Most people asked to describe a child with attention deficit hyperactivity disorder (ADHD) might use words like forgetful, restless, impulsive, disorganized and disruptive.
Researchers at the National Institute of Mental Health (NIMH) are studying an important, but little-understood feature seen in many children with ADHD: irritability. What is emerging from this work is that adults trying to help children with ADHD should think about whether irritability is present and, if so, how severe. Research is also beginning to offer clues about brain mechanisms underlying irritability, and about new ways to approach treatment.
Dr. Ken Towbin, a child psychiatrist at NIMH, notes that many children with ADHD can have stretches of calm, but may fly off the handle quickly. “They can be easily frustrated,” says Towbin, and in emotional terms, “they trigger, launch and become furious quickly.” While treatment for ADHD can help with “impulsive irritability,” some kids are still irritable even after ADHD treatment is optimal.
Researchers are finding that children with persistent, severe irritability may be at increased risk of developing a mood disorder like anxiety or depression later in life. The ADHD symptoms themselves—impulsivity, restlessness, etc.—are not so much correlated with later mood disorders but chronic irritability seems to carry a risk.
An important take-away message is that there is a range of irritability in children with ADHD. Also, finding effective ways to treat it matters. “We would like to treat this early,” says Towbin, “to prevent more serious problems down the line.” The hope is that getting proper help earlier improves the long-term outcome. Parents can be on the lookout for irritability, which may show up in almost any setting; home, school, socializing with friends. Reports from the classroom can be revealing. While adults often focus on hyperactivity, impulsivity, and inattention, it is also important to keep an eye on mood.
To help a child with irritability, parents can help him or her recognize the irritable behavior. At first, this will only be possible after an outburst. The “hair-trigger” nature of irritability makes it difficult for a child to stop right away; children want to stop it, but they can’t. It’s important, says Towbin, to have compassion for that. Parents can help children learn to monitor how they’re feeling, a difficult task for younger kids but one that gets easier as they get older. Some practice at self-reflection can help them recognize when their anger may go from zero to 60 very quickly; they can practice stopping at 40. The ability for self-reflection won’t come from a single conversation. So it’s important to support a child working on this and to recognize that age and practice make a difference.
While children with ADHD and chronic irritability are more likely to develop a mood disorder, there also may be a risk to those with less irritability. More study will help clarify this. Although rates of depression are low in young people, even young children can have depression. And it helps to treat mild depression before it becomes so ingrained that everyone believes it is just that child’s nature.
In the young, changes in the environment can make a big difference. Changing a bad school situation, intervening if a child is being bullied or improving a stressful situation at home can produce real improvement in a child’s mood. Also, one of the most powerful ways to address depression in a child is to ensure that a parent with depression gets treatment.
When parents view irritability or a mood disorder as something to watch for, along with other features of ADHD, they may be preventing a more serious mood disorder in adulthood.
Charlotte Armstrong is a science writer with the National Institute of Mental Health (NIMH). The mission of NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure.
For more information from the National Institute of Mental Health, visit:
NIMH main page: http://www.nimh.nih.gov/index.shtml
About ADHD (NIMH page all about ADHD): http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
ADHD Pediatric Research Studies: http://www.nimh.nih.gov/labs-at-nimh/join-a-study/trials/childrens-studies/comparing-attention-deficit-hyperactivity-disorder-to-bipolar-disorder-in-children-investigations-of-brain-function-and-irritability.shtml
ADHD Research Study:
Study describes children’s moods and behaviors through interviews, research testing and brain imaging. Ages 9-17 with ADHD diagnosis.
Call: 301-496-8381, TTY: 1-866-411-1010,
Email: [email protected]
For more articles on ADHD/ADD: