A study recently published in the Journal of Affective Disorders (January 1998, 113-122) examined the course of depression in 76 children with ADHD in order to learn more about the relationship between ADHD and depression. The authors were especially interested in whether depression in children with ADHD represents an actual clinical depression, or whether it may be better understood as a kind of "demoralization" that can result from the day to day struggles that children with ADHD often have.
Lets begin by reviewing what mental health professionals mean when they talk about depression. The important point to emphasize is that the clinical diagnosis of depression requires the presence of a collection of different symptoms - just because one is feeling down or depressed does not necessarily mean that the diagnosis of major depression would be appropriate.
According to DSM-IV, the publication of the American Psychiatric Association
that lists the official diagnostic criteria for all psychiatric disorders,
the symptoms of major depression are as follows:
depressed mood most of the
day nearly every day (in children and teens this can be irritable
mood rather than depressed);
loss of interest or pleasure
in all, or almost all, activities;
significant weight loss when
not dieting or weight gain, or a decrease or increase in appetite
insomnia or hypersomnia (i.e.
sleeping too much) nearly every day;
extreme restlessness or lethargy
(e.g. very slow moving;
fatigue or loss of energy
nearly every day;
feelings of worthlessness
or inappropriate guilt;
diminished ability to think
or concentrate nearly every day;
recurrent thoughts of death
and/or suicidal thoughts;
For the diagnosis of depression to apply, 5 or more of the symptoms
listed above need to be present during the same 2 week period (i.e.
the symptoms must have persisted for at least 2 weeks), and at least
one of the symptoms must be either
1) depressed mood (irritable mood in children can qualify) or
2) loss of interest or pleasure.
In addition, it must be determined that the symptoms cause clinically significant distress or impairment, are not due to the direct physiological effects of a medication or general medical condition, and are not better accounted for by Bereavement (i.e. loss of a loved one.)
As you can see, the important point is that true clinical depression is indicated by a collection ofsymptoms that persist for a sustained time period, and is clearly more involved that feeling "sad" or"blue" by itself.
Let me also say a few words about depression in children. Research has shown that the core symptoms for depression in children and adolescents are the same as for adults. Certain symptoms appear to be more prominent at different ages, however. As already noted above, in children and teens the predominant mood may be extreme irritability rather than "depressed". In addition, somatic complaints and social withdrawal are especially common in children, and hypersomina (i.e sleeping too much) and psychomotor retardation (i.e. being extremely slow moving are less common).
What, then, would a "typical" depressed child look like? Although there
of course would be wide variations from child to child, such achild
might seem to be extremely irritable, and this would represent a distinct
change from their typical state. They might stop participating or getting
excited & about things they used to enjoy and display a distinct change
in eating patterns. You would notice them as being less energetic, they
might complain about being unable to sleep well, and they might start referring
to themselves in critical and disparaging ways. It is also quite common
for school
grades to suffer as their concentration is
impaired, as does their energy to devoted to any task. As noted above,
this pattern of behavior would persist for at least several weeks, and
would appear as a real change in how the child typically is.
With this brief overview of depression behind us, lets get back to the study. The authors of this study started with 76 boys who had been diagnosed with both major depression and ADHD and followed them over a 4 year period. Because depression can be such a debilitating- condition they were interested in learning what factors predicted persistent major depression, and how the course of depression and ADHD were intertwined.
The results of the study indicated that the strongest predictor of persistent major depression was interpersonal difficulties (i.e being unable to get along well with peers). In contrast, school difficulty and severity of ADHD symptoms were not associated with persistent major depression. In addition, the marked diminishment of ADHD symptoms did not necessarily predict a corresponding remission of depressive symptoms. In other words, the course of ADHD symptoms and the course of depressive symptoms in this sample of children appeared to be relatively distinct.
The results of this study suggest that in children with ADHD who are depressed, the depression is not simply the result of demoralization that can result from the day to day struggles that having ADHD can cause. Instead, although such struggles may be an important risk factor that makes the development of depression in children with ADHD more likely, depression in children with ADHD is a distinct disorder and not merely "demoralization".
