When It's Not Just ADHD
ADHD and depression, anxiety, learning disabilities, and oppositional defiant disorder.
Depression and Anxiety
Anxiety and depression are diagnosed among ADHD patients more often than in the general population. There may be genetic reasons for this, or it could be triggered by unhappiness at school, particularly if the child has poor social skills and feels lonely and friendless. Anxiety often appears at an earlier stage; depression tends to develop as children age.
Depression and anxiety could both cause ADHD-like symptoms. If you're not sure which came first, tell your doctor what you've noticed in your child to help him figure out what's going on. You are your child's advocate.
"Depression is less frequently identified in younger children in general, and that's true for a comorbid condition for ADHD; both anxiety and depression are increased," Wolraich says. "It's harder to diagnose because, to a greater extent, anxiety and depression are internal states, and that depends on the reporting ability of children, whether they are cognitively able to get that across."
Once depression or anxiety is diagnosed, your doctor may recommend bringing your child to a psychiatrist for antidepressants and therapy. But the initial diagnosis may be difficult, because children with ADHD often exhibit less obvious symptoms.
"Depression in children and adolescents oftentimes presents with irritability instead of sadness," Vitiello says. "The kid is not patient, gets really upset, has no tolerance for frustration. Antidepressants are not effective for inattention and hyperactivity, but they can be helpful for irritability."
Oppositional Defiant Disorder
One of the most common conditions associated with ADHD is oppositional defiant disorder (ODD). Children with this condition are stubborn, get angry often, throw tantrums, and don't honor the requests of the adults they're supposed to listen to, namely parents and teachers. Experts don't know what causes the link between ADHD and ODD; genetic factors may be at play, but environmental influences likely have some impact.
"You can develop coping skills that are really counterproductive," Hughes says. "They may think, 'If everything I do is wrong, I don't care what you say,' or, 'If my schoolwork is always wrong, why even try?' It becomes much easier not to care what anyone says and do what you want. It also leads to a lot of anger."
Children who develop ODD may have endured frequent punishments for ADHD-type behavior, fueling their discontent.
"Punishment is not a very effective way to get kids with ADHD to do what they're supposed to do," Hughes says. "If you have ADHD and you are ruled by your impulses, you're not thinking, 'If I do this, I'm going to get into trouble.'"
ADHD medication may help improve ODD symptoms, Vitiello says. But "parent training" can also help, especially for parents who rely on punishments.
"You really need behavioral intervention to have someone guide you to build a relationship with your child," Hughes says. "You'll learn to recognize and nurture your child's strengths."
Ask your doctor where you might find local classes, or coaches, who can help. You might also want to check the web site of CHADD (Children and Adults with Attention Deficit/Hyperactivity Disorder).