Developmental Relations Between Internalising Problems and ADHD in Childhood: a Symptom Level Perspective

Lydia Gabriela Speyer,Michelle Luciano,Manuel Eisner,Bonnie Auyeung,Aja Louise Murray,Denis Ribeaud

doi:10.1007/s10802-021-00856-3

Abstract

ADHD and internalising problems commonly co-occur with up to 50% of children diagnosed with ADHD also suffering from anxiety or depression. However, their developmental relations are currently not well understood. Longitudinal symptom level analyses can provide valuable insights into how difficulties in these areas of psychosocial functioning affect each other. Using Gaussian Graphical Models and Graphical Vector Autoregression Models, this study estimated cross-sectional and longitudinal networks of ADHD and internalising symptoms in 1387 children using parent- and teacher-reported Social Behaviour Questionnaires (SBQ) when children were aged 7, 9 and 11. Cross-sectional and longitudinal networks suggested that ADHD shares reciprocal relations with internalising symptoms through a number of potential bridge symptoms that are primarily connected to anxiety symptoms. High scores on child cannot sit still, is restless, or hyperactive were found to be the strongest bridge symptom acting as an antecedent to higher internalising symptoms whereas child is worried was the strongest antecedent for higher ADHD symptoms. Findings of this study highlight several potential bridge symptoms that may serve as key intervention targets and further emphasise the need for clinicians to assess children presenting with ADHD symptoms for internalising problems and vice versa.

Highlights

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common mental health issues in children, affecting around 6.5% of youths worldwide (Polanczyk et al, 2015)
Existing evidence on the longitudinal development of internalising problems and ADHD in normative samples suggests that they share reciprocal relations, with, for example, internalising problems leading to higher ADHD symptomatology and vice versa across mid- to late- adolescence (Murray et al, 2020a, b)
Most longitudinal studies investigating the links between ADHD and internalising problems (e.g. Obsuth et al, 2020) have used modelling techniques such as cross-lagged panel models (CLPM), which conflate between- and within-person effects and provide ambiguous results regarding the development of co-occurring mental health issues (Berry & Willoughby, 2017)

Summary

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common mental health issues in children, affecting around 6.5% of youths worldwide (Polanczyk et al, 2015). GVAR models further have the advantage that they allow for an intuitive visualisation and interpretation of complex results, making it possible to investigate the relations between multiple mental health domains at the domain level and at the symptom level Another factor that has far limited our understanding of the links between ADHD symptoms and internalising problems has been the focus on the disorder level rather than the symptom level. Rather than conceptualising mental health disorders as a collection of symptoms caused by a unitary underlying abnormality, the network approach to psychopathology views mental health disorders as dynamic networks of multiple mutually reinforcing symptoms with taxonomic classifications only serving as a means to describe a specific symptom network This approach allows for a more parsimonious understanding of co-occurring mental health problems given that symptoms between mental health disorders show substantial overlap (e.g. concentration difficulties are a symptom of ADHD and of depression) (American Psychiatric Association, 2013). There is a clear need for more appropriate modelling of longitudinal symptom networks

Results

Discussion

Conclusion