ADHD comorbidity findings from the MTA study: comparing comorbid subgroups.

Published

Journal Article

Previous research has been inconclusive whether attention-deficit/hyperactivity disorder (ADHD), when comorbid with disruptive disorders (oppositional defiant disorder [ODD] or conduct disorder [CD]), with the internalizing disorders (anxiety and/or depression), or with both, should constitute separate clinical entities. Determination of the clinical significance of potential ADHD + internalizing disorder or ADHD + ODD/CD syndromes could yield better diagnostic decision-making, treatment planning, and treatment outcomes.Drawing upon cross-sectional and longitudinal information from 579 children (aged 7-9.9 years) with ADHD participating in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA), investigators applied validational criteria to compare ADHD subjects with and without comorbid internalizing disorders and ODD/CD.Substantial evidence of main effects of internalizing and externalizing comorbid disorders was found. Moderate evidence of interactions of parent-reported anxiety and ODD/CD status were noted on response to treatment, indicating that children with ADHD and anxiety disorders (but no ODD/CD) were likely to respond equally well to the MTA behavioral and medication treatments. Children with ADHD-only or ADHD with ODD/CD (but without anxiety disorders) responded best to MTA medication treatments (with or without behavioral treatments), while children with multiple comorbid disorders (anxiety and ODD/CD) responded optimally to combined (medication and behavioral) treatments.Findings indicate that three clinical profiles, ADHD co-occurring with internalizing disorders (principally parent-reported anxiety disorders) absent any concurrent disruptive disorder (ADHD + ANX), ADHD co-occurring with ODD/CD but no anxiety (ADHD + ODD/CD), and ADHD with both anxiety and ODD/CD (ADHD + ANX + ODD/CD) may be sufficiently distinct to warrant classification as ADHD subtypes different from "pure" ADHD with neither comorbidity. Future clinical, etiological, and genetics research should explore the merits of these three ADHD classification options.

Full Text

Duke Authors

Cited Authors

  • Jensen, PS; Hinshaw, SP; Kraemer, HC; Lenora, N; Newcorn, JH; Abikoff, HB; March, JS; Arnold, LE; Cantwell, DP; Conners, CK; Elliott, GR; Greenhill, LL; Hechtman, L; Hoza, B; Pelham, WE; Severe, JB; Swanson, JM; Wells, KC; Wigal, T; Vitiello, B

Published Date

  • February 2001

Published In

Volume / Issue

  • 40 / 2

Start / End Page

  • 147 - 158

PubMed ID

  • 11211363

Pubmed Central ID

  • 11211363

Electronic International Standard Serial Number (EISSN)

  • 1527-5418

International Standard Serial Number (ISSN)

  • 0890-8567

Digital Object Identifier (DOI)

  • 10.1097/00004583-200102000-00009

Language

  • eng