Patterns of Homotypic and Heterotypic Continuity Between ADHD Symptoms, Externalising and Internalising Problems from Age 7 to 15

Ingrid Obsuth,Manuel Eisner,Simona Di Folco,Denis Ribeaud,Aja Louise Murray

doi:10.1007/s10802-019-00592-9

Abstract

ADHD presents a serious community-health problem through its links to a wide range of negative outcomes. These outcomes are exacerbated when ADHD symptoms co-occur with other mental health problems. Research evidence suggests high rates of co-comorbidity with a range of problems. However, there is a paucity of longitudinal research that examines the predictive links between ADHD symptoms and symptoms of other mental health problems. We examined a cross-lagged autoregressive model in order to assess homotypic and heterotypic continuity between ADHD symptoms, aggressive behavior, non-aggressive behavior problems and anxiety/depression in a community-based sample of 1571 youth (761 female, 810 male) assessed annually from age 7 to 13 and again at age 15. Consistently significant correlations between each pair of problem behaviors provided support for concurrent comorbidity. Furthermore, significant autoregressive pathways provided support for homotypic continuity. Support for heterotypic continuity was limited to ADHD symptoms predicting both aggressive behavior and non-aggressive behavior problems, but not vice versa. Our study highlights the importance of focusing on ADHD symptoms to identify children at risk not only for continued ADHD symptomatology but also a range of externalizing behavior problems including different types of aggression and non-aggressive behavior problems, such as rule-breaking. Identifying these patterns in a community-based sample provides support for the possibility of early identification of risk for a range of problem behaviors.

Highlights

Attention deficit hyperactivity disorder (ADHD) presents a serious community-health problem through its links to a wide range of negative outcomes
These finding may be interpreted in light of the underlying neurodevelopmental deficits of ADHD related to difficulties in emotion regulation and functional impairments that may place young people at risk for later problem behaviors in the context of other risk factors
The strongest association was found for Aggression and Non-aggressive externalizing problems, followed by the link between ADHD symptoms and Nonaggressive externalizing problems, comparable with the link between ADHD and Aggression

Summary

Introduction

ADHD presents a serious community-health problem through its links to a wide range of negative outcomes. Attention deficit hyperactivity disorder (ADHD) is one of the most common disorders in school-aged children and it is characterised by hyperactivity, impulsiveness, and/or inattention (APA 2013) It presents a community-health problem when untreated as it has been linked to a wide range of negative long-term outcomes such as low educational attainment, unplanned pregnancy, unemployment, substance abuse and criminality (e.g., Owens et al 2017). Studies on children and/or adolescents with ADHD followed up in adulthood showed that antisocial personality disorder, criminality, and drug misuse are among their externalizing outcomes (e.g., Klein et al 2012) These finding may be interpreted in light of the underlying neurodevelopmental deficits of ADHD related to difficulties in emotion regulation and functional impairments that may place young people at risk for later problem behaviors in the context of other risk factors (e.g., parenting practices, peer problems; e.g., Anastapoulos et al 2010)

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