Attention Deficit-Hyperactivity Disorder, Depression, and Self- and Other-Assessments of Social...

J Abnorm Child Psychol (2006) 34:773–787DOI 10.1007/s10802-006-9051-x

ORIGINAL PAPER

Attention Deficit-Hyperactivity Disorder, Depression,and Self- and Other-Assessments of Social Competence:A Developmental StudyRick Ostrander · David S. Crystal · Gerald August

Published online: 25 October 2006C© Springer Science+Business Media, LLC 2006

Abstract This study examined whether others (i.e.,teachers and parents) and self-appraisals of social com-petence mediated the relationship between Attention-Deficit/Hyperactivity Disorder (ADHD) and depression. Todetermine whether age moderated the effects of the medi-ation, the total sample was divided into younger (under 9)and older (at or above 9 years) age levels. The total sample(age range 6.6 to 11.7 years) was primarily male (194 boysand 52 females) and consisted of 148 children diagnosedwith ADHD and 98 community controls. Three central find-ings were derived from this study. First, there was a strongrelationship between ADHD (with and without comorbidODD/CD) and depression in both younger and older agedchildren. Among younger children with ADHD, there was nodifferential influence on the level of depression dependingon whether or not ADHD was comorbid with ODD/CD;in contrast, with older children, comorbid ODD/CD hadhigher levels of depression than was the case for childrenwith ADHD that did not display such comorbidity. Second,

Rick Ostrander and David S. Crystal contributed equally to thisarticle, and the order of authorship was determined by a coin toss.

R. Ostrander (�)Department of Psychiatry, Johns Hopkins University, Division ofChild and Adolescent Psychiatry,600 N. Wolfe Street/CMSC 346, Baltimore, MD21287-3325, USAe-mail: [email protected]

D. S. CrystalDepartment of Psychology, Georgetown University,Washington, DC, USA

G. AugustDepartment of Psychiatry, University of MinnesotaMedical School,Minneapolis, MN, USA

with younger children approximately half of the relationshipbetween ADHD (with and without comorbid ODD/CD) anddepression was exclusively mediated by others appraisal ofsocial competence. Third, a more complex relationship be-tween ADHD and depression emerged during the later partof the childhood years. As such, the relationship betweenADHD, others appraisals of social competence, and depres-sion was further mediated by self-appraisals of social com-petence. Findings are discussed in terms of developmentaltheory and theoretical models of childhood depression.

Keywords Attention deficit hyperactivity disorder .

Depression . Comorbidity . Social competence .

Development

Research involving epidemiological (Angold, Costello, &Erkanli, 1999), clinical (Biederman, Newcorn, & Sprich,1991) and community samples (Blackman, Ostrander, &Herman, 2005) has reliably demonstrated a high rate ofcomorbidity between Attention-Deficit/Hyperactivity Dis-order (ADHD) and depression among children and adoles-cents. Recent studies have reported the relationship betweenADHD and depression cannot be attributed to the shared as-sociation that both disorders have with anxiety or conductsymptoms (Blackman et al., 2005). The high level of depres-sion displayed by children with ADHD does not seem to befurther differentiated when comparisons are made betweenthe inattentive and combined subtypes of ADHD (Crys-tal, Ostrander, Chen, & August, 2001). Likewise, childrenwith ADHD and comorbid depression have similar levelsof inattention and hyperactivity-impulsivity when comparedto their non-depressed ADHD counterparts (Blackman et al.,2005). In any case, ADHD in combination with high levels ofdepression is associated with a number of negative outcomes,including unusually high rates of suicide, aggression and

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psychiatric hospitalization (Biederman et al., 1996; Lewin-sohn, Rohde, & Seeley, 1993; Treuting & Hinshaw, 2001).

Unlike many disorders, ADHD is first manifest very earlyin development (before age 7); in contrast, depression is oneof the latest developing disorders of childhood and rarelyprecedes any comorbid disorder (Costello, Foley, & Angold,2006; Rohde, Lewinsohn, & Seeley, 1991). As a result, it isnot surprising that longitudinal studies have found ADHDindividuals to have an increased risk of depressive as devel-opment progresses (Biederman et al., 2006).

Although a number of studies have reported the relativelyhigh rates of comorbidity between ADHD and depression,major questions still remain as to the nature of the relation-ship between the two pathologies. For example, what is itabout ADHD that might predispose children with this dis-order to develop depression? Our reading of the relevantliterature would suggest that the strong relationship betweenADHD and depression may be mediated by the negative ap-praisals of social competence made by others’ and relatedappraisals reported by the children themselves.

Models of childhood depression

A majority of the paradigms most frequently used to explainthe emergence of depression in children and adolescents fo-cus on the role played by disruptions in social functioningand how various appraisals of social competence are linkedto the disorder. Beck (1987) would suggest that negativeschema concerning the self are closely aligned with nega-tive appraisals concerning one’s social competence. Thesenegative self appraisals have typically been viewed as evolv-ing from early socialization experiences; and at one time,negative cognitions may have been an accurate reflection ofearly life experience (Rudolph, Hammen, & Burge, 1995).Given the social deficits displayed by children with ADHD(Merrell & Boelter, 2001), one might expect that childrenwith ADHD develop negative perceptions concerning theirsocial competence. Yet, recent studies have suggested thatchildren with ADHD may actually have an overly optimisticview of what others think of them; in fact, this “positive il-lusory bias” may actually serve as a self-protective functionin coping with their social competency deficits (e.g., Hozaet al., 2004).

Interpersonal models of depression recognize that socialdifficulties play an integral role in causing and maintainingdepression (Barnett & Gotlib, 1988; Lewinsohn et al., 1993).There is also considerable evidence supporting the notionthat children with either ADHD (Merrell & Boelter, 2001) ordepression (Hammen & Rudolph, 1996) demonstrate deficitsin social competence. Blackman and colleagues (2005) alsofound an association between ADHD, social functioning anddepression. However, we are unaware of any study that has

specifically examined whether social competence mediatesthe relationship between ADHD and depression.

Cole (1990) has modified adult models of depression andoffered a competency based model of childhood depression.This model maintains that the negative self-appraisals of de-pressed children may very well reflect the severe appraisalsof others. Thus, children with ADHD would be at greaterrisk for depression because of their poor overall social com-petence (as assessed, for instance, by parents and teachers);in turn, a child’s own self-appraisals of social competenceare expected to mediate the relationship between depressionand others’ social appraisals. Longitudinal studies involv-ing community samples would suggest that the competencybased model has increasing relevance as children progressthrough the childhood years; interestingly, there was littlesupport for the a reversed causal path, whereby depres-sion caused negative self appraisals of competence derivedfrom others’ judgments (Hoffman, Cole, Martin, Tram, &Seroczynski, 2000). Recent evidence is in line with this for-mulation and would suggest that the positive illusory bias thatis typically displayed by most children with ADHD may notbe evident in children with both ADHD and high levels ofdepression (Hoza et al., 2004).

