Safeguarding ADHD Youth Against Depression in the Age of COVID
Parents are worried. About online learning and coronavirus and too many video games, yes. But more strikingly, they are worried about depression. Children with ADHD, who struggle to regulate emotions and manage stress, are at a higher risk for depression and other mood disorders. In a pandemic, that risk is aggravated by social isolation. Learn how to recognize the signs of depression and mitigate the risks for your child.
“My son is good at self-isolating, but we want him to interact with us, his family, more and keep in touch with the few friends he has virtually. He also gets depressed and we are worried this will come back.”
“My 13-year-old son has ADHD and anxiety, and he was having increased depressive symptoms just prior to all of this happening. He is petrified to go outside; it takes a lot of coaxing to get him out for a walk or in the yard or on the trampoline…”
“My son’s therapy was cancelled last week. Next week he will start online therapy and I’m not sure how effective this will be. Lots of transitions and unknowns. His anxiety is bubbling over!”
The COVID-19 pandemic, according to public health experts, is sure to trigger widespread mental health consequences, like anxiety and depression1. Indeed, it already has, according to concerned ADDitude readers who recently completed a survey on life in quarantine. Severe schedule disruptions, school closures, and social isolation strain everyone. Coping, we know, is all the more difficult for vulnerable groups like children and teens with ADHD and comorbidities, who often react more strongly to stress in a crisis.2
If you are worried that your child or teen with ADHD may be battling symptoms of depression during this disruptive and frightening time, here’s what you need to know.
Are Children and Teens with ADHD at Greater Risk for Depression Now?
The relationship between ADHD and depression is well established – about 17 percent of children with ADHD have depression, according to a 2018 national study3, and the prevalence of depression in this group increases with age4. But this does not mean that depression is an inevitability for children and adolescents with ADHD — even now.
“Having ADHD does not necessarily put a person in a category where they have one particular reaction to having to deal with the threat of this coronavirus,” said Dr. Thomas Brown, a clinical psychologist based in California. “There may be some ways that ADD tilts the table one way or another, but there’s a lot of variety.”
Dr. Maria Zimmitti, a clinical psychologist practicing in the Washington, D.C., area, said some children and teens — ADHD or not — are reporting lower levels of anxiety and stress due to significantly eased academic and social demands. At the same time, many are expressing boredom, a general lack of motivation, and sadness; they appear to be progressing through a grieving process as events like prom and graduation are cancelled. “There is no one-size-fits-all in how kids are responding to this,” she said.
According to Dr. Roberto Olivardia, a clinical psychologist in Boston, Massachusetts, some patients with ADHD who typically say they “hate” school are now missing it and the structure it provided. “We have to remember that, to a child, their social life and their academic life and the activities they do – that is their identity, that is their life. It’s a huge loss for them,” he said.
What Does Depression Look Like?
Depression may result from stressful life events5. Because tension and uncertainty are ubiquitous now, it’s critical for parents to learn to distinguish the signs of depression from normal responses to extreme stress.
Symptoms of depression may include:
- Low mood
- Low energy
- Sleep issues
- Loss of interest in activities
- Dramatic increase or decrease in weight
- Feelings of worthlessness; hopelessness
- Suicidal ideation or thoughts
Some of these symptoms, coupled with new behaviors and habits that have taken hold during the pandemic, may be inadvertently dismissed as an adolescent reaction to pandemic stress and disappointment.
Depression Symptom: Irritability
“With kids, sometimes depression manifests not as being mopey so much as being crabby,” Brown said. “Excessive irritability is a way that a lot of kids will cover and express their struggles.”
But irritability is largely seen as a typical teen behavior – even more so when families are seemingly on edge from too much time stuck inside together. In this case, Zimmitti suggests thinking of pervasive irritability in teens in the following terms to gauge whether it’s indicative of depression:
- “Do they come in and out of it, or does that irritability or prickliness stay with them?”
- “When they come out of their rooms, do they engage? Or does it become a negative, prickly interaction?”
Depression Symptom: Sleep Issues
One tell-tale sign of depression is significant sleep difficulties, whether that’s trouble sleeping through the night, or sleeping most of the time and still feeling unrested – even exhausted.
Many children and teens who are experiencing anxiety over the coronavirus may get a poor night’s sleep here and there, but if sleeplessness persists for weeks, that’s cause for concern. “Sleep deprivation then just makes you that much more vulnerable to more depression, more anxiety, and it becomes an avalanche,” Olivardia said.
With routines upended, it’s easy to conflate sleeping in or irregular sleep schedules with this symptom of depression. The key is noticing whether sleep patterns are being pushed to one extreme or the other. “Kids right now are sleeping if they don’t have to get up for a class and if classes are being recorded,” Zimmitti said. “Teens are on a whole different rhythm in terms of sleep – but sleeping late and being in their room a lot is really not in and of itself something to be worried about.”
Depression Symptom: Low Mood & Loss of Interest
There are important distinctions between feeling discouraged, bored, frustrated, and sad while living through the pandemic versus feeling hopeless and immobilized – the latter being strong indicators for depression in children and teens.
“A lot of times with depression, it’s not sadness,” Olivardia said. “Depression is defined more as the absence of emotion – feeling nothing. Feeling empty. Feeling numb.”
