ADHD Comorbidity Findings From the MTA Study: Comparing Comorbid Subgroups
Abstract
Objectives Previous research has been inconclusive whether attention-deficit/hyperactivity disorder (ADHD), when comorbid with disruptive disorders (oppositional defiant disorder [ODD] or conduct disorder [CD]), with the internalizing disorders (anxiety and/or depression), or with both, should constitute separate clinical entities. Determination of the clinical significance of potential ADHD + internalizing disorder or ADHD + ODD/CD syndromes could yield better diagnostic decision-making, treatment planning, and treatment outcomes.Method Drawing upon cross-sectional and longitudinal information from 579 children (aged 7-9.9 years) with ADHD participating in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA), investigators applied validational criteria to compare ADHD subjects with and without comorbid internalizing disorders and ODD/CD.Results Substantial evidence of main effects of internalizing and externalizing comorbid disorders was found. Moderate evidence of interactions of parent-reported anxiety and ODD/CD status were noted on response to treatment, indicating that children with ADHD and anxiety disorders (but no ODD/CD) were likely to respond equally well to the MTA behavioral and medication treatments. Children with ADHD-only or ADHD with ODD/CD (but without anxiety disorders) responded best to MTA medication treatments (with or without behavioral treatments), while children with multiple comorbid disorders (anxiety and ODD/CD) responded optimally to combined (medication and behavioral) treatments.Conclusions Findings indicate that three clinical profiles, ADHD co-occurring with internalizing disorders (principally parent-reported anxiety disorders) absent any concurrent disruptive disorder (ADHD + ANX), ADHD co-occurring with ODD/CD but no anxiety (ADHD + ODD/CD), and ADHD with both anxiety and ODD/CD (ADHD + ANX + ODD/CD) may be sufficiently distinct to warrant classification as ADHD subtypes different from "pure" ADHD with neither comorbidity. Future clinical, etiological, and genetics research should explore the merits of these three ADHD classification options.
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Comorbidity increases symptom heterogeneity and confounds treatment efficacy, creating a major clinical challenge.
“poses a major clinical challenge as it enhances symptom heterogeneity and confounds treatment efficacy (Jensen et al., 2001).”
From Data‐driven identification of subtypes of executive function across typical development, attention deficit hyperactivity disorder, and autism spectrum disorders (2020) · cites this paper as Jensen et al., 2001
Several studies in children found that ADHD outcomes of pharmacological treatment were similar among those with and without concurrent CD.
“and several studies in children found that ADHD outcomes of pharmacological treatment were similar among those with and without concurrent CD [82,83,84].”
From Treatment of Adolescents with Concurrent Substance Use Disorder and Attention-Deficit/Hyperactivity Disorder: A Systematic Review (2021) · cites this paper as [83]
Many youth with ADHD also struggle with significant levels of anxiety, and between 20-40% have a comorbid anxiety disorder.
“In addition to emotional lability, many youth with ADHD also struggle with significant levels of anxiety, and between 20 – 40% have a comorbid anxiety disorder [45, 46].”
From Using Stimulants to Treat ADHD-Related Emotional Lability (2014) · cites this paper as [45]
DR/ER-MPH treatment can alleviate daily challenges by restoring emotional lability to the level of non-ADHD peers.
“these studies show that DR/ER-MPH treatment can alleviate these daily challenges by restoring EL to the level of non-ADHD peers”
From A Post-Hoc Analysis of Emotional Lability With Delayed-Release/Extended-Release Methylphenidate in Children Aged 6 to 12 Years of Age Participating in Two Phase 3 Clinical Trials (2024) · cites this paper as Jensen et al., 2001
ADHD combined with severe EL increases the likelihood of certain comorbidities, such as oppositional defiant, affective, and substance use disorders.
“Additionally, ADHD combined with severe EL increases the likelihood of certain comorbidities, such as oppositional defiant, affective, and substance use disorders, which make identifying an appropriate treatment regime more challenging due to varying symptom profiles and complex medication regimens (Jensen et al., 2001; Sobanski et al., 2010).”
