Abstract
A significant literature suggests that youth diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) are at increased risk for later depression relative to youth without ADHD. Youth with co-occurring ADHD and depression experience more serious impairments and worse developmental outcomes than those with either disorder alone, including increased rates of suicidal ideation and suicide completion. Despite these very serious outcomes, few studies have examined the mechanisms underlying the relationship between ADHD and depression in youth. The present study examined emotion regulation (ER) as a mediator of the relationship between ADHD and depressive symptoms in 69 youth between the ages of 10 and 14, with (n = 37) and without (n = 32) ADHD. Parent and youth ratings of depressive symptoms and ER were collected. Youth with ADHD reported significantly more depressive symptoms and poorer ER ability relative to youth without ADHD. ER fully mediated the relationship between ADHD and depressive symptoms. Limitations and clinical implications are discussed.
Similar content being viewed by others
Notes
Two youth recruited for the control group were reported to have more than 3 symptoms of ADHD, but no impairment as rated by both parents and teachers. These youth were significantly different than the ADHD group in terms of total number of ADHD symptoms, inattention, hyperactivity/impulsivity, and parent and teacher ratings of impairment (all ps < 0.001). However, these two youth were not significantly different from the non-ADHD comparison group on these measures (all ps > 0.000); therefore, they were included in the non-ADHD comparison group.
Since none of the covariates included in the original mediation model demonstrated a robust effect on the DV, covariates were not included in these follow-up analyses
References
Ambrosini, P. J. (2000). Historical development and present status of the schedule for affective disorders and schizophrenia for school-age children (K-SADS). Journal of the American Academy of Child & Adolescent Psychiatry, 39, 49–58.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental (4th edition, text-revised). Washington, DC: Author.
Angold, A., Costello, E., Erkanli, A., & Worthman, C. (1999). Pubertal changes in hormone levels and depression in girls. Psychological Medicine, 29(5), 1043–1053.
Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychological Bulletin, 121, 65–94.
Barkley, R. A., Fisher, M., Edelbrook, C. S., & Smallish, L. (1991). The adolescent outcome of hyperactive children diagnosed by research criteria: III. Mother-child interactions, family conflicts and maternal psychopathology. Journal of Child Psychology and Psychiatry, 32, 233–256.
Baron, R., & Kenny, D. (1986). The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182.
Biederman, J., Ball, S., Monuteaux, M., Mick, E., Spencer, T., McCreary, M., et al. (2008). New insights into the comorbidity between ADHD and major depression in adolescent and young adult females. Journal of the American Academy of Child & Adolescent Psychiatry, 47(4), 426–434.
Blackman, G., Ostrander, R., & Herman, K. (2005). Children with ADHD and depression: a multisource, multimethod assessment of clinical, social, and academic functioning. Journal of Attention Disorders, 8(4), 195–207.
Bloch, L., Moran, E. K., & Kring, A. M. (2009). On the need for conceptual and definitional clarity in emotion regulation research. In A. M. Kring & D. S. Sloan (Eds.), Emotion regulation and psychopathology (pp. 88–104). New York: Guilford.
Bussing, R., Mason, D. M., Bell, L., Porter, P., & Garvan, C. (2010). Adolescent outcomes of childhood attention-deficit/hyperactivity disorder in a diverse community sample. Journal of the American Academy of Child & Adolescent Psychiatry, 49(6), 595–605.
Chronis, A. M., Lahey, B. B., Pelham, W. E., Kipp, H., Baumann, B., & Lee, S. S. (2003). Psychopathology and substance abuse in parents of young children with Attention Deficit/Hyperactivity Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 1425–1432.
Chronis-Tuscano, A., Molina, B. G., Pelham, W. E., Applegate, B., Dahlke, A., Overmyer, M., & Lahey, B. B. (2010). Very early predictors of adolescent depression and suicide attempts in children with attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 67(10), 1044–1051.
Claude, D., & Firestone, P. (1995). The development of ADHD boys: a 12-year follow-up. Canadian Journal of Behavioural Science, 27(2), 226–249.
