Journal article
Affective-cognitive-behavioral heterogeneity of Attention-Deficit/Hyperactivity Disorder (ADHD): Emotional dysregulation as a sentinel symptom differentiating “ADHD-simplex” and “ADHD-complex” syndromes?
Journal of Affective Disorders, Vol.307, pp.133-141
2022
Abstract
Background
Current DSM and ICD classifications of Attention-Deficit/Hyperactivity Disorder (ADHD) exclude emotional dysregulation (ED) in their diagnostic criteria, despite ED symptoms frequently co-occurring in ADHD and likely sharing common neurobiological substrates. In this study, we examined whether consideration of ED symptoms could delineate more informative “ADHD+ED” subphenotypes.
Method
4106 children with ADHD were recruited. ED and inattentive (IA) and hyperactive/impulsive (HI) symptoms were profiled using latent class analyses (LCA). The derived latent class (LC) subphenotypes were evaluated and validated in relation to comorbidity patterns, executive functions, and functional impairments.
Results
Five LC subphenotypes with ED symptoms were identified: IA/HI + ED profile (LC1); HI + ED profile (LC2); IA + ED profile (LC3); IA/HI profile (LC4); and IA profile (LC5). Cross-validation of the LCA model using support vector machine analysis confirmed 83% accuracy. ED positive (ED+ve) subphenotypes were associated with higher rates of oppositional defiant disorder, mood disorders, anxiety disorders, as well as more severe autistic traits and sluggish cognitive tempo symptoms. Higher rates of ecological executive functioning impairments (BRIEF ratings) were found among ED+ve subphenotypes (though no differences were detected by laboratory-based measures). Functional impairments were also more severe among participants with ED+ve subphenotypes.
Limitations
The data for our LCA were cross-sectional and based primarily on parent ratings.
Conclusion
Our classification model has parcellated IA, HI, and ED symptoms into novel informative subphenotypes. These classifications provide preliminary evidence that ED symptoms could serve as sentinel features to identify a potential “ADHD-complex” syndrome, which demarcates a more pervasive condition of greater severity, complexity, and impairment.
Details
- Title
- Affective-cognitive-behavioral heterogeneity of Attention-Deficit/Hyperactivity Disorder (ADHD): Emotional dysregulation as a sentinel symptom differentiating “ADHD-simplex” and “ADHD-complex” syndromes?
- Authors/Creators
- X. Yue (Author/Creator) - Peking University Sixth HospitalL. Liu (Author/Creator) - Peking University Sixth HospitalW. Chen (Author/Creator) - Curtin UniversityD.A. Preece (Author/Creator) - Curtin UniversityQ. Liu (Author/Creator) - Peking University Sixth HospitalH. Li (Author/Creator) - Peking University Sixth HospitalY. Wang (Author/Creator) - Peking University Sixth HospitalQ. Qian (Author/Creator) - Peking University Sixth Hospital
- Publication Details
- Journal of Affective Disorders, Vol.307, pp.133-141
- Publisher
- Elsevier
- Identifiers
- 991005540186807891
- Copyright
- © 2022 Elsevier B.V.
- Murdoch Affiliation
- School of Allied Health
- Language
- English
- Resource Type
- Journal article
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- Collaboration types
- Domestic collaboration
- International collaboration
- Citation topics
- 1 Clinical & Life Sciences
- 1.136 Autism & Development Disorders
- 1.136.641 ADHD
- Web Of Science research areas
- Clinical Neurology
- Psychiatry
- ESI research areas
- Psychiatry/Psychology