From A Post-Hoc Analysis of Emotional Lability With Delayed-Release/Extended-Release Methylphenidate in Children Aged 6 to 12 Years of Age Participating in Two Phase 3 Clinical Trials (2024) · cites this paper as Jensen et al., 2001
Other studies have documented the comorbidity between ADHD and depression.
“Other studies have documented the comorbidity between ADHD and depression [76, 77].”
From The brain anatomy of attention-deficit/hyperactivity disorder in young adults—a magnetic resonance imaging study (2017) · cites this paper as [77]
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PSYCHOTROPIC DRUGS AND SEXUAL BEHAVIOR
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2 of the 117 references couldn’t be matched to a known paper.
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Pliszka, S. (2007) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e318054e724 · Cited by 1,765 · see citing works
Attention-deficit hyperactivity disorder
Biederman, J., & Faraone, S. V. (2005) · The Lancet · doi:10.1016/s0140-6736(05)66915-2 · Cited by 1,463 · see citing works
Emotion Dysregulation in Attention Deficit Hyperactivity Disorder
Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2013.13070966 · Cited by 1,232 · see citing works
“reasonable, as this combination is effective in those with mixed internalizing and externalizing symptoms, many of whom have emotional dysregulation (51, 133).”
sagvolden, T., johansen, E. B., aase, H., & russell, V. A. (2005) · Behavioral and Brain Sciences · doi:10.1017/s0140525x05000075 · Cited by 1,035 · see citing works
“However, there seem to be two subtypes of ODD associated with ADHD: one that is prodromal to CD and another that is subsyndromal to CD but not likely to progress into CD in later years (Biederman et al. 1996; Jensen et al. 2001).”
BackgroundInfluentialEvidence-based psychosocial treatments for attention-deficit/hyperactivity disorder
Pelham, W. E., & Fabiano, G. A. (2008) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374410701818681 · Cited by 917 · see citing works
“…contingency management in peer=recreational settings. d In addition to the MTA primary outcome study, numerous other studies report on treatment related outcomes, the total of which would Jensen et al. (2001); MTACG (1999a, 1999b, in press); Owens et al. (2003); and Swanson et al. (2001). e…”
ResultSelf-citationAttention-Deficit, S. O., & Disorder, H. (2001) · Pediatrics · doi:10.1542/peds.108.4.1033 · Cited by 636 · see citing works
BIEDERMAN, J., MONUTEAUX, M. C., MICK, E., SPENCER, T., WILENS, T. E., SILVA, J. M., SNYDER, L. E., & FARAONE, S. V. (2006) · Psychological Medicine · doi:10.1017/s0033291705006410 · Cited by 850 · see citing works
“Our results showing that ADHD youth grown up have high levels of lifetime anxiety disorders are consistent with the pediatric (Biederman et al. 1996, 1999b ; March et al. 2000; Jensen et al. 2001) and adult literature (Biederman et al. 2004).”
