Subtyping Attention-Deficit/Hyperactivity Disorder Using Temperament Dimensions: Toward Biologically Based Nosologic Criteria

In the paper

“At the first step, including all 437 children in the sample, community detection identified three profiles of children (Q=.55) with sizes of 192, 181, 64.”

In the paper

“Type 3, in addition to greater impulsivity and attentional dyscontrol than the Mild type, also had more negative emotionality than the other two types or the controls (all p<.001).”

In the paper

“A main effect of group (F[3, 303]=3.97, p=.047, η2=0.03) was qualified by a 3-way interaction of Valence×Condition × Group (F[3, 303]=4.09, p=.018, η2=0.03).”

In the paper

“Profile 1 included 82% of the control children and only 13% of the ADHD children. Profiles 2 and 3 together included 87% of the ADHD children and only 18% of non-ADHD controls.”

In the paper

“This included higher levels of anger, discomfort, fear, and sadness, and lower levels of soothability (all p<.001), suggesting this is a group of children prone to anger, tantrums, and irritable behavior as described in recent literature [53].”

What the sources say

• Not checked yetcites [53] Leibenluft E Severe mood dysregulation, irritability, and the diagnostic boundaries of bipolar disorder in youths The American Journal of Psychiatry 2011 168 2 129 21123313 PMC3396206

In the paper

“None of the groups showed significant change in PEP from baseline to task (i.e. PEP reactivity scores did not differ from zero, all p>.05), and there were no significant main or interaction effects when PEP reactivity scores were examined for the emotion task (all p>.05).”

In the paper

“Type 2 had more severe impulsivity than Type 1, and also less shyness and more assertiveness/dominance, high-intensity pleasure seeking, and activity level than either of the other two types or than controls (all p<.001); we labeled this type “Surgent ADHD.””

In the paper

“Clinically, Type 1 was more impulsive and inattentive (all p<.01) than controls, as well as less affiliative (all p<.05), but otherwise did not differ from controls on any temperament domain.”

In the paper

“In contrast, the Mild type often changed profile: 43.6% remained Mild type at Time 2; 41% became Surgent type and 15.4% became Irritable type (see eVideo 1 in Supplement for depiction of stability of types over time).”

In the paper

“neither DSM-5 presentations nor groups based on the presence/absence of ODD symptoms (i.e. 0 symptoms versus 1+ symptoms) differed in their rates of new comorbid disorder onsets at Time 2 (χ2[1]=0.68, p=.409 and χ2[1]=2.54, p=.111, respectively).”

In the paper

“Neither the presence of Time 1 ODD symptoms (p=.563) nor ADHD DSM-5 presentation (p=.113) uniquely predicted new onsets at Time 2.”

In the paper

“The Irritable group displayed weaker connectivity (in the form of reduced negative relationships) from the amygdala to the anterior insula relative to all other groups (including non-ADHD controls) and weaker connectivity to the posterior cingulate (a key hub in the default network) relative to typically-developing and the Surgent children.”

In the paper

“The Surgent type evidenced increased connectivity from the amygdala to cingulate/precuneus compared to the Mild and Irritable groups, but was similar relative to control populations.”

In the paper

“the subgroups found here were largely stable over time”

In the paper

“Thus, data suggest that the Surgent and Irritable types have distinct peripheral physiological profiles as compared to each other and to typically-developing children.”

In the paper

“List of scales and reliabilities in the current sample (which were all satisfactory) are provided in the Supplement.”

In the paper

“The amygdala, in particular, plays a key role in emotion and motivation, and so is one important brain correlate of temperament domains [17, 28, 29].”

What the sources say

• Not checked yetcites [17] Smillie LD Extraversion and Reward Processing Current Directions in Psychological Science 2013 22 3 167 172 PMC3989147 24748727
• Not checked yetcites [28] Miskovic V Schmidt LA New directions in the study of individual differences in temperament: A brain–body approach to understanding fearful and fearless children Monographs of the Society for Research in Child Development 2012 77 2 28 38
• Not checked yetcites [29] Rothbart MK Temperament, development, and personality Current Directions in Psychological Science 2007 16 4 207 212

In the paper

“Standard methods for artifact detection were followed as published in our prior work [40] and are also provided in the Supplement.”

What the sources say

• Not checked yetcites [40] Musser ED Emotion regulation via the autonomic nervous system in children with attention-deficit/hyperactivity disorder (ADHD) Journal of Abnormal Child Psychology: An official publication of the International Society for Research in Child and Adolescent Psychopathology 2011 39 6 841 852 PMC3112468 21394506

In the paper

“but DSM-IV subtypes (and thus DSM-5 presentations) fail to elucidate clear differences in pathophysiology or clinical course, in part due to their own instability over time [5, 7–9].”

