Hostname: page-component-745bb68f8f-cphqk Total loading time: 0 Render date: 2025-01-26T08:47:32.447Z Has data issue: false hasContentIssue false
  • English
  • Français

Adolescent Outcome of ADHD: Impact of Childhood Conduct and Anxiety Disorders

Published online by Cambridge University Press:  07 November 2014

Jeffrey H. Newcorn ,
Scott R. Miller ,
Iliyan Ivanova ,
Kurt P. Schulz ,
Jessica Kalmar ,
David J. Marks  and
Jeffrey M. Halperin
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: This study examines the impact of comorbidity of attention-deficit/hyperactivity disorder (ADHD) with disruptive and anxiety disorders in childhood on clinical course and outcome. We consider the relative contribution of each comorbid symptom constellation, and also their interaction, to assess the following questions: (1) Does early comorbidity with conduct disorder (CD) and anxiety disorders define specific developmental trajectories?; (2) Is comorbid anxiety disorders in childhood continuous with anxiety disorders in adolescence?; (3) Does comorbid anxiety disorders mitigate the negative behavioral outcome of youth with ADHD?; and (4) Is there an interaction between comorbid CD and anxiety disorders, when they occur simultaneously, that predicts a different outcome than either comorbid condition alone?

Method: Thirty-two 15- to 18-year-old adolescent males, diagnosed with ADHD between 7 and 11 years of age, were re-evaluated for assessment of adolescent outcome 4.3–9.2 years later. Hierarchical regression analyses were run with each of the eight Child Behavior Checklist and Youth Self-Report problem scales, and the four anxiety symptom subscales of the Multidimensional Anxiety Scale for Children serving as outcome variables.

Results: Findings indicate that comorbid CD at baseline predicteds parent reports of behavior problems in adolescence, while comorbid anxiety disorders in childhood predicted youth reports of anxiety and social problems. Anxiety disorders without CD did not predict poor behavioral outcome. Children with both comorbid CD and anxiety disorder had the highest levels of parent-rated symptoms on follow up. In particular, adolescent social problems were best predicted by the combination of comorbid CD and anxiety disorder in childhood.

Conclusion: These data provide evidence that children with ADHD plus anxiety disorder do in fact have anxiety disorders, and that the combination of anxiety disorder and CD predicts a more rather than less severe course.

