Preteen with ADHD and Mood Disorder

December 28, 2014
A reader asked:

"I am considering adopting a preteen with ADHD (controlled with focalin for focus in school) and mood disorder, which does not require medication, reportedly. The child is described as positive and upbeat, yet all that I read about mood disorder indicates sadness and depression. What are some typical symptoms and/or behaviors I might expect now, and in the future, especially related to mood disorder? Thank you."


First, I can only answer this question in the most general sense, i.e., what does a mood disorder generally look like in a kid with ADHD? It will vary, of course, with age, environmental context, and cultural considerations.

That said, a mood disorder can mean episodes of sadness/depression or episodes of mania/hypomania. In preteens, mania/hypomania can mean a few days of being 'wired', easily irritated, angry, overly energetic and active, sleeping very little or not at all, talking a lot and changing subjects frequently, and in some kids, being elevated in mood (i.e., overly happy, silly, giddy) and/or grandiose (having big plans, thinking he has special abilities or powers - I'm smarter than everyone, I'm a better athlete, I can read minds, etc). If a child has bipolar disorder as well as ADHD, he or she may alternate between periods of sadness and periods of mania/hypomania, sometimes in cycles that only last a few days each. Some kids who are preteens are called "bipolar not otherwise specified" meaning that their episodes don't meet the duration criteria for a manic episode (typically, at least one week unless treated earlier). Sadness in kids can show up as an irritable, grouchy, 'leave me alone' attitude, often with excessive sleeping or the opposite, sleeping too much, plus fatigue, loss of interests, loss of appetite, and other symptoms.

The clinical question addressed in a psychiatric evaluation usually is, Can the kid's symptoms be explained by ADHD alone, or is there a mood disorder (depression or mania/hypomania) as well? Mood disorders DO respond to medications, by the way- often, when kids have both ADHD and a mood disorder, they take both a stimulant and an antidepressant, or a stimulant and a mood stabilizer. That treatment decision will be based on many variables, including the severity of his or her symptoms and whether the moods are impairing.

Good luck with everything!

David M.