Compas, B. E., Connor-Smith, J. K., & Jasper, S. S. (2004). Temperament, stress-reactivity, and coping: implications for depression in childhood and adolescence. Journal of Clinical Child and Adolescent Psychology, 33, 21–31.
Compas, B. E., Jaser, S. S., & Benson, M. (2009). Coping and emotion regulation: Implications for understanding depression during adolescence. In S. Nolen-Hoeksema & L. Hilt (Eds.), Handbook of adolescent depression. New York: Wiley.
Costello, E., Foley, D., & Angold, A. (2006). 10-year research update review: the epidemiology of child and adolescent psychiatric disorders: II. Developmental epidemiology. Journal of the American Academy of Child & Adolescent Psychiatry, 45(1), 8–25.
Davey, C. G., Yucel, M., & Allen, N. B. (2008). The emergence of depression in adolescence: development of the prefrontal cortex and the representation of reward. Neurosci Biobehav Rev, 32, 1–19.
Daviss, W. (2008). A review of co-morbid depression in pediatric ADHD: etiologies, phenomenology, and treatment. Journal of Child and Adolescent Psychopharmacology, 18(6), 565–571.
Daviss, W. B., Birmaher, B., Melhem, N. A., Axelson, D. A., Michaels, S. M., & Brent, D. A. (2006). Criterion validity of the Mood and Feelings Questionnaire for depressive episodes in clinic and non-clinic subjects. Journal of Child Psychology and Psychiatry, 47(9), 927–934.
Daviss, W., Diler, R., & Birmaher, B. (2009). Associations of lifetime depression with trauma exposure, other environmental adversities, and impairment in adolescents with ADHD. Journal of Abnormal Child Psychology, 37(6), 857–871.
Diler, R. A., Daviss, W. B., Lopez, A., Axelson, D., Iyengar, S., & Birmaher, B. (2007). Differentiating major depressive disorder in youths with attention deficit hyperactivity disorder. Journal of Affective Disorders, 102, 125–130.
DuPaul, G. J., Volpe, R. J., Jitendra, A. K., et al. (2004). Elementary school students with AD/HD: predictors of academic achievement. Journal of School Psychology, 42, 285–301.
Durbin, C., & Shafir, D. (2008). Emotion regulation and risk for depression. In J. R. Z. Abela & H. L. Hankin (Eds.), Handbook of depression in children and adolescents (pp. 149–176). New York: Guilford.
Eisenberg, N., & Spinrad, T. L. (2004). Emotion-related regulation: sharpening the definition. Child Development, 75, 334–339.
Elia, J., Ambrosini, P., & Berrettini, W. (2008). ADHD characteristics: I. Concurrent co-morbidity patterns in children & adolescents. Child and Adolescent Psychiatry and Mental Health, 2(1), 15.
Fabiano, G. A., Pelham, W. E., Waschbusch, D., Gnagy, E. M., Lahey, B. B., Chronis, A. M., Onyango, A. N., Kipp, H., Lopez-Williams, A., & Burrows-MacLean, L. (2006). A practical impairment measure: psychometric properties of the impairment rating scale in three samples of children with attention-deficit/hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology, 35, 369–385.
Feng, X., Keenan, K., Hipwell, A., Henneberger, A., Rischall, M., Butch, J., et al. (2009). Longitudinal associations between emotion regulation and depression in preadolescent girls: moderation by the caregiving environment. Developmental Psychology, 45(3), 798–808.
Field, A. (2005). Discovering statistics using SPSS—2nd edition. London: Sage Publications.
Fishman, P. A., Stang, P. E., & Hogue, S. L. (2007). Impact of comorbid attention deficit disorder on the direct medical costs of treating adults with depression in managed care. Journal of Clinical Psychiatry, 68(2), 248–253.
Gittelman, R., Mannuzza, S., Shenker, R., & Bonagura, N. (1985). Hyperactive boys almost grown up: I. Psychiatric status. Archives of General Psychiatry, 42(10), 937–947.
Gotlieb, I. H., & Hammen, C. L. (2008). Handbook of depression—2nd Edition. New York: The Guilford Press.
Gratz, K., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54.
