The co-occurrence of attention problems and depression is well-documented (Angold, Costello, & Erkanli, 1999
; Jensen, Shervette, Xenakis, & Richters, 1993
; Jensen et al., 2001
) although little is known about mechanisms underlying their association. The timing of symptom onset may offer a clue to how these conditions are related—severe inattention is generally viewed as a problem of early neurodevelopment that emerges prior to symptoms of depression (American Psychiatric Association, 2000
). Understanding processes that mediate the inattention-depression relationship could yield new insights about the nature and etiology of this particular type of comorbidity and lead to treatment and prevention innovations; indeed, some authors have suggested that the study of comorbidity is the most pressing issue in child psychopathology research and practice (Jensen, 2003
). Although few studies have examined the mechanisms involved in the co-occurrence of these conditions, extant theory and research gives reason to suspect that academic incompetence plays a pivotal role.
Several theories of development emphasize the role of academic competence during early childhood in determining social emotional outcomes. For instance, life course/social field theory (Kellam & Rebok, 1982) suggests that a key developmental challenge early in life is successful entrance into and adaptation to the school social field. At school entry, children are confronted with teacher demands for academic achievement, compliance, attention, and participation in classroom and peer activities. Unsuccessful adaptation to the school social field places children at risk for chronic school failure which in turn undermines their psychological well-being.
In line with a life course/social field perspective, Cole, Jacquez, and Maschman (2001)
refined traditional cognitive theories of adult depression and proposed a competency-based model to describe the emergence of depressive symptoms in children. Similar to the traditional models, self-perceptions of competence contribute to depressive symptoms in the competency framework. However, according to Cole, these self-perceptions are learned from others’ perceptions and represent accurate appraisals of academic and social competence in early childhood. In other words, real performance deficits may precede self-perceptions of incompetence that are linked to depressive symptoms. In later childhood and early adolescence these self-perceptions provide fertile ground for cognitive distortions that are associated with depressive symptoms in adults. Cross-sectional and longitudinal research supports Cole’s competency model of depression (Cole, Martin, Powers, & Truglio, 1996
; Cole & Turner, 1993
; Cole et al., 2001
Following the logic of Cole’s model, factors that place children at risk for academic performance deficits, such as attention problems, may also increase their chances for becoming depressed. Inattention is a significant risk factor for both academic failure and depressive symptoms. The school experiences of children with attention problems are characterized by many negative outcomes including learning problems, teacher conflict, and school dissatisfaction (Barkley, 1998
). Attention problems typically precede school maladjustment (Sanson, Prior, & Smart, 1996
; Smart, Sanson, & Prior, 1996
). Children with attention problems tend to have difficulty completing assignments and meeting the expectations of teachers; for that reason, a number of studies have identified inattention as a proximal cause of school and academic problems (Barkley, 1998
In turn, children with learning problems are at increased risk for experiencing psychiatric symptoms and disorders including depression (Arnold et al., 2005
; Carroll, Maughan, Goodman, & Meltzer, 2005
). Several studies have found that reading problems were uniquely associated with depressive symptoms even when controlling for attention problems (Arnold et al., 2005
; Willcutt & Pennington, 2000
), findings consistent with the hypothesis that academic problems mediate the relationship between attention problems and depression. Unlike its consequent relationship with inattention, learning problems typically precede depressive symptoms. Kellam and colleagues reported that early learning problems predicted later distress including depressive symptoms in boys (Kellam, Brown, Rubin, & Ensminger, 1983
), and an intervention that reduced academic risk also lowered subsequent depressive symptoms (Kellam, Rebok, Mayer, Ialongo, & Kalodner, 1994
). More recently, analysis of longitudinal data from the Pittsburgh Youth Study (Maughan, Rowe, Loeber, & Southamer-Loeber, 2003
) showed that reading problems occurred before the emergence of depressive symptoms for children aged 7–10 years but not for adolescents. The predictive value of reading problems remained strong even when controlling for family variables, conduct problems, and inattention.
