Summary: Adolescents with attention deficit hyperactivity disorder (ADHD) face a substantially higher risk of developing internalising problems such as anxiety and depression. A large longitudinal study of more than 5,000 UK teenagers has identified low self-esteem and parental mental health difficulties as two of the most important pathways that help explain this increased risk. The research also highlights that social difficulties with peers are a particularly relevant factor for girls.
The study underlines that ADHD rarely acts alone: its impact on a young person’s emotional wellbeing depends on family context, social relationships and how the adolescent feels about themselves. Addressing these interrelated influences offers clearer targets for prevention and support.
Key Facts
- Prevalence and risk: ADHD affects around 5% of children and young people in the UK. Among adolescents with ADHD symptoms, roughly one in four meet criteria for an anxiety disorder and about 40% experience depressive episodes.
- Primary mediators identified: Low self-esteem and parental mental health problems emerged as statistically significant mediators linking ADHD symptoms to later anxiety and depression.
- Gender differences: For girls, difficulties with peers and social relationships are an additional important pathway from ADHD symptoms to internalising problems.
- Implications for care: Interventions that build adolescents’ self-esteem and provide psychological support to parents may reduce the likelihood that ADHD symptoms progress into clinical anxiety or depression.
Source: University of Edinburgh
Researchers have clarified several pathways that help explain why young people with ADHD are more prone to anxiety and depression.
Led by the University of Edinburgh and funded by the Medical Research Foundation, this study is the first to test a wide range of potential mechanisms that might link ADHD symptoms in early adolescence with internalising symptoms later in the teenage years.
The team analysed data from the UK Millennium Cohort Study, which follows young people born between 2000 and 2002. The analytic sample included more than 5,000 adolescents aged 11 to 17. Researchers examined parent and self-report questionnaires collected at ages 11, 14 and 17 to track ADHD symptoms and emotional difficulties over time.
Fourteen candidate mediators were evaluated simultaneously. These covered social and family relationships, behaviour and school factors, injuries and risky behaviour, physical health, academic motivation and parental mental health, among others. The goal was to determine which of these pathways contribute most to the link between ADHD and later anxiety or low mood.
Using longitudinal mediation techniques with statistical regularisation, the analysis found that while many factors may play small roles, two stood out as consistently significant: low self-esteem in the adolescent and poor parental mental health. For girls, problems with peers also showed a notable contribution.
Importantly, these associations remained even after accounting for pre-existing neurodevelopmental or mental health difficulties, suggesting the identified mediators operate beyond simple co-occurrence of conditions.
The findings point to a multifactorial process in which several modest influences combine to increase vulnerability to internalising problems among adolescents with ADHD symptoms. This perspective supports a shift away from single-cause explanations toward comprehensive support strategies.
Professor Aja Murray, who led the research at the University of Edinburgh’s School of Philosophy, Psychology and Language Sciences, said the results imply two practical priorities: supporting parents’ mental health and helping adolescents build stronger self-esteem. She added that for girls, social skills support to reduce peer difficulties could be especially protective.
Dr Angela Hind, Chief Executive of the Medical Research Foundation, commented that the study sheds light on why adolescents with ADHD face elevated risks for anxiety and depression and underscores the importance of targeted research and services to support young people and their families.
Key Question Answered:
A: ADHD can create ongoing challenges at school and in social life that erode a young person’s self-esteem. That loss of confidence often triggers anxiety and low mood—so self-esteem acts as a strong bridge between ADHD symptoms and later internalising problems.
A: Yes. The study found parental mental health to be a key factor influencing whether adolescents with ADHD symptoms go on to develop anxiety or depression. Improving parental wellbeing can therefore be an important part of protecting young people.
A: Girls with ADHD are particularly affected by peer problems; social difficulties and strained friendships can raise the risk of internalising symptoms, making social support and skills training valuable preventative measures.
Editorial Notes:
- This article was edited by an editor at Neuroscience News.
- The journal paper was reviewed in full by the editorial team.
- Additional context was added by staff to clarify implications for practice and policy.
About this mental health research news
Author: Joanne Morrison
Source: University of Edinburgh
Contact: Joanne Morrison – University of Edinburgh
Image: The image is credited to Neuroscience News
Original Research: Identifying Candidate Mediators Linking ADHD Symptoms and Internalising Problems in Adolescence: An Exploratory Longitudinal Mediation Analysis. Journal of Attention Disorders. DOI: 10.1177/10870547261419589. Open access.
Abstract
Identifying Candidate Mediators Linking ADHD Symptoms and Internalising Problems in Adolescence: An Exploratory Longitudinal Mediation Analysis
Objective:
ADHD and internalising symptoms such as anxiety and depression co-occur in adolescence. Understanding the mechanisms that link them is important for improving mental health outcomes. This study aimed to examine those mechanisms using a longitudinal approach.
Method:
Using the Millennium Cohort Study (n = 2,607 male; n = 2,791 female), researchers simultaneously evaluated a range of hypothesised mediating mechanisms across ages 11, 14 and 17. Fourteen candidate mediators were included, such as peer problems, conduct problems, self-esteem, injuries, parent–child relationships, academic performance, risky decision-making, parental mental health, educational motivation and general health. Exploratory longitudinal mediation analysis with regularised structural equation modelling (regSEM) was used to identify robust indirect effects.
Results:
While regularisation techniques retained all candidate mediators in the model, only two were statistically significant: adolescent self-esteem and parental mental health. For girls, peer difficulties also showed a significant association.
Conclusion:
The findings suggest numerous small-effect pathways may connect ADHD symptoms and later internalising problems, but they highlight self-esteem and parental mental health as priority mechanisms for future causal and intervention research. Targeted support addressing these areas may help reduce the progression from ADHD symptoms to anxiety and depression during adolescence.