Developmental considerations

Normal developmental transformations are also apt to in-fluence the potency of some of the proposed risk factorsassociated with depression. For example, cognitive modelsof depression posit that negative social cognitions place theindividual at increased risk for depression (Beck, 1987; Cole,1990). During the early stages of elementary school, the so-cial cognitions of self and others tend to be concrete, one-dimensional, transient, and heavily influenced by immediatepersonal experiences (Bierman & Montminy, 1983; Cicchetti& Toth, 1995). It is only after 8 years of age that children arelikely to reliably attribute their success or failure to their ownpersonal attributes; at the same time, a child’s sense of hisor her competence in a particular area is increasingly linkedto specific (versus diffuse) interactions with the environment(Dweck & Leggett, 1988; Fincham & Cain, 1986; Harter &Whitesell, 1989). As middle childhood unfolds social self-cognitions become more stable and children are able to iden-tify consistencies in their own and others’ behavior (Bierman& Montminy, 1983; Dweck & Leggett, 1988; Nicholls &Miller, 1984). With cognitive maturation, children are alsoable to appraise themselves in a manner that is increasinglycongruent with the views of others (Eccles, Wigfield, Harold,& Blumenfeld, 1993; Nicholls & Miller, 1984). Consonantwith this developmental perspective, a number of studieshave found that negative cognitions assume a more essen-tial role in the etiology of depression during the later stages

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childhood (Hoffman et al., 2000; Nolen-Hoeksema, Girgus,& Seligman, 1992; Ostrander, Weinfurt, & Nay, 1998).

Normal cognitive and social transformations may haveparticular relevance in understanding how various appraisalsof social competence can help explain the relationship be-tween ADHD and depression. The negative appraisals thatothers often have concerning children with ADHD are likelyto be more salient as childhood unfolds and thus increasinglyassociated with elevated depression (Larson & Richards,1991). As development unfolds, the potency of negative ap-praisals by others is likely to be further augmented by an in-creasing cognitive capacity to accurately perceive the harshopinions of others (Ruble, Boggiano, Feldman, & Loebl,1980). These developmental transformations may have par-ticular relevance when considering the incompetent socialinteractions that typify many children with ADHD. For ex-ample, as children progress through elementary school, thesocial significance of disruptive behavior increases and be-comes a frequent source of rejection by peers and others(Pope, Bierman, & Mumma, 1991).

Further issues of comorbidity

The rate of comorbidity between depression and ADHD isreported to be very high (e.g., Angold et al., 1999; Biedermanet al., 1991); however, comorbidity rates of ADHD with otherdisorders are even higher. In particular, the co-occurrence ofADHD and externalizing disorders such as conduct disorder(CD) and oppositional defiant disorder (ODD) is estimatedto range from 55% to 75% (Angold et al., 1999). Given theextensive overlap between ADHD, ODD/CD and depres-sion, recent studies have pointed out the need to account forcomorbid CD or ODD when examining the relationship be-tween ADHD and depression (Angold et al., 1999; Crystalet al., 2001). It is also noteworthy that children with ADHDin conjunction with either depression or other externalizingdisorders have more social difficulties than do their ADHDcounterparts without such coexisting disorders (Blackmanet al., 2005; Treuting & Hinshaw, 2001). Thus, the cur-rent study examined the relationship between depressionand ADHD while also considering the effects of comorbidODD/CD.

In short, ADHD very likely places children at increasedrisk for depression and this risk may be intensified when co-morbid ODD/CD is present. There is theoretical and empir-ical support for the notion that the linkages between ADHDand depression may be related to negative appraisals of socialcompetence by self and others. Yet, there are notable devel-opmental transformations that occur in social cognitions,the social significance of disruptive behavior, and the rela-tive salience of others’ and self-appraisals of social compe-tence. These developmental transformations may influencethe degree to which various appraisals of social competence

explain the relationship between ADHD and depression.Based on these considerations, we expected to find: a) astrong relationship between ADHD and depression through-out the childhood years; however; with advancing age co-morbid ODD/CD would have a stronger association withdepression than would ADHD without such comorbidity.b) the relationship between ADHD and depression wouldbe mediated by others’ appraisals of social competencethrough the childhood years; and c) as middle childhood un-folds, the relationship between ADHD and depression wouldbe more complex such that self appraisals would increas-ingly mediate others’ appraisals of social competence anddepression.

Method

Participants

A community population of 7,231 children, initially inGrades 1–4, attending 22 schools was screened using a se-quential, two-stage assessment strategy (see August, Real-muto, Crosby, & MacDonald, 1995, for a detailed descrip-tion). Positive screens were based on parent and teacherratings, each exceeding 1.75 SD units above the mean on the10-item Hyperactivity Index (HI) of the Revised ConnersRating Scales (Goyette, Conners, & Ulrich, 1978). A totalof 309 (4.3%) children exhibited high levels of problem-atic behavior across settings and were identified as havingscreened positive. Comparison students were selected if they(a) scored less than 1 SD above the mean on the teacher ver-sion of the HI, (b) had no history of psychotropic medicationuse, and (c) had no prior history of clinical assessment forbehavioral problems. Ten percent of the students meetingthese criteria were randomly selected from the school popu-lation and were then required to score less than 1 SD abovethe mean on the parents’ version of the HI; in turn, the com-parison group was selected from this group and matchedto positive screens according to school, grade, and gender(August et al., 1995). The initial phase of the identificationprocess began in the early spring, and the final selectionwas completed 8 months later. At the outset of the screen-ing process, the sample, consisting of 309 problem and 144non-problem children (total n = 453), ranging in age from6.6 to 11.75 years and 79% male, was 95% Caucasian andpredominantly middle class, although all socioeconomic lev-els, as determined by the Hollingshead (1975) index, wererepresented. Between initial screening and final selectionone school district’s catchment area was redrawn and thechildren from this area did not participate further (n = 75)and together with family relocation, non-compliance anddrop out accounted a net reduction in the sample size(n = 369).

