Raising a child or teen with ADHD/ADD can seem quite overwhelming, but when these conditions are combined with a co-occurring mood disorder this can truly be a challenging situation for any parent. This, however, is a very real challenge for over half of the families of children with an ADHD diagnosis. Research studies show that as many as 60% of children and teens diagnosed with ADHD have one or more additional co-occurring mental health conditions, such as anxiety and/or depression.

The first challenge for any parent is to recognize the possibility that a co-occurring disorder is present. This is no easy task. Indeed, it will take the specialized skills of a qualified mental health professional familiar with both ADHD and anxiety / depression, to make the final determination. A pediatrician or educator familiar with ADHD will typically not have the specialized skills required to identify coexisting disorders and to know how to effectively treat them. If you suspect that your child is having challenges above and beyond those associated with ADHD, then it is wise to seek out a specialist familiar with the co-mingling of these disorders. The diagnosis is complicated by the fact that many of the symptoms associated with ADHD are the same as those that are associated with other conditions, such as anxiety or depression. In children, for example, depression can often manifest as irritability, which might look like one of the characteristic of ADHD. It takes a multi-faceted assessment that includes comprehensive psychological testing, interviewing multiple respondents, careful analysis of the history of the symptoms and overall development of the child, along with clinical observations, to make a proper diagnosis.

As the specialist builds the treatment plan the first consideration will be to determine what is the greatest impairment to your child’s life and how it should be remediated. Every child and teen is unique. It will be up to the specialist to determine if the ADHD and the coexisting disorder are treated simultaneously or one after the other. Especially in cases of severe depression a specialist may choose to address this first to improve the overall mood of your child and to increase compliance with further treatment. Invariably, a treatment plan will include cognitive-behavioral therapy to teach your child coping skills and behavior modification therapy to reduce unwanted behaviors. It may also include family therapy, play therapy, or expressive art therapy, based on the child’s age and needs.

When medication is recommended your specialist has a particular challenge since some of the ADHD medications are actually counter indicated for conditions such as anxiety. It may take several iterations of the medication plan before the right balance can be reached. This will require monitoring by you as a parent of your child or teen throughout the day. You can also ask one or more teachers to support you in this activity. As you do this, remember to not only check on the behavior of your child but also to ask them specifically about their feelings. Encourage them to be partners with you in figuring out what works for them.

The relationship between ADHD and anxiety / depression can be a bit of a chicken and an egg dilemma. While there are clear neurological reasons for the occurrence of anxiety and depression, these two conditions can also be brought on by environmental situations. Think about it. You have watched your child and teen struggle with their ADHD and the pain it has caused them. You have watched their confidence being sapped away by continued failures. These repeated experiences of failure can take a toll that can result in depression and/or anxiety. As parents, we try our best helping children build their self esteem, but it is especially important for parents of ADHD children. Healthy self-esteem is one of the best remedies against anxiety and depression.

Anxiety in particular can be conditioned by the testing process accompanying most educational environments. When a child or teen knows that even though they have studied twice as hard as anyone else they are likely to make critical mistakes during testing due to a lack of attention to detail or an inability to focus, they are likely to develop anxiety prior to testing. The fear of impending doom will be compounded with the inattentiveness that accompanies ADHD to make matters even worse.

Depression can result from continued rejection by peers and continued failure to live up to the expectations that everyone seems to have for them. The isolation that often accompanies ADHD can contribute to a loss of self-esteem and a sense of hopelessness. The child or teen experiencing this kind of depression may withdraw and simply stop trying to improve themselves.

This means that even if ADHD is treated by medications and instruction in organizational skills, the anxiety and depression may still remain as a result of a life history of disappointment. This is very important for a parent to be aware of. Medication alone will not be sufficient to help your child change the negative mindset resulted from years of discouragement.

Whether your child’s anxiety and/or depression are the result of a neurobiological condition, social conditioning, or a combination of both really does not change how you will work with him or her to overcome these challenges. In addition to the support of a counselor or therapist who fully understands what your child is experiencing you will need to be actively engaged in providing a supportive environment.

One of the most powerful tools you have at hand is your ability to praise your child. Given that their lives are primarily filled with criticism and rejection finding ways to compliment your child on a job well done can become incredibly important. There are several skills that you as a parent will need to develop to do this effectively. First, spend some time thinking about your child or teen’s strengths. What is it that they do well? Are they funny? Are they kind to a brother or sister? Do they have a passion for a particular subject or activity such as a sport or a hobby? Too often parents in their desperation to improve behavior in their ADHD boy or girl will use favorite activities as barter chips to negotiate for better behavior. But this can only increase depression and anxiety. Instead, whenever you see your child engaged in something that they love and are doing well, take the time to compliment them. Point out their strengths as a way to build up their damaged self-esteem.

Second, consider your expectations of them and the tasks that you give them. Remember that the ADHD brain is typically 3 to 5 years developmentally behind the brain of chronological peers. When you set tasks and expectations for your child remember to scale them accordingly. If you find that a task that you have assigned your child around the house, such as being responsible for taking out the garbage or doing their own laundry, repeatedly results in failure, then consider finding a way to break these tasks into smaller pieces with a larger chance of success. Especially for a child with a depressed mood it is important to experience success. For example, for the teen who can’t remember to do their own laundry you might begin by doing the laundry and then putting the unfolded clothes on their bed. This too may result in failure but it will have a stronger likelihood of success than asking them to take ownership of the entire laundry function.

Continually try to put your child in situations where they can be successful. Build on their strengths and praise them for what they do well and minimize the negative speech associated with their shortcomings. This means avoiding putting your child in situations where there is a high likelihood that they will in some way embarrass themselves. Your job, as difficult as it may be, is to continually reinforce your child’s sense of their own value and worth as a unique individual deserving your love - as indeed they are.

Image Credit: Conner Downey @ flickr.com/photos/jjcd7/2926380600/