Irritability, anxiety, and negative thinking may help to explain why childhood ADHD can lead to depression
Submitted by Eglė Padaigaitė-Gulbinienė
Children and young people with ADHD are more likely to develop depression, but less is known about which factors can explain this link. We examined whether the following factors could account for a large part of the relationship between ADHD and depression:
Cognitive–affective processes (emotion recognition, response inhibition, working memory, and sustained attention)
Negative thought patterns (external locus of control and negative cognitive style)
Clinical factors (irritability and anxiety)
Using data from two large longitudinal cohorts, we found that clinical factors —particularly irritability and anxiety — were especially important in childhood and young adulthood, and particularly for females. We also found that negative thought patterns, such as an external locus of control and a negative cognitive style, were important in adolescence. In contrast, cognitive-affective factors did not explain the link between ADHD and depression at any stage of development.
These findings suggest that targeting irritability and anxiety in childhood and young adulthood, and negative thinking patterns in adolescence, may help prevent later depression in children and young people with ADHD.
This is the first paper to use this kind of method to investigate whether different clinical and cognitive factors explain why ADHD can lead to subsequent depression. However, because this is an observational study and just recorded what happened in a natural setting, further research using other methods is needed to support these findings, such as experiments where we can change factors and see what happens.
I’m a clinician – what does this mean for me?
Our study suggests that irritability remains an important clinical factor across development, and that screening of anxiety and irritability in children and young people with ADHD (especially females) could help identify those at heightened risk for developing depression. Moreover, negative cognitive style (external attributional style and negative self-schemas) emerged as the strongest mediators in adolescence, suggesting that adolescents with ADHD might benefit from interventions targeting perceived agency, attribution style, and negative self-schemas to reduce depression. Finally, our study challenges theories suggesting that executive dysfunction plays a role in the development of depression, and suggests that these cognitive factors might not be an effective target for prevention of depression in children and young people with ADHD.