Gross, J. J., & Thompson, R. A. (2007). Emotion regulation: Conceptual foundations. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 3–24). New York: Guilford.
Hair, J. F., Black, W. C., Babin, B. J., Anderson, R. E., & Tatham, R. L. (2006). Multivariate data analysis—6th Edition. New Jersey: Pearson-Prentice Hill.
Hankin, B., Fraley, R., Lahey, B., & Waldman, I. (2005). Is depression best viewed as a continuum or discrete category? A taxometric analysis of childhood and adolescent depression in a population-based sample. Journal of Abnormal Psychology, 114(1), 96–110.
Hankin, B. L., & Abramson, L. Y. (2001). Development of gender differences in depression: an elaborated cognitive vulnerability-transactional stress theory. Psychological Bulletin, 127, 773–796.
Hankin, B. L., Gibb, B. E., Abela, J. R., & Flory, K. (2010). Selective attention to affective stimuli and clinical depression among youths: role of anxiety and specificity of emotion. Journal of Abnormal Psychology, 119(3), 491–501.
Hayes, A. F. (2009). Beyond Baron and Kenny: statistical mediation analyses in the new millennium. Communication Monographs, 76, 408–420.
Hinshaw, S. E. (1994). Attention deficits and hyperactivity in children. Thousand Oaks: Sage.
Hoza, B., Gerdes, A., Mrug, S., Hinshaw, S., Bukowski, W., Gold, J., et al. (2005). Peer-assessed outcomes in the multimodal treatment study of children with attention deficit hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology, 34(1), 74–86.
James, A., Lai, F., & Dahl, C. (2004). Attention deficit hyperactivity disorder and suicide: a review of possible associations. Acta Psychiatrica Scandinavica, 110(6), 408–415.
Jensen, P. S., Rubio-Stipec, M., Canino, G., Bird, H. R., Dulcan, M. K., Schwab-Stone, M. E., et al. (1999). Parent and child contributions to diagnosis of mental disorder: are both informants always necessary? Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1569–1579.
Johnston, C., & Mash, E. J. (2001). Families of children with attention-deficit/hyperactivity disorder: review and recommendations for future research. Clinical Child and Family Psychology Review, 4, 183–207.
Kaiser, H. F. (1960). The application of electronic computers to factor analysis. Educational and Psychological Measurement, 20, 141–151.
Karustis, J. L., Power, T. J., Rescorla, L. A., Eiraldi, R. B., & Gallagher, P. R. (2000). Anxiety and depression in children with ADHD: unique associations with academic and social functioning. Journal of Attention Disorders, 4, 133–149.
Kaufman, J., Birmaher, B., Brent, D., Rao, U., & Ryan, N. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 980–988.
Kovacs, M. (1992). Children’s Depression Inventory manual. North Tonawanda: Multi-Health Systems.
Kovacs, M., Sherrill, J., George, C., Pollock, M., Tumuluru, R., & Ho, V. (2006). Contextual emotion-regulation therapy for childhood depression: description and pilot testing of a new intervention. Journal of the American Academy of Child & Adolescent Psychiatry, 45(8), 892–903.
Lahey, B. B., Chronis, A. M., Lee, S., Loney, J., Pelham, W. E., & Hartung, C. M. (2007). Are there sex differences in the predictive validity of DSM-IV ADHD among younger children? Journal of Clinical Child and Adolescent Psychology, 36(2), 113–126.
Lee, S., Lahey, B., Owens, E., & Hinshaw, S. (2008). Few preschool boys and girls with ADHD are well-adjusted during adolescence. Journal of Abnormal Child Psychology, 36(3), 373–383.
Lewinsohn, P. M., Clarke, G. N., Seeley, J. R., & Rohde, P. (1994). Major depression in community adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 809–818.
Logan, D. E., & King, C. A. (2002). Parental identification of depression and mental health service use among depressed adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 41(3), 296–304.
Luebbe, A. M., Bell, D. J., Allwood, M. A., Swenson, L. P., & Early, M. C. (2010). Social information processing in children: specific relations to anxiety, depression and affect. Journal of Clinical Child and Adolescent Psychology, 39(3), 386–99.