ResultSocial fears and social phobia in the USA: results from the National Comorbidity survey replication
Ruscio, A. M., Brown, T. A., Chiu, W. T., Sareen, J., Stein, M. B., & Kessler, R. C. (2008) · Psychological Medicine · doi:10.1017/s0033291707001699 · Cited by 835 · see citing works
“The current study extends previous findings on comorbidity in social phobia (Kessler et al. 1994, 1999 ; Magee et al. 1996 ; Sonntag et al. 2000; Jensen et al. 2001 ; Sareen et al. 2001, 2004, 2006 ; Goodwin & Hamilton, 2003) by including a wider range of co-morbid conditions and by documenting a…”
ResultPersonality differences in childhood and adolescence: Measurement development, and consequences
Shiner, R., & Caspi, A. (2003) · Journal of Child Psychology and Psychiatry · doi:10.1111/1469-7610.00101 · Cited by 701 · see citing works
Frazier, T. W., Youngstrom, E. A., Glutting, J. J., & Watkins, M. W. (2007) · Journal of Learning Disabilities · doi:10.1177/00222194070400010401 · Cited by 700 · see citing works
3-year follow-up of the NIMH MTA study
JENSEN, P. S., ARNOLD, L. E., SWANSON, J. M., VITIELLO, B., ABIKOFF, H. B., GREENHILL, L. L., HECHTMAN, L., HINSHAW, S. P., PELHAM, W. E., WELLS, K. C., et al. (2007) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e3180686d48 · Cited by 643 · see citing works
“…in previous analyses of the MTA sample moderated 14-month outcomes (e.g., baseline comorbidity patterns, welfare status, parental psychopathology (Jensen et al., 2001; The MTA Cooperative Group, 1999b; Owens et al., 2003), and postrandomization factors (e.g., continuing medication use [The MTA…”
BackgroundResultSelf-citationWehmeier, P. M., Schacht, A., & Barkley, R. A. (2010) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2009.09.009 · Cited by 628 · see citing works
“Anxiety or depression are also common comorbid disorders of ADHD [17,63–69].”
BackgroundThe neurobiology of psychopathic traits in youths
Blair, J. (2013) · Nature reviews. Neuroscience · doi:10.1038/nrn3577 · Cited by 620 · see citing works
MTA Cooperative Group (2004) · Pediatrics · doi:10.1542/peds.113.4.754 · Cited by 589 · see citing works
Connolly, S. D., & Bernstein, G. A. (2007) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/01.chi.0000246070.23695.06 · Cited by 548 · see citing works
Attention-deficit/hyperactivity disorder and social dysfunctioning
Nijmeijer, J. S., Minderaa, R. B., Buitelaar, J. K., Mulligan, A., Hartman, C. A., & Hoekstra, P. J. (2008) · Clinical Psychology Review · doi:10.1016/j.cpr.2007.10.003 · Cited by 524 · see citing works
“…30 to 60% in children with ADHD of 7 years and older (Biederman, 2005; Biederman, Newcorn, & Sprich, 1991; Goldmann, Genel, Bezman, & Slanetz, 1998; Jensen et al., 2001), and for CD at least 20% of school aged children, with rates that tend to increase in adolescence (Biederman & Faraone, 2005).”
BackgroundCo?existing disorders in ADHD ? implications for diagnosis and intervention
Gillberg, C., Gillberg, I. C., Rasmussen, P., Kadesj�, B., S�derstr�m, H., R�stam, M., Johnson, M., Rothenberger, A., & Niklasson, L. (2004) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-004-1008-4 · Cited by 451 · see citing works
“[64], which indicated that three clinical profiles”
BackgroundCurry, J. F., Rohde, P., Simons, A. D., Silva, S. G., Vitiello, B., Kratochvil, C. J., Reinecke, M. A., Feeny, N. C., Wells, K., Pathak, S., et al. (2006) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/01.chi.0000240838.78984.e2 · Cited by 432 · see citing works
“of Pediatric Psychopharmacology Anxiety StudyGroup, 2003) or a moderator of differential treatment response (Brent et al., 1998; Jensen et al., 2001; March et al., 2000) in previous studies.”
ResultSelf-citationSymptom profiles in children with ADHD: effects of comorbidity and gender.
Newcorn, J. H., Halperin, J., Jensen, P. S., Abikoff, H., Arnold, L. E., Cantwell, D., Conners, C., Elliott, G., Epstein, J. N., Greenhill, L. L., et al. (2001) · Journal of the American Academy of Child and Adolescent Psychiatry · doi:10.1097/00004583-200102000-00008 · Cited by 442 · see citing works
“We did not examine comorbid mood disorder separately because this was a relatively small group which was not associated with an a priori hypothesis and because virtually all of these children also had ANX (Jensen et al., 2001).”