Type
Original Research
Information
CNS Spectrums , Volume 9 , Issue 9 , September 2004 , pp. 668 - 678
Copyright
Copyright © Cambridge University Press 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Biederman, J.Attention-deficit/hyperactivity disorder: a life-span perspective. J Clin Psychiatry. 1998;59(suppl 7):4–16.Google ScholarPubMed
2. Rowland, AS, Lesesne, CA, Abramowitz, AJ. The epidemiology of attention-deficit/hyperactivity disorder (ADHD): a public view. Ment Retard Dev Disabil Res Rev. 2002;8:162–170.CrossRefGoogle Scholar
3. American Academy of Pediatrics. Subcommittee on Attention-Deficit/Hyperactivity Disorder and Committee on Quality Improvement. Clinical practice guideline: treatment of the schoolaged child with attention-deficit/hyperactivity disorder. Pediatrics. 2001;108:1033–1044.CrossRefGoogle Scholar
4. Wilens, TE, Biederman, J, Spencer, TJ. Attention deficit/hyperactivity disorder across the lifespan. Annu Rev Med. 2002;53:113–31.CrossRefGoogle ScholarPubMed
5. Fischer, M, Barkley, RA, Smallish, L, Fletcher, K. Young adult follow-up of hyperactive children: self-reported psychiatric disorders, comorbidity, and the role of childhood conduct problems and teen CD. J Abnorm Child Psychol. 2002;30:463–475.CrossRefGoogle ScholarPubMed
6. Hechtman, L. Predictors of long-term outcome in children with attention deficit/hyperactivity disorder. Pediatr Clin North Am. 1999;46:1039–1052.CrossRefGoogle ScholarPubMed
7. Weiss, G, Hechtman, L, Milroy, T, Perlman, T. Psychiatric status of hyperactives as adults: a controlled prospective 15-year follow-up of 63 hyperactive children. J Am Acad Child Psychiatry. 1985;24:211–220.CrossRefGoogle ScholarPubMed
8. Costello, EJ, Mustillo, S, Erkanli, A, Keeler, G, Angold, A. Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry. 2003;60:837–844.CrossRefGoogle ScholarPubMed
9. Mannuzza, S, Klein, RG. Long-term prognosis in attention-deficit/hyperactivity disorder. Child Adolesc Psychiatr Clin N Am. 2000;9:711–726.CrossRefGoogle ScholarPubMed
10. Pliszka, SR. Patterns of psychiatric comorbidity with attention-deficit/hyperactivity disorder. Child Adolesc Psychiatr Clin N Am. 2000;9:525–540.CrossRefGoogle ScholarPubMed
11. MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 1999;56:1073–1086.CrossRefGoogle Scholar
12. Biederman, J, Newcorn, JH, Sprich, S. Comorbidity of attention-deficit hyperactivity disorder with conduct, depressive, anxiety and other disorders. Am J Psychiatry. 1991;148:251–256.Google ScholarPubMed
13. Garland, AF, Hough, RL, McCabe, KM, Yeh, M, Wood, PA, Aarons, GA. Prevalence of psychiatric disorders in youths across five sectors of care. J Am Acad Child Adolesc Psychiatry. 2001;40:409–418.CrossRefGoogle Scholar
14. MacDonald, VM, Achenbach, TE. Attention problems versus conduct problems as six-year predictors of problem scores in a national sample. J Am Acad Child Adolesc Psychiatry. 1996;35:1237–1246.CrossRefGoogle ScholarPubMed
15. Barkley, RA, Fischer, M, Smallish, L, Fletcher, K. Young adult followup of hyperactive children: antisocial activities and drug use. J Child Psychol Psychiatry. 2004;45:195–211.CrossRefGoogle ScholarPubMed
16. Taylor, E, Chadwick, O, Heptinstall, E, Danckaerts, M. Hyperactivity and conduct problems as risk factors for adolescent development. J Am Acad Child Adolesc Psychiatry. 1996;35:1213–1226.CrossRefGoogle ScholarPubMed
17. Newcorn, JH, Halperin, JM, Jensen, PS, et al. Symptom profiles in children with ADHD: effects of comorbidity and gender. J Am Acad Child Adolesc Psychiatry. 2001;40:137–146.CrossRefGoogle ScholarPubMed
18. Jensen, PS, Hinshaw, SP, Kraemer, HC, et al. ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. J Am Acad Child Adolesc Psychiatry. 2001;40:147–158.CrossRefGoogle ScholarPubMed
19. Newcorn, JH, Halperin, JM. Comorbidity of attention deficit disorders with oppositionality and aggression. In: Brown, T, ed. Subtypes of Attention-deficit Hyperactivity Disorders in Children, Adolescents and Adults. Washington, DC: American Psychiatric Association Press; 2000;171–207.Google Scholar
20. Reeves, JC, Werry, JS, Elkind, GS, Zemetkin, A. Attention deficit, conduct, oppositional, and anxiety disorders in children: II. Clinical characteristics. J Am Acad Child Adolesc Psychiatry. 1987;26:144–155.CrossRefGoogle ScholarPubMed
21. Werry, JS, Reeves, JC, Elkind, GS. Attention deficit, conduct, oppositional, and anxiety disorders in children: I. A review of research on differentiating characteristics. J Am Acad Child Adolesc Psychiatry. 1987;26:133–143.CrossRefGoogle Scholar
22. International Classification of Diseases. 10th ed. Geneva, Switerzland: World Health Organization; 1993.Google Scholar
23. March, JS, Swanson, JM, Arnold, LE, et al. Anxiety as a predictor and outcome variable in the multimodal treatment study of children with ADHD (MTA). J Abnorm Child Psychol. 2000;28:527–541.CrossRefGoogle ScholarPubMed
