Emotional and Behavioral Problems in Children with Attention Deficit-Hyperactivity Disorder: Impact of Age and Learning Disabilities

Article excerpt

Abstract. Comorbidity with other psychological problems (PP) complicates the course of attention deficit-hyperactivity disorder (ADHD) and makes treatment more difficult. The purpose of the present study was to (a) study the correspondence between the perceptions of parents and teachers about PP, (b) determine which PP predict the severity of the manifestations of ADHD, and (c) analyze the role of age and learning disabilities (LD) in the development of PP and ADHD. The participants were 72 children with a clinical diagnosis of ADHD. The PP were measured using rating scales filled out by parents and teachers. The results showed high correspondence between the two informant groups in rating the problems of behavior and overactivity. However, agreement on emotional symptoms was much lower. Inattention, emotional lability, and conduct problems predicted the severity of the ADHD. Finally, the younger children with ADHD+LD experienced more associated problems than the older children.


Attention deficit-hyperactivity disorder (ADHD) is one of the most frequently diagnosed childhood disorders, affecting approximately 5% of school-aged children (American Psychiatric Association, 2000). ADHD almost never occurs in a pure state, but is associated with other psychological problems (PP) at a rate much higher than would he found by mere chance. These behavioral and emotional problems present a serious obstacle to the academic, social, and emotional development of children with ADHD and negatively affect their adjustment to adult life. Thus, data have shown that emotional lability and social problems are better indicators of impairments in the daily life of the individual than the level of ADHD symptomatology per se due to the negative impact these problems have on academic, family, and work domains (Melia et al., 2006). Studies have provided valuable information about the moderator role comorbidity plays in interventions designed for students with ADHD. One of the objectives of the Multimodal Treatment Study of Children with ADHD (MTA; Jensen et al., 2001), in which 579 children participated, was to determine whether the clinical significance of potential ADHD + anxiety disorder (ADHD+ANX) or ADHD + oppositional disorder/conduct disorder (ADHD+ODD/CD) syndromes would yield better diagnostic decision-making, treatment planning, and treatment outcomes. Moderate evidence of interactions between parent-reported anxiety and ODD/CD status was noted in the response to treatment, indicating that children with ADHD and anxiety disorders (but without ODD/CD) were likely to respond equally well to the behavioral and medication treatments. Children with ADHD-only or ADHD with ODD/CD (but without anxiety disorders) responded best to medication treatments (with or without behavioral treatments), whereas children with multiple comorbid disorders (anxiety and ODD/CD) responded best to combined (medication and behavioral) treatments (Jensen et al.). There is also evidence indicating that children with pure ADHD generally obtain more benefits from cognitive-behavioral training in self-control than those with ADHD + ODD, who tend to function better with treatment combining psychological techniques with the administration of medication (Miranda & Presentacion, 2000).

In a review of 15 years of the literature on the most frequent comorbidity patterns, Jensen, Martin, and Cantwell (1997) concluded that the clinical course and evolution of ADHD generally worsened in the presence of comorbid problems, including conflictive parent-child interactions, poor school performance, risky driving behaviors, or risk of substance abuse and antisocial personality disorder. More recent studies have found that the severity of the symptoms of inattention and hyperactivity-impulsivity, as rated by parents and teachers, was related to externalizing and internalizing comorbid psychopathologies (Connor et al., 2003). In fact, Klassen, Miller, and Fine (2005) showed that comorbidity and the severity of ADHD symptoms have differential impacts on quality of life. …