Let’s talk mental health in ADHD children and adolescents (and adults too!). In this post, I want to start the discussions about mental health and wellness, the importance of being proactive with our children and some tips along the way from some of my own and my family’s experiences.
* Please note: the terminology used in this blog post around co-occurrence rates and names of conditions is reflective of the research papers and literature reviewed in this area.
I am not going talk too much about specific mental health conditions in this blog – otherwise we will be here all day! But here are some links to of my favourite webpages, so you can increase in your knowledge of mental health conditions that might affect your children and/or adolescents. (Note: These are Australian websites)
Beyond Blue, World Health Organisation, Black Dog Institute, Sane, Kids Helpline, Australian Government Drug Help.
TRIGGER WARNING: This post mentions mental health challenges, including depression, anxiety suicidal ideation and suicide. This may be distressing for some readers. Please consider your own circumstances prior to reading this blog post.
If you or someone you know is in crisis and needs immediate help call triple zero (000).
If you require support, or someone to talk to, there are many telephone supports available, including:
Lifeline on 13 11 14
Beyond Blue on 1300 22 4636
Kids Helpline on 1800 55 1800 (for people aged 5-25)
MensLine Australia on 1300 78 99 78
13YARN (13 92 76) for Aboriginal and Torres Strait Islander People
QLife (1800 184 527) for LGBTQIA+ people
OK… Let’s get started!
MY LITTLE STORY
Before we dive in I want to share with you why I decided to write this post.
My beautiful son (who is almost 15) came up to me the other day and gave me a big cuddle (he often does this – he has ALWAYS been a really affectionate child!) but just as I felt him about to let go of the cuddle, he said “Mum, thank you so much for telling me about mental health. I see many people struggling and I think I would have been depressed now if it wasn’t for you.” He had been noticing a couple of mates in particular, who had been different than they usually were, and he told them about depression and that they should see a psychologist.
Oh my goodness. My heart!!! He has such a beautiful spirit and I love the fact that he feels comfortable talking to his mates about this is beyond anything I could have imagined! This is hard at the best of times, but being a 15 year old , sharing about mental health and caring for his mates was unbelievable.
So, we chatted about a few concerns he has noticed with people around him from some of his different circles, and I found that we kept coming back to one thing:
When I would ask “can they talk to their parent/s about how they are feeling?” the answer was always “no.”
This was for many reasons of course (and I am not blaming the parents here!), but at the heart of it, not one of his friends or acquaintances who were feeling depressed, felt that they could talk to their parents about their depression, mental health or worries.
This got me thinking about how I grew up. When I was growing up (and even now) I don’t feel comfortable talking to my parents about mental health. In fact, I had never really even heard of ‘mental health’ until I went to Uni. It’s a different time now (I am in my 40s after all) and I know that children and adolescents are taught about mental health and wellness at school. But despite that, there is still so much discrimination and stigma surrounding mental health, that so many children and adolescents (and adults!) aren’t talking about it.
Looking back at my childhood however, I had significant anxiety, depression and of course I was an ADHDer, but we didn’t know that until much later! I was so good at masking my feelings and ‘performing’ socially (aka masking!), that no-one knew that I had significant mental health challenges. I never mentioned this to my parents, friends or teachers.
I remember thinking that I was the only person in the world that feels this way (i.e. depressed, anxious or suicidal) and there must be something terribly wrong with me. Of course, now, I know that this couldn’t be further from the truth, but I also know that there is still so much stigma, discrimination and hurtful and inaccurate stereotypes around mental health and wellness.
These are often caused by a lack of understanding (lack of education and misinformation) and/or prejudice (negative attitudes or beliefs). This stigma and discrimination is a significant factor in why so many people don’t seek help or advice. If we can break the stigma and discrimination around mental health and wellness, I believe our children and adolescents won’t feel any shame, worry or inadequecies about talking about their own mental health challenges, and they can alert their friends to supports for their mental health challenges too!
IS THERE A LINK BETWEEN ADHD and MENTAL HEALTH AND WELLNESS?
