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(August 3, 2003) Primary
school children with severely disruptive behaviour may be suffering from a
depressive disorder rather than - or as well as -
attention deficit
hyperactivity disorder (ADHD).
A Melbourne study has found that children who have this depressive condition - known as dysthymic disorder - display the same symptoms as those with a type of ADHD, including inattentiveness, poor organisational skills and aggressive, contrary behaviour.
They also are prone to extended bouts of feeling low and melancholy, and wild mood swings, which they display over a long period of time.
In a major breakthrough, a seven-year study of 300 children at the Alfred Hospital has shown that there is a biological reason for their depressive symptoms, as well as environmental factors that can trigger them. The finding is a controversial one, as doctors have long debated whether depressive illnesses have a biological root, and if children suffer from them.
A child psychiatrist and researcher at the Alfred, Alasdair Vance, told The Age the study showed that children with dysthymic disorder had an overactive adrenaline system, and performed poorly on psychological function tests. Dr Vance said about 1 to 2 per cent of primary school children suffered from dysthymic disorder, while the same proportion were believed to have ADHD. A group of children identified in the study had both and displayed all the symptoms of the two disorders.
Dr Vance said that as the children in the trial developed through puberty to their teenage years, dysthymic disorder was showing itself to be a significant predictor of depression later in life, with about 40 per cent or more going on to a major depressive disorder. While dysthymic disorder appeared to be equally prevalent in boys and girls - as opposed to ADHD, which is two to three times more common in boys - rates among girls skyrocketed when they reached puberty.
"We must now look very carefully for depressive symptoms," Dr Vance said, "because it's a main driver for oppositional, defiant behaviour alone or in combination with ADHD."
Dysthymic disorder was a treatable condition with a combination of medication and social support, Dr Vance said.
The findings of the study have been published in a number of international medical journals, with more planned. The research also found that medication used to treat children with ADHD was most effective when administered in conjunction with psychological methods to help children compensate for their difficulty with attention and behaviour. For example, Dr Vance said, that might involve setting up a child's bedroom or study area in a way that was conducive to concentrating.
But most importantly, parents should allocate 30 minutes, three times a week, to spending time with their child - on the child's terms. That might mean playing a game, taking the dog for a walk or just watching television.
Source: Sydney Morning Herald, Australia
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