Mood Disorders and ADHD

Overview

This resource provides brief information about the evaluation and management of children with attentive deficit/hyperactive disorder (ADHD) and mood disorders within the primary care medical home. For assessment and mangement of ADHD, see Attention-Deficit/Hyperactivity Disorder (ADHD).

Background

There are a number of mood disorders, including depressive disorder, seasonal affective disorder, bipolar disorder, dysthymia, disruptive mood dysregulation disorder (DMDD), and others, which may be comorbid with ADHD in children and adolescents, complicating diagnosis and treatment. Children and adolescents with ADHD and mood disorders are at risk of having more severe and harder to treat symptoms. [Daviss: 2008] Meta-analysis reveals that 16-26% of children with ADHD develop depression during their youth. [Clemow: 2017] Major depression is present in 3.2% of adolescents at any given time, [Ghandour: 2019] and suicide is the third leading cause of death in adolescents 12 to 19 years old. [Miniño: 2010] A 2014 meta-analysis of comorbid ADHD and depression indicates a “medium” strength association between the 2 conditions, meaning that more youth with ADHD have depression than their counterparts without ADHD. [Meinzer: 2014] Children with ADHD and mood disorders are also at increased risk of suicidal attempts due to their impulsivity. [American: 2013]
DMDD, a condition defined by chronic, severe irritability and severe temper outbursts, was identified as a comorbid condition in 21.8% of children ages 6-8 years diagnosed with ADHD in a 2016 Australian study. [Mulraney: 2016] This study revealed further complexity in the children with both ADHD and DMDD, with a prevalence of 89.7% of comorbid opposition-defiant disorder (ODD) and over 40% with comorbid anxiety; see Anxiety Disorders & Attention Deficit Hyperactivity Disorder (ADHD) for more information.
Bipolar disorder in children and adolescents is now thought to be less common than previous rates of diagnosis suggest. [Mulraney: 2016] Prevalence was calculated at 1.8-3% in adolescents based on U.S. data that are over 10 years old; a 2019 meta-analysis showed a prevalence of 0.6-3.9% based on international diagnostic information. [Marangoni: 2015] [Merikangas: 2010] [Van: 2019] Prominent mood problems, sleep problems, and aggressive behaviors in youth, with impulsive behaviors around money, sex, and substance use, tend to arise more in BD, whereas fidgeting, restlessness, and disorganization related to distractibility and inattention tend to point to ADHD. [Marangoni: 2015] Children with ADHD tend to have more consistent symptoms. Meta-analysis reveals that 0-22% of children and adolescents with ADHD develop bipolar disorder. [Clemow: 2017]
A child or adolescent with ADHD may not have a mood disorder at the time of the ADHD diagnosis, as depressive symptoms often emerge several years after ADHD symptoms. [Meinzer: 2013] [Daviss: 2008] Therefore, repeated screening for depressive symptoms is indicated for children with ADHD. [Meinzer: 2014]

Etiology

A 2020 study underscores that children with ADHD are at increased risk (odds ratio 1.27) of later developing depression when compared to children without symptoms of ADHD. [Powell: 2020] Their research highlighted problematic peer relationships and academic achievement as potential targets for interventions to decrease the risk of future depression in children with ADHD. In a separate study from 2020, low educational attainment in parents strongly increased the risk of ADHD, depression, and low educational attainment in offspring. Shared genetic factors were strongest in the association between parental educational attainment and depression in their offspring. [Torvik: 2020]

Distinguishing Mood Disorders and ADHD

Inattention can occur in both ADHD and mood disorders. In ADHD, distraction is typically caused by external stimuli, whereas in mood disorders, the distraction is internal. Suspect a mood disorder or depression when the child displays:
  • Irritability
  • Depressed mood/sad (not always evident)
  • Decreased interest in usual activities
  • Appetite changes
  • Unintended weight changes
  • Sleep problems
  • Changes in energy level, fatigue
  • Feelings of worthlessness
  • More difficulty concentrating, and/or
  • Suicidal ideation or behavior

