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Published November 30, 2013 | Version v1
Journal article Open

Impairment in Young Preschool Children with Symptoms of Attention-Deficit/Hyperactivity Disorder and Co-occurring Oppositional Defiant Disorder and Conduct Disorder

Creators

  • 1. University of Oslo, Oslo University Hospital, Department of Psychiatric Research and Development,,Norway
  • 2. The Norwegian Institute of Public Health, Division of Mental Health,,Norway
  • 3. Department of Clinical Epidemiology, University of Aarhus, Denmark,,Norway

Description

We have limited knowledge of the impact of attention-deficit/hyperactivity disorder (ADHD) symptoms on the daily functioning of young preschool children.This study investigated the level of impairment related to symptoms of ADHD in different functional domains. It also addressed how impairment caused by ADHD was related to ADHD subtype, symptom load, gender, and the co-occurrence of oppositional defiant disorder, conduct disorder, or both.Participating children (N = 807) who were 3.5 years old were recruited from a population-based sample included in The Norwegian Mother and Child Cohort Study. Children who scored above the 90th percentile for ADHD symptoms were included in the present sample. The assessment of the symptoms and functional impairment described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, text revision, was based on parental ratings and the semi-structured psychiatric interview entitled "The Preschool Age Psychiatric Assessment."Added burden and discord within family relationships were the areas that were most severely affected. All domain scores were strongly intercorrelated, and they were added to each child's total score. Children with symptoms of ADHD, inattentive type (mean [M], 3.5; standard deviation [SD], 3.4), or ADHD, hyperactive/impulsive type (M, 2.9; SD, 2.7), were significantly less impaired than children with symptoms of ADHD, combined type (M = 6.4; SD = 3.8; p < .001). Furthermore, co-occurring oppositional defiant disorder was associated with higher impairment scores (M, 6.1; SD, 4.3) than ADHD alone (M, 3.2; SD, 2.9; p < .001. About 30% of the variance of impairment score of ADHD was explained by symptoms of ADHD and co-occurring symptoms of oppositional defiant disorder and conduct disorder. Few gender differences were observed.Overall, these non-referred young children with clinical symptoms of ADHD were only modestly impaired. Impairment related to ADHD occurred mainly in the areas of family functioning, and it was associated with ADHD subtype and comorbidity. Still, it is important to assess the impact of ADHD symptoms and coexisting difficulties among preschoolers to identify children and families who are in need of early intervention efforts.

