ADHDDepression

and

Adolescent Girls

Douglas Cowan, Psy.D.

ADHD Information Library

Several studies in recent years have looked into the impact of ADHD on the lives of teenagegirls. MRI studies report that teenager’s brains are rapidly maturing, but that they are not fullymature until the early 20’s in females, and perhaps the early 30’s in males. Long-term studieson behavior and emotional health report that girls with ADHD may struggle through the teenyears. And other studies report that depression is common among teens with ADHD, and is socommon among adolescents that the use of medications for ADHD, antidepressants, anti-psychotics, and even sleep medications, is up sharply with adolescent girls.While many children and teens with ADHD also suffer from some degree of sadness,discouragement, or frustration, as many as 25% are clinically depressed. Children and teenswith ADHD are as much as 300% more likely to also suffer from depression than are children orteens without ADHD.The co-morbid depression seems little associated with the ADHD symptoms such as inattention,impulsivity, hyperactivity, or academic problems. These problems might result indiscouragement, sadness, or frustration, but not clinical depression.Rather, the depression seems to be most correlated to social awkwardness or interpersonaldifficulties that are often a part of having ADHD. The lack of friendships, the sense of loneliness,or the sense of being a “social outcast” seemed to be behind the depression. And these feelingsare, of course, much stronger in the teenage years.In girls who were diagnosed with ADHD, and were followed by long-term studies through theyears, it was observed that as they moved from childhood to adolescence their “outward”symptoms of ADHD, such as hyperactivity and impulsivity, tended to decrease.We do want to note that most girls with ADHD do not have the symptoms of hyperactivity orimpulsivity. Most girls with ADHD are inattentive, distracted, disorganized, or “space cadets,”which is why girls are so under-diagnosed for ADHD. Girls tend to just sit in the classroom, getdistracted, and do poorly on the tests. But they don’t cause trouble in the classroom so theydon’t get the attention that might lead to a diagnosis and treatment.But for those girls were did have the symptoms of hyperactivity orimpulsivity, and had been diagnosed as children, their “outward”symptoms tended to decrease as they reached the teenage years.However, as these girls reached the teenage years, it was notedthat their academic performance continued to be a problem, andthat the academic gap between them and their non-ADHD peerscontinued to widen with each passing year.These researchers also noted that, while some girls with ADHDactually “out-grew it” as they reached adolescence, for the most partthe girls not only continued to suffer from it but many began to getinto serious trouble. Both behavioral and emotional problems beganto emerge in many of these girls, and the need for specializedtreatment greatly increased.

There were increased problems with friends, which led to increased levels of depression. Therewere increased levels of substance abuse (both alcohol and drug abuse). School delinquencyincreased as the academic problems got worse. And, surprisingly, eating disorders became aserious problem among many of these girls.All of these problems were at higher levels among these ADHD girls than among their non-ADHD peers.As we have notedelsewhere, twice as many teens with ADHD will run away from home thanteens without ADHD. About 16% of teens run away from home at some point, versus 32% ofteens untreated for Attention Deficit Hyperactivity Disorder - ADD ADHD. And as many as 50%of all teenagers in juvenile facilities have Attention Deficit Hyperactivity Disorder but wereuntreated for ADHD.Teenagers untreated for ADHD are ten times more likely to get pregnant, or cause a pregnancy,than those without ADHD, and teenagers untreated for Attention Deficit Hyperactivity Disorderare 400% more likely to contract a sexually transmitted disease

than teens without ADHD: 16%to 4%.

ADHD, and Depression

With as many as 25% of teenagers with ADHD being clinically depressed, it is important tounderstand what depression looks like, why it is important to treat it and manage it, and thetreatment options available.When we think of someone who is depressed, we usually picture a sad, tearful, lonesomeperson. But teenagers with depression don't look like adults with depression.Current studies show that there are about as many teenagers who are depressed as there areadults that are depressed, about 10% of the general population. And as we have noted, asmany as 25% of teens with ADHD are depressed.However, depression in teenagers doesn’t always look like depression in adults. Teenagers donot commonly display gloom, self-depreciation, or talk about feeling hopeless like adults do.Teenagers with Major Depression are described as often becoming negative and antisocial.Feelings of wanting to leave home or wanting to run away will increase. There may be a strongsense of not being understood and approved of by parents, siblings, or peers.The teen often changes, and becomes more restless, grouchy, or aggressive. A reluctance tocooperate in family ventures, and withdrawing from the family by retreating into their room ispretty common.School difficulties are likely even in those few ADHD teens who were doing pretty well in school,as concentration is even more affected than from the ADHD alone.Sometimes the teen will stop paying attention to personal appearance, and sometimes they willadopt the “uniform” of social groups that profess depression or despondency as a way of life.