24. Shaffer, D. The National Institute of Mental Health Diagnostic Interview Schedule for Children (NIMH-DISC). New York, NY: Columbia University Press; 1997.Google Scholar
25. Gray, J. The Neuropsychology of Anxiety. New York, NY: Oxford University Press; 1982.Google Scholar
26. Pliszka, SR. Comorbidity of attention deficit hyperactivity disorder and overanxious disorder. J Am Acad Child Adolesc Psychiatry. 1992;31:197–203.CrossRefGoogle ScholarPubMed
27. Pliszka, SR. Effect of anxiety on cognition, behavior and stimulant response in ADHD. J Am Acad Child Adolesc Psychiatry. 1989;28:882–887.CrossRefGoogle ScholarPubMed
28. Fergusson, DM, Horwood, LJ. The structure, stability and correlations of the trait components of conduct disorder, attention deficit and anxiety/withdrawal reports. J Child Psychol Psychiatry. 1993;34:749–766.CrossRefGoogle ScholarPubMed
29. Diagnostic and Statistical Manual of Mental Disorder. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
30. Biederman, J, Faraone, S, Milberger, S, et al. A prospective 4-year follow-up study of attention-deficit hyperactivity and related disorders. Arch Gen Psychiatry. 1996;53:437–446.CrossRefGoogle ScholarPubMed
31. Biederman, J, Faraone, S, Milberger, S, et al. Predictors of persistence and remission of ADHD into adolescence: results from a four-year prospective follow-up study. J Am Acad Child Adolesc Psychiatry. 1996;35:343–345.CrossRefGoogle ScholarPubMed
32. Halperin, JM, Newcorn, JH, Schwartz, ST, et al. Age-related changes in the association between serotonergic function and aggression in boys with ADHD. Biol Psychiatry. 1997;41:682–689.CrossRefGoogle ScholarPubMed
33. Halperin, JM, Sharma, V, Siever, LJ, et al. Serotonergic function in aggressive and nonaggressive boys with attention-deficit/hyperactivity disorder. Am J Psychiatry. 1994;151:243–248.Google ScholarPubMed
34. Shaffer, D, Fisher, P, Dulcan, M, et al. The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): description, acceptability, prevalence rates, and performance in the MECA study. J Am Acad Child Adolesc Psychiatry. 1996;35:865.CrossRefGoogle ScholarPubMed
35. Achenbach, TM. Manual for the Child Behavior Checklist 4/18 and 1991 Profile. Burlington, VT: University of Vermont Press; 1991.Google Scholar
36. Loney, J, Milich, RHyperactivity, inattention and aggression in clinical practice. Adv Dev Behav Pediatr. 1982;3:113–147.Google Scholar
37. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. rev. Washington, DC: American Psychiatric Association; 1987.Google Scholar
38. Achenbach, TM. Manual for the Youth Self-Report and 1991 Profile. Burlington, VT: University of Vermont Press; 1991.Google Scholar
39. March, JS, Parker, JD, Sullivan, K, Stallings, P, Conners, CK. The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. J Am Acad Child Adolesc Psychiatry. 1997;36:554–565.CrossRefGoogle ScholarPubMed
40. March, JS, Sullivan, K. Test-retest reliability of the Multidimensional Anxiety Scale for Children. J Anxiety Disord. 1999;13:349–358.CrossRefGoogle ScholarPubMed
41. Aiken, LS, West, SG. Multiple Regression: Testing and Interpreting Interactions. Thousand Oaks, Calif: Sage Publications; 1991.Google Scholar
42. Pedhazur, EJ. Multiple Regression in Behavioral Research. Fort Worth, Tex: Harcourt Brace; 1997.Google Scholar
43. Doyle, AE, Biederman, J, Monuteaux, M, Cohen, SL, Schofield, HL, Faraone, SV. Diagnostic threshold for conduct disorder in girls and boys. J Nerv Ment Dis. 2003;191:379–386.CrossRefGoogle ScholarPubMed
44. Pliszka, SR. Psychiatric comorbidities in children with attention deficit hyperactivity disorder: implications for management. Paediatr Drugs. 2003;5:741–750.CrossRefGoogle ScholarPubMed
45. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, DC: American Psychiatric Association; 1980.Google Scholar
46. Kellem, SG, Brown, CH, Rubin, BR, Ensminger, ME. Paths leading to teenage psychiatric symptoms and substance use: developmental epidemiological studies in Woodlawn. In: Gure, SD, Earls, FJ, Barrett, JE, eds. Childhood Psychopathology and Development. New York, NY: Raven Press; 1983.Google Scholar
47. Lewczyk, CM, Garland, AF, Hurlburt, MS, Gearity, J, Hough, RL. Comparing DISC-IV and clinician diagnoses among youths receiving public mental health services. J Am Acad Child Adolesc Psychiatry. 2003;42:349–356.CrossRefGoogle ScholarPubMed
48. Vance, A, Costin, J, Barnett, R, Luk, E, Maruff, P, Tonge, B. Characteristics of parent- and child-reported anxiety in psychostimulant medication naive, clinically referred children with attention deficit hyperactivity disorder, combined type (ADHD-CT). Aust N Z J Psychiatry. 2002;36:234–239.CrossRefGoogle ScholarPubMed