Young children with attention-deficit/hyperactivity disorder (ADHD) appear to be at greater risk for adolescent depression and/or suicide attempts five to 13 years after diagnosis, according to a report in the October issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Sixteen to 37 percent of clinically-diagnosed adults with attention-deficit/hyperactivity disorder also suffer from major depressive disorder and/or dysthymia. "When major depressive disorder occurs concurrently with ADHD, major depressive disorder has an earlier age of onset, has a longer duration and results in greater impairment," according to background information in the article.

Andrea Chronis-Tuscano, Ph.D., of the University of Maryland, College Park, and colleagues studied 125 children between the ages of 4 and 6 who met medically-diagnosed criteria for ADHD, and 123 demographically matched children without ADHD in Chicago and Pittsburgh to determine if young children diagnosed with ADHD face a higher risk of depression and attempted suicide. Children in both groups underwent follow-up assessments until age 18.

The authors found that children diagnosed with ADHD between the ages of 4 and 6 were at greater risk for depression between the ages of 9 and 18. Additionally, 17 of 248 children had reported having a specific suicidal plan at least once during this same time period (12.0 percent of children and adolescents with ADHD and 1.6 percent of children and adolescents in the comparison group). "A total of 18.4 percent of children and adolescents with ADHD and 5.7 percent of comparison children and adolescents made at least one suicide attempt by assessment year 14."

According to the authors, "our findings indicate that young children with ADHD are at high risk for both single and recurrent episodes of adolescent depression and for suicidal behavior, even controlling for a history of major depression in their mothers and other demographic and methodologic predictors of these outcomes." Maternal depression, combined with child emotional and behavioral problems at 4 to 6 years, predicted depression and suicidal behaviors in children with ADHD. Additionally, the findings indicate that girls are at a greater risk for depression and suicide attempts.

The authors also categorized ADHD into three subtypes and found that each one (inattentiveness, hyperactivity and/or a combination of the two) predicted somewhat different outcomes. While children who have a combination of inattention and hyperactivity predicted both depression and attempted suicide, children who experience only inattentiveness predicted only depression. Children showing only hyperactivity predicted suicide attempts but not depression.

"These findings suggest that it is possible to identify children with ADHD at very young ages who are at very high risk for later depression and suicidal behavior," the authors conclude. "Considered in light of what is already known about the antisocial outcomes of childhood ADHD and their risk for unintentional injury, it would not be premature to test early prevention programs designed to reduce both serious behavioral and affective sequelae of ADHD in early childhood."

This study was supported by a grant from the National Institute of Mental Health.