Diagnosis

Untreated mood disorders can make it harder to effectively treat ADHD, and it can be challenging to differentiate some behaviors seen in ADHD from those in mood disorders. When diagnosing mood disorders, consider the following types of questions:
  • Family history
  • Changes in the child's usual affect and temperament. Note that DMDD is often present in childhood with severe, persistent irritability and temper outbursts, whereas depression is more likely to emerge once puberty has started. [Eyre: 2017]
  • Decreased involvement with friends or activities that are usually enjoyable for the child
  • Changes in sleep (sleeping more or less)
  • Decreased or dramatically increased energy level
  • Threatened or actual self-harm or suicidal ideation
  • Appetite changes
  • Increased outbursts of temper
  • Impact of symptoms on functioning
  • Information from the child's teacher is also important in sorting out degree of symptomatology
The Vanderbilt Assessment Scales - Parent and Teacher Initial and Follow-Up Scales with Scoring Instructions (NICHQ) (PDF Document 1.1 MB), frequently used to assist in diagnosis and monitoring response to treatment for children and youth with ADHD, include several questions about mood disorders in the initial evaluations for parents and teachers. A high score on the mood-related questions, along with impaired function, should raise concern for a mood disorder. As part of the ongoing assessment of children with ADHD, separate screens for mood disorders may periodically be used. For assistance clarifying a diagnosis or presence of suspected comorbid conditions, consult psychiatry. For more information, see the Clinical Assessment sections of the Portal's Depression and Attention-Deficit/Hyperactivity Disorder (ADHD) modules.

Treatment

Having ADHD and a comorbid mood disorder can complicate treatment of both conditions. For example, the medical home provider needs to consider whether inadequately treated ADHD symptoms are increasing the child’s depressive symptoms, or if inadequately treated mood disorders are contributing to the child’s inattentive or impulsive symptoms. Sudden worsening of ADHD symptoms when they had previously been controlled may indicate the onset of a mood disorder. On a good note, there is evidence that treatment of ADHD in childhood may be protective against later depression. [Biederman: 2009] [Daviss: 2008] [Cubero-Millán: 2014] Limited studies have investigated the pharmacologic treatment of both ADHD and DMDD symptoms, largely examining cross-over benefits of using stimulant medications, +/- an atypical antipsychotic; these studies do suggest improvements in both ADHD and externalizing symptoms. Strongly consider psychiatric referral for complicated treatment plans, such as needing 2 or more psychoactive medications, or multiple comorbid conditions.
Treatment with selective serotonin reuptake inhibitors (SSRIs) or selective norepinephrine reuptake inhibitors (SNRIs) and psychological interventions such as cognitive-behavioral therapy (CBT) have been shown to be helpful in treating children/youth with depression. Psychotherapy, in conjunction with medication, generally was found to have the strongest effect [Strawn: 2017], but the most recent Cochrane review did not show one better than the other. [Cox: 2014] In mild-moderate cases of depression, primary care clinicians are generally advised to start with referral to psychotherapy if readily accessible and the family is open to that approach. [Cheung: 2018] All patients with depression should be monitored closely (e.g., monthly) with a phone call or visit.
For children and adolescents with DMDD, treatment includes behavioral therapy as well as medications. A wide range of medications have been used to treat DMDD: antidepressants/selective norepinephrine reuptake inhibitors, mood stabilizers, psychostimulants, antipsychotics, and alpha-2 agonists. [Tourian: 2015]
Consult a psychiatrist for treatment of youth with bipolar disorder and comorbid ADHD.

Behavioral Therapy

CBT has the most evidence supporting its use in treatment for children with depression. Interpersonal psychotherapy for adolescents (IPT-A) appears to be beneficial based on smaller studies, and non-specific supportive therapy and symptom monitoring may be an effective primary care intervention in mild cases.
Parent management training, an evidence-based intervention for ADHD, has demonstrated some benefits for disruptive behaviors seen in DMDD based on limited evidence. [Maenner: 2014] [Blader: 2016]

Medications

An increasing number of studies have investigated the pharmacologic treatment of comorbid mood disorders and ADHD in children and adolescents; the following summarizes these findings.

