Behavioral and Emotional Correlates of ADHD in Children

1
Behavioral and Emotional Correlates of ADHD in
Children
Tammy D. Barry, Ph.D.1, Christopher T. Barry,
Ph.D.1, Beth H. Garland, M.A.2, and Robert D.
Lyman, Ph.D.3 1 The University of Southern
Mississippi, 2 Texas AM University, 3 North
Georgia College and State University
RESULTS Independent samples t-tests were
conducted to compare the ADHD and non-ADHD groups
on behavioral and emotional indices from the BASC
(clinical and adaptive scales) and the HSQ.
T-tests were significant for all scales with only
one exception (i.e., the two groups were
generally equivalent on the Withdrawal scale of
the BASC see Table 3). For each significant
finding, the ADHD group scored significantly
above the non-ADHD group on indices of behavioral
problems or emotional difficulties and
significantly below the non-ADHD group on indices
of adaptive functioning. Composite scores for the
BASC and HSQ are presented in Figure 1.
Results indicated a significant difference
between the K-BIT IQ Composite score of the ADHD
group (M 103.03, SD 14.39 ) and the non-ADHD
group (M 112.03, SD 9.35), t 3.01, p lt .01.
Thus, diagnostic group differences on behavioral
and emotional indices were also examined through
one-way ANCOVAs to control for group differences
in IQ. All group differences held with only two
exceptions Anxiety, F (1, 63) 2.78, p .100,
and Somatization, F (1, 63) 3.53, p .065.
In addition, ADHD was significantly related to
having a learning disability (LD) diagnosis,
Pearson ?2 (1, N 66) 9.10, p lt .01, and being
placed in special education classes, ?2 (1, N
63) 10.61, p lt .01. Eight of the participants
with ADHD (24) had a comorbid diagnosis of an
LD, whereas none of the non-ADHD children had
received an LD diagnosis. Fourteen children in
the ADHD group (42) had been placed in special
education classes, whereas only two non-ADHD
children (6) had been in special education.
Table 1 Demographic Characteristics of the
ADHD and non-ADHD Groups
ADHD Non-ADHD
(n 33)
(n 33) Gender ( males)
(63.6)
(45.5) Pearson ?2 (1, N 66)
2.20, p .14 Race ( Caucasian)
(87.9)
(88.4) Pearson ?2 (2, N 66) 1.02, p .60

Mean (SD)
Mean (SD) t-value Age in months
132.67 (15.59)
134.88 (13.87) 0.61 Grade in school
5.30 (1.24)
5.45 (1.18) 1.43 Average
education of caregivers (in years) 13.36
(2.07) 13.99 (2.05)
1.23 Household income (in thousand dollars)
51.99 (30.80) 52.75
(22.68) 0.11 K-BIT IQ Composite
103.03 (14.39)
112.03 (9.35) 3.01 Note
K-BIT Kaufman Brief Intelligence Test (Kaufman
Kaufman, 1990) p lt .01
INTRODUCTION Attention-Deficit/Hyperactivity
Disorder (ADHD) is defined by behavioral criteria
for three symptom areas inattention,
hyperactivity, and impulsivity (American
Psychiatric Association, 2000). However, several
correlates and associated features have been
identified in children with ADHD requiring
additional clinical attention. For example,
children with ADHD are at higher risk, in
comparison to children without ADHD, for a
comorbid diagnosis of a disruptive behavior
disorder, such as Oppositional Defiant Disorder
(ODD) or Conduct Disorder (CD Biederman, Mick,
Faraone, Burback, 2001). Some children with
ADHD do not meet diagnostic criteria for a
comorbid diagnosis but, nevertheless, often
exhibit significant symptoms of aggressiveness,
argumentativeness, and acting out behavior.
Likewise, children with ADHD may be at higher
risk for internalizing symptoms, such as anxiety
and depression (Power, Costigan, Eiraldi, Leff,
2004). Finally, children with ADHD may show
deficits in social and adaptive functioning
(Bagwell, Molina, Pelham, Hoza, 2001). Thus,
ADHD may involve more global deficits than those
delineated in the three symptom areas. This study
examined the pattern of differences in
functioning across a wide range of behavioral and
emotional indices between a group of children
with ADHD and a non-ADHD group. It was predicted
that children with ADHD would show impairment
relative to non-ADHD children across these
indices.

• METHOD
• Participants
• 66 children (33 in ADHD group and 33 in non-ADHD
  group).
• Ranging in age from 8 years, 9 months to 14
  years, 5 months.
• See Table 1 for demographic characteristics of
  the two groups.
• Measures
• Parents of participants completed a demographic
  form and three behavioral rating
• forms
• DSM-IV ADHD Checklist (DSM-IV-TR American
  Psychiatric Association, 2000).
• Behavior Assessment System for Children Parent
  Rating Scale, (BASC-PRS,
• Reynolds and Kamphaus, 1992).
• Home Situations Questionnaire (HSQ Barkley,
  1987).
• Participants were administered the Kaufman Brief
  Intelligence Test (K-BIT
• Kaufman Kaufman, 1990) when off their
  medication to obtain an estimate of IQ.
• Procedure
• Following informed consent from parents and
  verbal assent from participants,
• parents completed the demographic form and three
  behavioral rating forms.
• Participants were administered the K-BIT in a
  separate testing area.
• Although a diagnosis from an independent source
  (e.g., psychologist, pediatrician)