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Selection procedures

The Research protocol was approved by the Institutionalresearch Review Board Committee on Human Subjects. Par-ents from the entire school population were required to pro-vide consent for their child to participate in the initial screen-ing and identification phase. As part of the initial consent,parents were informed of the classroom wide assessmentprocedure and asked to consent for their child’s participa-tion. Approximately 5% of the school population refusedparticipation. All parents and their children that met the ini-tial screening criteria provided assent/consent before movingon to the diagnostic and assessment phase of the study. Afterthe parent and teacher screening was completed, a struc-tured diagnostic interview was conducted with the parentsduring the summer. Following the diagnostic interviews, anextensive battery of psychometric tests was administered tothe students, parents and teachers during the fall. Researchassistants conducted individual assessments with the stu-dents; at the same time, parents completed mailed question-naires and teachers completed questionnaires distributed inthe schools. The study was conducted during the transitionbetween DSM-III-R and DSM-IV and a revised version ofthe DICA was unavailable during the diagnostic phase of theassessment process. Therefore, child psychiatric diagnoseswere generated through use of the Diagnostic Interview forChildren and Adolescents-Revised-Parent Version (DICA-R-P; Reich, Shayla, & Taibelson, 1992). The DICA-R-P wasadministered to parents over the telephone by eight trainedresearch assistants (see August et al., 1995, for additional de-tails). Research assistants participated in an intensive train-ing program that included video training and role play. Anindependent rater who assessed 20% of each assistant’s in-terviews was used to obtain interrater reliability. Using al-gorithms specified in the manual, we identified: ADHD, CDand ODD. Interrater reliability for the DSM-III-R diagnosesfor these disorders (kappa) were as follows: ADHD, .97;CD, .88; and ODD .96.

Selection criteria for ADHD children

Since the DICA-R-P is based on DSM-III-R criteria, it wasnecessary to modify the selection criteria for ADHD so asto maximize concordance with DSM-IV criteria. Creatingthis analog to the DSM-IV criteria involves a method con-sistent with the approach we have reported elsewhere andhas demonstrated excellent discriminant and convergent va-lidity (Crystal et al., 2001). This analog procedure requiredover two-thirds of hyperactive-impulsive and/or inattentivesymptoms to be endorsed in order to indicate the symp-tom criteria of DSM-IV; in the end, this procedure dividedthe ADHD sample into 43% combined and 50% inatten-tive subtypes; the predominantly hyperactive subtype repre-

sented only 6% of the sample. Interrater reliability (kappa)for the reconstructed subtypes was .96 for the inattentiveand hyperactive-impulsive subtypes and 1.00 for the com-bined subtype. At the end of the identification process, thesample of children with ADHD consisted of 109 ADHD-Combined type, 123 ADHD-Inattentive type, and 16 ADHD-Hyperactive/Impulsive type (n = 248). Because of the rela-tively small numbers and the limited empirical support forthe impulsive-hyperactive subtype, these subjects were notincluded in the study. The respective Inattentive and Com-bined subtypes of ADHD did not differ in terms of age orgender distribution. Furthermore, a chi-square analysis ofthe parents’ reports on the Hollingshead Index of Socioeco-nomic Status (SES) (Hollingshead, 1975) showed no signifi-cant difference among the groups in their overall distributionacross Hollingshead’s categories.

Instruments

Behavioral assessment system for children (BASC)

The BASC (Reynolds & Kamphaus, 1992) is a multisourceand multidimensional assessment system that includes sep-arate reports derived from self, parent, and teacher re-spondents. Each of these measures assess various dimen-sions of psychopathology. The scales were constructed byrational item selection followed by item-level covariancestructural analysis. This process yielded scales that had nooverlapping content and insured the item “purity” of eachscale.

The BASC-Self Report Scale (BASC-SRS; Reynolds &Kamphaus, 1992) is a self-report measure for children ages8–11 years and is comprised of 152 items that are rated aseither true or false by the child. A subset (n = 86) of theparticipants in the current study were between 7 and 8 yearsof age when this instrument was administered. However,no significant differences between scores of children below8 years and those above 8 years old were found for any of theself-report measures used in the present investigation. Fur-thermore, in the current study we compared the correlationsbetween self-reports of depression or social competence andparents’ reports of the respective dimensions were not sig-nificantly different for children under 8 and children slightlyolder (8 to 8.5 year olds). The authors of the BASC de-scribed the three scales that were used in the present studyare as follows: Depression (which reflect feelings of un-happiness) Interpersonal Relations (the perception of havinggood social relationships) and Social Stress (stress and ten-sion in personal relationships and feeling of being excludedfrom social activities). The manual reports good test-retestand internal reliability on these scales (e.g., test-retest reli-abilities were above .75 for all three of these scales, with

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internal consistency ranging from .80 to .87). The manualreports that the respective scales demonstrate discriminantand convergent validity when compared to parent reportmeasures.

The BASC Parent Report Scale (BASC-PRS; Reynolds &Kamphaus, 1992) is a multidimensional measure designedto assess adaptive and problem behaviors in children. Theparents participating in the study received the child versionof the BASC-PRS, which is comprised of 130 items and usesa 4 point scale. The present study used the Depression andSocial Skills scales. The manual reports test-retest reliabili-ties, ranging from .89–.90, and internal consistency rangingfrom .77 to .89. Reynolds and Kamphaus (1992) report highcorrelations with similar parent measures of emotional andadaptive functioning.

The BASC Teacher Report Scale (BASC-TRS; Reynolds& Kamphaus, 1992) is comprised of 148 items and is ratedon the same 4 point scale as the parent version. This studyused the Social Skills scale. The manual of the BASC-TRSreports test-retest reliabilities, ranging from .85–.95, and in-ternal consistency ranging from .79 to .94. Good convergentvalidity was also represented by high correlations with sim-ilar parent measures of behavioral, emotional and adaptivefunctioning (Reynolds & Kamphaus, 1992).

Child behavior checklist (CBCL)

The parent version of the CBCL/4-18 (Achenbach, 1991)contains 118 items, each scored on a 0- to 2-point scale.Item and scale construction were determined empirically us-ing principal components analysis. For this study, we usedthe depression/anxiety scale from the CBCL. The CBCL/4–18 has demonstrated good internal consistency, test-retestreliability along with well established concurrent and dis-criminative validity (Achenbach, 1991). Recent research hasindicated the depression/anxiety scale reflects the degree towhich depression and anxiety is continuously representedthroughout the population (Wadsworth, Hudziak, Heath, &Achenbach, 2001).

Child depression inventory (CDI)

The CDI (Kovacs, 1982) is a 27 item self report measure andis the most commonly used measure of depressive symp-toms in children. The psychometric qualities of the CDI arewell documented and the measure has been found to haveacceptable internal consistency and validity; furthermore, ithas been validated using normative and clinic samples (Say-lor, Finch, Spirito, & Bennett, 1984). At the request of theparticipating schools, the suicide item was deleted from theinventory.

Piers-Harris self concept scale (PHSCS)

The PHSCS (Piers, 1984) is a measure of self concept andis completed by the child. The PHSCS is comprised of anumber of scales reflecting particular facets of self-efficacy.The PHSCS is one the most frequently used measures of selfconcept. For the purpose of this study the Popularity scalefrom the PHSCS was used to assess self-appraisals of socialcompetence. The 12 item Popularity scale has demonstratedsatisfactory internal consistency (.75) along with acceptableconvergent and discriminant validity (Marsh, 1990).

