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Longitudinal prediction of the one-year course of preschool ADHD symptoms: Implications for models of temperament–ADHD associations

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Highlights

  • Models of trait–psychopathology associations remain unclear.

  • Longitudinal study of associations between traits and ADHD may be informative.

  • Temperament traits predicted onset, but not one-year course, of ADHD symptoms.

  • Results provide support for a spectrum model of trait–psychopathology associations.

Abstract

Despite the fact that Attention-Deficit/Hyperactivity Disorder (ADHD) is often conceptualized as an extreme trait, there remains controversy about the best way to understand associations between temperament traits and ADHD. The current study examines longitudinal associations between temperament traits and ADHD during early childhood in order to critically examine vulnerability and spectrum models of trait–ADHD associations. Study participants were 109 children between the ages of 3 and 6 and their primary caregivers and teachers/daycare providers, community-recruited for ADHD-related problems. Primary caregivers completed the Kiddie Disruptive Behavior Disorders Schedule semi-structured diagnostic interview at the initial appointment and one year later. At the initial appointment, primary caregivers completed the Child Behavior Questionnaire as a measure of child temperament traits. Results from the initial time point indicated that high neuroticism and high surgency were associated with inattentive and hyperactive–impulsive ADHD symptoms, and low effortful control was associated with hyperactive–impulsive ADHD symptoms. However, none of these traits predicted the one-year course of ADHD symptoms. Results are more consistent with a spectrum (vs. vulnerability) model of trait–psychopathology associations, suggesting that traits may not influence longitudinal course during early childhood.

Introduction

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common and impairing behavioral disorder characterized by symptoms of inattention and hyperactivity–impulsivity that often emerges first during early childhood, or by age 4 (American Psychiatric Association, 2013, Keenan and Wakschlag, 2002). ADHD has been conceptualized as a disorder of extreme maladaptive temperament and/or personality traits (Martel, 2009, White, 1999). Yet, the nature of the associations between extreme levels of temperament and personality traits and ADHD behavioral manifestation remain relatively understudied, despite available theory.

Temperament traits are often emphasized in studies of early childhood development and have been defined as constitutionally-based individual differences in reactivity and self-regulation (Rothbart, 1989). Most commonly-used models of temperament traits converge on three higher-order traits: negative affect, surgency, and effortful control (Eisenberg et al., 1996, Rothbart, 1989). Negative affect is defined by a high level of negative emotions, including anger, sadness, and fear. Surgency can be defined by a high level of positive emotions related to approach or social behavior, including activity level. Effortful control refers to thoughtful, deliberate forms of regulation (Rothbart, Ahadi, & Evans, 2000).

Although ADHD has been conceptualized as an extreme temperament or personality trait, substantive explanations for associations between traits and ADHD remain largely unsubstantiated in the broader literature. There are a number of different models of trait–psychopathology associations. That is, it has been theorized that temperament traits may predispose individuals to psychopathology (vulnerability model), lie on the same continuum as psychopathology (spectrum model), or exacerbate (pathoplasty/exacerbation) or be exacerbated (complication/scar) by psychopathology (Shiner and Caspi, 2003, Tackett, 2006). In general, the vulnerability and spectrum models of trait–psychopathology associations have received most support (De Bolle et al., 2012, Eisenberg et al., 2001, Van Leeuwen et al., 2007). Research examining associations between temperament traits and ADHD suggest that high surgency may be specifically associated with ADHD hyperactivity–impulsivity, and low effortful control may be specifically associated with ADHD inattention (De Pauw and Mervielde, 2011, Herzhoff et al., 2013, Martel and Nigg, 2006), in line with recent multiple pathway models of ADHD (e.g., Nigg et al., 2004, Sonuga-Barke et al., 2010). Of course, these associations do not differentiate between the aforementioned models of trait–psychopathology associations.

Teasing apart these models remains a difficult and understudied issue. However, longitudinal modeling may provide one means by which to shed light on these associations and provide some preliminary evidence to differentiate vulnerability and spectrum models. For example, the vulnerability and spectrum models both make a basic prediction that associations between extreme traits and psychopathology will be reflected in strong concurrent associations, whether because traits are increasing risk for psychopathology, as posited by the vulnerability model, or because traits and psychopathology reflect positions on a shared underlying dimension, as posited by the spectrum model. Yet, the vulnerability model suggests an additional prediction that extreme traits will independently predict the onset and course of psychopathology. These two possibilities were tested in the current study. Study hypotheses were that high surgency and low effortful control would predict the onset and course of ADHD symptoms over a one-year period during early childhood (i.e., that both spectrum and vulnerability associations would be observed).

Section snippets

Overview

Participants were 109 young children between the ages of 3 and 6 (M = 4.34 years, SD = 1.08) and their primary caregivers and identified teachers, daycare providers, or babysitters. Sixty-four percent of the sample was male, and 36% of the sample was non-White. Family income ranged from below $20,000 to above $100,000 annually (see Table 1). Based on multistage and comprehensive diagnostic screening procedures (detailed below), children were recruited into two groups: ADHD (n = 61) and non-ADHD

Correlations between traits at initial time point and one year later

Bivariate correlations between temperament traits and ADHD symptom domains of inattention and hyperactivity–impulsivity at the initial time point and the one-year follow-up are shown in Table 2. In addition, partial correlations between temperament traits and ADHD symptoms of inattention and hyperactivity at the one-year follow-up, controlling for the initial level of symptoms, are shown in Table 2. As can be seen, correlations between temperament traits and ADHD symptoms were, by and large,

Discussion

The current study evaluated vulnerability and spectrum model explanations of trait–psychopathology associations in an early childhood sample of children over-recruited for ADHD-related problems and followed over one year. Overall, at the initial time point, high negative affect and high surgency were associated with inattentive and hyperactive–impulsive ADHD symptoms, and low effortful control was associated with hyperactive–impulsive ADHD symptoms. These results run somewhat counter to prior

Conclusion

Overall, study results suggest that temperament traits exhibit robust associations with early ADHD psychopathology, but do not predict its one-year course, consistent with the spectrum model of trait–psychopathology associations.

Acknowledgements

This research was supported by National Institute of Health and Human Development Grant 5R03 HD062599-02 to M. Martel. We are indebted to the families who made this study possible.

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