Maedgen, J., & Carlson, C. (2000). Social functioning and emotional regulation in the attention deficit hyperactivity disorder subtypes. Journal of Clinical Child Psychology, 29(1), 30–42.
Mannuzza, S., Klein, R., Bessler, A., Malloy, P., & LaPadula, M. (1998). Adult psychiatric status of hyperactive boys grown up. The American Journal of Psychiatry, 155(4), 493–498.
Martel, M. M. (2009). A new perspective on Attention-Deficit/Hyperactivity Disorder: emotion dysregulation and trait models. Journal of Child Psychology & Psychiatry, 50(9), 1042–1051.
Martel, M. M., & Nigg, J. T. (2009). Child ADHD and personality/temperament traits of reactive an effortful control, resiliency and emotionality. Journal of Child Psychology and Psychiatry, 46(11), 1437–1444.
Martinussen, R., Hayden, J., Hogg-Johnson, S., & Tannock, R. (2005). A meta-analysis of working memory impairments in children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 44(4), 377–384.
Maxwell, S. E., & Cole, D. A. (2007). Bias in cross-sectional analyses of longitudinal mediation. Psychological Methods, 12(1), 23–44.
McQuade, J. D., Hoza, B., Waschbusch, D. A., Murray-Close, D., & Owens, J. S. (2011). Changes in self-perceptions in children with ADHD: a longitudinal study of depressive symptoms and attributional style. Behavior Therapy, 42(2), 170–82.
Melnick, S. M., & Hinshaw, S. P. (2000). Emotion regulation and parenting in AD/HD and comparison boys: linkages with social behaviors and peer preference. Journal of Abnormal Child Psychology, 28, 73–86.
Monuteaux, M. C., Faraone, S. V., Gross, L., & Biederman, J. (2007). Predictors, clinical characteristics, and outcome of conduct disorder in girls with attention-deficit/hyperactivity disorder: a longitudinal study. Psychological Medicine, 37(12), 1731–1741.
Moretti, M. M., Fine, S., Haley, G., & Marriage, K. (1985). Childhood and adolescent depression: child—report versus parent report information. Journal of the American Academy of Child and Adolescent Psychiatry, 24(3), 298–302.
Musser, E. D., Backs, R. W., Schmitt, C. F., Ablow, J. C., Measelle, J. R., & Nigg, J. T. (2011). Emotion regulation via the autonomic nervous system in children with Attention Deficit/Hyperactivity Disorder (ADHD). Journal of Abnormal Child Psychology, 39(6), 841–852.
Neumann, A., van Lier, P. C., Gratz, K. L., & Koot, H. M. (2010). Multidimensional assessment of emotion regulation difficulties in adolescents using the difficulties in emotion regulation scale. Assessment, 17(1), 138–149.
Nigg, J. T., & Casey, B. J. (2005). An integrative theory of attention-deficit/ hyperactivity disorder based on the cognitive and affective neurosciences. Developmental Psychopathology, 17(3), 785–806.
Nigg, J. T., Goldsmith, H. H., & Sachek, J. (2004). Temperament and attention-deficit/hyperactivity disorder: the development of a multiple pathway model. Journal of Clinical Child and Adolescent Psychology, 33, 42–53.
Norvilitis, J., Casey, R., Brooklier, K., & Bonello, P. (2000). Emotion appraisal in children with attention-deficit/hyperactivity disorder and their parents. Journal of Attention Disorders, 4(1), 15–26.
Ostrander, R., & Herman, K. (2006). Potential cognitive, parenting, and developmental mediators of the relationship between ADHD and depression. Journal of Consulting and Clinical Psychology, 74(1), 89–98.
Paus, T., Keshavan, M., & Giedd, J. N. (2008). Why do many psychiatric disorders emerge during adolescence? Nature reviews Neuroscience, 9, 947–957.
Pelc, K., Kornreich, C., & Foisy, D. (2006). Recognition of emotional facial expressions in attention-deficit hyperactivity disorder. Pediatric Neurology, 35(2), 93–97.
Pelham, W. E., Gnagy, E. M., Greenslade, K. E., & Milich, R. (1992). Teacher ratings of DSM-III-R symptoms for the disruptive behavior disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 210–218.