Social skills rating system (SSRS)

The elementary version of the SSRS (Gresham & Elliott,1990) is derived from the parent reports and was designedto assess two dimensions of child behavior: social skills andproblem behaviors. Only the total score derived from the38 item social skills scale was used in the current study.This scale assesses a child’s overall level of competence asit relates to a variety of social skills (i.e., Cooperation, As-sertive, Responsibility and Self Control). The manual reportsthe SSRS social skills scale to have excellent stability andinternal reliability (.87 and .92, respectively); additionally,it has been very effective at discriminating between childrenwith ADHD and controls (Van der Oord et al., 2005).

Walker-McConnell scale of social competenceand school adjustment (WMS)

The WMS (Walker & McConnell, 1988) consists of 43 itemsand is completed by the teacher. As reported in the manual,a factor analysis of the WMS revealed one dominant factorand items having secondary loadings reflecting the threeareas of social competence (e.g., Peer-preferred, Teacher-preferred and School adjustment). Walker and McConnell(1988) report excellent test-retest reliability (range = .80–.97), and internal consistency (range = .95–.97). The totalscore was used in this study and has well established validity(Gresham & Elliot, 1989).

Aggregate measures

Using these instruments, we constructed composite mea-sures specifically designed to test the questions we soughtto address in the present study. In constructing these com-posite scales, we first standardized each of the respectiveinstruments across the entire sample and then the relevant in-struments were summed to generate the respective aggregatemeasures used in this study (i.e., others’ and self appraisalsof social competence and depression). A simple aggregationof sources and instruments has proven to result in a more

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practical and valid means of combining data sources than al-ternate methods that rely on statistical or clinically-derivedweighting procedures (Holmbeck, Li, Schurman, Friedman,& Coakley, 2002; Piacentini, Cohen, & Cohen, 1992). Byaggregating across valid indices of the respective constructs,enhance reliability was achieved; in the process, modest dis-crepancies between sources improved the incremental valid-ity of the aggregate measure. In contrast, statistical weight-ing procedures treat discrepancies as error and may yieldconstructs that do not generalize (Holmbeck et al., 2002;Piacentini et al., 1992). Our data aggregation strategy bal-anced our desire to minimize source bias while retaining co-herent constructs. These aggregate measures are describedbelow.

Depressive symptomatology

We did not include teacher-report in the depression com-posite because of concerns about diluting the construct—prior studies have questioned the validity of teacher-reportsof internalizing symptoms (Achenbach, McConaughty, &Howell, 1987). Consequently, the depression index, our chiefcriterion variable, was derived from the aggregate of fourseparate measures, equally representing both parent and self-report measures. The aggregate depression score was derivedfrom: the CDI, the respective depression scales from the selfand parent versions of the BASC and the Depression-AnxietyScale from the parent version of the CBCL. For children un-der 9, the Cronbach’s alpha on this composite measure was.70 and for children 9 and over, the Cronbach’s alpha was.75. Higher scores meant more depressive symptoms. Thereis considerable support for the notion that depression canbe viewed as a linear construct (Klein, Dougherty, & Olino,2005); however, certain features of clinical depression (i.e.,melancholia) may not be accurately represented in a linearfashion. Therefore, the aggregate measure used in the currentstudy is best seen as representing the degree of depressivesymptoms, rather than a clinical diagnosis of depression.

Social competence

Social competence is a molar construct that encompasses awide variety of skills, behaviors, judgments and outcomes(Dodge & Murphy, 1984; Cavell, 1990). There is no sin-gle unifying definition of social competence; however, mostresearchers agree that any operational definition of socialcompetence should measure the ability to effectively func-tion within a social context (Dodge & Murphy, 1984; Cavell,1990). Social competence often involves two related evalua-tive determinants, that is, social competence is typically re-flected in the judgments of others and self reports (Nowicki,2003). In order to construct measures that reflect the complexand multifaceted nature of social competence (Cavell, 1990)

our aggregate indices of social competence were derivedfrom the perspective of multiple social agents and based ona number of skills, behaviors and outcomes. Rather than relyon a single or narrow measure of social competence, severalindices of social competence were incorporated into globalevaluations as determined by either (a) parents’ and teachers’reports or (b) a child’s self reported judgment.

The aggregate measure reflecting self appraisals of socialcompetence comprised three self-report scales. Self reportsof global social competence typically include measures ofself-esteem and self-perceived social competence (Cavell,1990). Thus, we included the Popularity scale from the PH-SCS and two scales from the self report version of the BASC:the Interpersonal Relations and Social Stress scales (reversedscoring). For children under 9, the Cronbach’s alpha on thiscomposite measure was .87 and for children 9 and over, theCronbach’s alpha was .88. Higher scores indicated greaterself-perceived social competency.

The aggregate measure reflecting others’ appraisals of so-cial competency included four parent and teacher reports,with both sources contributing equally to the aggregate rat-ing. For parents, the Social Skills scale from the parent ver-sion of the BASC and the total score from the SSRS wereincluded. For teachers, we included the Social Skills scalefrom the teacher version of the BASC and the total scorefrom the WMS. For children under 9, the Cronbach’s alphaon this composite measure was .82 and for children 9 andover, the Cronbach’s alpha was .79. Higher scores meanthigher ratings of others’-perceived social competency.

Results

Data sets were nearly complete for measures derived fromself report (0–2% missing data) and teacher reports (4–5%missing data); however, higher rates of missing data wererepresented in measures derived from parent measures (25–26%). We compared those participants who completed all themeasures that comprised our predictor and criterion variableswith those that did not complete all the measures. Therewere non-significant correlations between the missing datadichotomous variable (yes or no) and any of the individualmeasures that contributed to the respective predictor andcriterion variables. All participants with missing data weredropped from the analysis. Because missing data was notassociated with any of the relevant variables, it is reasonableto assume that the following analysis represents unbiasedestimates (Cohen, Cohen, West, & Aiken, 2003).

Of the 362 subjects that completed the screening anddiagnostic phase of the assessment over two thirds (68%)complete all the assessment instruments and were includedin subsequent data analysis. The data analysis that followsincluded a total of 246 subjects, consisting of 148 ADHD

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Table 1 Correlations within between ADHD, depression symptoms,others’ and self appraisals of social competence

1 2 3 4

Youngest students (n = 118)1. Depression. Symptoms 1.02. Self appraisals −.68 1.03. Others’ appraisals −.64 .35 1.04. All ADHD vs. control .66 −.34 −.74 1.0

Oldest students (n = 128)1. Depression. Symptoms 1.02. Self appraisals −.75 1.03. Others’ appraisals −.65 .44 1.04. All ADHD vs. control .62 −.39 −.72 1.0

Note. All correlations are significant at p < .001. All ADHD (coded 1 =all ADHD subjects; 0 = controls); Self appraisals: Self appraisalsof social competence. Others’ appraisals: Others’ appraisals of socialcompetence.

subjects and 98 controls. Of the total number of childrenwith ADHD a smaller number met criteria for ODD orCD (n = 60) than did not meet ODD/CD diagnostic crite-ria (n = 88). In order to perform developmental analyses onthe data, we also divided the sample into two age groups.The youngest age group was under 9 years of age (n = 118)and the oldest group was 9 years or older (n = 128).

