Pervasive versus situational childhood ADHD: latent classes and their clinical characteristics, based on parent and teacher ratings in a large longitudinal population sample

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Abstract

Attention-deficit/hyperactivity disorder (ADHD) diagnoses require symptoms to be present in two settings. Low levels of concordance between symptoms rated at home and school raise questions regarding this approach. The aim was to examine whether there are sub-groups with context-specific expressions of ADHD symptoms (i.e., at home or school only) with clinically significant problems sufficient to support a new diagnostic formulation. We applied latent class transition analysis to parent and teacher data ( N = 10,476) from the Avon Longitudinal Study of Parents and Children (ALSPAC), collected at ages 8, 10, and 20 years. We examined the short-term stability of emergent classes and their childhood and adult-associated risk profiles. In addition to an Unaffected class (~ 45%), there was a Pervasive Combined class with elevated inattentive and hyperactive/impulsive symptoms at both home and school (~ 11%) and three classes with situational expressions; School Combined (~ 9%), Home Combined (~ 18%), and School Inattentive (~ 16%). Stability ranged from 0.27 to 0.78. The Pervasive Combined class was most symptomatic and impaired. School inattentive also displayed clinical symptom levels, whereas the School and Home Combined classes displayed subclinical levels. Different profiles regarding sex, cognition, conduct problems, and substance use emerged for the three situational classes. Distinct groupings of pervasive and situational ADHD expressions are identifiable in the general population. The isolation of a stable and burdensome Pervasive Combined class lends support to the current diagnostic approach. However, there are indications of situational expressions of ADHD with clinical symptom levels and associated difficulties.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00787-023-02308-3.

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Author and article information

Contributors

Matilda A. Frick:

ORCID: http://orcid.org/0000-0002-1307-4928

matilda.frick@psychology.su.se

Journal

Journal ID (nlm-ta): Eur Child Adolesc Psychiatry

Journal ID (iso-abbrev): Eur Child Adolesc Psychiatry

Title: European Child & Adolescent Psychiatry

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 1018-8827

ISSN (Electronic): 1435-165X

Publication date (Electronic): 17 October 2023

Publication date PMC-release: 17 October 2023

Publication date (Print): 2024

Volume: 33

Issue: 7

Pages: 2253-2266

Affiliations

[1 ]Department of Psychology, Stockholm University, ( https://ror.org/05f0yaq80) Albanovägen 12, 106 91 Stockholm, Sweden

[2 ]Department of Psychology, Uppsala University, ( https://ror.org/048a87296) Uppsala, Sweden

[3 ]Department of Medical Sciences, Uppsala University, ( https://ror.org/048a87296) Uppsala, Sweden

[4 ]School of Behavioural, Social and Legal Sciences, Center for Health and Medical Psychology, Örebro University, ( https://ror.org/05kytsw45) Örebro, Sweden

[5 ]Department of Behavioural Sciences and Learning, Linköping University, ( https://ror.org/05ynxx418) Linköping, Sweden

[6 ]Department of Clinical Medicine, Aarhus University, ( https://ror.org/01aj84f44) Aarhus, Denmark

[7 ]Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, ( https://ror.org/0220mzb33) London, UK

Author information

Matilda A. Frick http://orcid.org/0000-0002-1307-4928

Hugo Hesser http://orcid.org/0000-0002-9736-8228

Edmund Sonuga-Barke http://orcid.org/0000-0002-6996-3935

Article

Publisher ID: 2308

DOI: 10.1007/s00787-023-02308-3

PMC ID: 11255028

PubMed ID: 37845375

SO-VID: 1f08ff51-dfb4-46b7-9502-5a0c3891333c

License:

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