BackgroundResultSelf-citationComorbidity prevalence and treatment outcome in children and adolescents with ADHD
on behalf of Lombardy ADHD Group, Reale, L., Bartoli, B., Cartabia, M., Zanetti, M., Costantino, M. A., Canevini, M. P., Termine, C., & Bonati, M. (2017) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-017-1005-z · Cited by 414 · see citing works
JENSEN, P. S., HINSHAW, S. P., SWANSON, J. M., GREENHILL, L. L., CONNERS, C. K., ARNOLD, L. E., ABIKOFF, H. B., ELLIOTT, G., HECHTMAN, L., HOZA, B., et al. (2001) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/00004703-200102000-00008 · Cited by 591 · see citing works
Self-citationADHD With Comorbid Anxiety: A Review of the Current Literature
Schatz, D. B., & Rostain, A. L. (2006) · Journal of Attention Disorders · doi:10.1177/1087054706286698 · Cited by 407 · see citing works
Child anxiety in primary care: Prevalent but untreated
Chavira, D. A., Stein, M. B., Bailey, K., & Stein, M. T. (2004) · Depression and Anxiety · doi:10.1002/da.20039 · Cited by 305 · see citing works
“Third, childhood anxiety may intensify the impact of commonly co-occurring disorders such as ADHD [Jensen et al., 2001].”
BackgroundObserved Classroom Behavior of Children with ADHD: Relationship to Gender and Comorbidity
Abikoff, H. B., Jensen, P. S., Arnold, L. L. E., Hoza, B., Hechtman, L., Pollack, S., Martin, D., Alvir, J., March, J. S., Hinshaw, S., et al. (2002) · Journal of Abnormal Child Psychology · doi:10.1023/a:1015713807297 · Cited by 367 · see citing works
Self-citationNikolas, M., & Burt, S. (2010) · Journal of Abnormal Psychology · doi:10.1037/a0018010 · Cited by 388 · see citing works
“For example, the Multi-Modal Treatment of ADHD (MTA) studies have demonstrated significant improvements in ADHD (and even in related disruptive behaviors) with the combined use of medications and behavioral interventions (Jensen et al., 2001), demonstrating that the degree to which a disorder is genetically influenced…”
BackgroundToward an empirical definition of pediatric PTSD: the phenomenology of PTSD symptoms in youth.
Carrion, V., Weems, C., Ray, R., & Reiss, A. (2002) · Journal of the American Academy of Child and Adolescent Psychiatry · doi:10.1097/00004583-200202000-00010 · Cited by 338 · see citing works
Comorbidity of ADHD and dyslexia
Germanò, E., Gagliano, A., & Curatolo, P. (2010) · Developmental Neuropsychology · doi:10.1080/87565641.2010.494748 · Cited by 331 · see citing works
“Psychiatric comorbidities include oppositional defiant disorder, conduct disorder, anxiety, and depression (Jensen et al., 2001).”
Backgroundde Boo, G. M., & Prins, P. J. M. (2007) · Clinical Psychology Review · doi:10.1016/j.cpr.2006.03.006 · Cited by 334 · see citing works
“Significant differences were established between the ADHD+ANX and ADHD+ODD/CD for parent-rated social skills (SSRS) (Jensen et al., 2001) at baseline.”
BackgroundMethylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD)
Storebø, O. J., Ramstad, E., Krogh, H. B., Nilausen, T. D., Skoog, M., Holmskov, M., Rosendal, S., Groth, C., Magnusson, F. L., Moreira-Maia, C. R., et al. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009885.pub2 · Cited by 347 · see citing works
Treatment of Attention-Deficit/Hyperactivity Disorder: Overview of the Evidence
Brown, R. T., Amler, R. W., Freeman, W. S., Perrin, J. M., Stein, M. T., Feldman, H. M., Pierce, K., & Wolraich, M. L. (2005) · PEDIATRICS · doi:10.1542/peds.2004-2560 · Cited by 331 · see citing works
Faraone, S. V., Biederman, J., Spencer, T., Mick, E., Murray, K., Petty, C., Adamson, J. J., & Monuteaux, M. C. (2006) · American Journal of Psychiatry · doi:10.1176/ajp.2006.163.10.1720 · Cited by 329 · see citing works
“When compared with the subjects without ADHD, both groups had increased lifetime prevalences of mood, disruptive behavior, substance use, and anxiety disorders, each of which are known to be elevated among youth with ADHD (15, 16), clinically referred ADHD adults (17, 18), and ADHD youth followed into adulthood (19, 2…”
ResultJarrett, M. A., & Ollendick, T. H. (2008) · Clinical Psychology Review · doi:10.1016/j.cpr.2008.05.004 · Cited by 311 · see citing works
The effects of infant media usage: what do we know and what should we learn?
Christakis, D. A. (2009) · Acta Paediatrica · doi:10.1111/j.1651-2227.2008.01027.x · Cited by 304 · see citing works
Attention deficit hyperactivity disorder and comorbidity: a review of literature
Gnanavel, S., Sharma, P., Kaushal, P., & Hussain, S. (2019) · World Journal of Clinical Cases · doi:10.12998/wjcc.v7.i17.2420 · Cited by 296 · see citing works
ADHD and autism: differential diagnosis or overlapping traits? A selective review
Taurines, R., Schwenck, C., Westerwald, E., Sachse, M., Siniatchkin, M., & Freitag, C. (2012) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-012-0086-2 · Cited by 301 · see citing works
“The first line treatment for ADHD is methylphenidate treatment, which showed superior effects on ADHD symptoms compared to behavioral therapy in a large randomized controlled trial (Jensen et al. 2001b).”
Adult Outcome of Attention-Deficit/Hyperactivity Disorder: A Controlled 16-Year Follow-Up Study
Biederman, J., Petty, C. R., Woodworth, K. Y., Lomedico, A., Hyder, L. L., & Faraone, S. V. (2012) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.11m07529 · Cited by 291 · see citing works
Nigg, J. T., Knottnerus, G. M., Martel, M. M., Nikolas, M. A., CAVANAGH, K. T., Karmaus, W., & Rappley, M. D. (2007) · Biological Psychiatry · doi:10.1016/j.biopsych.2007.07.013 · Cited by 284 · see citing works
“The syndrome frequently co-occurs with other disruptive behaviors, particularly conduct and oppositional defiant disorders (3), so their effects must be considered.”
BackgroundOzer, E. J., & Weinstein, R. S. (2004) · Journal of Clinical Child & Adolescent Psychology · doi:10.1207/s15374424jccp3303_4 · Cited by 278 · see citing works
“…and externalizing disorders (Harrington, Rutter, & Fombonne, 1996), there is evidence that the presence of internalizing versus externalizing disorders reflect meaningful differences with implications for understanding variations in both etiology and treatment response (Jensen et al., 2001).”
BackgroundWhich treatment for whom for ADHD? Moderators of treatment response in the MTA.
Owens, E. B., Hinshaw, S. P., KRAEMER, H. C., Arnold, L. E., Abikoff, H., Cantwell, D. P., Conners, C. K., Elliott, G. R., Greenhill, L. L., Hechtman, L. T., et al. (2003) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.71.3.540 · Cited by 275 · see citing works
“, 2000; MTA Cooperative Group, 1999b) or in combination with only one other potential moderator (Jensen et al., 2001).”
BackgroundResultSelf-citationBeauchaine, T. P., Klein, D. N., Crowell, S. E., Derbidge, C. M., & Gatzke‐Kopp, L. M. (2009) · Development and Psychopathology · doi:10.1017/s0954579409000418 · Cited by 263 · see citing works
“Furthermore, central DA dysfunction may account for the co-occurrence of both externalizing and internalizing symptoms among comorbid individuals (see Beauchaine & Neuhaus, 2008; Beauchaine et al., 2008).”