On the other hand, available research does not support the reverse, that depression causes learning problems and school maladjustment in the early years of education (Maughan et al., 2003
; Rutter et al., 1970
). Maughan and colleagues found that depressive symptoms explained less than 1% of the variance of subsequent reading scores when controlling for prior reading scores, background variables, and conduct problems. Additionally, two longitudinal studies failed to find evidence that internalizing disorders served as independent risk factors for academic failure (Anderson, Williams, McGee, & Silva, 1989
; Rutter et al., 1970
Two recent studies have investigated academic pathways linking inattention and depressive symptoms. Herman and Ostrander (2006) found that a composite variable labeled school maladjustment that included teacher ratings of learning problems and student school satisfaction mediated the relationship between inattention and depressive symptoms in a sample of children aged 6–11 years-old. However, Blackman, Herman, and Ostrander (2006)
found that academic incompetence alone did not distinguish between children with ADHD versus children with ADHD plus depression. The discrepant findings between these studies may be explained by how study variables were defined. Whereas Herman and Ostrander (2006) used continuous variables, Blackman et al. (2006)
focused on diagnostic categories. Additionally, Herman and Ostrander (2006) used an aggregate measure of school maladjustment defined by teacher- and child-reports; Blackman et al. (2006)
separately analyzed the effects of teacher-rated, child-rated, and performance based competence.
Equally important, both studies had serious limitations. First, both analyses were based on cross-sectional data. Optimal tests of mediation should include longitudinal data to test the temporal sequence of variables. Second, the children in the study were fairly homogeneous in terms of race and ethnicity. It is unclear if and how these findings apply to other samples of children. Third, neither study considered gender differences in their models because of the high percentage of boys in their samples.
Gender differences in academic self-perceptions may emerge during early and middle childhood. Boys tend to have higher expectations and be more optimistic about their academic potential (Frey & Ruble, 1987
) whereas girls tend to underestimate their academic competence (Cole, 1990; Cole et al., 1999; Frome & Eccles, 1995). Girls are also more apt to adopt attributional biases by focusing on their low ability in explaining failure experiences (Frey & Ruble, 1987
). Additionally, some studies have found the link between academic difficulties and depressive symptoms was restricted to girls (Willcutt & Pennington, 2000
). Given the potential for gender differences to emerge on studied variables we conducted analyses separately for boys and girls.
Additionally, because we were concerned with the unique relationships among inattention, academic competence, and depressive symptoms, we also controlled for a known correlate of all three variables, conduct problems. A prominent theory suggests that the high rate of comorbidity between externalizing disorders, academic problems, and depression may originate with early antisocial behaviors (Patterson, Dishion, & Chamberlain, 1993
). Early problems with attention, however, may explain much of the association between school maladjustment and conduct problems during the childhood years. For example, in an integrated review article, Hinshaw (1992)
concluded that the apparent link between conduct problems and academic problems could be explained by comorbid attention deficits.
In sum, theory and empirical data gives reason to suspect academic incompetence as a potential mediator of the inattention-depression relationship. Children with attention problems are prone to academic failure which may place them at greater risk for becoming depressed. The present study builds on prior literature by exploring these relationships among a group of African American children living in an urban context, a population on which inattention-depression mechanisms have not been tested. Although the prevalence of attention problems is similar across ethnic groups, less research has focused on African American children (Bailey & Owens, 2005
; Jones, 2005). Additionally, prior studies have not considered the role of gender differences or conduct problems in modifying the relationship between attention problems and depressive symptoms.
Using data from the Baltimore Prevention and Intervention Research Center (PIRC), the present study investigated the relationship between attention problems, academic competence, and depressive symptoms for African American children. We conducted analyses separately for boys and girls and controlled for baseline conduct problems and academic competence. We hypothesized that academic competence would mediate the relationship between attention problems and depressive symptoms for boys and girls when controlling for conduct problems. Given evidence that girls may be more susceptible to internalize academic failure, we expected the mediating role of academic competence to be especially strong for them.