Fw: Your New Issue of Attention Research Update - ADHD & Depression in Children

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Your New Issue of Attention Research Update - ADHD & Depression in

Children

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**** ATTENTION RESEARCH UPDATE ****

**** December 2006 - Understanding the relationship between ADHD and Depression

in Children ****

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Dear Subscriber,

I hope you are doing well.

In this issue of Attention Research Update I review an interesting study in

which the researchers examine the relationship between ADHD and depression in

children. In particular, they explore the role that others' perceptions of

children's social competence, and children's perception of their own social

competence, may play in explaining the high rates of depression in children with

ADHD. They also examine these linkages in younger and older children with ADHD

and whether this varies as a function of whether or not the child also has

significant oppositional behavior.

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I hope you enjoy today's issue and find it to be interesting.

Sincerely,

Rabiner, Ph.D.

Duke University

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** New Issue - Understanding the relationship between ADHD and Depression in

Children **

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Prior research with both community and clinical samples has documented that

rates of depression are significantly higher in children with ADHD than in other

children. This is concerning because children with ADHD and depression, in

addition to experiencing greater distress in the present are likely to have

greater difficulty over the course of their development.

In children with both ADHD and depression, it is almost always the case that

ADHD emerges first, and depression emerges later in development. This has led

researchers to consider what it is about ADHD that might predispose children to

develop depression.

One prominent theory is that the relationship between ADHD and depression may

result from the social/interpersonal difficulties that many children with ADHD

experience. These difficulties can lead important others in the child's life to

develop negative appraisals of the child's social competence that are

communicated to the child during the course of ongoing negative social

exchanges. With increasing age, these negative social experiences and others'

negative appraisals can adversely affect children's view of their social

competence, which, in turn, can predispose them to develop depressive symptoms.

An interesting study published recently in the Journal of Abnormal Child

Psychology was designed to test this theory (Ostrander, Crystal, & August

[2006]. Attention Deficit-Hyperactivity Disorder, Depression, and Self- and

Other Assessments of Social Competence: A Developmental Study. JACP, 34,

773-787.)

Participants were 246 children in grades 1-4 that included 148 children with

ADHD and 98 children without ADHD who served as controls. Approximately 80% of

participants were male and all were recruited based on screening results

obtained in a large community sample. Of the 148 children with ADHD, 60 also met

criteria for either Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD)

while 88 did not. You can find information on diagnostic criteria for ODD and CD

at www.helpforadd.com/oddcd.htm.

Measures - The main constructs of interest were children's depressive symptoms,

others' appraisal of children's social competence, and children's self-appraisal

of their social competence. These constructs were measured using a number of

well-validated rating scales as described below.

Depression - Depressive symptoms were obtained from both children and their

parents. Children completed the Child Depression Inventory (CDI), a widely used

and standardized measure of self-reported depressive symptoms. They also

completed the self-report version of the Behavioral Assessment System for

Children (BASC); the BASC includes a scale to measure depressive symptoms.

Parents completed 2 standardized and nationally normed behavior rating scales,

the BASC and the Child Behavior Checklist (CBCL). Both measures contain scales

to measure parents' perceptions of depressive symptoms in their child. Child and

parent reports of depressive symptoms were then combined to create an overall

depression score for each child with higher scores reflecting greater depressive

symptomatology.

- Social Competence-

Others' Appraisal - Parents and teachers provided appraisals of children's

social competence using several different measures of this construct. For

parents, the Social Skills scale from the BASC and their ratings on the Social

Skills Rating System were used to assess their perceptions of their child's

social competence. Teacher perceptions of children's social competence were

derived from the Social Skills scale from the teacher version of the BASC and

the -McConnell Scale of Social Competence and School Adjustment. Parent

and teacher reports were averaged for each child to provide a composite social

competence rating. Higher scores reflected higher ratings of others'-perceived

social competence.

Self-appraisal - To assess children's views of their own social competence, each

child completed the Piers Self-Concept Scale, which includes a 12-item

scale of perceived popularity. Children also completed the self-report version

of the BASC, which contains scales that assess the perception of having good

social relationships, the stress and tension experienced in social

relationships, and the feeling of being excluded from social activities. These

different scales were summed to create an overall measure of self-appraisal of

social competence, with higher scores indicating greater self-perceived social

competency.

- Results -

- ADHD and Depression -

The authors first examined differences in depressive symptoms in 3 groups of

children: those with ADHD only, those with ADHD + ODD/CD, and comparison

children. They examined this in both younger children (younger than 9) and older

children (age 9 and above).

In both younger and older children, depressive symptoms were significantly

higher among children with ADHD; this was true regardless of whether ODD or CD

was also present. The magnitude of the differences would be considered

relatively large. Among older children, depressive symptoms were highest when

ODD or CD co-occurred with ADHD.

It is important to note that although children with ADHD had significantly

higher scores on the depressive symptom composite, this does not mean that all,

or even the majority of children with ADHD, were experiencing clinically

elevated levels of depressive symptoms. Instead, it simply indicates that the

average depression score was higher for these children. Unfortunately, the

authors do not indicate the percentage of children in the ADHD group with scores

that fell in what would be considered a clinically elevated range. Thus,

although these children were experiencing more distress than others, it is not

clear how many would be considered clinically depressed.

- ADHD and Others' Appraisal of Social Competence -

At both younger and older ages, children with ADHD were viewed as having

significantly lower levels of social competence by their parents and teacher.