Pelham, W. E., Fabiano, G. A., & Massetti, G. M. (2005). Evidence-based assessment of attention-deficit/hyperactivity disorder in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 34(3), 548–58.
Piacentini, J. C., Cohen, P., & Cohen, J. (1992). Combining discrepant diagnostic information from multiple sources: are complex algorithms better than simple ones? Journal of Abnormal Child Psychology, 20, 51–63.
Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891.
Reynolds, C. R., & Kamphaus, R. W. (2004). Behavior assessment system for children, second edition (BASC-2). Circle Pines: American Guidance Service.
Rothbart, M. K., & Posner, M. I. (2006). Temperament, attention, and developmental psychopathology. In D. Cicchetti & D. Cohen (Eds.), Developmental psychopathology. Vol. 2: Developmental neuroscience (pp. 465–501). Hoboken: John Wiley & Sons.
Rubio-Stipec, M., Fitzmaurice, G., Murphy, J., & Walker, A. (2003). The use of multiple informants in identifying the risk factors of depression and disruptive disorders: are they interchangeable? Social Psychiatry and Psychiatric Epidemiology, 38(2), 51–58.
Schmeichel, B., Volokhov, R., & Demaree, H. (2008). Working memory capacity and the self-regulation of emotional expression and experience. Journal of Personality and Social Psychology, 95(6), 1526–1540.
Scime, M., & Norvilitis, J. (2006). Task performance and response to frustration in children with attention deficit hyperactivity disorder. Psychology in the Schools, 43(3), 377–386.
Shields, A. M., & Cicchetti, D. (1997). Emotion regulation in school-age children: the development of a new criterion Q-sort scale. Developmental Psychology, 33, 906–916.
Shields, A., Ryan, R. M., & Cicchetti, D. (2001). Narrative representations of caregivers and emotion dysregulation as predictors of maltreated children’s rejection by peers. Developmental Psychology, 37(3), 321–337.
Singh, S., Ellis, C., Winton, A., Singh, N., Leung, J., & Oswald, D. (1998). Recognition of facial expressions of emotion by children with attention-deficit hyperactivity disorder. Behavior Modification, 22(2), 128–142.
Smith, B. H., Pelham, W. E., Jr., Gnagy, E., Molina, B., & Evans, S. (2000). The reliability, validity, and unique contributions of self-report by adolescents being treated for Attention-Deficit Hyperactivity Disorder. Journal of Consulting and Clinical Psychology, 68, 489–499.
Tortella-Feliu, M., Balle, M., & Sesé, A. (2010). Relationships between negative affectivity, emotion regulation, anxiety, and depressive symptoms in adolescents as examined through structural equation modeling. Journal of Anxiety Disorders, 24(7), 686–693.
Walcott, C., & Landau, S. (2004). The relation between disinhibition and emotion regulation in boys with attention deficit hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology, 33(4), 772–782.
Wechsler, D. (1991). Wechsler intelligence scale for children—third edition: Manual. San Antonio: The Psychological Corporation.
Weinberg, A., & Klonsky, E. (2009). Measurement of emotion dysregulation in adolescents. Psychological Assessment, 21(4), 616–621.
Willcutt, E. G., Doyle, A. E., Nigg, J. T., Faraone, S. V., & Pennington, B. F. (2005). Validity of the executive function theory of Attention-Deficit/Hyperactivity Disorder: a meta-analytic review. Biological Psychiatry, 57(11), 1336–1346.
Williams, L. M., Hermens, D. F., Palmer, D., Kohn, M., Clarke, S., Keage, H., et al. (2008). Misinterpreting emotional expressions in attention-deficit/hyperactivity disorder: evidence for a neural marker and stimulant effects. Biological Psychiatry, 63(10), 917–926.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Seymour, K.E., Chronis-Tuscano, A., Halldorsdottir, T. et al. Emotion Regulation Mediates the Relationship between ADHD and Depressive Symptoms in Youth. J Abnorm Child Psychol 40, 595–606 (2012). https://doi.org/10.1007/s10802-011-9593-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10802-011-9593-4