Longitudinal Evaluation of the Role of Academic and Social Impairment and Parent-Adolescent Conflict in the Development of Depression in Adolescents with ADHD

Abstract

Older adolescents with attention-deficit/hyperactivity disorder (ADHD) have a significantly increased likelihood of developing comorbid depression. It is important to evaluate factors during the early adolescent period that may contribute to this risk. A predominant theory is that impairment and failure experiences lead to the development of low-self efficacy and depression, and that parent and family factors also play a role. In a sample of 326 young adolescents with ADHD (Mage = 12), the present study evaluated whether parent-adolescent conflict mediated the association between social and academic impairment and the development of depression. This study builds upon prior work by evaluating these associations longitudinally and by using a multi-rater approach, including the parent, adolescent, and teacher perspectives. Social and academic impairment directly predicted depression controlling for baseline levels of depression and change in ADHD symptoms. The association between social impairment and depression was partially mediated by parent-adolescent conflict. Mediation through conflict was not found for academic impairment, and the association between academic impairment and depression was no longer significant when accounting for conflict. These findings highlight the importance of social impairment in the development of depression in adolescents with ADHD. Caregivers may play an important role in determining whether adolescents with ADHD internalize social impairment and failure experiences and develop depressive symptoms. Implications of these findings in terms of the importance of interventions focused on parent-adolescent conflict are discussed.

Top problems of adolescents and young adults with ADHD during the COVID-19 pandemic

“…School connectedness may decrease as students move to online learning formats ( Becker et al, 2020 ) and is an important protective factor against adolescent substance use in youth with ADHD ( Flory et al, 2011 ). Family conflict may increase during COVID-19 as a consequence of confinement ( Behar-Zusman et al, 2020 ) and predicts onset of depression among adolescents with ADHD ( Eadeh et al, 2017 ; Ward et al, 2019 ). Identifying emergent risk factors experienced by A/YAs with ADHD during COVID-19 confinement might guide targeted screening and prevention efforts.…”

Interventions for Adolescents With ADHD to Improve Peer Social Functioning: A Systematic Review and Meta-Analysis

“…Remediation of social impairment is particularly important in adolescent ADHD for several reasons. Beyond the risks for adverse outcomes conferred by ADHD alone, social impairment places youth with ADHD at increased risk of developing depression (Eadeh et al, 2017;Feldman et al, 2017), conduct disorder, substance-use disorder (Greene et al, 1997), and eating pathology (Mikami & Hinshaw, 2006), whereas social acceptance may be protective in academic functioning (Dvorsky et al, 2018;Mikami, Ruzek, et al, 2017). A compounding challenge to treating adolescents in particular is that many desist or refuse standard treatments of stimulant medication (Sibley et al, 2014), despite evidence for their continued efficacy on core symptomatology (Chan et al, 2016).…”

Cognitive mechanisms underlying depressive disorders in ADHD: A systematic review

“…In this context, a demoralization model has been proposed in which depression results from the academic and/or social failures associated with ADHD (Biederman et al, 1998;Herman et al, 2007;Humphreys et al, 2013). However, this model may not be fully sufficient to explain the large increase of co-morbid depression that specifically occurs during young adulthood (Biederman et al, 1998;Eadeh et al, 2017;Meinzer et al, 2013). Alternatively, the pathway from ADHD to depression may be mediated by shared risk factors that contribute to the development of both disorders.…”