BackgroundA cognitive remediation programme for adults with Attention Deficit Hyperactivity Disorder
Stevenson, C. S., Whitmont, S., Bornholt, L., Livesey, D., & Stevenson, R. J. (2002) · Australian & New Zealand Journal of Psychiatry · doi:10.1046/j.1440-1614.2002.01052.x · Cited by 261 · see citing works
“A final question, raised by childhood ADHD literature [34,35], warrants addressing here, namely, whether adults with ADHD who had problems with anxiety faired better as a results of this psychosocial intervention when compared to non-anxious adults with ADHD.”
ResultEmotional Dysregulation in Adult ADHD and Response to Atomoxetine
Reimherr, F. W., Marchant, B. K., Strong, R. E., Hedges, D. W., Adler, L., Spencer, T. J., West, S. A., & Soni, P. (2005) · Biological Psychiatry · doi:10.1016/j.biopsych.2005.04.040 · Cited by 258 · see citing works
MOLINA, B. S. G., FLORY, K., HINSHAW, S. P., GREINER, A. R., ARNOLD, L. E., SWANSON, J. M., HECHTMAN, L., JENSEN, P. S., VITIELLO, B., HOZA, B., et al. (2007) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e3180686d96 · Cited by 255 · see citing works
“, 2001), or a composite of ODD and conduct disorder (CD) diagnoses (Arnold et al., 2005; Jensen et al., 2001).”
BackgroundSelf-citationMarch, J. S., Swanson, J. M., Arnold, L. E., Hoza, B., Conners, C. K., Hinshaw, S. P., Hechtman, L. T., KRAEMER, H. C., Greenhill, L. L., Abikoff, H., et al. (2000) · Research on Child and Adolescent Psychopathology · doi:10.1023/a:1005179014321 · Cited by 250 · see citing works
Self-citationAssessment and Management of Sleep Problems in Youths With Attention-Deficit/Hyperactivity Disorder
Cortese, S., Brown, T. E., Corkum, P. V., Gruber, R., O'Brien, L. M., Stein, M. A., Weiss, M. D., & Owens, J. A. (2013) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2013.06.001 · Cited by 241 · see citing works
Prevalence of attention deficit/hyperactivity disorder among adults in obesity treatment
Altfas, J. R. (2002) · BMC Psychiatry · doi:10.1186/1471-244x-2-9 · Cited by 240 · see citing works
Tarver, J., Daley, D., & Sayal, K. (2014) · Child: Care, Health and Development · doi:10.1111/cch.12139 · Cited by 234 · see citing works
Ollendick, T. H., Jarrett, M. A., Grills, A. E., Hovey, L. D., & Wolff, J. C. (2008) · Clinical Psychology Review · doi:10.1016/j.cpr.2008.09.003 · Cited by 235 · see citing works
Yoshimasu, K., Barbaresi, W. J., Colligan, R. C., Voigt, R. G., Killian, J. M., Weaver, A. L., & Katusic, S. K. (2012) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2012.02567.x · Cited by 290 · see citing works
“Clinical studies show that combinations of ADHD with ODD/CD, and/or anxiety should be strictly distinguished as the most effective treatment differs among these conditions (Jensen et al., 2001).”
BackgroundZwi, M., Jones, H. G., Thorgaard, C., York, A., & Dennis, J. A. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003018.pub3 · Cited by 229 · see citing works
Behavioral abnormality and pharmacologic response in social isolation-reared mice
Koike, H., Ibi, D., Mizoguchi, H., Nagai, T., Nitta, A., Takuma, K., Nabeshima, T., Yoneda, Y., & Yamada, K. (2009) · Behavioural Brain Research · doi:10.1016/j.bbr.2009.03.028 · Cited by 221 · see citing works
Connor, D. F., Steeber, J., & McBurnett, K. (2010) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0b013e3181e121bd · Cited by 218 · see citing works
Executive function in adolescents with ADHD
MARTEL, M., NIKOLAS, M., & NIGG, J. T. (2007) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e31814cf953 · Cited by 214 · see citing works
“so effects may not generalize to adolescents with comorbid ADHD and aggression (Jensen et al., 2001).”
