Longitudinal course of deficient emotional self-regulation CBCL profile in youth with ADHD: prospective controlled study

Abstract

Joseph Biederman,1,2 Thomas J Spencer,1,2 Carter Petty,1 Laran L Hyder,1 Katherine B O’Connor,1 Craig BH Surman,1,2 Stephen V Faraone31Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Yawkey Center for Outpatient Care, Boston, MA, 2Department of Psychiatry, Harvard Medical School, Cambridge, MA, 3Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NYBackground: While symptoms of deficient emotional self-regulation (DESR) have been long associated with attention-deficit/hyperactivity disorder (ADHD), there has been limited investigation of this aspect of the clinical picture of the disorder. The main aim of this study was to examine the predictive utility of DESR in moderating the course of ADHD children into adolescence.Methods: Subjects comprised 177 children with and 204 children without ADHD followed for an average of 4 years (aged 6–18 years at baseline, 54% male). Subjects were assessed with structured diagnostic interviews and measures of psychosocial functioning. DESR was defined by the presence (n = 79) or absence (n = 98) of Child Behavior Checklist (CBCL)-DESR profile (score ≥ 180 < 210 total of Attention, Aggression, and Anxious/Depressed subscales) at the baseline assessment.Results: Of subjects with DESR at baseline, 57% had DESR at follow-up. Persistent ADHD was significantly associated with DESR at follow-up (χ2(1) = 15.37, P < 0.001). At follow-up, ADHD + DESR subjects had significantly more comorbidities (z = 2.55, P = 0.01), a higher prevalence of oppositional defiant disorder (z = 3.01, P = 0.003), and more impaired CBCL social problems t-score (t(227) = 2.41, P = 0.02) versus ADHD subjects.Conclusion: This work suggests that a positive CBCL-DESR profile predicts subsequent psychopathology and functional impairments in children with ADHD suggesting that it has the potential to help identify children with ADHD at high risk for compromised outcomes.Keywords: attention-deficit/hyperactivity disorder, emotion, regulation, longitudinal, youth