Cognitive Therapy and Research

, Volume 37, Issue 6, pp 1220–1232 | Cite as

Depression in Adults with Attention-Deficit/Hyperactivity Disorder (ADHD): The Mediating Role of Cognitive-Behavioral Factors

  • Laura E. Knouse
  • Ivori Zvorsky
  • Steven A. Safren
Original Article


Adults with Attention-Deficit/Hyperactivity Disorder (ADHD) are at increased risk for depressive disorders but little is known about the potential cognitive and behavioral mechanisms of risk that could shape treatment. This study evaluated the degree to which cognitive-behavioral constructs associated with depression and its treatment—dysfunctional attitudes and cognitive-behavioral avoidance—accounted for variance in depressive symptoms and disorder in adults with ADHD. 77 adults clinically diagnosed with ADHD completed self-report questionnaires, diagnostic interviews, and clinician-administered symptom rating scales. Statistical mediation analysis was employed and indirect effects assessed using bootstrap analysis and bias-corrected confidence intervals. Controlling for recent negative life events, dysfunctional attitudes and cognitive-behavioral avoidance fully accounted for the variance between ADHD symptoms and depressive symptoms. Each independent variable partially mediated the other in accounting for depression symptoms suggesting overlapping and unique variance. Cognitive-behavioral avoidance, however, was more strongly related to meeting diagnostic criteria for a depressive disorder than were dysfunctional attitudes. Processes that are targeted in cognitive behavior therapy (CBT) for depression were associated with symptoms in adults with ADHD. Current CBT approaches for ADHD incorporate active coping skills and cognitive restructuring and such approaches could be further tailored to address the ADHD-depression comorbidity.


Attention-Deficit/Hyperactivity Disorder (ADHD) Depression Depressive symptoms Adults Cognitive behavior therapy (CBT) 



This research was supported by the Kaplen Fellowship on Depression and the Livingston Award from the Psychiatry Department at Harvard Medical School awarded to the first author. Data analysis and writing of the manuscript was supported by a Faculty Summer Research Fellowship at the University of Richmond awarded to Dr. Knouse. Dr. Steven Safren is supported by grant 5K24MH094214. Sincere thanks to Meghan Groves, B.A. for her assistance with data collection on this project.

Conflict of interest

The authors have no potential conflicts of interest pertaining to this manuscript to declare.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Laura E. Knouse
    • 1
    • 2
  • Ivori Zvorsky
    • 2
    • 3
  • Steven A. Safren
    • 1
  1. 1.Behavioral Medicine Service, Department of PsychiatryMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Department of PsychologyUniversity of RichmondRichmondUSA
  3. 3.Behavioral Pharmacology Research UnitJohns Hopkins School of MedicineBaltimoreUSA

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