What the sources say

• Not checked yetcites [5] Khan SA Faraone SV The genetics of ADHD: a literature review of 2005 Current Psychiatry Reports 2006 8 5 393 16968622
• Not checked yetcites [7] Chhabildas N Pennington BF Willcutt EG A comparison of the neuropsychological profiles of the DSM-IV subtypes of ADHD Journal of Abnormal Child Psychology 2001 29 6 529 540 11761286
• Not checked yetcites [8] Lahey BB Pelham WE Loney J Lee SS Willcutt E Instability of the DSM-IV subtypes of ADHD from preschool through elementary school Archives of General Psychiatry 2005 62 8 896 902 16061767
• Not checked yetcites [9] Willcutt EG Validity of DSM–IV Attention Deficit/Hyperactivity Disorder Symptom Dimensions and Subtypes 2012 PMC3622557 22612200

In the paper

“To account for multiple comparisons, thresholding based on Monte Carlo simulation was implemented [52].”

What the sources say

• Not checked yetcites [52] Forman SD Improved assessment of significant activation in functional magnetic resonance imaging (fMRI): use of a cluster-size threshold Magnetic Resonance in Medicine 1995 33 5 636 647 7596267

In the paper

“A secondary validation method [Variation of Information Algorithm (VOI), 37] was also used to evaluate internal validity (group robustness to chance data variation).”

What the sources say

• Not checked yetcites [37] Karrer B Levina E Newman ME Robustness of community structure in networks Physical Review E 2008 77 4 046119 18517702

In the paper

“Community detection is a widely used optimization clustering method (another well-known optimization clustering method is mixture modeling). As a clustering approach it has the attractive features of being data-driven (in that the number of communities does not have to be pre-specified in the model) and provides a quantitative measure of group robustness to chance variations in the data structure.”

What the sources say

• Not checked yetcites [30] Newman MEJ Modularity and community structure in networks Proceedings of the National Academy of Sciences of the United States of America 2006 103 23 8577 8582 16723398 PMC1482622

In the paper

“Temperament traits also have distinct neurobiological correlates with a substantial literature in humans and animals [18–20].”

What the sources say

• Not checked yetcites [18] Depue RA Lenzenweger MF A neurobehavioral dimensional model of personality disturbance Major theories of personality disorder 2005 2 391 453
• Not checked yetcites [19] Kennis M Rademaker AR Geuze E Neural correlates of personality: An integrative review Neuroscience & Biobehavioral Reviews 2012 23142157
• Not checked yetcites [20] Zuckerman M Psychobiology of personality 2005 2nd ed. New York, NY Cambridge University Press

In the paper

“Motion, a known confound in functional MRI studies, was corrected and quantified several ways [46, 49] (for details see the Supplement).”

What the sources say

• Not checked yetcites [46] Fair DA Distinct neural signatures detected for ADHD subtypes after controlling for micro-movements in resting state functional connectivity MRI data Frontiers in Systems Neuroscience 2012 6 PMC3563110 23382713
• Not checked yetcites [49] Power JD Barnes KA Snyder AZ Schlaggar BL Petersen SE Spurious but systematic correlations in functional connectivity MRI networks arise from subject motion Neuroimage 2012 59 3 2142 2154 22019881 PMC3254728

In the paper

“Clustering algorithms can be expected to yield varying results depending on the algorithm used and features selected as input [13] and therefore are, in themselves, exploratory [14]”

What the sources say

• Not checked yetcites [13] Everitt BS Landau S Leese M Stahl D Cluster Analysis 2011 5th ed. West Sussex, United Kingdom John Wiley & Sons, Ltd
• Not checked yetcites [14] Jain AK Data clustering: 50 years beyond K-means Pattern Recognition Letters 2010 31 8 651 666

In the paper

“To generate a single, stable depiction of structure, final group assignments for each child were based on the modal group assignment across 10 runs of the modularity algorithm.”

In the paper

“In humans, temperament domains are differentially related to peripheral nervous system indicators [21–25], as well to specific neural circuitry [e.g. amygdala, hippocampus, insula, and striatum, anterior cingulate cortex, and prefrontal cortex, 26, 27].”

