Affective-cognitive-behavioral heterogeneity of Attention-Deficit/Hyperactivity Disorder (ADHD): Emotional dysregulation as a sentinel symptom differentiating "ADHD-simplex" and "ADHD-complex" syndromes?

Xinxin Yue; Lu Liu; Wai Chen; David A Preece; Qianrong Liu; Haimei Li; Yufeng Wang; Qiujin Qian

doi:10.1016/j.jad.2022.03.065

Affective-cognitive-behavioral heterogeneity of Attention-Deficit/Hyperactivity Disorder (ADHD): Emotional dysregulation as a sentinel symptom differentiating "ADHD-simplex" and "ADHD-complex" syndromes?

J Affect Disord. 2022 Jun 15:307:133-141. doi: 10.1016/j.jad.2022.03.065. Epub 2022 Apr 1.

Authors

Xinxin Yue¹, Lu Liu¹, Wai Chen², David A Preece³, Qianrong Liu¹, Haimei Li¹, Yufeng Wang¹, Qiujin Qian⁴

Affiliations

¹ Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & NHC Key Laboratory of Mental Health (Peking University), Beijing 100191, China.
² Mental Health Service, Fiona Stanley Hospital, Perth, Australia; Graduate School of Education, University of Western Australia, Australia; School of Medicine, University of Notre Dame Australia, Fremantle, Australia; School of Psychology, Murdoch University, Perth, Australia; Curtin Medical School, Curtin University, Perth, Australia; The enAble Institute, Curtin University, Perth, Australia. Electronic address: wai.chen@curtin.edu.au.
³ The enAble Institute, Curtin University, Perth, Australia; School of Psychology, Curtin University, Perth, Australia; School of Psychological Science, University of Western Australia, Perth, Australia.
⁴ Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & NHC Key Laboratory of Mental Health (Peking University), Beijing 100191, China. Electronic address: qianqiujin@bjmu.edu.cn.

PMID: 35367500
DOI: 10.1016/j.jad.2022.03.065

Abstract

Background: Current DSM and ICD classifications of Attention-Deficit/Hyperactivity Disorder (ADHD) exclude emotional dysregulation (ED) in their diagnostic criteria, despite ED symptoms frequently co-occurring in ADHD and likely sharing common neurobiological substrates. In this study, we examined whether consideration of ED symptoms could delineate more informative "ADHD+ED" subphenotypes.

Method: 4106 children with ADHD were recruited. ED and inattentive (IA) and hyperactive/impulsive (HI) symptoms were profiled using latent class analyses (LCA). The derived latent class (LC) subphenotypes were evaluated and validated in relation to comorbidity patterns, executive functions, and functional impairments.

Results: Five LC subphenotypes with ED symptoms were identified: IA/HI + ED profile (LC1); HI + ED profile (LC2); IA + ED profile (LC3); IA/HI profile (LC4); and IA profile (LC5). Cross-validation of the LCA model using support vector machine analysis confirmed 83% accuracy. ED positive (ED+ve) subphenotypes were associated with higher rates of oppositional defiant disorder, mood disorders, anxiety disorders, as well as more severe autistic traits and sluggish cognitive tempo symptoms. Higher rates of ecological executive functioning impairments (BRIEF ratings) were found among ED+ve subphenotypes (though no differences were detected by laboratory-based measures). Functional impairments were also more severe among participants with ED+ve subphenotypes.

Limitations: The data for our LCA were cross-sectional and based primarily on parent ratings.

Conclusion: Our classification model has parcellated IA, HI, and ED symptoms into novel informative subphenotypes. These classifications provide preliminary evidence that ED symptoms could serve as sentinel features to identify a potential "ADHD-complex" syndrome, which demarcates a more pervasive condition of greater severity, complexity, and impairment.

Keywords: ADHD; Emotional symptoms; Latent class analysis; Nosology; Subphenotypes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Attention Deficit Disorder with Hyperactivity* / psychology
Attention Deficit and Disruptive Behavior Disorders
Child
Cognition
Comorbidity
Humans
Syndrome