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Should we subtype ADHD according to the context in which symptoms occur? Criterion validity of recognising context-based ADHD presentations


Murray, Aja Louise; Ribeaud, Denis; Eisner, Manuel; Murray, G; McKenzie, K (2019). Should we subtype ADHD according to the context in which symptoms occur? Criterion validity of recognising context-based ADHD presentations. Child Psychiatry & Human Development, 50(2):308-320.

Abstract

ADHD symptoms show considerable individual variation in the contexts in which they are expressed. It has previously been proposed that subtyping individuals according to the contexts in which symptoms are expressed may be clinically useful. We examined context-based patterns of ADHD symptoms in a longitudinal cohort study of n = 1388 children, as well as context-specific and context-general predictors of symptoms. Participants were community-ascertained and provided ADHD symptom data at ages 7, 9, and 11. Using growth mixture modelling we identified five inattention and five hyperactivity/impulsivity categories that differed in the developmental patterns of symptoms reported by parent and teacher informants. We found some evidence that context-specific predictors were related to context-specific expressions. Specifically, after controlling for other risk factors for ADHD symptoms, relationships with teachers predicted school-specific (teacher-reported) but not home-specific (parent-reported) symptom levels. However, no subtypes defined by exclusively home-based symptoms emerged, suggesting that while symptoms may sometimes be specific to the school context, they are only rarely confined to the home context. Subtyping by context could be informative; however, further work will required to uncover the nature of any etiological, functional, or outcome differences between those who show symptom expression in different contexts.

Abstract

ADHD symptoms show considerable individual variation in the contexts in which they are expressed. It has previously been proposed that subtyping individuals according to the contexts in which symptoms are expressed may be clinically useful. We examined context-based patterns of ADHD symptoms in a longitudinal cohort study of n = 1388 children, as well as context-specific and context-general predictors of symptoms. Participants were community-ascertained and provided ADHD symptom data at ages 7, 9, and 11. Using growth mixture modelling we identified five inattention and five hyperactivity/impulsivity categories that differed in the developmental patterns of symptoms reported by parent and teacher informants. We found some evidence that context-specific predictors were related to context-specific expressions. Specifically, after controlling for other risk factors for ADHD symptoms, relationships with teachers predicted school-specific (teacher-reported) but not home-specific (parent-reported) symptom levels. However, no subtypes defined by exclusively home-based symptoms emerged, suggesting that while symptoms may sometimes be specific to the school context, they are only rarely confined to the home context. Subtyping by context could be informative; however, further work will required to uncover the nature of any etiological, functional, or outcome differences between those who show symptom expression in different contexts.

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Item Type:Journal Article, refereed, original work
Communities & Collections:06 Faculty of Arts > Jacobs Center for Productive Youth Development
Dewey Decimal Classification:370 Education
Scopus Subject Areas:Health Sciences > Pediatrics, Perinatology and Child Health
Social Sciences & Humanities > Developmental and Educational Psychology
Health Sciences > Psychiatry and Mental Health
Language:English
Date:2019
Deposited On:25 Jul 2019 14:51
Last Modified:29 Jul 2020 09:55
Publisher:Springer
ISSN:0009-398X
OA Status:Green
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.1007/s10578-018-0842-4
PubMed ID:30168001

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