Preliminary descriptive analyses

Table 1 reflects the relationship between ADHD, Depres-sion and the respective reports of social competence derivedfrom self and others’ reports. At the outset, we hypothesizedthat there would be a uniformly strong relationship betweenADHD and depression throughout the childhood years. Inorder to investigate the general relationship we consideredADHD without regard to issues related to comorbidity. Asreported in Table 1 ADHD status (1 = including All ADHD

subjects and 0 = control participants) displayed strong pointbiserial correlations with all of the aggregate measures acrossthe age levels. The relationship between ADHD status anddepression was very similar across the age levels; likewise,the age level did not exhibit significant differences in the rela-tionship between ADHD and variables reflecting the respec-tive reports of social competence or depression (Zs < .567;p > .05). The relationship between ADHD status and others’reports of social competence was uniformly strong acrossthe respective age groups. In comparison to the relationshipbetween ADHD status and others’ reports of social com-petence, there was a uniformly more modest relationshipbetween ADHD and self-reports of social competence rep-resented across the younger and older age levels.

For the remaining analysis, the ADHD group was di-vided according to who met criteria for ODD or CD(ADHD + ODD/CD) and who did not meet ODD/CD di-agnostic criteria (ADHD-Only). The Controls, ADHD-Onlyand ADHD + ODD/CD groups displayed very similar demo-graphic characteristics at the two age levels. At both olderand younger age levels, the sample was typically male (male:109 and 85, female: 19 and 33, respectively) and middle class(median SES category: 2.0). The average age of the oldergroup was nearly 10 years (9.98) and at the younger age levelthe mean age was 8.0 years. At both the younger and olderage levels, there were no group differences (p > .05) as it re-lates to the child age [F(2,115) = .18; F(2,125) = 1.04], SES[X2(8, 118) = 13.41; X2(8, 128) = 5.05] and gender [X2(2,118) = 2.91; X2(2, 128) = 3.49].

Table 2 reports the number of subjects across the re-spective groups by age level. Table 2 also reports the meanscores on the aggregate measures for the Control, ADHD +ODD/CD and ADHD-Only groups by age level. To com-pare the groups, a significant ANOVA was followed byindividual t-tests. Across age levels, both ADHD groupsconsistently displayed higher levels depression and lower

Table 2 Scores on aggregate measures obtained by controls, attention deficit hyperactivity disorder (ADHD-Only) and ADHD plus oppositionaldefiant or conduct disorders (ADHD + ODD/CD) by age level

GroupsAge level Controls ADHD + ODD/CD ADHD-Onlyvariables Mean (SD) Mean (SD) Mean (SD) F Statistic

Young children n = 49 n = 22 n = 47Others’ appraisals of social competence 3.87 (2.53)a −1.95 (2.47)b −.99 (1.94) b F (2,115) = 73.00∗∗∗

Self appraisals of social competence 1.26 (1.93)a −.08 (2.30) b .54 (2.60) b F (2,115) = 7.69∗∗∗

Depression symptoms −2.67 (1.30)a 1.93 (3.00) b 1.18 (2.59) b F (2,115) = 46.88∗∗∗

Older children n = 39 n = 38 n = 51Others’ appraisals of social competence 3.07 (2.12)a −2.22 (2.60)b −1.35 (2.18)b F (2,125) = 70.47∗∗∗

Self appraisals of social competence 1.58 (2.00)a −.81 (2.95)b −.59 (3.14)b F (2,125) = 11.23∗∗∗

Depression symptoms −2.61 (1.55)a 2.60 (2.99)b .88 (3.11)c F (2,125) = 46.32∗∗∗

Note. Changes in superscript reflect significant differences between groups.∗p ≤ .05; ∗∗p ≤ .01; ∗∗∗p ≤ .001.

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levels social competence according to either other or selfreports. However, a more complex pattern emerged whencomparing the respective ADHD groups. At each age level,the ADHD groups did not differ on measures reflecting selfreports of social competence. With younger children, theADHD-Only and the ADHD + ODD/CD groups were alsoindistinguishable according to others’ appraisals of socialcompetence; yet, for older children, there was a modesttrend (p = .10) for others to rate the social competence ofthe ADHD + ODD/CD group to be more impaired that theirADHD-Only counterparts. At the outset, we hypothesizedthat with advancing age, comorbid ODD/CD would havea stronger association with depression than would ADHDwithout such comorbidity. When compared to controls, highlevels of depression were equally represented in young chil-dren with ADHD-Only and ADHD + ODD/CD. Amongolder children, both ADHD groups also displayed signifi-cantly higher levels of depression than controls; however,the ADHD + ODD/CD had notably higher levels of depres-sion than their ADHD-Only cohorts.

The utility of cross sectional data

The following analysis involves a cross-section design.When used judiciously, cross-sectional studies can informcausal inferences under certain restrictive conditions. Thecurrent study met the conditions suggested for cross sec-tional studies (Cole & Maxwell, 2003; Kraemer, Yesavage,Taylor, & Kupfer, 2000). Thus, the predictors (in this case,ADHD) and mediators (others’ and self appraisals of socialcompetence) have demonstrated comparable stability withchildren in elementary school (Spira & Fischel, 2005; Cole,Martin, Powers, & Truglio, 1996). Also, the respective ag-gregate measures used in the present study displayed verygood internal consistency across age groups. Further, ouranalysis would suggest that data was missing at random.Rather than treating time/developmental level as a covariate,we carefully selected developmental time periods of interestbased on available evidence; then, we separately analyzeddata within each identified age group. Most importantly, thefollowing analysis was dictated by the empirical and theo-retical foundation reviewed in the introduction.

The association between ADHD and depression: Themediation effects of others’ and self appraisalsof social competence

As noted in our introduction, we expected the relationshipbetween ADHD and Depression to be mediated by others’-and self-appraisals of social competence. However, we ex-pected the mediation model to differ depending on the age ofthe child. For younger children, we hypothesized that ADHDwould be associated with negative appraisals of social com-

petence, which, in turn, would be related to increased de-pression. For older children, we again expected ADHD to beassociated with negative appraisals by others; however, wealso expected that negative self appraisals would mediate therelationship between others’ appraisals and depression.

