Study of Depression in Attention Deficit Hyperactive Disorder Subtypes in sample of children patients

INTRODUCTION

Attention deficit hyperactivity disorder (ADHD) is one of the most common diagnoses made in the field of child psychiatry. However, it appears to be more challenging to diagnose and to treat ADHD, especially when it is comorbid with depressive disorder.¹ Children with Attention Deficit Hyperactivity Disorder (ADHD) are 4 times more likely to develop depression than other adolescents with a 5 to 47 percent probability of having a major depressive episode,² and in another  prevalence study, there was 9.4% of those with ADHD were found to have major depressive episodes.³

Children with hyperactive or mixed type of ADHD may be suspected to be confronted with more behavioral and emotional problems later on in life more than the attention-deficit type of ADHD.⁴ On the other hand, children with attention-deficit type are more prone to social problems such as loneliness

and social isolation compared to the other two subtypes, meanwhile, they are not responding well to stimulants although they share the cognitive rhythm slowness with hyperactive and mixed types of ADHD.⁵ So children with ADHD, attention-deficit Type, mostly have comorbid depression and/or anxiety and they may respond better to psychotherapy targeting the comorbid anxiety and/or depression than other ADHD children. Mixed type of ADHD is considered the most common type representing more than half of the diagnosed cases where patients exceeded the lower limit of diagnostic criteria on both domains.¹ Meeting these disorders together can complicate the diagnosis and treatment process dramatically.⁶

On the other hand, when a mood disorder complicates ADHD, the mood disorder must be addressed first, however, parents of ADHD children appeared to be more annoyed with ADHD symptoms and willing to target it first in the treatment.⁷ Nearly 25% of children with ADHD suffer from a bipolar mood disorder. Children who have bipolar disorder with ADHD are more aggressive and more prone to behavioral problems than their ADHD counterparts. While anxiety Disorder, which was found to be prevalent among girls with type 2 ADHD, is often overlooked.⁸

This study aimed to detect the relation between depressive disorder and each subtype of  Attention Deficit Hyperactivity Disorder.

PATIENT AND MATERIALS

Type of study: comparative study that compares the incidence of depression in each type of ADHD children

Sample:

The study took place at the outpatient child and adolescent psychiatric clinic at Al-Hussien University Hospital in Cairo. At time from January to June 2017. The  total number of children patients was 96 child, age between 6 and 18 years old. The presenting complaints of children’s' parents were mostly behavioral abnormalities and learning difficulties. 9 children were ruled out due to comorbid autistic spectrum disorder ASD that prevented communication, and 18 child had an organic comorbidity affected their mental state. While 5 parents refused to participate in the study and didn't give a written consent.  The remaining 64 participant fulfilled diagnostic criteria for ADHD and a written consent was collected from their parents. 36% (n 23) of the sample were girls while 64% (n 41) were boys.

Tools:

The following tools were applied:

Psychiatric semi-structured clinical interview has been done for the diagnosis of ADHD disorder and to rule out other psychiatric disorders.

Complete medical and neurological examination to rule out other medical and neurological diseases.

The Arabic version of The Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI Kid) is a short, structured diagnostic interview for DSM-IV and ICD-10 psychiatric disorders in children and adolescents.⁹

3a- at first we applied ADHD part of the MINI KID test to confirm the diagnosis of ADHD  in children, this part consist of 18 questions for parents, 9 questions addressing hyperactivity and impulsivity and 9 questions addressing inattention.

3b- After confirmation of ADHD diagnosis, a nine question depression test of MINI KID was applied on children with ADHD.

Statistical analysis was conducted using SPSS (IBM SPSS for Windows, version 22.0). ANOVA and (r): Pearson Correlation coefficient were used.

RESULTS

The total sample size was 64 child divided into three groups depending on the type of ADHD according to mini kid scale. Group (1) was 12 pt. (18.7%) hyperactive type, Group (2) was 36 pt. (56.3%) inattentive type and Group (3) was 16 pt. (25%) mixed type. Sociodemographic data appear in Table (1) show that the mean age was highest in group 3 mixed type 9.93 + 2.01y and the lowest was group 1 hyperactive type 8.91 + 3.4 y. according to sex the three groups were more prevalent in male than female participants, almost 2: 1. ADHD diagnosis appeared to be more prevalent among school children living in urban areas. Regarding the level of family education, we found that the inattentive type of ADHD was more prevalent in highly educated parents, while the mixed type of ADHD is more prevalent in parents with lower educational levels.

Depressive disorder found to be more present in inattentive type of ADHD in all the sample while depressive patients more than non-depressive in hyperactive type specifically as it appears  in table 2.

When we studying the correlation between age and presence of depression in table 3 we found that depression increases with advance of age in hyperactive type, while there was a negative correlation with the other two groups.

While in table 4, 5, 6  The correlation between sex, education, parent's educational level and presence of depression found that a positive correlation between depression and male sex in all subtypes.

Table (7) shows a correlation between depression and residential area among three groups indicating that depression increases in the urban than the rural area. With statistical significance in mixed type.

Table 1: Sociodemographic data for the sample

Table 2: Comparison between children with attentiondeficit hyperactivity and the incidence of depression.