Heterogeneity and Subtyping in Attention-Deficit/Hyperactivity Disorder—Considerations for Emerging Research Using Person-Centered Computational Approaches
Open accessAbstract
Few if any experts believe that existing psychiatric diagnostic categories included in DSM and ICD are actually discrete disease entities. Attention-deficit/hyperactivity disorder (ADHD) is emblematic of the problems in the existing psychiatric classification system. ADHD symptoms reliably cluster into two correlated dimensions in factor analysis. However, children with ADHD vary considerably in their symptom profiles, symptom trajectories, clinical outcomes, and biological and psychological correlates. Thus, the field has sought alternative approaches that harness the dimensions of emotional, cognitive, and behavioral functioning that underlie ADHD and other existing psychiatric categories to create informative phenotypes that improve clinical prediction and clarify etiology. Within ADHD, cognitive (neuropsychological) and temperament/personality features have received considerable attention. In some cases, subphenotypes based on these features appear to improve on existing classifications and could eventually be translated into clinical practice. This review summarizes findings from subphenotyping efforts in ADHD that use cognitive, emotion-related, and other features to highlight major considerations for research applying person-oriented approaches to inform an improved psychiatric nosology. Considerations related to feature selection, validation of newly proposed divisions, defining populations of interest, and incorporating a developmental perspective are discussed.
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Previous studies indicate that neurophysiological profiles are highly heterogeneous in children with neurodevelopmental disorders, particularly with ADHD and ASD, meaning that the lack of replication on these measures may not be solely attributable to methodological limitations of original studies (e.g., unrepresentative and underpowered samples).
“Of note, previous studies indicate that neurophysiological profiles are highly heterogeneous in children with neurodevelopmental disorders, particularly with ADHD 73 and ASD 74 , meaning that the lack of replication on these measures may not be solely attributable to methodological limitations of original studies (e.g., unrepresentative and underpowered samples).”
From Candidate diagnostic biomarkers for neurodevelopmental disorders in children and adolescents: a systematic review (2023) · cites this paper as [73]
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References 97 · Cited by 84
Research works printed but not linked: 1
- [54]Bates JE, Goodnight JA, Fite JE (2008): Temperament and Emotion In: Lewis M, Haviland-Jones JM, Barrett LF, editors. Handbook of Emotion, 3 ed. New York, NY: The Guilford Press.
- Authors
- Karalunas, S. L., & Nigg, J. T.
- Affiliations
- Oregon Health & Science University (US)
- Corresponding author
- Karalunas, Sarah L.
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2020-07
- Volume
- 88
- Issue
- 1
- Pages
- 103-110
- ISSN
- 0006-3223 (ISSN-L)
- PMC
- PMC7210094
- OpenAlex
- W2986001364
- Cited by
- 84
- References
- 97
- Citations by year
- 2026: 11 · 2025: 15 · 2024: 19 · 2023: 7 · 2022: 18 · 2021: 7 · 2020: 7
- FWCI
- 1.35
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Keywords
- attention deficit hyperactivity disorder, subphenotypes, psychiatric classification, symptom dimensions, neuropsychological characteristics, temperament, personality traits, emotional functioning, developmental perspective, feature selection, clinical prediction
- MeSH terms
- Attention, Attention Deficit Disorder with Hyperactivity, Child, Humans, Temperament
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