SSRIs and SNRIs

Among the multiple SSRIs, fluoxetine and escitalopram have been approved by the FDA for treatment of major depressive disorder in children/adolescents [Strawn: 2017]; however, many providers prescribe alternative SSRIs/SNRIs to children as an off-label use. Although these medications carry an FDA black box warning for suicidal ideation and behavior, studies suggest that the benefits of treatment for depression in children/youth may outweigh these risks. [Hetrick: 2012] SSRIs and SNRIs are increasingly used to treat irritability and anger as well, [Bruno: 2019], but there is not good evidence currently to demonstrate concurrent benefits for symptoms of ADHD. In children and adolescents, antidepressants can cause activation, with symptoms including impulsivity, hyperactivity, restlessness, disinhibition, giddiness, and/or insomnia. There is very limited information about the likelihood of children with ADHD treated with stimulant medications to develop activation with the addition of an antidepressant, although it appears to be low. [Luft: 2018] Consider starting at a lower dose if an autism spectrum disorder is also present as activation is more likely to occur in this population
Medical home providers who prescribe medications for depression should ensure that the family understands the risks involved, the patient be monitored closely, and a plan is in place should the child/youth have increasing suicidal ideation or behavior. See Suicidality.

Atomoxetine

Atomoxetine, generally considered a second-line ADHD treatment, has SNRI properties but is not generally prescribed as an anti-depressant and furthermore has not been shown consistently to improve depressive symptoms in children with ADHD. [Clemow: 2017] Although it has a black box warning for suicidality due to its medication class, studies seem to show that it does not increase the risk of suicidality when prescribed for treatment of ADHD. [Linden: 2016] Paroxetine, duloxetine, and venlafaxine are associated with higher rates of side effects in youth than the other SSRI/SNRIs, so are not advised as first-line antidepressants. [Cheung: 2018]

Bupropion

Bupropion, a dopamine and norepinephrine reuptake inhibitor, is occasionally used in the treatment of ADHD, although it is not considered a first-line intervention. It is thought to have a smaller effect on symptoms of ADHD but may be considered in children with comorbid mood disorders. More study is needed to understand the medication’s potential benefits and risks in pediatrics. [Ng: 2017]

Psychostimulants

Limited research of stimulant medications for children/adolescents with ADHD and DMDD generally demonstrate positive effects both on the core symptoms of ADHD and externalizing and aggressive symptoms of DMDD, but with inconsistent improvement on the depressive symptoms of DMDD. Stimulant monotherapy may be reasonable to try in children with ADHD and DMDD with high irritability, significant aggression, and explosiveness and may decrease depressive symptoms in these children. Be aware that amphetamine derivatives have been associated with increased risk of irritability, whereas methylphenidate class stimulants may decrease risk of irritability. [Luft: 2018]
In contrast to DMDD, stimulants are not recommended to treat symptoms of major depression in children with comorbid ADHD. [Blader: 2016]

Alpha-2 Agonists

Very limited information is available on pharmacologic treatment for both DMDD and ADHD. Both clonidine and guanfacine can be used to help treat ADHD. Because studies show that they also can reduce irritability, one can infer that using these medications may help treat both DMDD and ADHD simultaneously.

Atypical Antipsychotics

Risperidone and aripiprazole are approved for treatment of irritability in children with autism spectrum disorder but have not been widely studied for treatment of irritability in children with DMDD and ADHD. One open-label study demonstrated improved irritability, attention, externalizing behaviors, depression, and anxiety in children treated with aripiprazole and methylphenidate. [Pan: 2018]
Atypical antipsychotics, which may be used to treat bipolar disorder, are not generally used to treat core symptoms of ADHD.

Mood Stabilizers

Mood stabilizers, which may be used to treat DMDD, bipolar disorder, or complicated depression, are not generally used to treat core symptoms of ADHD.

Role of the Medical Home Provider

  • Provide routine screening for mood disorders in all children and adolescents.
  • Remain vigilant for the emergence of a mood disorder among children and adolescents with a known diagnosis of ADHD, particularly if there is a family history of mood disorders.
  • When a mood disorder is present, screen for thoughts of self-harm and suicidal ideation.
  • Work with both the patient and family to establish treatment goals and priorities.
  • Provide a referral to behavioral health to clarify a diagnosis and/or help with treatment and family training.
  • Prescribe and monitor medication when indicated.
  • Encourage good sleep hygiene, regular physical activity, and nutrition. [Cheung: 2018]
  • Obtain consultation from a psychiatrist when severe symptoms and/or failing interventions, or when there are concerns about medication interactions.
  • Provide families and patients with information about all of their medical conditions.