YES! Many research studies have shown the link between ADHD and poorer mental health outcomes compared to their neurotypical peers. The most commonly reported co-occurring mental health conditions with ADHD are depression, anxiety disorders, bipolar disorders, and substance use disorders (specifically alcohol and/or nicotine, cannabis and cocaine use).
Child and adolescent ADHDers are:
* TEN (10) TIMES MORE LIKELY to develop depression, when compared to the rate of a neurotypical child. It was also found that being assigned female at birth (AFAB) and/or having a mother with depression also increased the likelihood. (Chronis-Tuscano et al , 2010)
* More likely for the depression to be more significant, earlier to develop and last longer than in neurotypical peers. (Biederman, 2008)
* more likely to have anxiety than their neurotypical peers, with up to 50% of childrenand adolescentADHDers fulfilling the diagnostic criteria for an ‘anxiety disorder.’
* THIRTY (30) TIMES more likely to develop a bipolar disorder if they have also been diagnosed with anxiety as well as ADHD. (Meier, 2018)
* TWICE as likely to develop substance use disorder, and when a child has co-occurring challenging behaviour, the likelihood is FOUR (4) times greater than a neurotypical peer. (Thomasius et al, 2022
The statistics are quite sobering aren’t they.
Over 80% of ADHDers will have a co-occurring condition, and around 50% will have two or more. (Katzman, 2017). Which means, it is MORE likely that our children and adolescent ADHDers will develop a mental health condition, than them not developing one.
I know these sounds like horrible stats – and they are! But don’t give up just yet! Because, there are things we can do to support our children!
FOUR TOP TIPS FOR PARENTS/CARERS
1. Focus on Family!
Family functioning refers to the way a family system operates effectively and how they maintain healthy relationships between members. This includes things like communication, conflict management, emotional support, respect and even appropriate discipline.
Family functioning plays a crucial role in the mental health and wellness outcomes of ALL family members. Research tells us time and time again that having strong family functioning acts as a protective factor for ADHD children and adolescents, when it comes to their mental health outcomes. On the flipside, research also tells us that families with poor cohesion are associated with an increased likelihood of depression and disruptive, defiant or aggressive behaviour.
Research also tells us that families with children or adolescent ADHDers have more significant challenges in family functioning than families without ADHDers, leading to poorer mental health outcomes.
It makes total sense when you know about ADHD symptoms and how it can affect the family dynamic. We often have more difficulty with emotional regulation, higher stress levels, less effective conflict resolution skills and more challenges being consistent – particularly if the parent/carer is an ADHDer too.
Now I am not saying that parenting or family functioning causes ADHD! But ADHD can make family functioning and parenting a lot more challenging.
So my advice here – FOCUS ON FAMILY BY FOCUSSING ON YOURSELF FIRST.
Find a great family counsellor or psychologist. Someone who can look at your family as a whole, who focusses on your strengths and works to bring these out, while being honest and open about the challenges they see.
We were extremely lucky to find an amazing psychologist, early in our ADHD journey, who saw our family as a whole and focussed on educating us about family dynamics, functioning and how to raise incredible ADHDers!
As hard as it was to hear early on, my post-partum depression and anxiety, was having a significant impact on my children and my family. As much as I tried to hide it, push through it and ignore it, it wasn’t until I sought treatment for myself, that I started to see my family turn around from the chaotic, tense, clashing, conflicting war zone that it was, to a haven of peace and harmony we have now (most days!)
2. Share your own mental health challenges
Make mental health a regular and ongoing discussion point in your family. Make it just as commonplace as talking about friends, events, school or work!
Speak openly about any times in your life, where you were not mentally well, or struggling. It is so important that our children know that they are not alone! That they aren’t the only person in the world that feels sad, depressed, anxious, out of control or even suicidal. There is such power in knowing you are not alone. Connection to people in our family who understand us is a powerful protective factor.
(Note: Of course it is also really important to take your children’s ages, maturity level, emotional regulation abilities and comprehension into consideration before you let loose! Tailor your discussions to the level of your children and abilities to handle that information. If you aren’t sure how to start the discussion, speak to a counsellor or psychologist first.)
