A Symptom Level Perspective on Reactive and Proactive Aggressive Behaviours and ADHD Symptoms in Childhood

Abstract

Objective: Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent childhood disorders, affecting around 6.5% of youths worldwide. One common and impairing correlate of ADHD is aggressive behaviour which likely acts as a major contributor to the negative outcomes associated with ADHD. ADHD symptoms and aggression are both heterogeneous and it has been speculated that certain symptoms of ADHD might map more closely to certain types of aggressive behaviour. This study uses a symptom-level analysis to investigate the concurrent and temporal links between symptoms of ADHD and aggressive behaviours. This allows insights into whether specific symptoms are more likely to be connected which is highly important to refine intervention targets aiming to reduce aggressive behaviours associated with ADHD.Method: Using Gaussian Graphical Models and Graphical Vector Autoregression Models, cross-sectional and longitudinal networks of ADHD symptoms and aggressive behaviours, measured using parent-reported Social Behaviour Questionnaires (SBQ), were estimated. Participants included 1379 children taking part in the longitudinal Swiss z-proso cohort study at ages 7, 9 and 11. Results: Cross-sectional networks indicated that impulsivity symptoms and fidgeting were connected to reactive aggression under different types of provocation, with fidgeting also connected to a form of proactive aggression, namely dominating other children. The longitudinal network highlighted that ADHD symptoms and aggressive behaviours share a multitude of reciprocal temporal relations with inattentive ADHD symptoms preceding both reactive and proactive aggression. Conclusion: Findings from the current study present preliminary evidence indicating that interventions should focus on both hyperactive/impulsive and inattentive symptoms in order to reduce aggressive behaviours in children with ADHD. They further highlight that it is important to target feedback loops resulting from aggressive behaviours. Future research is needed to better understand the mechanisms through which ADHD and aggressive behaviours become linked.

Exploring the effect of ADHD traits on the moment‐to‐moment interplay between provocation and aggression: Evidence from dynamic structural equation modeling

“…In brief, the z-proso cohort currently consists of a large sample of young Swiss adults (e.g., n = 1,180 for age 20 wave) who have participated in 10 waves of data collection, tracking their childhood development, since the age of seven. Participants were recruited using a stratified sampling procedure, selecting 56 schools based on school size and location to warrant sufficient representativeness across a wide range of ethnicities, socioeconomic backgrounds, and area-based deprivation (Eisner et al, 2019;Speyer, Eisner, et al, 2022). Previous investigations have indicated that the sample is largely illustrative of the underlying same-aged population (N. L. Eisner et al, 2019).…”

“…For example, as the roles typically adopted during adulthood (e.g., obtaining jobs, fostering romantic relationships, and having children) require prosocial behaviors (e.g., empathy, perspective-taking, and responsibility), those who experience heightened aggression may struggle to gain and maintain such roles (Murray et al, 2021;Wensveen et al, 2017). Considering these findings, aggression is often considered one of the most impairing consequences of ADHD (Speyer, Eisner, et al, 2022). Thus, numerous efforts have been made to identify the underlying factors in the ADHD/aggression link that may be important to target in interventions.…”