What the sources say

• Not checked yetcites [21] Beauchaine TP Katkin ES Strassberg Z Snarr J Disinhibitory psychopathology in male adolescents: Discriminating conduct disorder from attention-deficit/hyperactivity disorder through concurrent assessment of multiple autonomic states Journal of Abnormal Psychology 2001 110 4 610 624 11727950
• Not checked yetcites [22] Healy B Treadwell A Reagan M Measures of RSA suppression, attentional control, and negative affect predict self-ratings of executive functions Journal of Psychophysiology 2011 25 4 164 173
• Not checked yetcites [23] Miller JG Children's dynamic RSA change during anger and its relations with parenting, temperament, and control of aggression Biological Psychology 2012 PMC4055035 23274169
• Not checked yetcites [24] Stifter CA Dollar JM Cipriano EA Temperament and emotion regulation: the role of autonomic nervous system reactivity Developmental psychobiology 2011 53 3 266 279 21400489 PMC3737744
• Not checked yetcites [25] Zalewski M Lengua LJ Wilson AC Trancik A Bazinet A Emotion regulation profiles, temperament, and adjustment problems in preadolescents Child Development 2011 82 3 951 966 21413935 PMC4080917
• Not checked yetcites [26] Ochsner KN Silvers JA Buhle JT Functional imaging studies of emotion regulation: a synthetic review and evolving model of the cognitive control of emotion Annals of the New York Academy of Sciences 2012 1251 1 E1 E24 23025352 PMC4133790
• Not checked yetcites [27] Whittle S Allen NB Lubman DI Yücel M The neurobiological basis of temperament: Towards a better understanding of psychopathology Neuroscience & Biobehavioral Reviews 2006 30 4 511 525 16289282

In the paper

“Functional images were processed to reduce artifacts and connectivity was processed following published methods [48] and are reproduced in the Supplement.”

What the sources say

• Not checked yetcites [48] Miezin FM Maccotta L Ollinger J Petersen S Buckner R Characterizing the hemodynamic response: effects of presentation rate, sampling procedure, and the possibility of ordering brain activity based on relative timing Neuroimage 2000 11 6 735 759 10860799

In the paper

“imaging results are based on a small subsample of participants and should be considered preliminary”

In the paper

“Together these data may highlight the region’s importance for emotional regulation and impulse control.”

In the paper

“Importantly, this and other modularity algorithms are not deterministic, and thus can yield slightly different solutions on different runs.”

In the paper

“they emerge as promising, novel types of ADHD”

In the paper

“temperament traits have been investigated in many other disorders [65]”

What the sources say

• Not checked yetcites [65] Nigg JT Temperament and developmental psychopathology Journal of Child Psychology and Psychiatry 2006 47 3–4 395 422 16492265

In the paper

“while being mostly consistent with and building on previous work exploring temperament subgroups in ADHD in a different sample [66]”

What the sources say

• Not checked yetcites [66] Martel MM Goth-Owens T Martinez-Torteya C Nigg JT A person-centered personality approach to heterogeneity in attention-deficit/hyperactivity disorder (ADHD) Journal of Abnormal Psychology 2010 119 1 186 196 20141255 PMC2846424

In the paper

“Results suggest that revising the nosology in the case of ADHD is tractable and will be biologically meaningful.”

In the paper

“suggesting some validity and clinical applicability for these measures”

In the paper

“these findings are broadly consistent with, but suggest some modifications to, prior theory of ADHD temperament variation that inspired this work [64, 65]”

What the sources say

• Not checked yetcites [64] Nigg J Goldsmith HH Sachek J Temperament and Attention Deficit Hyperactivity Disorder: The Development of a Multiple Pathway Model Journal of Clinical Child and Adolescent Psychology 2004 33 1 42 53 15028540
• Not checked yetcites [65] Nigg JT Temperament and developmental psychopathology Journal of Child Psychology and Psychiatry 2006 47 3–4 395 422 16492265

In the paper

“it has also been shown to be heavily involved in higher order control processing [62, 63]”

What the sources say

• Not checked yetcites [62] Dosenbach NU Fair DA Cohen AL Schlaggar BL Petersen SE A dual-networks architecture of top-down control Trends in Cognitive Sciences 2008 12 3 99 105 18262825 PMC3632449
• Not checked yetcites [63] Dosenbach NU Distinct brain networks for adaptive and stable task control in humans Proceedings of the National Academy of Sciences 2007 104 26 11073 11078 PMC1904171 17576922

In the paper

“A parent/guardian completed the widely used Temperament in Middle Childhood Questionnaire [TMCQ, 34].”

What the sources say

• Not checked yetcites [34] Simonds J Rothbart MK The Temperament in Middle Childhood Questionnaire (TMCQ): A computerized self-report measure of temperament for ages 7–10, in Occasional Temperament Conference 2004 Athens, GA