ADHD comorbidity findings from the MTA study: Comparing comorbid subgroups

Peter S. Jensen; Stephen P. Hinshaw; Helena C. Kraemer; Nilantha Lenora; Jeffrey H. Newcorn; Howard B. Abikoff; John S. March; L. Eugen Arnold; Dennis P. Cantwell; C. Keith Conners; Glen R. Elliott; Laurence L. Greenhill; Lily Hechtman; Betsy Hoza; William E. Pelham; Joanne B. Severe; James M. Swanson; Karen C. Wells; Timothy Wigal; Benedetto Vitiello

doi:10.1097/00004583-200102000-00009

ADHD comorbidity findings from the MTA study: Comparing comorbid subgroups

Peter S. Jensen, Stephen P. Hinshaw, Helena C. Kraemer, Nilantha Lenora, Jeffrey H. Newcorn, Howard B. Abikoff, John S. March, L. Eugen Arnold, Dennis P. Cantwell, C. Keith Conners, Glen R. Elliott, Laurence L. Greenhill, Lily Hechtman, Betsy Hoza, William E. Pelham, Joanne B. Severe, James M. Swanson, Karen C. Wells, Timothy Wigal, Benedetto Vitiello

Psychiatry and Psychology

Research output: Contribution to journal › Article › peer-review

649 Scopus citations

Abstract

Objectives: Previous research has been inconclusive whether attention-deficit/hyperactivity disorder (ADHD), when comorbid with disruptive disorders (oppositional defiant disorder [ODD] or conduct disorder [CD]), with the internalizing disorders (anxiety and/or depression), or with both, should constitute separate clinical entities. Determination of the clinical significance of potential ADHD + internalizing disorder or ADHD + ODD/CD syndromes could yield better diagnostic decision-making, treatment planning, and treatment outcomes. Method: Drawing upon cross-sectional and longitudinal information from 579 children (aged 7-9.9 years) with ADHD participating in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA), investigators applied validational criteria to compare ADHD subjects with and without comorbid internalizing disorders and ODD/CD. Results: Substantial evidence of main effects of internalizing and externalizing comorbid disorders was found. Moderate evidence of interactions of parent-reported anxiety and ODD/CD status were noted on response to treatment, indicating that children with ADHD and anxiety disorders (but no ODD/CD) were likely to respond equally well to the MTA behavioral and medication treatments. Children with ADHD-only or ADHD with ODD/CD (but without anxiety disorders) responded best to MTA medication treatments (with or without behavioral treatments), while children with multiple comorbid disorders (anxiety and ODD/CD) responded optimally to combined (medication and behavioral) treatments. Conclusions: Findings indicate that three clinical profiles, ADHD co-occurring with internalizing disorders (principally parent-reported anxiety disorders) absent any concurrent disruptive disorder (ADHD + ANX), ADHD co-occurring with ODD/CD but no anxiety (ADHD + ODD/CD), and ADHD with both anxiety and ODD/CD (ADHD + ANX + ODD/CD) may be sufficiently distinct to warrant classification as ADHD subtypes different from "pure" ADHD with neither comorbidity. Future clinical, etiological, and genetics research should explore the merits of these three ADHD classification options.

Original language	English (US)
Pages (from-to)	147-158
Number of pages	12
Journal	Journal of the American Academy of Child and Adolescent Psychiatry
Volume	40
Issue number	2
DOIs	https://doi.org/10.1097/00004583-200102000-00009
State	Published - 2001

Keywords

Anxiety
Attention deficit
Attention-deficit/hyperactivity disorder
Classification
Comorbidity
Diagnosis
Outcomes
Treatment

ASJC Scopus subject areas

Developmental and Educational Psychology
Psychiatry and Mental health

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10.1097/00004583-200102000-00009

Cite this

Jensen, P. S., Hinshaw, S. P., Kraemer, H. C., Lenora, N., Newcorn, J. H., Abikoff, H. B., March, J. S., Arnold, L. E., Cantwell, D. P., Conners, C. K., Elliott, G. R., Greenhill, L. L., Hechtman, L., Hoza, B., Pelham, W. E., Severe, J. B., Swanson, J. M., Wells, K. C., Wigal, T., & Vitiello, B. (2001). ADHD comorbidity findings from the MTA study: Comparing comorbid subgroups. Journal of the American Academy of Child and Adolescent Psychiatry, 40(2), 147-158. https://doi.org/10.1097/00004583-200102000-00009

