Behavioral and Emotional Correlates of ADHD in Children

1. Behavioral and Emotional Correlates of ADHD in Children Tammy D. Barry, Ph.D.1, Christopher T. Barry, Ph.D.1, Beth H. Garland, M.A.2, and Robert D. Lyman, Ph.D.3 1 The University of Southern Mississippi, 2 Texas A&M University, 3 North Georgia College and State University Table 1: Demographic Characteristics of the ADHD and non-ADHD Groups ADHD Non-ADHD (n = 33) (n = 33) Gender (% males) (63.6%) (45.5%) Pearson 2 (1, N = 66) = 2.20, p = .14 Race (% Caucasian) (87.9%) (88.4%) Pearson 2 (2, N = 66) = 1.02, p = .60 Mean (SD) Mean (SD) t-value Age in months 132.67 (15.59) 134.88 (13.87) 0.61 Grade in school 5.30 (1.24) 5.45 (1.18) 1.43 Average education of caregivers (in years) 13.36 (2.07) 13.99 (2.05) 1.23 Household income (in thousand dollars) 51.99 (30.80) 52.75 (22.68) 0.11 K-BIT IQ Composite 103.03 (14.39) 112.03 (9.35) 3.01 ** Note: K-BIT = Kaufman Brief Intelligence Test (Kaufman & Kaufman, 1990); ** p < .01 RESULTS Independent samples t-tests were conducted to compare the ADHD and non-ADHD groups on behavioral and emotional indices from the BASC (clinical and adaptive scales) and the HSQ. T-tests were significant for all scales with only one exception (i.e., the two groups were generally equivalent on the Withdrawal scale of the BASC; see Table 3). For each significant finding, the ADHD group scored significantly above the non-ADHD group on indices of behavioral problems or emotional difficulties and significantly below the non-ADHD group on indices of adaptive functioning. Composite scores for the BASC and HSQ are presented in Figure 1. Results indicated a significant difference between the K-BIT IQ Composite score of the ADHD group (M = 103.03, SD = 14.39 ) and the non-ADHD group (M = 112.03, SD = 9.35), t = 3.01, p < .01. Thus, diagnostic group differences on behavioral and emotional indices were also examined through one-way ANCOVAs to control for group differences in IQ. All group differences held with only two exceptions: Anxiety, F (1, 63) = 2.78, p = .100, and Somatization, F (1, 63) = 3.53, p = .065. In addition, ADHD was significantly related to having a learning disability (LD) diagnosis, Pearson 2 (1, N = 66) = 9.10, p < .01, and being placed in special education classes, 2 (1, N = 63) = 10.61, p < .01. Eight of the participants with ADHD (24%) had a comorbid diagnosis of an LD, whereas none of the non-ADHD children had received an LD diagnosis. Fourteen children in the ADHD group (42%) had been placed in special education classes, whereas only two non-ADHD children (6%) had been in special education. INTRODUCTION Attention-Deficit/Hyperactivity Disorder (ADHD) is defined by behavioral criteria for three symptom areas: inattention, hyperactivity, and impulsivity (American Psychiatric Association, 2000). However, several correlates and associated features have been identified in children with ADHD requiring additional clinical attention. For example, children with ADHD are at higher risk, in comparison to children without ADHD, for a comorbid diagnosis of a disruptive behavior disorder, such as Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD; Biederman, Mick, Faraone, & Burback, 2001). Some children with ADHD do not meet diagnostic criteria for a comorbid diagnosis but, nevertheless, often exhibit significant symptoms of aggressiveness, argumentativeness, and acting out behavior. Likewise, children with ADHD may be at higher risk for internalizing symptoms, such as anxiety and depression (Power, Costigan, Eiraldi, & Leff, 2004). Finally, children with ADHD may show deficits in social and adaptive functioning (Bagwell, Molina, Pelham, & Hoza, 2001). Thus, ADHD may involve more global deficits than those delineated in the three symptom areas. This study examined the pattern of differences in functioning across a wide range of behavioral and emotional indices between a group of children with ADHD and a non-ADHD group.It was predicted that children with ADHD would show impairment relative to non-ADHD children across these indices. • METHOD • Participants • 66 children (33 in ADHD group and 33 in non-ADHD group). • Ranging in age from 8 years, 9 months to 14 years, 5 months. • See Table 1 for demographic characteristics of the two groups. Measures • Parents of participants completed a demographic form and three behavioral rating forms: • DSM-IV ADHD Checklist (DSM-IV-TR; American Psychiatric Association, 2000). • Behavior Assessment System for Children – Parent Rating Scale, (BASC-PRS, Reynolds and Kamphaus, 1992). • Home Situations Questionnaire (HSQ; Barkley, 1987). • Participants were administered the Kaufman Brief Intelligence Test (K-BIT; Kaufman & Kaufman, 1990) when off their medication to obtain an estimate of IQ. • Procedure • Following informed consent from parents and verbal assent from participants, parents completed the demographic form and three