Q: My son was diagnosed with ADHD in first grade and has been on meds for years. In the past two years he has become more withdrawn and doesn’t hang out with his friends except on rare occasions and never makes plans with school friends. I am concerned that he may be depressed. He has admitted that on some occasions he has felt blue but refuses to see a psychologist to discuss his feelings. Any suggestions? — A Concerned Mom
A: It sounds, at least in part, like you are asking: “How can I tell if my son is depressed, and if he is, where do I start?”
It is not uncommon for children struggling with ADHD to also struggle with depression. Often, when children are asked if they are feeling depressed, they may not consider themselves depressed because they don’t know all the signs of depression. Many think it is feeling sad all the time, which it can be, but there are many more signs and symptoms of depression. Some of these signs of depression in children and adolescents are:
-- Feeling irritable, angry, isolated, sad, guilty, hopeless, worthless or bored.
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-- Becoming withdrawn or losing interest in activities they enjoyed before.
-- Loss of appetite or an increase in appetite. Weight gain or loss.
-- Trouble sleeping, whether it is not being able to sleep or sleeping significantly more than usual.
-- Having nightmares, especially younger children.
-- Difficulty concentrating. Often, this impacts school and parents may see a sudden drop in grades because of a lack of motivation that leads to incomplete assignments and not being prepared for tests and quizzes.
-- Children who are struggling with depression may “act out” in school and at home, particularly boys. Parents may see their child having angry outbursts or may be getting calls from the teacher about their child’s behavior. The child may be getting suspended or arguing with their peers and teachers.
-- Children may have physical complaints, such as headaches or stomachaches and may be clingier to their caregivers. They may be missing more school than usual.
As you can see, this is quite a list of signs and symptoms, and it is by no means exhaustive. However, there may be many other reasons for these behaviors, so just because your child shows some of these, it does not necessarily mean it is because he is depressed. In fact, some of these can be related to ADHD. He could be responding “normally” to stressors with peers, school, or home life, or these could be indicators that there is something else going on that share some of these signs or symptoms.
There could be several reasons why a child may be struggling with depression. A few of these possible reasons could be family conflict, learning difficulties, or peer challenges including being bullied (to name a few). Children diagnosed with ADHD may be younger socially and emotionally than their peers, which can lead to challenges in social interaction with peers. This can leave the child feeling socially challenged and isolated, and can result in lower self-esteem. Children with ADHD may also struggle in the classroom even though they are typically very intelligent. Due to difficulties with concentration and focus, kids with ADHD may have a hard time completing assignments and may also struggle managing the frustrations they feel with these challenges.
Since your son is reluctant to go to a therapist, one option is to start with your pediatrician or primary care doctor, especially if you have one that has been prescribing meds for ADHD. The doctor can at least evaluate the symptoms, check for any underlying medical conditions to rule these out and also talk with your son about any other issues that may be occurring. We are suggesting your son see a doctor versus a psychotherapist, primarily because it sounds like your son may be more agreeable to this, not because we are advocating use of medication if the doctor feels your son is depressed.
You are also welcome to contact us to discuss these concerns further. We have found it really beneficial to parents and families to meet with parents to explore their concerns and strategize how to engage their child in talking and getting help if it is needed.
Got a question about your child’s health or happiness? Send your question to firstname.lastname@example.org to be considered for a future “Ask” Q&A.
Michelle Topal, MSW, LCSW, is the owner and a therapist at Change for Living Counseling (changeforlivingcounseling.org) and Erin Towle-Silva is a licensed psychologist there.