Jensen, PS, Hinshaw, SP, Kraemer, HC, Lenora, N, Newcorn, JH, Abikoff, HB, March, JS, Arnold, LE, Cantwell, DP, Conners, CK, Elliott, GR, Greenhill, LL, Hechtman, L, Hoza, B, Pelham, WE, Severe, JB, Swanson, JM, Wells, KC, Wigal, T & Vitiello, B 2001, 'ADHD comorbidity findings from the MTA study: Comparing comorbid subgroups', Journal of the American Academy of Child and Adolescent Psychiatry, vol. 40, no. 2, pp. 147-158. https://doi.org/10.1097/00004583-200102000-00009

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title = "ADHD comorbidity findings from the MTA study: Comparing comorbid subgroups",

abstract = "Objectives: Previous research has been inconclusive whether attention-deficit/hyperactivity disorder (ADHD), when comorbid with disruptive disorders (oppositional defiant disorder [ODD] or conduct disorder [CD]), with the internalizing disorders (anxiety and/or depression), or with both, should constitute separate clinical entities. Determination of the clinical significance of potential ADHD + internalizing disorder or ADHD + ODD/CD syndromes could yield better diagnostic decision-making, treatment planning, and treatment outcomes. Method: Drawing upon cross-sectional and longitudinal information from 579 children (aged 7-9.9 years) with ADHD participating in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA), investigators applied validational criteria to compare ADHD subjects with and without comorbid internalizing disorders and ODD/CD. Results: Substantial evidence of main effects of internalizing and externalizing comorbid disorders was found. Moderate evidence of interactions of parent-reported anxiety and ODD/CD status were noted on response to treatment, indicating that children with ADHD and anxiety disorders (but no ODD/CD) were likely to respond equally well to the MTA behavioral and medication treatments. Children with ADHD-only or ADHD with ODD/CD (but without anxiety disorders) responded best to MTA medication treatments (with or without behavioral treatments), while children with multiple comorbid disorders (anxiety and ODD/CD) responded optimally to combined (medication and behavioral) treatments. Conclusions: Findings indicate that three clinical profiles, ADHD co-occurring with internalizing disorders (principally parent-reported anxiety disorders) absent any concurrent disruptive disorder (ADHD + ANX), ADHD co-occurring with ODD/CD but no anxiety (ADHD + ODD/CD), and ADHD with both anxiety and ODD/CD (ADHD + ANX + ODD/CD) may be sufficiently distinct to warrant classification as ADHD subtypes different from {"}pure{"} ADHD with neither comorbidity. Future clinical, etiological, and genetics research should explore the merits of these three ADHD classification options.",

keywords = "Anxiety, Attention deficit, Attention-deficit/hyperactivity disorder, Classification, Comorbidity, Diagnosis, Outcomes, Treatment",

author = "Jensen, {Peter S.} and Hinshaw, {Stephen P.} and Kraemer, {Helena C.} and Nilantha Lenora and Newcorn, {Jeffrey H.} and Abikoff, {Howard B.} and March, {John S.} and Arnold, {L. Eugen} and Cantwell, {Dennis P.} and Conners, {C. Keith} and Elliott, {Glen R.} and Greenhill, {Laurence L.} and Lily Hechtman and Betsy Hoza and Pelham, {William E.} and Severe, {Joanne B.} and Swanson, {James M.} and Wells, {Karen C.} and Timothy Wigal and Benedetto Vitiello",

year = "2001",

doi = "10.1097/00004583-200102000-00009",

language = "English (US)",

volume = "40",

pages = "147--158",

journal = "Journal of the American Academy of Child and Adolescent Psychiatry",

issn = "0890-8567",

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number = "2",

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TY - JOUR

T1 - ADHD comorbidity findings from the MTA study

T2 - Comparing comorbid subgroups

AU - Jensen, Peter S.

AU - Hinshaw, Stephen P.

AU - Kraemer, Helena C.

AU - Lenora, Nilantha

AU - Newcorn, Jeffrey H.

AU - Abikoff, Howard B.

AU - March, John S.

AU - Arnold, L. Eugen

AU - Cantwell, Dennis P.

AU - Conners, C. Keith

AU - Elliott, Glen R.

