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Anxiety, Depression and ADHD ADHD rarely occurs in isolation. There are a broad range of other issues that an individual may struggle with. Among those, anxiety and depression are among the most common. Up to 30% of children with ADHD may also have depression, while and even greater percentage of adults with ADHD (47% according to one study) have co-occurring depression. Depression Joseph Biederman, MD, has described the condition in children with ADHD as being “demoralization” rather than true clinical depression. By that, he means that many children with ADHD find themselves falling short in school, frequently criticized by parents, coaches and teachers, and sometimes rejected by peers who may find them annoying. Such children with ADHD may appear depressed when they are reacting to very discouraging chronic situations. In fact, growing up feeling criticized, inadequate and rejected may be one of the most difficult aspects of having ADHD. Parents can do a great deal to mitigate these situations by providing them structure and support at home, advocating for them at school, encouraging them and helping them to find their strengths, and by helping them socialize with children that are more tolerant and accepting. With age, true depression seems to become more frequent. Girls with ADHD tend to become more vulnerable to anxiety and depression after they go through puberty. The combination of fluctuating hormonal levels, often resulting in significant pre-menstrual symptoms including irritability and moodiness, may be a strong contributing factor. Tom Brown, Ph.D., Yale professor and noted ADHD authority, has recently proposed the idea that ADHD is a “foundational disorder” – one that makes individuals more vulnerable to developing other psychiatric disorders later in life. Until recently, females with ADHD were significantly under-diagnosed. While this is changing, it remains common for girls’ ADHD symptoms to be misunderstood and interpreted as anxiety or depression. In fact, the most common prior diagnosis among women diagnosed with ADHD is the diagnosis of depression. While their diagnosis of depression may have been accurate, it was incomplete. Bipolar Disorder There is a significant overlap between bipoar disorder and ADHD. Up to 20% of individuals with ADHD may also develop Bipolar Disorder. And some experts write that in early-onset bipolar disorder (prior to age 18) there is a 100% overlap between bipolar disorder and ADHD. These conditions can and should be treated together. The best treatment protocol is to first treat the bipolar disorder. Once mood stability has been established, a stimulant to address ADHD symptoms can be added. In adults, bipolar disorder is diagnosed in individuals that have had at least one episode of mania (a period during which the individual feels energetic, even euphoric, and has a markedly reduced need for sleep. During such a manic episode, the individual may behave in an impulsive, poorly controlled fashion that is out of character with her normal behavior – for example, making sudden dramatic decisions (to change jobs, to leave a marriage, to suddenly take off on an unplanned and ill-conceived journey), to develop unrealistic plans or to spend money excessively. While some adults swing from periods of mania to periods of depression, other adults are more likely to move in and out of depression with only a single period of mania. In younger people bipolar disorder may present very differently. Children may have big mood swings, precipitated by little or nothing, may have extreme irritability and become wildly explosive. It is very important that a child’s ADHD not be ignored by a physician that is over-focused on his bipolar symptoms. Helping stabilize a child’s moods as well as helping her focus and be able to perform well at school and in daily life are both important to future success. Anxiety Up to 30% of children and 25% to 40% of adults with ADHD have an anxiety disorder in addition to ADHD. Research shows that parents and teachers may overlook anxiety symptoms. A child may feel chronically “stressed”, yet not be appropriately treated for anxiety. Research suggests that half of children with ADHD and anxiety are not recognized by their parents as anxious. Often a parent may attribute a child’s anxiety to shyness, lack of confidence, or to problems associated with ADHD. Such children (and adults) often have pervasive anxiety and worry about almost everything in daily life. This anxiety is compounded by the ongoing challenges of ADHD such as disorganization, losing personal items, running late, forgetting important things, and feeling criticized by others for these ADHD-related problems. Students with ADHD and anxiety report more school, family, and social problems than students who only have ADHD without anxiety. Anxiety and ADHD can be easily treated together. It is important for parents to be aware that children with untreated anxiety may respond very poorly to stimulant medication because it increases their feelings of anxiety. Children and adults whose anxiety is treated, however, are usually able to respond well to stimulants and to benefit from them. Girls with ADHD and anxiety or depression According to a new study, older girls with attention deficit hyperactivity disorder are more likely than younger girls to also suffer from depression and anxiety. These girls also often have higher IQ scores than boys with the same diagnosis, the researchers found in the study published in the October, 2008, issue of the Journal of Developmental and Behavioral Pediatrics. Pamela Kato, Ph.D. led a research team that studied the medical records of 75 girls diagnosed with ADHD. They compared younger girls (ages 4-8) with older girls (ages 9-19) and compared girls with ADHD to boys with ADHD. They found that older girls internalized their feelings, were often withdrawn and complained of physical distress, reported social problems and showed symptoms of anxiety and depression. Kato found that in boys, depression, anxiety and ADHD seem to develop independently of each other. Kato writes that “the nature of the association between the course of these two disorders in females is unclear” and should be further studied. Kato suggests that girls who are being tested for ADHD should also be assessed for depression and anxiety disorders. Treating anxiety, depression, bipolar and ADHD What’s important for adults with ADHD and parents of children with ADHD to understand is that a very careful diagnostic process is critical to receiving proper treatment. ADHD treatment with stimulants may be unsuccessful if anxiety remains undiagnosed and treated. And untreated depression will render ADHD treatment significantly less effective. These disorders are commonly associated and need to be appropriately treated, in tandem, in order for the child or adult with ADHD to be able to live more satisfying and successful lives. |
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