behavioral rating forms. Participants were administered the K-BIT in a separate testing area. • Although a diagnosis from an independent source (e.g., psychologist, pediatrician) was required for the ADHD group, each participant with ADHD also met the study cut-off criteria on the Attention Problems scale for both the BASC (T-score > 60) and the DSM-IV Checklist (85th percentile or higher). • All non-ADHD participants were below this threshold. See Table 2 for group differences on criteria measures. Table 2. Differences Between ADHD and non-ADHD Groups on ADHD Symptom Inclusion Criteria Measures ADHD Non-ADHD (n = 33) (n = 33) Mean (SD) Mean (SD) t-value DSM-IV ADHD Checklist Inattention Percentile 95.42 ( 4.30) 41.15 (25.02) -12.21 *** Hyperactivity Percentile 91.03 ( 8.54) 31.21 (29.53) -11.18 *** BASC-Parent Rating Scale Attention Problems T-score 70.36 ( 6.59) 45.97 ( 7.83) -13.69 *** Hyperactivity T-score 71.42 (14.45) 40.55 ( 6.09) -11.31 *** Note: DSM-IV = Diagnostic and Statistical Manual, fourth edition, text revision (American Psychiatric Association, 2000); BASC = Behavior Assessment System for Children (Reynolds & Kamphaus, 1992); *** p < .001 DISCUSSION Consistent with the study’s hypothesis, the ADHD group exhibited significant impairment relative to the non-ADHD group across a wide range of behavioral and emotional indices. The problematic areas exhibited by the ADHD group extended beyond ADHD symptoms and included other externalizing behaviors (e.g., conduct problems, aggression), internalizing symptoms (e.g., depression, anxiety), and difficulties in areas of adaptive functioning (e.g., social skills, leadership). Likewise, children in the ADHD group were more likely to have a comorbid diagnosis of a learning disability and to be in special education than non-ADHD children. In light of these findings, treatments for ADHD must consider the various comorbid problems beyond the symptoms of inattention, hyperactivity, and impulsivity that are associated with this disorder. These findings highlight the importance of assessing for associated problems when treating a child with an ADHD diagnosis. Furthermore, comprehensive psychosocial treatments should target associated behavioral problems and internalizing symptoms, as well as build social skills and other adaptive coping skills for the child with ADHD. Table 3. Comparison of ADHD and Non-ADHD Groups on Behavioral and Emotional Functioning Comorbidities ADHD Non-ADHD (n = 33) (n = 33) Mean (SD) Mean (SD) t-value BASC Aggression 61.97 (11.09) 45.91 ( 6.39) - 7.21 *** Conduct Problems 64.03 (10.96) 45.27 ( 8.68) - 7.71 *** Anxiety 54.06 (12.87) 47.97 (10.73) - 2.09 * Depression 63.24 (14.62) 45.03 ( 7.86) - 6.30 *** Somatization 54.52 (14.05) 46.48 ( 9.40) - 2.73 ** Atypicality 64.24 (18.67) 44.21 ( 6.70) - 5.79 *** Withdrawal 50.76 ( 9.94) 51.27 ( 9.35) 0.22 Adaptability 40.81 ( 7.48) 51.73 ( 8.26) 4.76 *** Social Skills 40.91 ( 7.21) 50.82 ( 7.47) 5.48 *** Leadership 43.70 ( 6.39) 50.79 ( 6.81) 4.36 *** HSQ Problematic Setting 10.94 ( 3.39) 2.52 ( 2.41) -11.63 *** Mean Severity Rating 4.27 ( 1.63) 1.12 (1.24) - 8.84 *** Note: BASC = Behavior Assessment System for Children (Reynolds & Kamphaus, 1992); HSQ = Home Situations Questionnaire (Barkley, 1987). * p < .05, ** p < .01, *** p < .001. REFERENCES American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, fourth edition, text revision (DSM-IV-TR). Washington DC: Author. Bagwell, C. L., Molina, B. S. G., Pelham, W. E., & Hoza, B. (2001). Attention-deficit hyperactivity disorder and problems in peer relations: Predictions from childhood to adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1285-1292. Barkley, R. A. (1987). Defiant children: Parent-teacher assignments. New York: Guilford Press. Biederman, J., Mick, E., Faraone, S. V., & Burback, M. (2001). Patterns of remission and symptom decline in conduct disorder: A four-year prospective study of an ADHD sample. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 290-298. Kaufman, A. S., & Kaufman, N. L. (1990). Kaufman brief intelligence test (K-BIT). Circle Pines, MN: American Guidance Service. Reynolds, C. R., & Kamphaus, R. W. (1992). Behavior assessment system for children (BASC). Circle Pines, MN: American Guidance Services. Power, T. J., Costigan, T. E., Eiraldi, R. B., & Leff, S. S. (2004). Variations in anxiety and depression as a function of ADHD subtypes defined by DSM-IV: Do subtype differences exist or not? Journal of Abnormal Child Psychology, 32, 27-37. Figure 1. Differences between ADHD and non-ADHD groups on BASC and HSQ composite scores. Poster presented at the 2004 Convention of the Association for the Advancement of Behavior Therapy, New Orleans, LA For further information, please contact Tammy D. Barry, Ph.D., The University of Southern Mississippi, Department of Psychology, 118 College Drive, #5025, Hattiesburg, MS, 39406; Email: tammy.barry@usm.edu