AU - Greenhill, Laurence L.

AU - Hechtman, Lily

AU - Hoza, Betsy

AU - Pelham, William E.

AU - Severe, Joanne B.

AU - Swanson, James M.

AU - Wells, Karen C.

AU - Wigal, Timothy

AU - Vitiello, Benedetto

PY - 2001

Y1 - 2001

N2 - Objectives: Previous research has been inconclusive whether attention-deficit/hyperactivity disorder (ADHD), when comorbid with disruptive disorders (oppositional defiant disorder [ODD] or conduct disorder [CD]), with the internalizing disorders (anxiety and/or depression), or with both, should constitute separate clinical entities. Determination of the clinical significance of potential ADHD + internalizing disorder or ADHD + ODD/CD syndromes could yield better diagnostic decision-making, treatment planning, and treatment outcomes. Method: Drawing upon cross-sectional and longitudinal information from 579 children (aged 7-9.9 years) with ADHD participating in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA), investigators applied validational criteria to compare ADHD subjects with and without comorbid internalizing disorders and ODD/CD. Results: Substantial evidence of main effects of internalizing and externalizing comorbid disorders was found. Moderate evidence of interactions of parent-reported anxiety and ODD/CD status were noted on response to treatment, indicating that children with ADHD and anxiety disorders (but no ODD/CD) were likely to respond equally well to the MTA behavioral and medication treatments. Children with ADHD-only or ADHD with ODD/CD (but without anxiety disorders) responded best to MTA medication treatments (with or without behavioral treatments), while children with multiple comorbid disorders (anxiety and ODD/CD) responded optimally to combined (medication and behavioral) treatments. Conclusions: Findings indicate that three clinical profiles, ADHD co-occurring with internalizing disorders (principally parent-reported anxiety disorders) absent any concurrent disruptive disorder (ADHD + ANX), ADHD co-occurring with ODD/CD but no anxiety (ADHD + ODD/CD), and ADHD with both anxiety and ODD/CD (ADHD + ANX + ODD/CD) may be sufficiently distinct to warrant classification as ADHD subtypes different from "pure" ADHD with neither comorbidity. Future clinical, etiological, and genetics research should explore the merits of these three ADHD classification options.

AB - Objectives: Previous research has been inconclusive whether attention-deficit/hyperactivity disorder (ADHD), when comorbid with disruptive disorders (oppositional defiant disorder [ODD] or conduct disorder [CD]), with the internalizing disorders (anxiety and/or depression), or with both, should constitute separate clinical entities. Determination of the clinical significance of potential ADHD + internalizing disorder or ADHD + ODD/CD syndromes could yield better diagnostic decision-making, treatment planning, and treatment outcomes. Method: Drawing upon cross-sectional and longitudinal information from 579 children (aged 7-9.9 years) with ADHD participating in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA), investigators applied validational criteria to compare ADHD subjects with and without comorbid internalizing disorders and ODD/CD. Results: Substantial evidence of main effects of internalizing and externalizing comorbid disorders was found. Moderate evidence of interactions of parent-reported anxiety and ODD/CD status were noted on response to treatment, indicating that children with ADHD and anxiety disorders (but no ODD/CD) were likely to respond equally well to the MTA behavioral and medication treatments. Children with ADHD-only or ADHD with ODD/CD (but without anxiety disorders) responded best to MTA medication treatments (with or without behavioral treatments), while children with multiple comorbid disorders (anxiety and ODD/CD) responded optimally to combined (medication and behavioral) treatments. Conclusions: Findings indicate that three clinical profiles, ADHD co-occurring with internalizing disorders (principally parent-reported anxiety disorders) absent any concurrent disruptive disorder (ADHD + ANX), ADHD co-occurring with ODD/CD but no anxiety (ADHD + ODD/CD), and ADHD with both anxiety and ODD/CD (ADHD + ANX + ODD/CD) may be sufficiently distinct to warrant classification as ADHD subtypes different from "pure" ADHD with neither comorbidity. Future clinical, etiological, and genetics research should explore the merits of these three ADHD classification options.

KW - Anxiety

KW - Attention deficit

KW - Attention-deficit/hyperactivity disorder

KW - Classification

KW - Comorbidity

KW - Diagnosis

KW - Outcomes

KW - Treatment

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ADHD comorbidity findings from the MTA study: Comparing comorbid subgroups

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