BackgroundTen good reasons to consider biological processes in prevention and intervention research
Beauchaine, T. P., Neuhaus, E., Brenner, S. L., & Gatzke-Kopp, L. (2008) · Development and Psychopathology · doi:10.1017/s0954579408000369 · Cited by 215 · see citing works
Teplin, L. A., Elkington, K. S., McClelland, G. M., Abram, K. M., Mericle, A. A., & Washburn, J. J. (2005) · Psychiatric Services · doi:10.1176/appi.ps.56.7.823 · Cited by 214 · see citing works
“Examining comorbid substance use disorders is critical because they are so prevalent in populations at risk of HIV-AIDS—for example, youths in the juvenile justice system (9), youths in mental health treatment (23,24), homeless youths (25), and adult jail detainees (26,27).”
BackgroundStimulant Medication and Substance Use Outcomes
Humphreys, K. L., Eng, T., & Lee, S. S. (2013) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2013.1273 · Cited by 211 · see citing works
GELLER, D. A., Donnelly, C. L., López, F. A., Rubin, R. L., Newcorn, J. H., Sutton, V. K., Bakken, R., Paczkowski, M., Kelsey, D. K., & Sumner, C. R. (2007) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e3180ca8385 · Cited by 208 · see citing works
Self-citationMyers, K., Stoep, A. V., Zhou, C., McCarty, C. A., & Katon, W. J. (2015) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2015.01.009 · Cited by 204 · see citing works
Developmental comorbidity in attention-deficit/hyperactivity disorder
Taurines, R., Schmitt, J., Renner, T., Conner, A. C., Warnke, A., & Romanos, M. (2010) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-010-0040-0 · Cited by 198 · see citing works
ADHD characteristics: I. Concurrent co-morbidity patterns in children & adolescents
Elia, J., Ambrosini, P., & Berrettini, W. (2008) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/1753-2000-2-15 · Cited by 196 · see citing works
Co-occurrence of ADHD and autism spectrum disorders: phenomenology and treatment
Reiersen, A. M., & Todd, R. D. (2008) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.8.4.657 · Cited by 189 · see citing works
Antshel, K. M., & Remer, R. (2003) · Journal of Clinical Child & Adolescent Psychology · doi:10.1207/s15374424jccp3201_14 · Cited by 186 · see citing works
“, 2001) found that children with ADHD and comorbid ODD did not show a differential response to treatments (Jensen et al., 2001).”
BackgroundMethodResultInfluentialvan den Hoofdakker, B. J., van der Veen-Mulders, L., Sytema, S., Emmelkamp, P., Minderaa, R., & Nauta, M. (2007) · Journal of the American Academy of Child and Adolescent Psychiatry · doi:10.1097/chi.0b013e3181354bc2 · Cited by 182 · see citing works
King, S., Griffin, S. C., Hodges, Z., Weatherly, H. L. A., Asseburg, C., Richardson, G. A., Golder, S., Taylor, E., Drummond, M., & Riemsma, R. P. (2006) · Health Technology Assessment · doi:10.3310/hta10230 · Cited by 185 · see citing works
Categorization and cognitive deficits in compulsive hoarding
Grisham, J. R., Norberg, M. M., Williams, A. D., Certoma, S. P., & Kadib, R. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.05.011 · Cited by 184 · see citing works
Cheng, J. Y. W., Chen, R. Y. L., Ko, J. S. N., & Ng, E. M. L. (2007) · Psychopharmacology · doi:10.1007/s00213-007-0840-x · Cited by 185 · see citing works
“Oppositional defiant disorder (ODD) is the most common comorbid condition in ADHD, and it affects 30–60% of children with ADHD (Biederman et al. 1991; Goldman et al. 1998; Jensen et al. 2001).”