Although there was some indication that children with ADHD plus ODD or CD had

the lowest ratings, differences between these children and children with ADHD

only were not significant. Once again, the magnitude of the difference between

children with and without ADHD would be considered large.

- Self-Appraisal of Social Competence -

Similar results were found for children's appraisal of their own social

competence. Children with ADHD, regardless of whether they also met criteria for

ODD or CD, rated themselves as less socially competent than other children at

both age groups. There was a clear indication that the relationship between ADHD

and negative self-perceptions of competence was stronger among the older

children.

- Test of Theoretical Model -

The final analyses conducted by the authors involved testing for hypothesized

linkages between ADHD, others- and self-appraisals of social competence, and

depression in younger and older children.

Among younger children, the authors expected that the relationship between ADHD

and depression would be mediated by others' perception of children's social

competence. In other words, they hypothesized that the reason children with ADHD

have higher rates of depressive symptoms is because ADHD results in others

developing negative views of the child's social competence, and these negative

appraisals of others contributes to the development of depression. This

hypothesized model is shown below:

ADHD ===> Others' negative appraisal of social competence =======> Depression

Among older children, the relationships predicted by the authors were a bit more

complex. Here, they again expected that ADHD would lead others' to develop

negative appraisal of the child's social competence. Because older children are

more sensitized and attuned than younger children to how others' view them,

however, the negative appraisal of others was expected to negatively influence

children's own appraisal of their competence, which, in turn, would lead to

depressive symptoms.Thus, the model they hypothesized for older children is as

follows:

ADHD ==> Others' negative appraisal ==> Negative self-appraisal ==> Depression

Although the statistical procedures used to test these relationships are a

complex, the results obtained were reasonably straightforward. For younger

children, it was found that having ADHD predicted more negative appraisal of

social competence by others, which, in turn, predicted higher rates of

depressive symptoms. In fact, about half of the relationship between ADHD and

depression was explained by the negative appraisals of others. Thus, the model

suggested by the authors was supported, although it is important to note that

about half of the link between ADHD and depression did not depend on others'

appraisals and is thus attributable to other factors, e.g., genetics, academic

struggles, etc., that were not measured in this study.

The authors' model for older depression was also supported. As predicted, ADHD

predicted negative appraisal by others, which, in turn, predicted more negative

self-appraisals, which, in turn, was associated with higher rates of depressive

symptoms. Nearly half of the association between others' appraisals and

depressive symptoms was explained by the relationship between others' appraisals

and self-appraisals, a relationship that was not evident in the younger sample.

As with younger children, there remained a direct relationship between ADHD and

depression that could not be explained by the variables in the model.

- Summary and Implications -

Three primary findings were evident in this study. First, there was a strong

relationship between ADHD and depression - with and without co-morbid ODD/CD -

in both younger and older children. Among older children, the relationship

between ADHD and depression was stronger when ODD or CD was also present.

Second, about half of the relationship between ADHD and depression in younger

children was explained by the others' negative appraisals of social competence

in children with ADHD.

Third, among older children, a more complex relationship emerged as children's

negative self-appraisals - and not just others' appraisals of them - were

important in understanding the linkage between ADHD and depression.

In interpreting the results of this study, it is important to recognize that

demonstrating a link between ADHD, the negative appraisal of others, and

depressive symptoms does not mean that parents and teacher " cause " children with

ADHD become depressed because of their negative appraisals.

Instead, I believe a more reasonable interpretation is that the difficult

behavior that many children with ADHD exhibit contributes to ongoing

difficulties in parent-child and teacher-child relationships. These difficulties

may contribute to parents and teachers viewing the child with ADHD as having

poor social interaction skills.

In some circumstances, these negative views may be directly communicated to the

child, and this could certainly contribute to an increase in depressive symptoms

over time. However, it is perhaps more likely that the ongoing negative

interactions resulting from challenges that many children with ADHD present, and

how these interactions come to affect the child's view of their relationships

and themselves, is what contributes to an increase in depressive symptoms over

time.

This view differs in important ways from one that " blames " parents and/or

teachers for the distress that many children with ADHD experience. Instead, it

recognizes that ADHD leads to conditions that increase the risk of other

problems, such as depressive symptoms, emerging over time. Interventions that

target these conditions - such as repeated negative exchanges that lead others

to develop negative appraisals of the child - may thus reduce the risk of such

problems developing, even though the same conditions are not related to the

original core symptoms of ADHD.

The authors point to several limitations to their study that should be

considered. Most important is that all data was collected at a single time

point, rather than thru a longitudinal design. Given the developmental nature of

their hypotheses, studying the relationship between ADHD, others' and

self-appraisals, and depressive symptoms across time will be very important to

do.

They also note that because their participants were derived from a community

sample, it is unclear whether the results reported would generalize to a clinic

sample or represent children who have more severe levels of depression such as

those with a formal diagnosis.

These limitations not withstanding, this study makes a useful contribution to

our understanding of the link between ADHD and depressive symptoms in children,

and suggests targets for intervention that may reduce the strength of this

association.

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** SPONSOR'S MESSAGE FROM ASPEN EDUCATION GROUP **

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Thanks again for your ongoing interest in the newsletter. I hope you enjoyed the

above article and found it to be useful to you.

Sincerely,

Rabiner, Ph.D.

Senior Research Scientist

Center for Child and Family Policy

Duke University

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© 2006 Rabiner, Ph.D.

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