Once last year, my daughter came home from school really upset. She told me that I can’t possibly understand how horrible her life was and how she is so different to everyone else. She said she wishes she was never born. That is extremely hard to hear as a Mumma, but it speaks to her pain and inability to deal with her emotions in that moment. So, I listening to her, sitting with her as she cried and after having lots of cuddles she began to settle.
I told her that even though we are different people, I do understand what she means. I described how when I was a teenager, I always felt like I was out of place – like I didn’t belong. I talked to her about how I used to pretend to be someone else and ignoring all the feelings I had on the inside, while pretending to be happy and loud.
We chatted about how I ended up depressed because I didn’t think I was worth anything and how it has taken me many years to just be me. She couldn’t believe it. Just like that, she wasn’t different to everyone else – she had one person in the world, that completely understood her and loved her just the way she is, and she now knows she is not the only person that thinks that way.
3. Prepare your children
We have always been really open with our children about mental health. My children know all my mental health diagnoses. They know I take medication and they know it is something I will have to overcome throughout my entire life. It is not something I am ashamed of, or something I want them to think is taboo or embarrassing. It takes a whole heap of intestinal fortitude to fight your thoughts, emotions and mental health challenges everyday, and I want them to know it doesn’t make them weak or less, it makes them a strong, brave, tough and gutsy person.
My children also have a strong family history (on both sides) of mental health challenges. When family members have gone to hospital, or had challenging times, we talk openly (developmentally appropriately though!) about it. There is no hiding it, no shame and no embarrassment.
So, when we started seeing the signs of puberty in our children, we had “the talk.” You know the one, “this is what is happening to your body,” the birds and the bees talk. But we decided to also include a proactive discussion about mental health and wellness.
We told our children that puberty and adolescence is a time where they may have challenges with their mental health and wellness. We told them that research tells us that over a quarter of adolescents (25.3%) will have challenges with depression and anxiety between the ages of 10 and 24 years (Kasturi et al 2023) and having an ADHD brain increases that likelihood again.
We spoke about what their brain might tell them, and the signs to look out for in themselves. We told them we will be looking out for the signs as well, and will be asking sometimes tough questions and they can share tough answers.
Most of all, we shared about supports. That they have a family who loves and supports them. And that there are lots of ways we can support mental health and wellness!!
4. Monitor your child or adolescent and ACT IMMEDIATELY
Approximately 18 months ago, I started to have some concerns that my son was showing signs of depression. He was down, didn’t want to go out with mates and stopped wanting to go out with the family. He was becoming very irritable and down right cranky, and I noticed how he began saying that he was “crap” at things. These, of course, could be signs of puberty, but because of our family history, ADHD and because this was a different person than I had been raising, I opened up the discussion.
I went into his room while he was playing his guitar and asked him if he was depressed. He said no and said “I’m just playing my guitar.” I decided to sit with him for a little while and listen to him play. He is actually incredibly talented – and has never had a guitar lesson! After about 10 mins of listening to him playing, he stopped, looked at me and asked, “why do you think I’m depressed?”
I shared how I have noticed some changes in his behaviour and I shared that I was worried about him. He then asked “what does being depressed feel like?” We talked about some of the things I notice about myself when I’m depressed, and then he asked about some symptoms in himself and asked whether I thought they were signs of depression.
We decided that we had some cause for concern, and made an appointment with his psychologist.
Just as an aside -another one of my tips here is to have a psychologist that your child has built a relationship with. My son sees a psychologist every 2-4 months, whether he “needs” it or not. This way, he has a relationship with them – someone who knows him, can also monitor him for any changes, and can be a safe person to talk through any issues he doesn’t want to talk us about.
Anyway – it turned out that our son was actually stressed (not depressed) about school and some of the challenges we were having with our girls at the time. We booked some additional psychology appointments and he was able to talk through the stressors and put some great plans into place, so that now he has strong mental health and wellness.
I don’t share all of this as a “brag” – but I share this to get the conversation about mental health and wellness in our ADHD population going.
Let’s stop the stigma, open the conversation and let our ADHDers thrive – from childhood through the lifespan!
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