Exploration of ADHD Subtype Definitions and Co-Occurring Psychopathology in a Missouri Population-Based Large Sibship Sample.
Exploration of ADHD Subtype Definitions and Co-Occurring Psychopathology in a Missouri Population-Based Large Sibship Sample.
复制标题
DOI：
10.21307/sjcapp-2013-002
复制
发表时间：
2013-03
影响因子：
1.9
通讯作者：
Todorov AA
中科院分区：
文献类型：
--
作者：
Reiersen AM;Todorov AA
背景：目前关于注意力缺陷多动障碍（ADHD）亚型的定义存在一些争议。亚型之间共同发生的精神病理学的差异将支持亚型定义的有效性。目的：探讨ADHD亚型如何与儿童和青少年（n=5744）的大样本人群中共同发生的精神病理学。方法：父母完成了ADHD症状和正常行为（SWAN）问卷，儿童行为检查表（CBCL）和社会反应量表（SRS）的优点和缺点。采用判别分析、主成分分析和分数多项式回归等方法来研究ADHD诊断亚型与共存精神病理学之间的关系。结果：不同ADHD亚型的儿童在CBCL的几个分量表上存在差异。CBCL分量表与SRS评分相结合对ADHD亚型有较好的区分能力。相反，对于相同总数的ADHD症状，存在注意力不集中和多动/冲动症状的个体在CBCL子量表和SRS的主成分分析得出的汇总测量上表现出更高的共发精神病理学严重程度。这包括一些不符合DSM-IV-TR ADHD症状标准的受试者，因为他们有少于6个注意力不集中和少于6个多动-冲动症状，但ADHD症状严重程度与注意力不集中或多动-冲动亚型相似。结论：几种趋同的分析路线为继续使用ADHD亚型（或当前表现症状特征）提供了支持，共存精神病理学的差异就证明了这一点。我们还发现，目前的诊断标准可能无法识别一组潜在受损的个体，这些个体具有低至中度的注意力不集中和多动/冲动。根据即将发布的DSM-5，临床医生必须考虑对此类儿童进行“其他地方未分类”的多动症诊断。
Background: There is some debate regarding the utility of Attention-Deficit/Hyperactivity Disorder (ADHD) subtypes as currently defined. Differences in co-occurring psychopathology among subtypes would support the validity of subtype definitions. Objective: To explore how ADHD subtype relates to co-occurring psychopathology in a large population-based sample of children and adolescents (n=5744). Method: Parents completed the Strengths and Weaknesses of ADHD-symptoms and Normal behavior (SWAN) questionnaire, the Child Behavior Checklist (CBCL) and the Social Responsiveness Scale (SRS). Methods including discriminant analysis, principal components analysis, and fractional polynomial regression were used to examine the relationship between ADHD diagnostic subtypes and co-occurring psychopathology. Results: Children with different ADHD subtypes show differences on several CBCL subscales. A combination of CBCL sub-scales and SRS score had good ability to discriminate ADHD subtypes. Conversely, for the same overall number of ADHD symptoms, individuals who present with both inattentive and hyperactive/impulsive symptoms exhibit higher severity of co-occurring psychopathology on a summary measure derived from principal components analysis of the CBCL subscales and SRS. This includes some subjects who fail to meet the DSM-IV-TR ADHD symptom criterion due to having less than 6 inattentive and less than six hyperactive-impulsive symptoms, yet have ADHD symptom severity similar to those with the inattentive or hyperactive-impulsive subtype. Conclusions: Several convergent lines of analysis provide support for the continued use of ADHD subtypes (or current presentation symptom profiles), as evidenced by differences in co-existing psychopathlogy. We also found that current diagnostic criteria may fail to identify a potentially impaired group of individuals who have low-to-moderate levels of both inattention and hyperactivity/impulsivity. Under the upcoming DSM-5, it will be important for clinicians to consider the option of giving an ADHD “not elsewhere classified” diagnosis to such children.