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References

  • American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR®. American Psychiatric Publication, 2000.
  • Egger HLM, Kondo DM, Angold AM. The epidemiology and diagnostic Issues in preschool Attention-Deficit/Hyperactivity Disorder: A review. Infants & Young Children Attention-Deficit/Hyperactivity Disorder 2006;19(2):109-22.
  • Lahey BB, Pelham WE, Loney J, et al. Three-year predictive validity of DSM-IV attention deficit hyperactivity disorder in children diagnosed at 4-6 years of age. Am J Psychiatry 2004;161(11):2014-20.
  • Wilens TE, Biederman J, Brown S, et al. Psychiatric comorbidity and functioning in clinically referred preschool children and school-age youths with ADHD. J Am Acad Child Adolesc Psychiatry 2002;41(3):262-8.
  • Egger HL, Angold A. Common emotional and behavioral disorders in preschool children: presentation, nosology, and epidemiology. J Child Psychol Psychiatry 2006;47(3-4):313-37.
  • Healey DM, Miller CJ, Castelli KL, Marks DJ, Halperin JM. The impact of impairment criteria on rates of ADHD diagnoses in preschoolers. J Abnorm Child Psychol 2008;36(5):771-8.
  • Nolan EE, Gadow KD, Sprafkin J. Teacher reports of DSM-IV ADHD, ODD, and CD symptoms in schoolchildren. J Am Acad Child Adolesc Psychiatry 2001;40(2):241-9.
  • Willcutt EG, Nigg JT, Pennington BF, Solanto MV, Rohde LA, Tannock R, et al. Validity of DSM-IV attention deficit/hyperactivity disorder symptom dimensions and subtypes. J Abnorm Psychol 2012;121(4):991-1010.
  • Gathje RA, Lewandowski LJ, Gordon M. The role of impairment in the diagnosis of ADHD. J Atten Disord 2008;11(5):529-37.
  • Gordon M, Antshel K, Faraone S, Barkley R, Lewandowski L, Hudziak JJ, et al. Symptoms versus impairment: the case for respecting DSM-IV's Criterion D. J Atten Disord 2006;9(3):465-75.
  • Pickles A, Rowe R, Simonoff E, Foley D, Rutter M, Silberg J. Child psychiatric symptoms and psychosocial impairment: relationship and prognostic significance. Br J Psychiatry 2001;179:230-5.
  • Coghill D, Spiel G, Baldursson G, et al. Which factors impact on clinician-rated impairment in children with ADHD? Eur Child Adolesc Psychiatry 2006;15 Suppl 1:I30-I37.
  • Connor DF, Doerfler LA. ADHD with comorbid oppositional defiant disorder or conduct disorder: discrete or nondistinct disruptive behavior disorders? J Atten Disord 2008;12(2):126-34.
  • Kessler RC, Adler LA, Barkley R, Biederman J, Conners CK, Faraone SV, et al. Patterns and predictors of attention-deficit/hyperactivity disorder persistence into adulthood: results from the national comorbidity survey replication. Biol Psychiatry 2005;57(11):1442-51.
  • Newcorn JH, Halperin JM, Jensen PS, Abikoff HB, Arnold LE, Cantwell DP, et al. Symptom profiles in children with ADHD: effects of comorbidity and gender. J Am Acad Child Adolesc Psychiatry 2001;40(2):137-46.
  • Pliszka SR. Comorbidity of attention-deficit/hyperactivity disorder with psychiatric disorder: an overview. J Clin Psychiatry 1998;59 Suppl 7:50-8.
  • Gadow KD, Nolan EE. Differences between preschool children with ODD, ADHD, and ODD+ADHD symptoms. J Child Psychol Psychiatry 2002;43(2):191-201.
  • Lavigne JV, Lebailly SA, Hopkins J, Gouze KR, Binns HJ. The prevalence of ADHD, ODD, depression, and anxiety in a community sample of 4-year-olds. J Clin Child Adolesc Psychol 2009;38(3):315-28.
  • Ezpeleta L, de la Osa N, Domenech JM. Prevalence of DSM-IV disorders, comorbidity and impairment in 3-year-old Spanish preschoolers. Soc Psychiatry Psychiatr Epidemiol 2014;49(1):145-55.
  • Kadesjo C, Hagglof B, Kadesjo B, Gillberg C. Attention-deficit-hyperactivity disorder with and without oppositional defiant disorder in 3- to 7-year-old children. Dev Med Child Neurol 2003;45(10):693-9.
  • Lahey BB, Loeber R, Burke JD, Applegate B. Predicting future antisocial personality disorder in males from a clinical assessment in childhood. J Consult Clin Psychol 2005;73(3):389-99.
  • Lahey BB, Van Hulle CA, Rathouz PJ, Rodgers JL, D'Onofrio BM, Waldman ID. Are oppositional-defiant and hyperactive-inattentive symptoms developmental precursors to conduct problems in late childhood?: genetic and environmental links. J Abnorm Child Psychol 2009;37(1):45-58.
  • Mannuzza S, Klein RG, Abikoff H, Moulton JL, III. Significance of childhood conduct problems to later development of conduct disorder among children with ADHD: a prospective follow-up study. J Abnorm Child Psychol 2004;32(5):565-73.
  • Moffitt TE, Caspi A, Harrington H, Milne BJ. Males on the life-course-persistent and adolescence-limited antisocial pathways: follow-up at age 26 years. Dev Psychopathol 2002;14(1):179-207.
  • Burke JD, Rowe R, Boylan K. Functional outcomes of child and adolescent oppositional defiant disorder symptoms in young adult men. J Child Psychol Psychiatry 2014;5(3):264-72.
  • Bendiksen B, Svensson E, Aase H, et al. Co-Occurrence of ODD and CD in Preschool Children With Symptoms of ADHD. J Atten Disord 2014 Jul 3.
