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Correlates of Comorbid Psychopathology in Children With ADHD

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ABSTRACT

Objective

To investigate correlates of internalizing and externalizing psychopathology in a clinical sample of children with attention-deficit/hyperactivity disorder (ADHD).

Method

Parent and teacher Child Behavior Checklists were administered to 300 children with ADHD to ascertain comorbid symptoms. Based on previous research, a seven-step hierarchical regression analysis was developed. Six hierarchical regression analyses were conducted with either parent or teacher Child Behavior Checklist aggression, delinquency, or anxious/depressive comorbid symptoms as dependent measures.

Results

Controlling for (1) variables known to increase risk for ADHD child psychopathology and (2) estimated duration of ADHD, our results suggest that the presence of comorbid symptoms is influenced by age of onset. An early age of onset of ADHD was correlated with a greater rate of parent-reported child aggressive symptoms, and a later age of onset was correlated with a greater rate of parent-reported child anxious/depressive symptoms. Elevated levels of comorbid externalizing and internalizing symptoms are associated with greater ADHD symptom severity.

Conclusions

Comorbid externalizing and internalizing symptoms are correlated with age of ADHD onset and are related to the severity of clinical presentation in a referred sample of children with ADHD.

Section snippets

Study Site

The ADHD clinic is a specialty clinical referral and research setting located in a tertiary care academic hospital center. Many providers in the surrounding community make referrals to the clinic including primary care physicians, community mental health providers, and school districts. The catchment area includes urban, suburban, and rural communities surrounding the medical center. The ADHD clinic participates in grant-funded ADHD research as well as clinical assessment (Barkley et al., 1993,

Subject Characteristics

Characteristics of the sample are presented in Table 1. There was a 5:1 male-female ratio. Ethnicity was not coded, but most were white. ADHD age-of-onset was ≤4 years in 67% of the sample (0–2 years in 120 [40%] of children, 3–4 years in 82 [27.3%], 5–6 years in 76 [25.3%], and older than 6 years in 22 [7.4%] [for ADHD NOS]).

Risk Factor Models

Results of the six regression analyses are presented in Murphy and Myors, 1998).

Estimated Age of Onset and Comorbidity

Controlling for known risk factors, estimated ADHD duration, and ADHD symptom severity at

DISCUSSION

The purpose of our research was to assess correlates of comorbid psychopathology in a clinically referred sample of children with ADHD. A specific focus of this analysis involved investigating the relationships between estimated age of onset and symptom severity to comorbid symptom presentation. Our results show that, in addition to known risk factors, severity of ADHD at time of referral and estimated age of onset of child ADHD symptoms are associated with a greater degree of comorbid symptoms

REFERENCES (29)

  • RA Barkley et al.

    A comparison of three family therapy programs for treating family conflicts in adolescents with attention-deficit hyperactivity disorder

    J Consult Clin Psychol

    (1992)
  • RA Barkley et al.

    Attention Deficit Hyperactivity Disorder: A Clinical Workbook

    (1998)
  • RA Barkley et al.

    Preliminary findings of an early intervention program with aggressive hyperactive children

    Ann N Y Acad Sci

    (1996)
  • J Biederman

    Attention-deficit/hyperactivity disorder: a life-span perspective

    J Clin Psychiatry

    (1998)
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    The authors thank Trang Au for editorial assistance.

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