Table 2. Differences Between ADHD and non-ADHD
Groups on ADHD Symptom Inclusion
Criteria Measures
ADHD Non-ADHD
(n 33)
(n 33)
Mean (SD)
Mean (SD) t-value DSM-IV
ADHD Checklist Inattention Percentile
95.42 ( 4.30)
41.15 (25.02) -12.21
Hyperactivity Percentile
91.03 ( 8.54) 31.21
(29.53) -11.18 BASC-Parent Rating Scale
Attention Problems T-score
70.36 ( 6.59) 45.97 (
7.83) -13.69 Hyperactivity T-score
71.42 (14.45)
40.55 ( 6.09) -11.31
Note DSM-IV Diagnostic and Statistical
Manual, fourth edition, text revision (American
Psychiatric Association, 2000) BASC Behavior
Assessment System for Children (Reynolds
Kamphaus, 1992) p lt .001
DISCUSSION Consistent with the studys
hypothesis, the ADHD group exhibited significant
impairment relative to the non-ADHD group across
a wide range of behavioral and emotional indices.
The problematic areas exhibited by the ADHD group
extended beyond ADHD symptoms and included other
externalizing behaviors (e.g., conduct problems,
aggression), internalizing symptoms (e.g.,
depression, anxiety), and difficulties in areas
of adaptive functioning (e.g., social skills,
leadership). Likewise, children in the ADHD group
were more likely to have a comorbid diagnosis of
a learning disability and to be in special
education than non-ADHD children. In light of
these findings, treatments for ADHD must consider
the various comorbid problems beyond the symptoms
of inattention, hyperactivity, and impulsivity
that are associated with this disorder. These
findings highlight the importance of assessing
for associated problems when treating a child
with an ADHD diagnosis. Furthermore,
comprehensive psychosocial treatments should
target associated behavioral problems and
internalizing symptoms, as well as build social
skills and other adaptive coping skills for the
child with ADHD.

Table 3. Comparison of ADHD and Non-ADHD Groups
on Behavioral and Emotional
Functioning Comorbidities
ADHD Non-ADHD
(n 33)
(n 33)
Mean
(SD) Mean (SD)
t-value BASC Aggression
61.97 (11.09)
45.91 ( 6.39) - 7.21
Conduct Problems
64.03 (10.96) 45.27 (
8.68) - 7.71 Anxiety
54.06
(12.87) 47.97 (10.73)
- 2.09 Depression
63.24 (14.62)
45.03 ( 7.86) - 6.30
Somatization
54.52 (14.05)
46.48 ( 9.40) - 2.73
Atypicality
64.24 (18.67)
44.21 ( 6.70) - 5.79
Withdrawal
50.76 ( 9.94)
51.27 ( 9.35) 0.22
Adaptability
40.81 ( 7.48)
51.73 ( 8.26) 4.76
Social Skills
40.91 ( 7.21)
50.82 ( 7.47) 5.48
Leadership
43.70 ( 6.39) 50.79
( 6.81) 4.36 HSQ Problematic
Setting 10.94
( 3.39) 2.52 ( 2.41)
-11.63 Mean Severity Rating
4.27 ( 1.63)
1.12 (1.24) - 8.84
Note BASC Behavior Assessment System for
Children (Reynolds Kamphaus, 1992) HSQ Home
Situations Questionnaire (Barkley, 1987). p lt
.05, p lt .01, p lt .001.
REFERENCES American Psychiatric Association
(2000). Diagnostic and statistical manual of
mental disorders, fourth edition, text revision
(DSM-IV-TR). Washington DC Author. Bagwell, C.
L., Molina, B. S. G., Pelham, W. E., Hoza, B.
(2001). Attention-deficit hyperactivity disorder
and problems in peer relations Predictions from
childhood to adolescence. Journal of the American
Academy of Child and Adolescent Psychiatry, 40,
1285-1292. Barkley, R. A. (1987). Defiant
children Parent-teacher assignments. New York
Guilford Press. Biederman, J., Mick, E., Faraone,
S. V., Burback, M. (2001). Patterns of
remission and symptom decline in conduct
disorder A four-year prospective study of an
ADHD sample. Journal of the American Academy of
Child and Adolescent Psychiatry, 40,
290-298. Kaufman, A. S., Kaufman, N. L. (1990).
Kaufman brief intelligence test (K-BIT). Circle
Pines, MN American Guidance Service. Reynolds,
C. R., Kamphaus, R. W. (1992). Behavior
assessment system for children (BASC). Circle
Pines, MN American Guidance Services. Power, T.
J., Costigan, T. E., Eiraldi, R. B., Leff, S.
S. (2004). Variations in anxiety and depression
as a function of ADHD subtypes defined by DSM-IV
Do subtype differences exist or not? Journal of
Abnormal Child Psychology, 32, 27-37.
Figure 1. Differences between ADHD and non-ADHD
groups on BASC and HSQ composite
scores.
Poster presented at the 2004 Convention of the
Association for the Advancement of Behavior
Therapy, New Orleans, LA For further information,
please contact Tammy D. Barry, Ph.D., The
University of Southern Mississippi, Department of
Psychology, 118 College Drive, 5025,
Hattiesburg, MS, 39406 Email tammy.barry_at_usm.edu