To test whether others’- or self-appraisals of social com-petence mediated the relationship between ADHD and de-pression we conducted a series of hierarchical regressionanalyses with depression as the criterion. In order to ac-count for ADHD subjects that did and did not display comor-bid ODD/CD, two dichotomous ADHD variables were cre-ated using the procedure detailed by Cohen and colleagues(2003). With the ADHD-Only variable a positive diagnosisof only ADHD was coded 1 and a code of 0 was assigned toparticipants who were diagnosed with ADHD + ODD/CDor were derived from the community controls. With theADHD + ODD/CD variable a positive diagnosis of ADHD(with comorbid ODD/CD) was coded 1 and a code of 0was assigned to participants who were diagnosed with ei-ther ADHD-Only or were derived from the communitycontrols.

To investigate whether the effect of ADHD (with andwithout comorbid ODD/CD) on depression was mediatedby other and self appraisals of social competence differentlyacross age groups, we conducted two types of analysis. First,in order to test for mediation at two separate age groups,we conducted a series of separate multiple regressions foryounger (under 9) and older (9 and older) children usingthe method described by Baron and Kenny (1986). Then, inaccordance with the analytic approach described by Muller,Judd, and Yzerbyt (2005) for testing moderated-mediation,we tested whether the respective mediation effects were mod-erated by age.

Baron and Kenny (1986) approach of testing for mediation

Consistent with the approach of testing mediation using themultiple regression analysis offered by (Baron & Kenny,1986) we followed the following steps: (1) The ADHD vari-ables (ADHD-Only and ADHD + ODD/CD) were both en-tered in the first step to determine their respective relation-ship with depression without the proposed mediators in themodel; (2) others’ appraisals of social competence was addedat the second step to determine if the significant relations thatemerged from the first step disappeared or decreased whencontrolling for the proposed mediator; and (3) self appraisalsof social competence was entered at step three to determineits direct effects on depression controlling for all other vari-ables. Mediation was suggested if the significant relationsthat emerged from step 2 were diminished when consideringself appraisals in Step 3. We repeated steps 1–2 using self ap-praisals of social competence as the criterion, to determinethe degree to which the relationship between the ADHD

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variables and self appraisal of social competence were me-diated by others’ appraisals. To determine the unique effectsof ADHD (with and without comorbid ODD/CD) on oth-ers’ appraisals, we repeated step 1 using others’ appraisalsof social competence as the criterion variable. The respec-tive steps were conducted with the younger and older groupsseparately. To confirm the path analysis derived from mul-tiple regression analysis, we conducted additional tests todetermine the mediation effects of ADHD on depression.The significance levels of the indirect effects were tested us-ing Sobel’s approximation significance test (Sobel, 1982) forthe indirect effect of the predictor variable on the criterionvariable via the mediator. Preliminary univariate analysis re-vealed that gender was not a significant predictor of depres-sion and did not have a significant effect on other variables(r = − .12 to .14, p > .05). Therefore, we omitted genderfrom the regression equation.

Testing the direct and indirect effects of ADHD ondepression: Young children

In the analyses summarized in Table 3, the criterion vari-able was the composite depression index and the targetsample was the group of younger children. On the firststep of the regression, we first entered variables represent-ing ADHD status. As reflected in Table 3, ADHD-Onlyand ADHD + CD/ODD uniquely accounted for a signifi-cant proportion of the variance in depression (ps < .001).In the second step, others’ appraisals of social compe-tence explained significantly more of the variance in de-pression than was explained by ADHD-Only and ADHD +ODD/CD alone. While the relationship of ADHD-Only andADHD + CD/ODD to depression remained significant, theywere all reduced when others’ reports of social competencewas added to the equation. These findings suggest that oth-ers’ appraisals partially mediated the respective relationshipsof ADHD-Only and ADHD + CD/ODD with depression. Inthe third step, the inclusion of self appraisals of social com-petence resulted in an increase in the R2 and some measur-able decline in the relationship between depression and therespective variables entered at step 2.

Table 3 also displays the results of a second regressionanalysis focusing on young children, with self appraisals ofsocial competence as the criterion variable. Step 1 indicatedthat both of the respective ADHD groups had a modest, sig-nificant and unique relationship with self appraisals of socialcompetence. Including others’ appraisals of social compe-tence (Step 2) reduced the association between the respectiveADHD variables to non-significance; yet, the unique rela-tionship between others’ and self appraisals was marginallynon-significant (p = .07). Theses results suggest that self-appraisals of social competence did not mediate the rela-tionship between the respective ADHD variables or others’

appraisals of social competence with depression. Likewise,others’ views of social competence played a very marginalrole in mediating the relationship between negative self ap-praisals and ADHD for children under 9 years of age.

A third multiple regression analysis focusing on youngchildren is reported in Table 3. This analysis included others’appraisal of social competence as the criterion variable. Theresults revealed a strong and unique relationship between therespective ADHD variables and others’ appraisals of socialcompetence.

We conducted Sobel’s approximate significance tests inorder to further test the mediation effects of ADHD-Only(and ADHD + ODD/CD) on the respective outcome vari-ables reflecting self-reports of social competence and depres-sion. The results of the significance tests using Sobel’s firstorder solution revealed significant indirect effects (Zs > 3.03,p = .002) for the following relationships: ADHD-Only →Others’ Appraisals of Social Competence → Depression,and ADHD + ODD/CD → Others’ Appraisals of SocialCompetence → Depression. The multiple regression anal-ysis suggests that the relationship between others’ and selfreports were marginally non-significant. Follow-up analyseson Sobel’s tests were performed to further assess the po-tential indirect effects of the respective ADHD variableson self appraisals of social competence and to also testwhether self appraisals would contribute to an indirect re-lationship between others’ reports of social competence anddepression. These mediation relations were non-significant(Zs < 1.84, p > .05). Taken together, this analysis is consis-tent with our hypothesis and indicates that the relationshipbetween ADHD (with or without comorbid ODD/CD) anddepression is largely mediated by others’ appraisals of socialcompetence. By considering the total effect that the respec-tive ADHD groups have in predicting depression at Step 1and comparing the direct effect that remained after includingother reports of social competence (Step 2), we calculatedthe percent of the effect that was mediated by others’ reportsof social competence. Nearly half of the large total effectof ADHD-Only and ADHD + ODD/CD on depression wasmediated by the effect of others’ reports of depression (41%and 56%, respectively). This analysis would also suggest thatself appraisals of social competence do not play a significantrole in mediating the relationship between ADHD (with andwithout ODD/CD), others’ appraisals of social competenceand depression. The final model is presented in Fig. 1.

