Presenting problem profiles for adolescents with ADHD: differences by sex, age, race, and family adversity

Stefany Coxe; Margaret H Sibley; Stephen P Becker

doi:10.1111/camh.12441

Presenting problem profiles for adolescents with ADHD: differences by sex, age, race, and family adversity

Child Adolesc Ment Health. 2021 Sep;26(3):228-237. doi: 10.1111/camh.12441. Epub 2020 Dec 17.

Authors

Stefany Coxe¹, Margaret H Sibley², Stephen P Becker^{3

4}

Affiliations

¹ Department of Psychology, Florida International University, Miami, FL, USA.
² Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA, USA.
³ Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
⁴ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

PMID: 33350581
DOI: 10.1111/camh.12441

Abstract

Background: Adolescents with attention-deficit/hyperactivity disorder (ADHD) experience developmentally distinct challenges from children and adults with ADHD. Yet no work in this age group identifies treatment-related phenotypes that can inform treatment matching, development of tailored treatments, and screening efforts.

Method: This study uses Latent Profile Analysis to detect unique presenting problem profiles among adolescents with ADHD and to test whether these profiles differ by key individual characteristics (age, sex, race, family adversity level). Participants were 854 ethnically diverse adolescents (ages 10-17) from the ADHD Teen Integrative Data Analysis Longitudinal (TIDAL) dataset who were assessed at clinical referral. Parent, adolescent, and teacher ratings, educational testing, and school records measured eight key presenting problems at intake.

Results: A three-profile solution emerged. ADHD simplex (63.7%) was characterized by a mix of the ADHD-Inattentive and ADHD-Combined subtypes, moderate impairment levels, and infrequent comorbidities. ADHD + internalizing (11.4%) was characterized by higher likelihood of comorbid anxiety and/or depression. The disruptive/disorganized ADHD (24.9%) profile was characterized by severe organization, time management, and planning (OTP) problems, the ADHD-Combined subtype, and frequent disruptive behavior at school. Age did not vary across these phenotypes. More females were present in the ADHD + internalizing phenotype; males were more likely to be found in the disruptive/disorganized ADHD phenotype. Higher family adversity and African American race were associated with the disruptive/disorganized ADHD phenotype.

Conclusions: Adolescents with ADHD demonstrate varying presenting problem phenotypes that vary by sex, family adversity, and race/ethnicity. Consideration of these phenotypes may inform treatment matching and efforts to improve screening among under-diagnosed groups.

Keywords: ADHD; adolescence; methodology; structural equation modeling.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Anxiety
Anxiety Disorders
Attention Deficit Disorder with Hyperactivity* / diagnosis
Attention Deficit Disorder with Hyperactivity* / epidemiology
Child
Comorbidity
Female
Humans
Male
Parents

Abstract

Publication types

MeSH terms

Grants and funding