Depressive symptoms in youth with ADHD: the role of impairments in cognitive emotion regulation

Abstract

Youth with attention-deficit/hyperactivity disorder (ADHD) are at increased risk to develop co-morbid depression. Identifying factors that contribute to depression risk may allow early intervention and prevention. Poor emotion regulation, which is common in adolescents, is a candidate risk factor. Impaired cognitive emotion regulation is a fundamental characteristic of depression and depression risk in the general population. However, little is known about cognitive emotion regulation in youth with ADHD and its link to depression and depression risk. Using explicit and implicit measures, this study assessed cognitive emotion regulation in youth with ADHD (N = 40) compared to demographically matched healthy controls (N = 40) and determined the association with depressive symptomatology. As explicit measure, we assessed the use of cognitive emotion regulation strategies via self-report. As implicit measure, performance in an ambiguous cue-conditioning task was assessed as indicator of affective bias in the processing of information. Compared to controls, patients reported more frequent use of maladaptive (i.e., self-blame, catastrophizing, and rumination) and less frequent use of adaptive (i.e., positive reappraisal) emotion regulation strategies. This pattern was associated with the severity of current depressive symptoms in patients. In the implicit measure of cognitive bias, there was no significant difference in response of patients and controls and no association with depression. Our findings point to depression-related alterations in the use of cognitive emotion regulation strategies in youth with ADHD. The study suggests those alterations as a candidate risk factor for ADHD-depression comorbidity that may be used for risk assessment and prevention strategies.

Sleep patterns, sluggish cognitive tempo, and daytime sleepiness – a commentary on Fredrick et al. (2022)

“…Fourth and relatedly, children and adolescents with ADHD display high comorbidity rates for symptoms of anxiety and depression (Mayer et al., 2022 ); similar patterns have also been observed for individuals with SCT (Smith, Zald, & Lahey, 2020 ). Given this, future studies should assess symptoms of depression and anxiety as possible confounders blurring or even accentuating the associations between SCT traits and sleep.…”

Testing the Impact of Depressive and Anxiety Features on the Association between Attention-Deficit/Hyperactivity Disorder Symptoms and Academic Performance among University Students: A Mediation Analysis

“…In young adults with ADHD, avoidant behaviors, in terms of both self-isolation [ 45 ] and challenging task procrastination [ 46 ], are frequent maladaptive strategies that also maintain and worsen depressive symptoms [ 47 , 48 ]. Thus, treatment targets for university students with comorbid ADHD who show internalizing symptoms, such as depression, should address procrastination and avoidant behaviors [ 49 ] through strategies improving emotion regulation [ 50 ]. Moreover, a timely screening for depression might be considered for subjects with ADHD symptoms who report persisting academic difficulties, to ensure a comprehensive assessment of students’ mental health [ 51 , 52 ].…”

Annual Research Review: Perspectives on progress in ADHD science – from characterization to cause

“…ERD has trans‐diagnostic relevance across emotional and behavioral psychopathologies (Aldao, Gee, De Los, & Seager, 2016). It is a common feature of depression and anxiety as well as ADHD (Mayer et al., 2022). There are behavior genetic correlations between ERD, ADHD, and mood (Merwood et al., 2014).…”