Testing the direct and indirect effects of ADHDon depression: older children

Table 3 also summarizes a similar set of analyses for olderchildren. At the outset, the criterion variable was the com-posite depression index; however, the target sample was thegroup of older children. On the first step of the regression,

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Table 3 Multiple regressionsby age level

Age levelVariables

R2 β t R2 overall

Young childrenPredicting depression

Step 1ADHD-Only .63 8.33∗∗∗

ADHD + CD/ODD .45 .60 7.88∗∗∗ .45∗∗∗


ADHD + CD/ODD .38 3.88 ∗∗∗

Others’ appraisals .04 −.32 −3.18∗∗ .49∗∗∗


ADHD + CD/ODD .36 3.48∗∗∗

Others’ appraisals −.20 −2.52∗

Self appraisals .18 −.49 −8.93∗∗∗ .67∗∗∗

Predicting self appraisals of social competenceStep 1

ADHD-Only −.37 −3.84∗∗∗

ADHD + CD/ODD .12 −.22 −2.27∗ .12∗∗∗

Step 2ADHD-Only −.20 −1.48ADHD + CD/ODD −.05 −.42Others appraisals .04 .25 1.88 .14∗∗∗

Predicting others’ appraisals of socialcompetence

Step 1ADHD-Only −.70 −10.39∗∗∗

ADHD + CD/ODD .56 −.67 −9.83∗∗∗ .56∗∗∗

Older childrenPredicting depression


ADHD + CD/ODD .43 .69 9.30∗∗∗ .43∗∗∗

Step 2ADHD-Only .23 2.56∗

ADHD + CD/ODD .42 4.27∗∗

Others’ appraisals .06 −.38 −4.07∗∗∗ .49∗∗∗

Step 3ADHD-Only .15 2.31∗

ADHD + CD/ODD .34 4.81∗∗∗

Others’ appraisals −.19 −2.83∗∗

Self appraisals .25 −.56 −10.76∗∗∗ .74∗∗∗

Predicting self appraisals of social competenceStep 1

ADHD-Only −.35 −3.81∗∗∗

ADHD + CD/ODD .15 −.38 −4.17∗∗∗ .15∗∗∗

Step 2ADHD-Only −.14 −1.27ADHD + CD/ODD −.14 −1.12Others’ appraisals .05 .33 2.82∗∗ .20∗∗∗

Predicting others’ appraisals of social competenceStep 1

ADHD-Only −.62 −9.09∗∗∗

ADHD + CD/ODD .53 −.73 −10.80∗∗∗ .53∗∗∗

Note. ADHD-Only: childrendiagnosed with onlyattention-deficit/hyperactivitydisorder (ADHD);ADHD + CD/ODD = childrendiagnosed with ADHD andconduct disorder (CD) oroppositional defiant disorder(ODD); Self appraisals = Selfappraisals of social competence;Others’ appraisals = Others’appraisals of social competence.∗p ≤ .05; ∗∗p ≤ .01; ∗∗∗p ≤ .001.

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OthersSocial

Competence

ADHD+ODD/CD

ADHD

ADHD+ODD/CD

OthersSocial

CompetenceDepression

ADHD

SelfSocial

CompetenceDepression

Young Children

Older Children

-.62

-.73

.33 -.56

.15

.34

-.70

-.67

-.32

.41

.38

-.19

Fig. 1 Path analysis depicting the mediating role of others and selfappraisals of social competence in explaining the relationship betweenADHD (with and without comorbid CD/ODD) and depression. In thefirst path reports the respective paths and betas for youngest children.The second path depicts the paths and betas for the oldest children.

we entered variables representing ADHD-Only and thecomorbid diagnosis of ADHD + CD/ODD. As reflected inTable 3, ADHD-Only and ADHD + CD/ODD uniquelyaccounted for a significant proportion of the variance indepression (ps < .001). In the second step, the significantR2 change indicated that others’ appraisals of socialcompetence explained significantly more of the variancein depression than was explained by ADHD-Only andADHD + ODD/CD alone. The relationship of ADHD-Onlyand ADHD + CD/ODD to depression remained significant;at the same time, the direct effects of the ADHD variableswere both reduced when others’ reports of social compe-tence were added to the equation. In the third step, includingself-appraisals of social competence resulted in a declinein the relationship between depression and the respectivevariables entered at step 2.

Table 3 also displays the results of a second regressionanalysis involving older children, with self-appraisals of so-cial competence included as the criterion variable. Step 1indicated that both of the respective ADHD diagnoses had asignificant and unique relationship with self-appraisals of so-cial competence. Including others’ appraisals of social com-petence (Step 2) reduced the association between the respec-tive ADHD variables to non-significance; yet, the uniquerelationship between others’ and self-appraisals remainedstatistically significant (p < .01).

A third multiple regression analysis involving older chil-dren is reported in Table 3, which included others’ appraisalof social competence as the criterion variable. The resultsrevealed a strong and unique relationship between the re-spective ADHD variables and others’ appraisals of socialcompetence.

To further test the mediation effects of ADHD-Only,ADHD + ODD/CD, and others’ reports of social compe-tence on the respective outcome variables, we followed upthe multiple regression analyses conducted on older childrenwith a series of Sobel’s approximate significance tests. Theresults of tests using Sobel’s first order solution revealedsignificant indirect effects (Zs > 2.69, p < .01) for the fol-lowing relationships: ADHD-Only → Others’ Appraisalsof Social Competence → Depression; ADHD + ODD/CD→ Others’ Appraisals of Social Competence → Depres-sion; ADHD-Only → Others’ Appraisals of Social Com-petence → Self Appraisals; ADHD + ODD/CD → Oth-ers’ Appraisals of Social Competence → Self Appraisals;and, Others’ Appraisals → Self Appraisals → Depres-sion. Over half of the large total effect of ADHD-Only andADHD + ODD/CD on depression was mediated by the ef-fect of others’ or self appraisals of social competence (68%and 51%, respectively); additionally, nearly half of the re-lationship between others’ appraisals of social competenceand depression was mediated by self appraisals of socialcompetence (42%). Thus, as hypothesized, with age, self-appraisals of social competence increasingly mediated therelationship between others’ appraisals of social competenceand depression. However, there remained a significant directrelationship between depression and the respective variablesreflecting ADHD-Only, ADHD + ODD/CD and Others’ Ap-praisals of social competence. As noted, Table 3 reportsthe related statistics for the respective path models; how-ever, the betas were represented in Fig. 1 as path coeffi-cients to represent the final model for younger and olderchildren.

Muller Judd and Yzerbyt (2005) moderated mediationapproach

As noted above, the degree to which others’ or self ap-praisals of social competence mediate the relationship be-tween ADHD and depression appears to be different de-pending on the age of the child. Muller Judd and Yzerbyt(2005), offered a method for comparing the effects of thepredictors at different levels of the moderator. In the currentcase, moderated mediation occurred if age affects any of thepathways between ADHD (with and without ODD/CD) anddepression. To test this effect, we analyzed the entire sampleand re-centered age at 9.0 years (by subtracting 9.0 fromeach case). We then entered ADHD-Only, ADHD + ODDand others’ reports of social competence in addition to atwo-way interaction of others’ reports of social competencewith age (others’ appraisals × age) to predict variance in selfappraisals of social competence. The overall effect was sig-nificant F(5, 240) = 10.752. p < .0001; specially, the impactof others’ appraisals of social competence on self appraisalswas greatest for older children B = .086 t(240) = 2.090,

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p < 05. We also tested if the other proposed mediators inter-acted with age and the results were non-significant (i.e. p >

.05).

