Comorbid externalising behaviour in AD/HD: evidence for a distinct pathological entity in adolescence

PLoS One. 2012;7(9):e41407. doi: 10.1371/journal.pone.0041407. Epub 2012 Sep 12.

Abstract

While the profiling of subtypes of Attention Deficit Hyperactivity Disorder (AD/HD) have been the subject of considerable scrutiny, both psychometrically and psychophysiologically, little attention has been paid to the effect of diagnoses comorbid with AD/HD on such profiles. This is despite the greater than 80% prevalence of comorbidity under the DSM-IV-TR diagnostic definitions. Here we investigate the event related potential (ERP) and psychometric profiles of Controls, AD/HD, and comorbid AD/HD (particularly AD/HD+ODD/CD) groups on six neurocognitive tasks thought to probe the constructs of selective and sustained attention, response inhibition and executive function. Data from 29 parameters extracted from a child group (age range 6 to 12; 52 Controls and 64 AD/HD) and from an adolescent group (age range 13 to 17; 79 Controls and 88 AD/HD) were reduced via a Principal Components Analysis, the 6 significant eigenvectors then used as determinants of cluster membership via a Two-Step Cluster Analysis. Two clusters were found in the analysis of the adolescent age group--a cluster dominated by Control and AD/HD participants without comorbidity, while the second cluster was dominated by AD/HD participants with externalising comorbidity (largely oppositional defiant/conduct disorder ODD/CD). A similar segregation within the child age group was not found. Further analysis of these objectively determined clusters in terms of their clinical diagnoses indicates a significant effect of ODD/CD comorbidity on a concurrent AD/HD diagnosis. We conclude that comorbid externalising behaviour in AD/HD constitutes a distinct pathological entity in adolescence.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adolescent Behavior*
  • Attention Deficit Disorder with Hyperactivity / epidemiology
  • Attention Deficit Disorder with Hyperactivity / pathology*
  • Attention Deficit Disorder with Hyperactivity / physiopathology
  • Attention Deficit Disorder with Hyperactivity / psychology*
  • Attention Deficit and Disruptive Behavior Disorders / epidemiology
  • Attention Deficit and Disruptive Behavior Disorders / physiopathology
  • Attention Deficit and Disruptive Behavior Disorders / psychology
  • Australia / epidemiology
  • Case-Control Studies
  • Child
  • Child Behavior
  • Cluster Analysis
  • Comorbidity
  • Conduct Disorder / epidemiology
  • Conduct Disorder / physiopathology
  • Conduct Disorder / psychology
  • Evoked Potentials
  • Humans
  • Male
  • Principal Component Analysis

Grants and funding

This study was funded under an Australian Research Council Linkage Grant (no. LP0349079) and the authors acknowledge the support of linkage partner, the Brain Resource Company (BRC) [www.brainresource.com], for use of the Brain Resource International Database (BRID). The authors also thank the individuals who gave their time to take part in the study. R. Clark holds shares (<1% of capital) in the BRC. All scientific decisions are made independent of BRC's commercial decisions via the independently operated scientific division, BRAINnet (www.brainnet.org.au), which is overseen by the independently funded Brain Dynamics Centre and scientist members. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.