Depression in children can be effectively treated with psychological intervention. In fact, the evidence to support the efficacy of psychological interventions for depression in children and adolescents is more compelling than the evidence supporting the use of medication.
The important point that can be taken from this study, I think, is that
parents need to be sensitive to recognizing the symptoms of depression
in their child, and not to simply assume that it is just another facet
of their child's ADHD. In addition, if a child with ADHD does develop depression
as well, treatments that target the depressive symptoms specifically need
to be implemented. As this study shows, one should
not assume that just addressing the difficulties caused by the ADHD symptoms
will also alleviate a child's depression.
If you have concerns about depression in your child, a thorough evaluation by an experienced child mental health professional is strongly recommended. This can be a difficult diagnosis to correctly make in children, and you really want to be dealing with someone who has extensive experience in this area.
One especially important area that has not been carefully studied is the effect that ADHD may have on children's reading comprehension. Because reading comprehension requires sustained mental effort and attention, it seems reasonable to expect that ADHD would have an adverse effect on this skill. An interesting study published in the Journal of Attention Disorders (Vol. 3, 1996, pages & 173-185) provides an interesting and instructive initial look at this important question.
In this study, the reading comprehension abilities of 21 children in grades 4-6 with and without ADHD were compared. What is noteworthy about the children in this study is that the authors first made sure that the two groups were matched on their basic sight reading skills. In other words, the children with ADHD were selected so that their ability to read individual words did not differ from the non-ADHD children. This enabled the authors to determine whether children with ADHD have deficits in reading comprehension even when their more basic reading abilities (e.g. their ability to read and sound out individual words) are intact.
For the reading comprehension assessment, children were asked to read several passages of approximately 440 words in length from a 5th grade science text. After reading each passage, children were asked to rate on a 5-point scale how well they understood what they had just read. They were then asked to give the passage a good title and to identify the specific number of main ideas in the text and their accuracy in identifying the topic and main ideas present in each passage was evaluated.
As predicted, children with ADHD were less accurate than children
in the control group in correctly identifying the different topics and
main ideas in each passage. Children without ADHD were able to correctly
identify about 50% more of the important topics and were twice as likely
to correctly identify the main idea of the passage. Thus, even though children
with ADHD were able to read the passages as well (recall that they were
carefully matched to insure that their basic sight reading skills were
equivalent) they were still less able to correctly comprehend the important
aspects of what they
had read. (It is interesting to note that some of the children
in the ADHD group were on medication at the time of testing. These children
did better on the comprehension tasks than the non-medicated children and
did not differ in their comprehension results from the children without
ADHD).
What are the implications of these results? First, the authors suggest that children with ADHD may have special reading instructional needs. Even when children with ADHD are able to sight read passages as well as other children - as the children in this study were selected to be able to do - they are still less able to construct meaning from the passages they have read. Thus, they will be at a disadvantage when asked to read for new learning. In other words, comprehending material read from a long chapter may be quite difficult for the student with ADHD. (This may ring a bell for you. I have had many children I work with who report that it is very difficult for them to read chapters in social studies or science books and then have to answer questions about what they have read.)
Special instruction in understanding and comprehending written material
may thus be very important
for the student with ADHD, even if he or she is a very good oral
reader. (Recall, however, that the results of this study also suggest
that medication may significantly improve reading comprehension in a child
with ADHD, although this was based on a very small sample size. Therefore,
any firm conclusions about the effects of medication on reading comprehension
can not be made from these results alone.)
In regards to assessment, it may be quite important to use longer passages
when evaluating the reading comprehension abilities of children with ADHD.
The use of longer passages, as was done in this study, increases the demands
for sustained attention and effort while processing the material. The most
widely used tests to evaluate reading comprehension for students being
assessed for possible learning difficulties, however, typically use much
shorter passages. As a result, how a child with
ADHD does on these reading achievement tests may overestimate how they
will actually perform when required to read chapter books for school assignments.