Discussion

This study examined the relationship between ADHD anddepression. Three primary findings were derived from theanalyses, all in support of our hypotheses. First, there wasa strong relationship between ADHD (with and without co-morbid ODD/CD) and depression in both younger and olderaged children. Among younger children with ADHD therewas no differential influence on the level of depressive symp-toms depending on whether or not ADHD was comorbidwith ODD/CD. In contrast, for older children the signifi-cant relationship between ADHD and depression was no-tably stronger when ADHD was comorbid with ODD/CD.Second, among younger children approximately half of therelationship between ADHD (with and without comorbidODD/CD) and depression was exclusively mediated by oth-ers’ appraisal of social competence. Third, we found thata more complex relationship between ADHD and depres-sion emerged during the later part of the childhood years.As such, the relationship between ADHD, others’ appraisalsof social competence and depression was further mediatedby self appraisals of social competence for older children. Amore extensive discussion of these findings will follow.

The relationship between ADHD and depression has beenwell established (Angold et al., 1999; Biederman et al., 1991;Crystal et al., 2002). However, few of these studies have ex-amined the differential effects of how comorbid ODD/CD af-fects the relationship between ADHD and depression. Someresearchers have suggested that children who have ADHD,in addition to comorbid externalizing disorders, are at in-creased risk for depression (e.g., Treuting & Hinshaw, 2001).The current study offers qualified support for this contention.Thus, ADHD had a uniformly strong relationship with de-pression in our sample; yet, it was only in older children (i.e.,9 or older) that the presence of comorbid ODD/CD yieldeda much stronger influence on depression than did ADHDwithout such comorbidity.

We began this study with the question of what it is aboutADHD that predisposes children with this disorder to de-velop depression? In large measure, our findings supportedour initial expectations concerning the role played by oth-ers’ and self appraisals of social competence. Results ofthe current study suggest that approximately half (41–68%)of the relationship between ADHD (with and without co-morbid ODD/CD) and depression is mediated by appraisalsof social competence derived from self or others. Cogni-tive (Beck, 1987), interpersonal (Barnett & Gotlib, 1988;Lewinsohn et al., 1993) and competency-based (Cole et al.,

1996) models of depression would suggest that the problem-atic social affiliations experienced by children with ADHDmay directly or indirectly explain the high rate of comorbiddepression represented in this population. The current find-ings support the important role played by others’ perceptionsof social competence; indeed, we found that others’ socialjudgments explain approximately half of the relationship be-tween ADHD (with and without ODD/CD) and depressionin younger children. We also found that others’ judgmentsconcerning social competence helped explain the relation-ship between ADHD and depression in older children; infact, others’ reports of social competence had a significantdirect relationship on depression in both older and youngerchildren. Similar findings were also reported by Biedermanet al. (1996), indicating that external assessments of socialdysfunction appear to account for the waning significanceof ADHD as a predictor of depression. The current findingsare also consistent with research suggesting that depressionin children is linked to negative social exchanges; and withyoung children, this relationship appears to operate indepen-dent of negative cognitions (Nolen-Hoeksema et al., 1992;Ostrander et al., 1998).

Consistent with the studies which have examined the rela-tionship between others’ and self-judgments of young chil-dren with ADHD (Hoza et al., 2004), we found that theself appraisals of social competence among young childrenwith ADHD were only marginally related to how othersjudge their social competence. Unlike prior studies, we alsoexamined whether age influenced the relationship betweenothers’ and self-appraisals of social competence in childrenwith ADHD. We found that the self-appraisals of social com-petence for older children (9–11 years) with ADHD were infact related to others’ judgments. Interestingly, recent stud-ies have also suggested that the positive ‘illusionary bias’displayed by most children with ADHD may not be evidentwhen elevated levels of depression are also manifested (Hozaet al., 2004).

The current findings suggest that with age, self-assessments of social competence increasingly mediate therelationship between others’ perceptions of social function-ing and depression. As such, during the later stages of child-hood, 42% of the relationship between depression and others’reports of social competence was indirect and mediated byself-appraisals. This finding is consistent with the compe-tency model advocated by Cole and his associates (1996).These findings are also consistent with the notion that normaldevelopmental transformations related to perspective takingand self-related attributions (Bierman & Montminy, 1983;Ruble et al., 1980; Dweck & Leggett, 1988; Nicholls &Miller, 1984) may help explain the emergence of depressionduring the later part of childhood.

On the basis of the current findings, effective interven-tions to treat and prevent depression in children with ADHD

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should consider the degree to which developmental con-siderations might direct the specific focus of the interven-tion. Previous research would suggested that an exclusivefocus on changing the behavior of children with ADHD maybe insufficient to change the ingrained negative reputationsthat others have acquired concerning these children (Hozaet al., 2005). Consistent with these findings, the currentstudy would also support devising interventions that di-rectly address the negative reputations that others mayhave concerning the social competencies of children withADHD. To achieve the broadest possible benefit, the treat-ment and prevention of depression in older children withADHD may require a coordinated effort to specificallytarget: the child’s maladaptive behavior, the harsh socialjudgments of others, and negative self appraisals of socialcompetence.

These findings would suggest that there may be multiplepathways that explain the relationship between ADHD anddepression; moreover, developmental considerations maymoderate the role played by negative self perceptions inexplaining that pathways from ADHD to depression. Forexample, recent studies has found that high levels of depres-sion in young children with ADHD can be largely attributedto actual disruptions in the parenting practices and schoolfunctioning that is a consequence of ADHD. Yet, during thelater stages of childhood, the resulting maladaptive cogni-tions provided the more proximal explanation for high lev-els of depression (Ostrander & Herman, 2006; Herman &Ostrander, in press).

There are several limitations associated with this studyand that will provide the impetus for future research. First,it is unclear whether these findings will generalize to other(e.g., clinic) samples or represent children that display themore extreme levels of depression that is found in childrenreceiving a formal diagnosis of Major Depression. We ad-dressed many of the methodological pitfalls that can com-promise the degree to which cross sectional studies allow forvalid inferences to be made concerning causal or mediationalprocesses (Kraemer et al., 2000). Yet, the current study willneed to be tested through future studies that incorporate a lon-gitudinal design. Finally, our approach to data aggregationresulted in very reliable measures and may have advantagesover statistically derived methods of devising psychologicalconstructs; nevertheless, this approach does not control forsystematic measurement (e.g., source) error.

Acknowledgements This study was funded by Grant MH-46584 fromthe National Institute of Mental Health.

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