Resources

Information & Support

For assessment and mangement of ADHD, see Attention-Deficit/Hyperactivity Disorder (ADHD).

For Professionals

Child and Adolescent Mental Health (NIMH)
Information about mental health conditions in children and adolescents, including a list of warning signs, featured videos, and health hotlines; National Institute of Mental Health.

ADHD Resource Center (AACAP)
Includes excellent provider and parent resources; American Academy of Child & Adolescent Psychiatry.

Depression Resource Center (AACAP)
Information for clinicians and families, including FAQs, “Facts for Families,” books, videos, practice parameters, research, and getting help for depression; American Academy of Child & Adolescent Psychiatry.

For Parents and Patients

ADHD (HealthyChildren)
Links to more than 90 articles that discuss aspects of ADHD evaluation and management; developed by the American Academy of Pediatrics.

ADHD Resource Center (AACAP)
Includes excellent provider and parent resources; American Academy of Child & Adolescent Psychiatry.

Spence Children’s Anxiety Scale (SCAS)
Child (45-question) and parent (39-question) forms for school-aged children. Scores for overall anxiety disorder plus scores for separation anxiety, social phobia, obsessive-compulsive problems, panic/agoraphobia, generalized anxiety/overanxious symptoms, and fears of physical injury. Based on DSM-IV, with free access to downloadable PDFs and online scoring versions. Available in many languages.

Depression Resource Center (AACAP)
Information for clinicians and families, including FAQs, “Facts for Families,” books, videos, practice parameters, research, and getting help for depression; American Academy of Child & Adolescent Psychiatry.

Practice Guidelines

Cheung AH, Zuckerbrot RA, Jensen PS, Laraque D, Stein REK.
Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Management.
Pediatrics. 2018. PubMed abstract

Wolraich ML, Hagan JF Jr, Allan C, Chan E, Davison D, Earls M, Evans SW, Flinn SK, Froehlich T, Frost J, Holbrook JR, Lehmann CU, Lessin HR, Okechukwu K, Pierce KL, Winner JD, Zurhellen W.
Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.
Pediatrics. 2019;144(4). PubMed abstract / Full Text
This guideline revision provides incremental updates to the 2011 guideline on ADHD, including the addition of a key action statement related to diagnosis and treatment of comorbid conditions in children and adolescents with ADHD. The accompanying process of care algorithm has also been updated to assist in implementing the guideline recommendations; American Academy of Pediatrics (AAP).

Zuckerbrot RA, Cheung A, Jensen PS, Stein REK, Laraque D.
Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management.
Pediatrics. 2018. PubMed abstract

Patient Education

Depression Resource Center (AACAP)
Information for clinicians and families, including FAQs, “Facts for Families,” books, videos, practice parameters, research, and getting help for depression; American Academy of Child & Adolescent Psychiatry.

Tools

Brown Stanley Patient Safety Plan Template (PDF Document 57 KB)
A template outlining 6 steps to help those considering suicide to first self-help, then reach out to others for help when a crisis may be developing. Template may be reproduced.

Services for Patients & Families in Idaho (ID)

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Helpful Articles

Eyre O, Langley K, Stringaris A, Leibenluft E, Collishaw S, Thapar A.
Irritability in ADHD: Associations with depression liability.
J Affect Disord. 2017;215:281-287. PubMed abstract / Full Text
This study aims to establish levels of irritability and prevalence of DMDD in a clinical sample of children with ADHD, and examine their association with anxiety, depression, and a family history of depression.

Strawn JR, Dobson ET, Giles LL.
Primary Pediatric Care Psychopharmacology: Focus on Medications for ADHD, Depression, and Anxiety.
Curr Probl Pediatr Adolesc Health Care. 2017;47(1):3-14. PubMed abstract / Full Text

Tourian L, LeBoeuf A, Breton JJ, Cohen D, Gignac M, Labelle R, Guile JM, Renaud J.
Treatment Options for the Cardinal Symptoms of Disruptive Mood Dysregulation Disorder.
J Can Acad Child Adolesc Psychiatry. 2015;24(1):41-54. PubMed abstract / Full Text
The objective of this article is to provide a thorough review of peer-reviewed studies on the subject of pharmacological treatment options for children and adolescents with the cardinal symptoms of DMDD.

