Why do attention-deficit/hyperactive disorder and/or autism traits place adolescents at risk for depression? Protocol for a longitudinal comparison of the mediating role of emotion regulation deficits versus emotional burden

Background: Depression levels increase dramatically during adolescence in the general population. This effect is exacerbated in adolescents with a diagnosis of attention-deficit/hyperactivity disorder (ADHD), autism, or both. Here we detail the protocol for the My Emotions and Me Over Time (MEMO) study, a 12-month longitudinal study with the primary aim to compare two competing hypotheses for why this is the case. The first, established hypothesis is that depression risk associated with ADHD and/or autism is mediated by emotion regulation deficits (ERD). The second and new perspective is that it is mediated by the experience of elevated emotional burden (EB) created by (i) greater exposure to upsetting events and encounters, which are (ii) experienced more intensely. Cross-lagged path models will test the relative importance of the ERD and EB pathways to the relationship between autism and ADHD traits and depression symptoms. Exploratory analyses examining secondary mediators (i.e., self-esteem) and moderators (rumination, resilience and alexithymia) will also be conducted. Methods: A sample of 600 adolescents aged 11 to 16 years, enriched for the presence of autism and ADHD diagnosed cases, and their parent/guardian will be recruited via schools, local NHS (South London and Maudsley) and ADHD and autism charities. Measures of ADHD, autism and depression, ERD, EB, self-esteem, rumination, resilience and alexithymia will be completed at baseline, 6 months and/or 12 months by parents and/or participants. Background factors such as age, sex, cognitive abilities and socioeconomic status as well as service use and medication status will also be collected as covariates. Results: The pathways between ADHD/autism and depression, along with their mediators and moderators, will be analysed using structural equation modelling.Conclusion: The findings from MEMO will feed into the other studies within the RE-STAR programme to support the development of an intervention to reduce ADHD and/or autism-related depression risk in adolescence.