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Practitioner review examines the importance of understanding depression in young people with neurodevelopmental disorders

15 September 2022

A young person works at a desk

Researchers have undertaken a review aimed at clinicians, which explores the latest findings on depression in young people with attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).

The review was authored by Professor Anita Thapar, Dr Lucy Riglin and Dr Olga Eyre from the Wolfson Centre for Young People’s Mental Health and Dr Lucy Livingston from the Neurosciences and Mental Health Innovation Institute at Cardiff University.

Young people with neurodevelopmental disorders, such as ADHD and ASD, show high rates of mental health problems, of which depression is one of the most common.

Depression in young people with ASD and ADHD is linked with a range of poor outcomes. Therefore, knowledge of how clinicians should assess, identify and treat depression in the context of these neurodevelopmental disorders is much needed.

Professor Anita Thapar, the review's lead author, said: “We provide an overview of the latest research on depression in young people with ADHD and ASD, including possible mechanisms underlying the link between ADHD/ASD and depression, as well as the presentation, assessment and treatment of depression in these neurodevelopmental disorders.

“We also discuss the implications for clinicians and make recommendations for critical future research in this area.”

Depression is particularly common in young people with ADHD and ASD. Studies have shown that 23% of individuals with ADHD followed up to age 19 experience depression, and 44% have experienced a depressive episode before age 30.

In ASD, one recent meta-analysis estimated 10.6% prevalence of depression, which is four times that seen in typically developing youth, and the prevalence only increases further as individuals transition into adulthood.

Professor Thapar added: “This review has highlighted many research gaps. One striking gap is that research has focused exclusively on ADHD or ASD in young people despite their established overlap.

"A second gap is that although young people with ADHD/ASD are at elevated risk for depression, it remains unknown how best to screen for and assess depression in the context of neurodevelopmental disorders. Many widely-used depression measures have not been validated in ADHD or ASD individuals.”

“From our review, our main message for clinicians is that risks for depression in ADHD/ASD include a family history of depression, irritability, alexithymia (problems with understanding one’s emotions) and social stressors.

Clinicians should ask the young person, as well as parents and teachers about new changes in mood, behaviour, and functioning. They should also be aware that early-onset, recurrent or treatment-resistant depression may be masking underlying ASD/ADHD.
Professor Anita Thapar Professor, Division of Psychological Medicine and Clinical Neurosciences

Professor Thapar concluded: “I’m looking forward to continuing to collaborate with colleagues across the Wolfson Centre to undertake further research in this area, helping us better understand what measures can best identify depression in ADHD and ASD and the optimum depression prevention strategies for young people with neurodevelopmental disorders.”

The full review, Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder: The Importance of Depression, is available to view online in the Journal of Child Psychology and Psychiatry and is open access.

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