Marangoni C, De Chiara L, Faedda GL.
Bipolar disorder and ADHD: comorbidity and diagnostic distinctions.
Curr Psychiatry Rep. 2015;17(8):604. PubMed abstract
This article reviews recent relevant findings and highlight epidemiological, clinical, family history, course, and treatment-response differences that can aid the differential diagnosis of these conditions in an outpatient pediatric setting.

Authors & Reviewers

Initial publication: July 2009; last update/revision: September 2020
Current Authors and Reviewers:
Author: Jennifer Goldman-Luthy, MD, MRP, FAAP
Reviewer: Peer review pending
Authoring history
2015: first version: Jennifer Goldman-Luthy, MD, MRP, FAAPSA; Robyn Nolan, MDR
AAuthor; CAContributing Author; SASenior Author; RReviewer

Page Bibliography

American Psychiatric Association.
Diagnostic and Statistical Manual of Mental Disorders, DSM-5.
Fifth ed. Arlington, VA: American Psychiatric Association; 2013. 978-0-89042-554-1

Biederman J, Monuteaux MC, Spencer T, Wilens TE, Faraone SV.
Do stimulants protect against psychiatric disorders in youth with ADHD? A 10-year follow-up study.
Pediatrics. 2009;124(1):71-8. PubMed abstract
An encouraging 10-year case-control study of how stimulant use for treatment of ADHD decreases risk of developing comorbid mood disorders and improves academic success.

Blader JC, Pliszka SR, Kafantaris V, Sauder C, Posner J, Foley CA, Carlson GA, Crowell JA, Margulies DM.
Prevalence and Treatment Outcomes of Persistent Negative Mood Among Children with Attention-Deficit/Hyperactivity Disorder and Aggressive Behavior.
J Child Adolesc Psychopharmacol. 2016;26(2):164-73. PubMed abstract / Full Text
This study examined the association between the presence of persistent mood disturbances and treatment outcomes among children with attention-deficit/hyperactivity disorder (ADHD) and periodic aggressive, rageful outbursts.

Bruno A, Celebre L, Torre G, Pandolfo G, Mento C, Cedro C, Zoccali RA, Muscatello MRA.
Focus on Disruptive Mood Dysregulation Disorder: A review of the literature.
Psychiatry Res. 2019;279:323-330. PubMed abstract
The aim of this review is to collect and analyze the literature on DMDD diagnostic criteria and main hallmarks, with particular attention to comorbidities and treatment options.

Cheung AH, Zuckerbrot RA, Jensen PS, Laraque D, Stein REK.
Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Management.
Pediatrics. 2018. PubMed abstract

Clemow DB, Bushe C, Mancini M, Ossipov MH, Upadhyaya H.
A review of the efficacy of atomoxetine in the treatment of attention-deficit hyperactivity disorder in children and adult patients with common comorbidities.
Neuropsychiatr Dis Treat. 2017;13:357-371. PubMed abstract / Full Text
This study reviews information about the impact of individual common comorbid disorders on the efficacy of atomoxetine for ADHD.

Cox GR, Callahan P, Churchill R, Hunot V, Merry SN, Parker AG, Hetrick SE.
Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents.
Cochrane Database Syst Rev. 2014;11:CD008324. PubMed abstract

Cubero-Millán I, Molina-Carballo A, Machado-Casas I, Fernández-López L, Martínez-Serrano S, Tortosa-Pinto P, Ruiz-López A, Luna-del-Castillo JD, Uberos J, Muñoz-Hoyos A.
Methylphenidate ameliorates depressive comorbidity in ADHD children without any modification on differences in serum melatonin concentration between ADHD subtypes.
Int J Mol Sci. 2014;15(9):17115-29. PubMed abstract / Full Text

Daviss WB.
A review of co-morbid depression in pediatric ADHD: etiology, phenomenology, and treatment.
J Child Adolesc Psychopharmacol. 2008;18(6):565-71. PubMed abstract / Full Text
An article discussing comorbid conditions of ADHD, pediatric bipolar disorder, and overlapping or distinguishing characteristics.