Boredom and frustration are near universal feelings now. It’s understandable, since children are not able to go out, enjoy their normal activities, and live life as usual. “That doesn’t in itself tell us much of anything,” Brown said. “The question is: How different is it from the way this kid usually operates?”
Inability to engage in “pre-pandemic” activities doesn’t directly translate to a loss in interest in those activities, but according to Dr. Wes Crenshaw, a psychologist based in Lawrence, Kansas, there’s a concerning trend toward “learned helplessness” – a condition characterized by a sense of powerlessness and hopelessness, and thought to lead to depression.
“If you’re trapped in a box of COVID, then it’s not that you’re no longer interested in your activities, or your friends, or doing things that are meaningful in your life,” he said. “You’re forced not to do them… kids then become hopeless and helpless.”
What then? Parents must work to encourage healthy and resilient behaviors that reduce their risk of depressive episodes in their kids.
How to Prevent Depression in Children and Teens with ADHD
Parents can significantly influence their kids’ mental health during this time. “Kids are having so many different responses to being home, but what can be the bigger stressor is really how the system is functioning at home and the dynamic within the family,” Zimmitti said.
“The best thing we can do as parents,” she said, “is to stay calm.” Prioritize having a good relationship with your child and minimizing negative emotional interactions, even if that means more flexibility than you’re used to and avoiding hyper-vigilance.
Help Instill Some Routine
“Especially for someone with ADHD, even having two or three anchors in the day can make a significant difference in mobilizing and grounding somebody,” Olivardia said.
The schedule need not be rigid or chock full of tasks, especially if they aren’t enjoyable for your child. Create balance and order with one or two daily chores, plus creative and educational activities that interest your child or teen.
Engage in Social Time
Spending time with family, friends, and others now is essential. There is no right way to facilitate bonding, but making and building positive connections is paramount, and provides an opportunity to check in and see how everyone is coping.
Social time ideas include:
- Texting or video calling friends and family using social apps
- Playing board or card games
- Watching movies together
- Playing video or computer games online with others
- Making and sharing meals together
- Exercising or doing a sport together
“We don’t have to have deep, deep interactions with our kids all the time,” Zimmitti said. “But even just sitting with your kids, whether young or teenagers, and watching a show together would be wonderful.”
Social isolation is a valid concern. That said, parents should not make social time and activities mandatory, but rather view them as ways to experience healthy interactions.
Most social interactions (plus leisure activities and schoolwork) will be playing out virtually in the weeks and months to come. For parents concerned about screen time, having a sense of the content and how their child responds to it can help gauge possible limits.
Watching thought-provoking documentaries, for example, may leave your child’s mind more activated and engaged, whereas playing a first-person shooter game for hours on end could have the opposite effect.
The Role of Diet, Exercise, and Sleep
Healthy eating and exercise — critical components of any daily routine right now — are known to help decrease risk for and alleviate symptoms of depression6 7. Exercise especially sharpens focus and attention in individuals with ADHD8.
“It burns out stress, it clears your frontal lobe and helps you think more clearly, and it gets your heart rate going,” Olivardia said. “I recommend that the earlier the better, almost as soon as someone wakes up.”
For children with ADHD, who experience sleep problems at five times the rate of neurotypical children9, regulating sleep is essential to help stem depressive symptoms. This can be achieved in part through proper sleep hygiene, like turning off electronic devices at least one hour before bed, and deviating no more than an hour or two from normal wake and sleep schedules.
How to Get Help for Depression in Children and Teens Today
Depression is treated through medication and/or psychotherapy. If you are observing symptoms of depression and other drastic changes in your child’s demeanor, there are several ways to get help.
1. Consult with your child’s pediatrician. If your child is taking ADHD medication, speak with the prescribing doctor or medical professional managing treatment about your concerns. Any treatment for depression should be developed in consultation with other members of your child’s care team.
2. Reach out to the school psychologist or counselor. School’s “out,” but that doesn’t mean typical services aren’t in place. School personnel can provide and help coordinate counseling support, especially for families who may not have access to mental health services or insurance.
3. Find a therapist or psychologist. Many mental health providers have shifted to online therapy now, and they are accepting first-time patients and conducting teletherapy consultations. Some insurance companies have also stepped in and waived co-pays for telehealth services10, making it easier for families and individuals to get the help they need. To find a professional specializing in ADHD and depression, consider these resources:
- The ADDitude Directory
- The CHADD Professional Directory
- Psychology Today Therapist Directory (search ADHD)
1 Galea S, Merchant RM, Lurie N. The Mental Health Consequences of COVID-19 and Physical Distancing: The Need for Prevention and Early Intervention. JAMA Intern Med. Published online April 10, 2020. doi:10.1001/jamainternmed.2020.1562
3 Danielson ML, Bitsko RH, Ghandour RM, Holbrook JR, Kogan MD, Blumberg SJ. Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents, 2016. Journal of Clinical Child and Adolescent Psychology. 2018, 47:2, 199-212. https://doi.org/10.1080/15374416.2017.1417860
6 Craft, L. L., & Perna, F. M. (2004). The Benefits of Exercise for the Clinically Depressed. Primary care companion to the Journal of clinical psychiatry, 6(3), 104–111. https://doi.org/10.4088/pcc.v06n0301
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Updated on January 3, 2021