  • Posner K, Melvin GA, Murray DW, Gugga SS, Fisher P, Skrobala A, et al. Clinical presentation of attention-deficit/hyperactivity disorder in preschool children: the Preschoolers with Attention-Deficit/Hyperactivity Disorder Treatment Study (PATS). J Child Adolesc Psychopharmacol 2007;17(5):547-62.
  • Magnus P, Irgens LM, Haug K, Nystad W, Skjaerven R, Stoltenberg C. Cohort profile: the Norwegian Mother and Child Cohort Study (MoBa). Int J Epidemiol 2006;35(5):1146-50.
  • Achenbach TM. Child Behavior Checklist, 2000.
  • Egger HL, Angold A. The Preschool Age Psychiatric Assessment (PAPA): a structured parent interview for diagnosing psychiatric disorders in preschool children. In: Del Carmen-Wiggins R, A. Carter A (Eds): Handbook of infant, toddler, and preschool mental health assessment. New York, NY: Oxford University Press; 2004, pp. 223-43.
  • Egger HL, Erkanli A, Keeler G, Potts E, Walter BK, Angold A. Test-retest reliability of the Preschool Age Psychiatric Assessment (PAPA). J Am Acad Child Adolesc Psychiatry 2006;45(5):538-49.
  • Keenan K, Wakschlag LS, Danis B, et al. Further evidence of the reliability and validity of DSM-IV ODD and CD in preschool children. J Am Acad Child Adolesc Psychiatry 2007;46(4):457-68.
  • Magnus P, Haug K, Nystad W, Skjaerven R. [The mother and child cohort study will give new answers]. Tidsskr Nor Laegeforen 2006;126(13):1747-9.
  • Roid GH. Stanford-Binet Intelligence Scales (SB5). Rolling Meadows, IL: Riverside Publishing; 2003.
  • Cohen J, Cohen P, West SG, Aiken LS. Applied multiple regression/correlation analysis for the behavorial sciences. 3rd ed. Mahwah, NJ: Lawrence Elbaum Associates; 2003.
  • Nigg JT. Attention-deficit/hyperactivity disorder and adverse health outcomes. Clin Psychol Rev 2013;33(2):215-28.
  • Simonoff E, Pickles A, Meyer JM, Silberg JL, Maes HH, Loeber R, et al. The Virginia twin study of adolescent behavioral development. Influences of age, sex, and impairment on rates of disorder. Arch Gen Psychiatry 1997;54(9):801-8.
  • Wille N, Bettge S, Wittchen HU, Ravens-Sieberer U. How impaired are children and adolescents by mental health problems? Results of the BELLA study. Eur Child Adolesc Psychiatry 2008;17 Suppl 1:42-51.
  • Lahey BB, Pelham WE, Stein MA, Loney J, Trapani C, Nugent K, et al. Validity of DSM-IV attention-deficit/hyperactivity disorder for younger children. J Am Acad Child Adolesc Psychiatry 1998;37(7):695-702.
  • Wichstrom L, Berg-Nielsen TS, Angold A, Egger HL, Solheim E, Sveen TH. Prevalence of psychiatric disorders in preschoolers. J Child Psychol Psychiatry 2012;53(6):695-705.
  • Gadow KD, Sprafkin J, Nolan EE. DSM-IV symptoms in community and clinic preschool children. J Am Acad Child Adolesc Psychiatry 2001;40(12):1383-92.
  • Biederman J, Kwon A, Aleardi M, Chouinard VA, Marino T, Cole H, et al. Absence of gender effects on attention deficit hyperactivity disorder: findings in nonreferred subjects. Am J Psychiatry 2005;162(6):1083-9.
  • Gaub M, Carlson CL. Gender differences in ADHD: a meta-analysis and critical review. J Am Acad Child Adolesc Psychiatry 1997;36(8):1036-45.
  • Novik TS, Hervas A, Ralston SJ, et al. Influence of gender on attention-deficit/hyperactivity disorder in Europe--ADORE. Eur Child Adolesc Psychiatry 2006;15 Suppl 1:I15-I24.
  • Rapee RM, Bogels SM, van der Sluis CM, Craske MG, Ollendick T. Annual research review: Conceptualising functional impairment in children and adolescents. J Child Psychol Psychiatry 2012;53(5):454-68.
  • Krueger RF, Markon KE. Reinterpreting comorbidity: a model-based approach to understanding and classifying psychopathology. Annu Rev Clin Psychol 2006;2:111-33.
  • Nilsen RM, Vollset SE, Gjessing HK, Skjaerven R, Melve KK, Schreuder P, et al. Self-selection and bias in a large prospective pregnancy cohort in Norway. Paediatr Perinat Epidemiol 2009;23(6):597-608.
  • Goodman R, Ford T, Simmons H, Gatward R, Meltzer H. Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. Br J Psychiatry 2000;177:534-9.
  • O'Neill S, Schneiderman RL, Rajendran K, Marks DJ, Halperin JM. Reliable ratings or reading tea leaves: can parent, teacher, and clinician behavioral ratings of preschoolers predict ADHD at age six? J Abnorm Child Psychol 2014;42(4):623-34.
  • Reiersen AM, Todorov AA. Exploration of ADHD subtype definitions and co-occurring psychopathology in a Missouri population-based large sibship sample. Scand J Child Adolesc Psychiatr Psychol 2013;1(1):3-13.
  • Angold A, Costello EJ, Farmer EMZ, Burns BJ, Erkanli A. Impaired but undiagnosed. J Am Acad Child Adolesc Psychiatry 1999;(2):129-37.
  • Chacko A, Wakschlag L, Hill C, Danis B, Espy KA. Viewing preschool disruptive behavior disorders and attention-deficit/hyperactivity disorder through a developmental lens: what we know and what we need to know. Child Adolesc Psychiatr Clin N Am 2009;18(3):627-43.
  • Kim-Cohen J, Arseneault L, Newcombe R, Adams F, Bolton H, Cant L, et al. Five-year predictive validity of DSM-IV conduct disorder research diagnosis in 4(1/2)-5-year-old children. Eur Child Adolesc Psychiatry 2009;18(5):284-91.