Eyre O, Langley K, Stringaris A, Leibenluft E, Collishaw S, Thapar A.
Irritability in ADHD: Associations with depression liability.
J Affect Disord. 2017;215:281-287. PubMed abstract / Full Text
This study aims to establish levels of irritability and prevalence of DMDD in a clinical sample of children with ADHD, and examine their association with anxiety, depression, and a family history of depression.

Ghandour RM, Sherman LJ, Vladutiu CJ, Ali MM, Lynch SE, Bitsko RH, Blumberg SJ.
Prevalence and Treatment of Depression, Anxiety, and Conduct Problems in US Children.
J Pediatr. 2019;206:256-267.e3. PubMed abstract / Full Text
This article reviews data from the 2016 National Survey of Children's Health (NSCH) to report nationally representative prevalence estimates of each condition among children aged 3-17 years and receipt of treatment by a mental health professional.

Hetrick SE, McKenzie JE, Cox GR, Simmons MB, Merry SN.
Newer generation antidepressants for depressive disorders in children and adolescents.
Cochrane Database Syst Rev. 2012;11:CD004851. PubMed abstract

Linden S, Bussing R, Kubilis P, Gerhard T, Segal R, Shuster JJ, Winterstein AG.
Risk of Suicidal Events With Atomoxetine Compared to Stimulant Treatment: A Cohort Study.
Pediatrics. 2016;137(5). PubMed abstract / Full Text
This study analyzed whether the observed increased risk of suicidal ideation in clinical trials translates into an increased risk of suicidal events in pediatric patients treated with atomoxetine compared with stimulants in 26 Medicaid programs.

Luft MJ, Lamy M, DelBello MP, McNamara RK, Strawn JR.
Antidepressant-Induced Activation in Children and Adolescents: Risk, Recognition and Management.
Curr Probl Pediatr Adolesc Health Care. 2018;48(2):50-62. PubMed abstract / Full Text
This article describes the pathophysiology of antidepressant-related activation, predictors of activation, and its clinical management in youth with depressive and anxiety disorders treated with antidepressant medications.

Maenner MJ, Rice CE, Arneson CL, Cunniff C, Schieve LA, Carpenter LA, Van Naarden Braun K, Kirby RS, Bakian AV, Durkin MS.
Potential impact of DSM-5 criteria on autism spectrum disorder prevalence estimates.
JAMA Psychiatry. 2014;71(3):292-300. PubMed abstract / Full Text

Marangoni C, De Chiara L, Faedda GL.
Bipolar disorder and ADHD: comorbidity and diagnostic distinctions.
Curr Psychiatry Rep. 2015;17(8):604. PubMed abstract
This article reviews recent relevant findings and highlight epidemiological, clinical, family history, course, and treatment-response differences that can aid the differential diagnosis of these conditions in an outpatient pediatric setting.

Meinzer MC, Lewinsohn PM, Pettit JW, Seeley JR, Gau JM, Chronis-Tuscano A, Waxmonsky JG.
Attention-deficit/hyperactivity disorder in adolescence predicts onset of major depressive disorder through early adulthood.
Depress Anxiety. 2013;30(6):546-53. PubMed abstract / Full Text
The aim of this study was to examine the prospective relationship between a history of attention-deficit/hyperactivity disorder (ADHD) assessed in mid-adolescence and the onset of major depressive disorder (MDD) through early adulthood in a large school-based sample. A secondary aim was to examine whether this relationship was robust after accounting for comorbid psychopathology and psychosocial impairment.

