.
Golubchik P, Kodesh A, Weizman A. Attention-deficit/hyperactivity disorder and comorbid subsyndromal depression: what is the impact of methylphenidate on mood? Clin Neuropharmacol. 2013;36(5):141–5.
Findling RL. Open-label treatment of comorbid depression and attentional disorders with co-administration of serotonin reuptake inhibitors and psychostimulants in children, adolescents, and adults: a case series. J Child Adolesc Psychopharmacol. 1996;6(3):165–75.
Davis WB, Bentivoglio P, Racusin R, Brown KM, Bostic JQ, Wiley L. Bupropion sustained release in adolescents with comorbid attention-deficit/hyperactivity disorder and depression. J Am Acad Child Adolesc Psychiatry. 2001;40(3):307–14.
Quintana H, Butterbaugh GJ, Purnell W, Layman AK. Fluoxetine monotherapy in attention-deficit/hyperactivity disorder and comorbid non-bipolar mood disorders in children and adolescents. Child Psychiatry Hum Dev. 2007;37(3):241–53.
Hoza B, Mrug S, Gerdes AC, Hinshaw SP, Bukowski WM, Gold JA, et al. What aspects of peer relationships are impaired in children with attention-deficit/hyperactivity disorder? J Consult Clin Psychol. 2005;73(3):411.
Mrug S, Molina BS, Hoza B, Gerdes AC, Hinshaw SP, Hechtman L, et al. Peer rejection and friendships in children with attention-deficit/hyperactivity disorder: contributions to long-term outcomes. J Abnorm Child Psychol. 2012;40(6):1013–26.
Hoza B. Peer functioning in children with ADHD. J Pediatr Psychol. 2007;32(6):655–63.
Coplan RJ, Ooi L. Young children’s peer relations: links with early developing anxiety and depression. Anxiety Depress. 2013; 30.
Daviss WB. A review of co-morbid depression in pediatric ADHD: etiologies, phenomenology, and treatment. J Child Adolesc Psychopharmacol. 2008;18(6):565–71.
Blackman GL, Ostrander R, Herman KC. Children with ADHD and depression: a multisource, multimethod assessment of clinical, social, and academic functioning. J Atten Disord. 2005;8(4):195–207.
McQuade JD, Hoza B, Murray-Close D, Waschbusch DA, Owens JS. Changes in self-perceptions in children with ADHD: a longitudinal study of depressive symptoms and attributional style. Behav Ther. 2011;42(2):170–82.
Finkelhor D, Shattuck A, Turner H, Hamby SA. A revised inventory of adverse childhood experiences. Child Abuse Negl. 2015;S0145–2134(15):00240–9.
Seeds PM, Harkness KL, Quilty LC. Parental maltreatment, bullying, and adolescent depression: evidence for the mediating role of perceived social support. J Clin Child Adolesc Psychol. 2010;39(5):681–92.
Maguire SA, Williams B, Naughton AM, Cowley LE, Tempest V, Mann MK, et al. A systematic review of the emotional, behavioural and cognitive features exhibited by school-aged children experiencing neglect or emotional abuse. Child Care Health Dev. 2015;41:641–53.
Yang SJ, Stewart R, Kim JM, Kim SW, Shin IS, Dewey ME, et al. Differences in predictors of traditional and cyber-bullying: a 2-year longitudinal study in Korean school children. Eur Child Adolesc Psychiatry. 2013;22(5):309–18.
Bacchini D, Affuso G, Trotta T. Temperament, ADHD and peer relations among schoolchildren: the mediating role of school bullying. Aggress Behav. 2008;34(5):447–59.
Nigg JT, Wong MM, Martel MM, Jester JM, Puttler LI, Glass JM, et al. Poor response inhibition as a predictor of problem drinking and illicit drug use in adolescents at risk for alcoholism and other substance use disorders. J Am Acad Child Adolesc Psychiatry. 2006;45(4):468–75.
Jacobvitz D, Hazen N, Curran M, Hitchens K. Observations of early triadic family interactions: boundary disturbances in the family predict symptoms of depression, anxiety, and attention-deficit/hyperactivity disorder in middle childhood. Dev Psychopathol. 2004;16:577–92.
Ullsperger JM, Nigg JT, Nikolas MA. Does child temperament play a role in the association between parenting practices and child attention deficit/hyperactivity disorder? J Abnorm Child Psychol. 2015.
