Transcript N - The University of Southern Mississippi

Behavioral and Emotional Correlates of ADHD in Children
Tammy D. Barry,
1 The
1
Ph.D. ,
Christopher T. Barry,
1
Ph.D. ,
Beth H. Garland,
2
University of Southern Mississippi, Texas A&M University,
2
M.A. ,
3 North
and Robert D. Lyman,
Georgia College and State University
Table 1: Demographic Characteristics of the ADHD and non-ADHD Groups
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.
Gender (% males)
Pearson 2 (1, N = 66) = 2.20, p = .14
Race (% Caucasian)
Pearson 2 (2, N = 66) = 1.02, p = .60
Age in months
Grade in school
Average education of caregivers (in years)
Household income (in thousand dollars)
K-BIT IQ Composite
ADHD
(n = 33)
Non-ADHD
(n = 33)
(63.6%)
(45.5%)
(87.9%)
(88.4%)
Mean (SD)
132.67 (15.59)
5.30 (1.24)
13.36 (2.07)
51.99 (30.80)
103.03 (14.39)
Mean (SD)
134.88 (13.87)
5.45 (1.18)
13.99 (2.05)
52.75 (22.68)
112.03 (9.35)
RESULTS
Independent samples t-tests were conducted to compare the ADHD and nonADHD 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.
t-value
0.61
1.43
1.23
0.11
3.01 **
Note: K-BIT = Kaufman Brief Intelligence Test (Kaufman & Kaufman, 1990); ** p < .01
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
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.
Figure 1. Differences between ADHD and non-ADHD
groups on BASC and HSQ composite scores.
80
70
60
50
40
30
20
10
0
ADHD
Non-ADHD
61.97
64.03
54.06
63.24
54.52
64.24
50.76
40.81
40.91
43.70
10.94
4.27
(11.09)
(10.96)
(12.87)
(14.62)
(14.05)
(18.67)
( 9.94)
( 7.48)
( 7.21)
( 6.39)
( 3.39)
( 1.63)
45.91
45.27
47.97
45.03
46.48
44.21
51.27
51.73
50.82
50.79
2.52
1.12
( 6.39)
( 8.68)
(10.73)
( 7.86)
( 9.40)
( 6.70)
( 9.35)
( 8.26)
( 7.47)
( 6.81)
( 2.41)
(1.24)
- 7.21 ***
- 7.71 ***
- 2.09 *
- 6.30 ***
- 2.73 **
- 5.79 ***
0.22
4.76 ***
5.48 ***
4.36 ***
-11.63 ***
- 8.84 ***
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Note: BASC = Behavior Assessment System for Children (Reynolds & Kamphaus, 1992); HSQ = Home Situations
Questionnaire (Barkley, 1987). * p < .05, ** p < .01, *** p < .001.
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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
Conduct Problems
Anxiety
Depression
Somatization
Atypicality
Withdrawal
Adaptability
Social Skills
Leadership
HSQ Problematic Setting
Mean Severity Rating
3
Ph.D.
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: [email protected]
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 nonADHD children (6%) had been in special education.
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.
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.