Symptoms versus Impairment: The Case for Respecting DSM-IV's Criterion D

Gordon, Michael S.; Antshel, Kevin M.; Faraone, Stephen V.; Barkley, Russell A.; Lewandowski, Larry; Hudziak, J.; Biederman, Joseph; Cunningham, Charles E.

doi:10.1521/adhd.2005.13.4.1

Cited by 91 publications

(119 citation statements)

References 19 publications

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“…Previous studies of school-aged children have found that ADHD symptoms explain about 25% to 30% of variance in impairment (9)(10)(11), which is quite similar to our findings of less than 30%. A pertinent question is of course which other factors determine impairment in children with ADHD, but studies specifically addressing these issues are largely missing.…”

Section: Discussionsupporting

confidence: 92%

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

Bendiksen

Aase

Svensson

et al. 2013

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

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Background: We have limited knowledge of the impact of attention-deficit/hyperactivity disorder (ADHD) symptoms on the daily functioning of young preschool children. Objective: 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 cooccurrence of oppositional defiant disorder, conduct disorder, or both. Method: 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." Results: 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. Conclusion: 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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Section: Discussionsupporting

confidence: 92%

“…Thus, it will be expected that psychiatric symptoms will only explain a smaller proportion of the variance in impairment. However, it is also possible that the answer to this question will in part depend on which functional domains are being scrutinized (10).…”

Section: Discussionmentioning

confidence: 99%

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

Bendiksen

Aase

Svensson

et al. 2013

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

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“…Behavioral ratings of the ADHD symptom dimensions (hyperactive-impulsive behavior and inattention) should also qualify given that they fulfill the first three qualifications of an endophenotype. Indeed they are likely to predict liability or risk for disorder better than neuropsychological tests (which are poor at doing so; Grodzinsky & Barkley, 1999), have better ecological validity (relationships to behavior in natural settings; Barkley, 1991), sample behavior over longer time periods (months rather than minutes), are stable over development (Barkley et al, 2002), are predictive of domains of major life impairments (Barkley et al, 2002;Gordon et al, 2005), and are more sensitive to drug interventions for ADHD than are those psychological tests proposed for use as endophenotypes. And given that psychological tests are just other ways of measuring behavior and are not necessarily more proximal to the etiological factor of interest or more sensitive to the underlying mechanisms giving rise to disorder than are behavior ratings, we see no reason to prefer the former over the latter absent any empirical evidence for doing so.…”

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

“…The correlations between the two scales are: r = . 43 Child Behavior Checklist (CBCL; Achenbach & Edelbrock, 1983)-The original version of this widely used rating scale became available shortly after this study began. This version contains 138 items rated on a scale of 0-2 and is designed for use with parents in rating children between 4-16 years of age.…”

Section: Measures From Childhood (Study Entry)mentioning

confidence: 99%

“…We have therefore chosen for analysis not simply psychological tests that have had some success in distinguishing ADHD from control groups in prior studies and that are regarded as prime candidates for endophenotypes in genetic research on ADHD (Castellanos & Tannock, 2002). We also chose ratings of ADHD and related behavior (inhibition, attention, externalizing) and a few selected measures of potential genetic consequences "at a distance" which have been previously linked to ADHD symptoms (Gordon et al, 2005). These were grade point average in high school, class ranking, and employer ratings of ADHD and of work performance that may be considered part of its extended phenotype.…”

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confidence: 99%

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An examination of the behavioral and neuropsychological correlates of three ADHD candidate gene polymorphisms (DRD4 7+, DBH TaqI A2, and DAT1 40 bp VNTR) in hyperactive and normal children followed to adulthood

Barkley

Smith

Fischer

et al. 2006

American J of Med Genetics Pt B

104

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Several candidate gene polymorphisms have been implicated in attention deficit hyperactivity disorder (ADHD), including DAT1 40bp VNTR, DRD4 7+, and DBH TaqI A2 alleles. We used the Milwaukee longitudinal study of hyperactive (N=122) and normal (N=67) children to compare participants with and without these respective polymorphisms on ADHD-related behavioral ratings at childhood, 8 years later in adolescence, and 13+ years later into young adulthood. Neuropsychological tests were given at the adolescent and young adulthood follow-up. No differences were found between the DRD4-7+ and 7-repeat polymorphism. The DBH TaqI A2 allele, when homozygous, was associated with being more hyperactive in childhood, having more pervasive behavior problems at adolescence, and earning less money on a Card Playing Task in adulthood. At adolescence, poorer test scores were also found only in the hyperactive group with homozygous for this allele. The DAT1 40bp VNTR heterozygous 9/10 repeat, however, differed from the 10/10 repeat pair in many respects, having greater ADHD and externalizing symptoms at all three follow-ups, more cross-situational behavioral problems at both childhood and adolescence, poorer mother-teen relations at adolescence, and lower class rankings in high school. Participants with the 9/10 pair in the control group also had lower work performance, a lower grade point average in high school, greater teacher rated externalizing symptoms at adolescence, and greater omission errors on a continuous performance test in adulthood. The DAT1 40bp VNTR 9/10 polymorphism pairing appears to be reliably associated with greater symptoms of ADHD and externalizing behavior from childhood to adulthood, and with family, educational, and occupational impairments. We also present a contrary view on the appropriate endophenotypes for use in behavioral genetic research on ADHD.Children with Attention Deficit Hyperactivity Disorder (ADHD), or what was previously diagnosed as Hyperactive Child Syndrome, are characterized by developmentally inappropriate levels of inattentive, impulsive, and hyperactive behavior that arise early in childhood and occur across multiple settings (American Psychiatric Association, 1968, 1980, 2001. Follow-up studies of hyperactive children suggest that from 35-80 percent of NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript cases diagnosed in childhood will persist into adolescence Gittelman et al., 1985). By adulthood, 49-66% will have significant symptoms of the disorder or meet diagnostic criteria for it (Barkley et al., 2002;Mannuzza et al., 1993Mannuzza et al., ,1998 Rasmussen & Gillberg, 2002;Weiss and Hechtman, 1993).Biological relatives of children with the disorder are more likely to have ADHD (Biederman et al. 1990, Biederman et al. 1992, Biederman et al. 1995, Maher et al. 1999, Samuel et al. 1999. Numerous twin studies found that genetic factors account for the majority of variance in this trait with an average heritability of .75-.80, with more recent studies u...

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