Because a child's score on these tests is one factor used to determine
his or her eligibility for specialized reading instruction, some children
with ADHD who actually require extra instruction in reading will not be
selected to receive it.
"These articles were published in ADHD RESEARCH UPDATE,
an electronic newsletter designed to help parents and professionals
stay informed about new research on ADHD, and how new findings can be applied
to help children with this condition. The newsletter is published by Dr.
David Rabiner, a child clinical psychologist at Duke University.
You can learn more about ADHD RESEARCH
UPDATE, and request complete sample issues, by visiting
www.helpforadd.com."
 |
The Gifted Child Today Magazine is a bi-monthly publication for parents, teachers, and other professionals who are interested in gifted education. Each issue contains lesson ideas, program suggestions, new product announcements, and more. |  |
America's authority on raising happy healthy children. Expert advice on discipline, self-esteem, safety, bedtime and health |
| For the younger
ADHD people, we found a comprehensive reading program, that is very
much worth your while investigating. As teachers we know the value of having
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Hooked on Phonics Whether your child is just learning to read or needs to improve his or her reading skills, Hooked on Phonics promises dramatic improvement in four weeks or less. The Hooked on Phonics - Learn to Read program is designed for children ages four to ten. It's a simple three-step program which combines systematic phonics instruction with a library of 79 magical books and stories. A major study from the National Academy of Sciences concluded that the most effective way to learn to read is to combine systematic instruction in phonics and exposure to rich literature. Hooked on Phonics is the home reading program that does just that. Now you can buy buy Hooked on Phonics here.Click on the book to find out more. |
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They would not sit at the table for meals; they hardly ever wanted meals. They were constantly screaming crying and throwing items.They tore every bit of clothing off as fast as I could put it on. They hated to be confined in clothes.
They continued to have bowel movements whenever they happened to be at the time, and they continued to jump in the excrement, smear it and fling it on the walls, into the furniture and into their hair"
Nancy became a patient of a Dr. Zigurts Strauts. He recognised the underlying cause of the twins problems. Together they identified a major childhood epidemic of metal poisoning and after detoxification treatment, observed remarkable changes in their condition and behaviour. When they took their findings to the medical profession and appropriate government authorities, they were met with only shock, denial, resistance, and disbelief, hence this book.
This is critical medical information that could improve the lives of hundreds of thousands of children and their families, including yours!
This is not a fad, this is real and when you read how severly afflicted the author's twins were, and the changes to them after treatment, you may experience various reactions. Initially perhaps, great excitement, which then may turn intio anxiety, sadness, and finally anger, when you wonder why nobody told you about this before!!
 |
"Turning
Lead into Gold" Nancy Hallaway RN and Zigurts Strauts MD
The book tells you where the heavy toxic metals are likely to have come from, how to t avoid excessive exposures in the future and how to get toxic metals out of your child's brain and body. They believe the lead and other heavy metals status should be determined prior to the initial diagnosis of a child who presents with severe ADHD, autism, language delay and collective symptoms such as colic, diarrhoea, poor appetite, anxiety and pica (eating of non-foods) We are advised that blood testing is not a good measure of chronic lead toxicity. It is a poor indicator of the long term chronic body burden of lead, showing recent exposure only. Children with neurological damage are subject to CHRONIC toxicity, not acute toxicity! |
They no longer need medication, their appetites have improved, and they now have excellent eye contact. They are happy and playful most of the time and fecal smearing a thing of the past.
Get a copy of this book and read it!
Click
on this link for direct, secure, on line ordering.
This article was written by Di Wellacott for the Hyper Express,
the bi-monthly newsletter of the ADHD Association Inc New Zealand, number
97.
Who do you know who has ADHD people in their family and who is on the Internet?We would like to swop links with you and people you know, so we can all benefit from a wider ADHD community, worldwide, as knowledge is power! If you belong to an ADHD group,feel free to
That's us for another month ~ keep in touch ~ we love to hear from you.
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Cheers Tricia and Mike Legg
editors
ADHD ezines
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