Meinzer MC, Pettit JW, Viswesvaran C.
The co-occurrence of attention-deficit/hyperactivity disorder and unipolar depression in children and adolescents: A meta-analytic review.
Clin Psychol Rev. 2014;34(8):595-607. PubMed abstract

Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J.
Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A).
J Am Acad Child Adolesc Psychiatry. 2010;49(10):980-9. PubMed abstract / Full Text

Miniño AM.
Mortality Among Teenagers Aged 12-19 Years: United States, 1999-2006.
National Center for Health Statistics; (2010) https://www.cdc.gov/nchs/data/databriefs/db37.pdf.
NCHS Data Brief No. 37, May 2010

Mulraney M, Schilpzand EJ, Hazell P, Nicholson JM, Anderson V, Efron D, Silk TJ, Sciberras E.
Comorbidity and correlates of disruptive mood dysregulation disorder in 6-8-year-old children with ADHD.
Eur Child Adolesc Psychiatry. 2016;25(3):321-30. PubMed abstract
This study aimed to characterize the nature and impact of disruptive mood dysregulation disorder (DMDD) in children with attention-deficit/hyperactivity disorder (ADHD) including its co-occurrence with other comorbidities and its independent influence on daily functioning.

Ng QX.
A Systematic Review of the Use of Bupropion for Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.
J Child Adolesc Psychopharmacol. 2017;27(2):112-116. PubMed abstract
Bupropion, a dopamine and norepinephrine reuptake inhibitor, is a promising nonstimulant alternative with reports of positive outcomes for ADHD management in both adolescent and adult populations. This study systematically reviews clinical trials on the subject.

Pan PY, Fu AT, Yeh CB.
Aripiprazole/Methylphenidate Combination in Children and Adolescents with Disruptive Mood Dysregulation Disorder and Attention-Deficit/Hyperactivity Disorder: An Open-Label Study.
J Child Adolesc Psychopharmacol. 2018;28(10):682-689. PubMed abstract
This pilot study showed the tolerability of the aripiprazole/methylphenidate combination by patients with DMDD and ADHD and its efficaciousness for treating clinical symptoms and for improving cognitive function.

Powell V, Riglin L, Hammerton G, Eyre O, Martin J, Anney R, Thapar A, Rice F.
What explains the link between childhood ADHD and adolescent depression? Investigating the role of peer relationships and academic attainment.
Eur Child Adolesc Psychiatry. 2020. PubMed abstract
This study investigated the relationship between childhood ADHD symptoms and late-adolescent depressive symptoms in a population cohort, and examined whether academic attainment and peer problems mediated this association.

Strawn JR, Dobson ET, Giles LL.
Primary Pediatric Care Psychopharmacology: Focus on Medications for ADHD, Depression, and Anxiety.
Curr Probl Pediatr Adolesc Health Care. 2017;47(1):3-14. PubMed abstract / Full Text

Torvik FA, Eilertsen EM, McAdams TA, Gustavson K, Zachrisson HD, Brandlistuen R, Gjerde LC, Havdahl A, Stoltenberg C, Ask H, Ystrom E.
Mechanisms linking parental educational attainment with child ADHD, depression, and academic problems: a study of extended families in The Norwegian Mother, Father and Child Cohort Study.
J Child Psychol Psychiatry. 2020. PubMed abstract
This study investigated whether associations between maternal and paternal educational attainment and child symptoms of attention deficit/hyperactivity disorder (ADHD), depression, and academic problems are due to shared genetic factors, shared family environmental factors, or effects of the parental phenotype educational attainment itself.

Tourian L, LeBoeuf A, Breton JJ, Cohen D, Gignac M, Labelle R, Guile JM, Renaud J.
Treatment Options for the Cardinal Symptoms of Disruptive Mood Dysregulation Disorder.
J Can Acad Child Adolesc Psychiatry. 2015;24(1):41-54. PubMed abstract / Full Text
The objective of this article is to provide a thorough review of peer-reviewed studies on the subject of pharmacological treatment options for children and adolescents with the cardinal symptoms of DMDD.

Van Meter A, Moreira ALR, Youngstrom E.
Updated Meta-Analysis of Epidemiologic Studies of Pediatric Bipolar Disorder.
J Clin Psychiatry. 2019;80(3). PubMed abstract
This updated meta-analysis confirms that rates of bipolar spectrum disorders are not higher in the United States than in other Western countries, nor are rates increasing over time. Nonstandard diagnostic criteria result in highly variable prevalence rates, as does focusing on narrow definitions of PBD to the exclusion of the full spectrum.