Deault LC. A systematic review of parenting in relation to the development of comorbidities and functional impairments in children with attention-deficit/hyperactivity disorder (ADHD). Child Psychiatry Hum Dev. 2010;41:168–92.
Chen WL, Tsai ST, Chou FH. Depression and related factors in mothers of school-aged children with attention-deficit hyperactivity disorder. Hu Li Za Zhi. 2014;62(1):39–49.
Oldehinkel AJ, Ormel J, Verhurlst FC, Nederhof E. Childhood adversities and adolescent depression: a matter of both risk and resilience. Dev Psychopathol. 2014;26:1067–75.
Kim J, Cicchetti D. Longitudinal trajectories of self-system processes and depressive symptoms among maltreated and nonmaltreated children. Child Dev. 2006;77:624–39.
Schwartz OS, Sheeber LB, Dudgeon P, Allen NB. Emotion socialization within the family environment and adolescent depression. Clin Psychol Rev. 2012;32(6):447–53.
Rudolph KD, Kurlakowsky KD, Conley CS. Developmental and social–contextual origins of depressive control-related beliefs and behavior. Cogn Ther Res. 2001;25(4):447–75.
Cicchetti D, Toth SL. A developmental psychopathology perspective on child abuse and neglect. J Am Acad Child Adolesc Psychiatry. 1995;34(5):541–65.
Zwierzynska K, Wolke D, Lereya TS. Peer victimization in childhood and internalizing problems in adolescence: a prospective longitudinal study. J Abnorm Child Psychol. 2013;41(2):309–23.
Kumpulainen K, Räsänen E. Children involved in bullying at elementary school age: their psychiatric symptoms and deviance in adolescence: an epidemiological sample. Child Abuse Negl. 2000;24(12):1567–77.
Kaltiala-Heino R, Fröjd S, Marttunen M. Involvement in bullying and depression in a 2-year follow-up in middle adolescence. Eur Child Adolesc Psychiatry. 2010;19(1):45–55.
Sourander A, Ronning J, Brunstein-Klomek A, Gyllenberg D, Kumpulainen K, Niemelä S, et al. Childhood bullying behavior and later psychiatric hospital and psychopharmacologic treatment: findings from the Finnish 1981 birth cohort study. Arch Gen Psychiatry. 2009;66(9):1005–12.
Sweeting H, Young R, West P, Der G. Peer victimization and depression in early–mid adolescence: a longitudinal study. Br J Educ Psychol. 2006;76(3):577–94.
Reijntjes A, Kamphuis JH, Prinzie P, Telch MJ. Peer victimization and internalizing problems in children: a meta-analysis of longitudinal studies. Child Abuse Negl. 2010;34(4):244–52.71.
Cussen A, Sciberras E, Ukoumunne OC, Efron D. Relationship between symptoms of attention-deficit/hyperactivity disorder and family functioning: a community-based study. Eur J Pediatr. 2012;171(2):271–80.
Tarver J, Daley D, Sayal K. Beyond symptom control for ADHD: what can parents do to improve outcomes. Child Care Health Dev. 2015;41:1–14.
Further Reading
Kratochvil CJ, May DE, Silva SG, Madaan V, Puumala SE, Curry JF, et al. Treatment response in depressed adolescents with and without co-morbid attention-deficit/hyperactivity disorder in the Treatment for Adolescents with Depression Study. J Child Adolesc Psychopharmacol. 2009;19(5):519–27.
Chronis-Tuscano A, Molina BS, Pelham WE, Applegate B, Dahlke A, Overmyer M, et al. Very early predictors of adolescent depression and suicide attempts in children with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 2010;67(10):1044–51.
Shaw P, Stringaris A, Nigg J, Leibenluft E. Emotion dysregulation in ADHD. Am J Psychiatry. 2014;171:276–93.
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Jeannette LeGris, Khrista Boyla, Victoria Stead, Kaitlyn Beyfuss and Allison Chan declare that they have no conflict of interest.
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LeGris, J., Boylan, K., Stead, V. et al. Developmental Risk Relationships between ADHD and Depressive Disorders in Childhood. Curr Dev Disord Rep 3, 25–32 (2016). https://doi.org/10.1007/s40474-016-0075-9
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DOI: https://doi.org/10.1007/s40474-016-0075-9