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ADHD can be one of the most disrupting things that can ever
happen to your family. But, it’s very obvious from stories told to me by
parents of ADHD teens, dealing with an ADHD adolescent who is also
depressed can be a living hell.
More and more newspaper headlines are bringing to our attention, teenage
depression and the possibility of suicide. There are even a few studies
showing an increased risk of suicide in teens treated for ADHD. So, it’s
just common sense and very important to spot subtle symptoms and signs
of depression in ADHD teenagers before emotional, physical and family
damage occurs. You just may be doing yourself, family and friends a big
favor, but the bigger favor will be in helping your ADHDer reach his or
her fullest emotional and social potential in life.
Let’s look at a few facts about depression in general:
· 15 to 20% of all adolescents will experience depression in their
lifetime
· 6% of adolescents will suffer severe depression during their teen
years
· Probably as much as 75% of all depression begins showing it’s ugly
head in adolescence
The following conditions place a teen at increased risk of depression:
· Mother, father, brother or sister with depression
· History of depression as a child or pre-teen
· History of a previous emotional disorder such as anxiety or panic
attacks
· Divorce or dysfunctional family dynamics
· Death of a close loved one
· Learning disabilities
· Verbal skills, speech, vision and hearing disorders
· ADDS, ADHD, defiant or confrontational disorders
· Poor social-peer interaction and coping skills
· Chronic illness such as asthma, diabetes, heart disease
· Academic or school related problems
· Negative lifestyle and poor stress coping skills
As you can clearly see, many of the above risk factors impact directly
or are already attributable to ADHDers anyway. Keeping these important
foundational bits in mind, let’s go on to discuss the symptoms and signs
of depression in ADHD teenagers.
Here is an expanded list of the most common and some very subtle things
seen in teens with depression, and even more so in ADHD teens with
depression:
· Appears or acts sad even when there is no reason to be sad or in
circumstances where others would normally be happy or satisfied
· Doesn’t want to engage in activities that you know he or she is
normally interested in or loses interest in what is considered a hobby.
In girls, this is usually seen as avoiding activities with other girls
such as dances, sleep-overs and parties or making excuses as to why she
doesn’t date or fails to be interested in boys. In teenage boys, what we
usually see is a lack of interest in sports, games, outdoor events, and
going to the mall to “hang” with the guys.
· Loss of energy or wants to sleep at long periods. Complains of being
tired all the time. Often is too tired from lack of sleep to do chores
or hard to get out of bed for school on time. Sometimes the reverse
occurs and depressed teens will be hyper and can’t sleep. These kids
will stay up all night long and complain they can’t sleep at night or
when anyone else is around.
· Losing or gaining a fair amount of weight is often a sign of teen
depression. Some experts feel that Anorexia Nervosa first shows up in
the very early teen or late pre-teen years. When you’re depressed either
you don’t feel like eating, or you want comfort foods and eat a lot.
Remember that it’s in the teen years that body self-image is developed!
· Complaints of being tired and fatigued in situations where your teen
would normally be enthusiastic, such as amusement parks, beach trips,
parties for similar aged kids, sports events, and shopping trips
dedicated to buying clothing for them.
· Obsessing over weight, appearance and clothing can indicate an attempt
to gain control of one’s feelings and emotions. This is one of the
reasons teens risk tattoos, body art and multiple body piercing. Some of
these behaviors are seen in non-ADHD-non-depressed teens, so one has to
observe closely for “excessive amounts” of these behaviors. Remember,
you can have some of the signs of ADHD or depression and NOT suffer from
the disorders.
· Problems concentrating or focusing on even the simple aspects of being
a teen, Often, these teens won’t bathe for days, wear the same clothing
for 3-4 days at a time, won’t brush teeth, forget to feed the dog or
cat, forget family members birthdays and important events. Sometimes
they cut classes instead of suffering humiliation over their “worse than
usual” school performance.
