Children with ADHD are six times more likely to experience depression

Children and teenagers with attention-deficit/hyperactivity disorder (ADHD) are significantly more likely to experience depression than their peers, according to a new study published in the Journal of Attention Disorders.

ADHD is a neurodevelopmental condition that affects attention, impulse control, and activity levels. While it is widely known for these behavioral symptoms, experts have increasingly recognized that mental health challenges often occur alongside it. Previous research has shown that many children with ADHD develop additional conditions, but the exact rate of co-occurring depression in this group has remained unclear.

To address this gap, researchers set out to bring together existing evidence from across the world. They wanted to better understand how common depression is in young people with ADHD and whether certain factors—such as age, sex, or medication—make a difference in reported rates.

Led by Shipei Wang from the University of Edinburgh in the U.K., the research team analyzed data from 24 rigorous studies involving a total of 6,815 children and adolescents. Of these, just over 5,000 had ADHD. Crucially, the researchers specifically focused on children with ADHD who did not have an intellectual disability, as intellectual disabilities can independently influence depression severity.

Participants ranged in age from early childhood to late adolescence (5 to 19 years old), with an average age below 18. The studies included both boys and girls, although boys made up the vast majority of ADHD participants (over 76%), reflecting a long-standing sex imbalance in ADHD diagnoses.

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Across the included studies, depression was assessed using clinical interviews, standardized questionnaires, or a combination of both. The researchers combined these results using a statistical approach called a meta-analysis. This allowed them to estimate an overall, pooled rate of depression across all studies while also examining differences between subgroups.

Their findings revealed that depression is highly common among young people with ADHD. Across the individual studies, reported rates varied widely—from as low as 1.7% to as high as 60%. When pooled together, the estimated average rate was 11.31%. Importantly, in seven case-control studies that directly compared the two groups, young people with ADHD were found to be far more likely to experience depression—around 12%, compared to just 2% in their neurotypical peers.

The meta-analysis also uncovered notable differences between boys and girls. Girls with ADHD were found to have much higher rates of depression—nearly 21%—compared to roughly 9% in boys. While this mirrors the gender disparity seen in the general population, the researchers noted that the severe underrepresentation of girls in ADHD research may mean that the true rate of co-occurring depression in females is even higher than current estimates suggest.

Another key finding was that the method used to measure depression heavily influenced the results. Studies that used a combination of interviews and questionnaires tended to report the highest rates (roughly 21%), while those relying solely on interviews reported the lowest (roughly 8.4%).

Wang and colleagues highlighted the urgent need to develop depression assessment tools tailored specifically to the ADHD population.

“ADHD symptoms such as inattention, restlessness, and irritability also manifest in depressive symptomatology, potentially leading children and their parents to overreport depressive symptoms on standardized questionnaires designed for neurotypical populations,” the authors noted. Conversely, they added, “The lack of ADHD-specific validated measures may cause interviewers to interpret overlapping symptoms as part of ADHD, potentially masking and underestimating co-occurring depression.”

Despite these critical insights, the researchers caution that the overall pooled results should be interpreted carefully. There was massive statistical variability (heterogeneity) between the studies in terms of design, sample characteristics, and assessment methods. Furthermore, the review only included studies published in English, potentially excluding relevant research conducted in other regions.

The study, “Rates of Depression in Children and Adolescents With ADHD: A Systematic Review and Meta-Analysis,” was authored by Shipei Wang, Tracy M. Stewart, Isinsu Ozen, Arnab Mukherjee, and Sinead M. Rhodes.