· Complains of being bored when normally would be enjoying an event such
as a movie, school play, or a family outing at the circus. During these
times you’ll notice the classic ADHD signs of being restless, hyper,
fidgety, and agitated over loss of perceived loss of control will be
seen to a greater extent.
· They often just can’t make decisions that even a few weeks ago would
have been easy. Things like not being able to decide on hair styles,
clothing choices, whether to go on that school or church outing, or even
whether to go to school at all indicate problems with indecisiveness and
concentration. Often as this level of indecisiveness progresses, they
just “freeze-up” and won’t risk making a decision. If pushed to do so,
they may become angry or even hostile!
· Saying no to everything or being very argumentative. This teen is
often the one who talks back and argues about little things, refuses to
do certain normal things such as cleaning his room, eating at a favorite
restaurant with the family, has nothing nice to say about anything or
anyone, and is plain oppositional in his or her refusal to do things
with the family.
· Acts withdrawn, guilty or as if he or she feels worthless by being
very negative about everything including themselves. They may talk about
how “worthless they are”, how “nobody loves them”, or they “should never
been born”. They may become very defiant and oppose any attempt to
change their room style, clothing style or immediate environment. Often
they will refuse to go to counseling or see the doctor. Sometimes they
act as if they have done something wrong or illegal.
· Running away from home and trying to stay away from home for long
periods is a sign of avoidance behavior. These teens are literally
running away or “sort of running away” from home to avoid having to deal
with a conflict. There is usually some type of stress in their life that
is confusing, difficult to resolve and threatens their sense of
security.
· Joins a street gang or socially unacceptable club or gang. In essence,
this is like running away from home in that you now have a “new or
better” family who accepts you as the depressed, indecisive, confused
teenager you really are. After all, that’s what they are looking for,
unconditional acceptance in a time of confusion or conflict.
· Talking about or frequently discussing pain, death or dying indicates
your teen is thinking about ways out of his or her predicament. Some
depressed teens listen to or sing to death, dark and evil songs over and
over. Some start reading books on death, magic, witchcraft and the
occult. They often become obsessed with these habits and start dwelling
in their fantasy world more and more as their depression gets deeper.
“She’s in a world of her own” sometimes means she’s escaping from the
pain of depression.
· Subtle signs of suicidal thinking include an increase in risk taking
behavior, such as running in front of cars, taking dares, speeding,
ignoring laws and rules, promiscuous sex, experimenting with drugs or
alcohol, or testing the waters of homosexuality.
· Recurring suicidal thoughts, plans, gestures or attempts. Most
depressed ADHD kids don’t sit down and plan how to commit suicide. They
are too impulsive to plan, don’t focus on task well, and when depressed
have indecisiveness, guilt and problems committing to any plan. Usually,
their impulsivity leads them to do abrupt acts such as medication or
street drug overdoses, using a knife to cut a wrist, shooting themselves
in the heart or head, driving their high speed car into a bridge
abutment or jumping out of a window from great heights. This tendency
makes it vitally important to have no narcotics, alcohol, or firearms
readily accessible to the depressed one.
So now that you understand ADHD and depression in teenagers, what do you
do about it?
In general, all depressed ADHDers will need at least three months of
counseling by a skilled adolescent psychologist or psychiatrist. In some
cases, a year or more of therapy may be needed to help them resolve the
issues causing their depression. Family counseling will be needed if
there are marital problems, chronic illnesses or recent significant
deaths affecting the family unit.
Social services and schoolteachers may need to be involved to assist in
out of family conflicts such as peer pressure. Often, we consider
finding the teen an independent coach to help them learn to cope with
life’s little and big ups and downs.
Then, after a thorough evaluation has been made, medications may be
needed and if used, must be monitored closely for side effects, as an
increased risk of suicidal behavior has been associated with the use of
anti-depressants in this age group.
Above all, learn to understand, listen to and I mean really listen to
your ADHD teenager in hopes that you will spot these symptoms and signs
of depression and avoid the bad times that can follow. Of course,
teenagers can have any or all of these symptoms and signs and not be
ADHD!
Dr. Frank
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