BackgroundStorebø, O. J., Pedersen, N., Ramstad, E., Kielsholm, M. L., Nielsen, S. S., Krogh, H. B., Moreira-Maia, C. R., Magnusson, F. L., Holmskov, M., Gerner, T., et al. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012069.pub2 · Cited by 321 · see citing works
LEVIN, F. R., Evans, S. M., Brooks, D. J., Kalbag, A. S., Garawi, F., & Nunes, E. V. (2005) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2005.06.012 · Cited by 174 · see citing works
Who Is at Greatest Risk of Adverse Long-Term Outcomes? The Finnish From a Boy to a Man Study
Sourander, A., Jensen, P. S., Davies, M., Niemelä, S., Elonheimo, H., Ristkari, T., Helenius, H. Y. M., Sillanmäki, L. H., Piha, J., Kumpulainen, K., et al. (2007) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e31809861e9 · Cited by 171 · see citing works
Self-citationSchwartz, S., & Correll, C. U. (2014) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2013.11.005 · Cited by 166 · see citing works
Biederman, J., Monuteaux, M. C., Mick, E. O., Spencer, T. J., Wilens, T. E., Klein, K. L., Price, J., & Faraone, S. V. (2006) · Biological Psychiatry · doi:10.1016/j.biopsych.2006.02.031 · Cited by 168 · see citing works
Comorbidity between ADHD and Anxiety Disorders across the Lifespan
D’Agati, E., Curatolo, P., & Mazzone, L. (2019) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651501.2019.1628277 · Cited by 165 · see citing works
“Furthermore, CBT treatment positively affected academic, social function and ADHD symptoms (Jensen et al., 2001), youth patients with comorbid anxiety disorders are less likely to benefit from CBT strategies alone and need adjunctive psychosocial or pharmacotherapy interventions (Halldorsdottir et…”
BackgroundADHD: Does Parenting Style Matter?
Modesto‐Lowe, V., Danforth, J. S., & Brooks, D. (2008) · Clinical Pediatrics · doi:10.1177/0009922808319963 · Cited by 166 · see citing works
“According to the US/Canadian multimodal treatment study of ADHD, only 33% of children with ADHD have “pure” ADHD, compared with 64% with a comorbid condition.(20) CD and oppositional defiant disorder (ODD) are common childhood disruptive behavioral disorders (DBDs) that frequently co-occur with ADHD.”
MethodRole of Oxidative Stress and Neuroinflammation in Attention-Deficit/Hyperactivity Disorder
Corona, J. C. (2020) · Antioxidants · doi:10.3390/antiox9111039 · Cited by 163 · see citing works
Chang, Z., Ghirardi, L., Quinn, P. D., Asherson, P., D’Onofrio, B. M., & Larsson, H. (2019) · Biological Psychiatry · doi:10.1016/j.biopsych.2019.04.009 · Cited by 175 · see citing works
“Treating ADHD is a major public health issue, as the disorder is associated with high rates of comorbidity (7, 8) and serious outcomes (9–11).”
Jensen, P. S., Garcia, J. A., Glied, S., Crowe, M., Foster, M., Schlander, M., Hinshaw, S. P., Vitiello, B., Arnold, L. E., Elliott, G. R., et al. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.9.1628 · Cited by 161 · see citing works
“However, the effectiveness for each treatment varied as a function of comorbidity, as reported previously (17) and shown here in Table 1 in terms of the proportion of children “normalized” by each treatment for each of the comorbidity profiles.”
BackgroundMethodInfluentialSelf-citationEffects of ethnicity on treatment attendance, stimulant response/dose, and 14-month outcome in ADHD
Arnold, L. E., Elliott, M., Sachs, L., Bird, H., Kraemer, H. C., Wells, K. C., Abikoff, H. B., Comarda, A., Conners, C. K., Elliott, G. R., et al. (2003) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.71.4.713 · Cited by 159 · see citing works
“Many such characteristics have already been reported (Abikoff et al., 2002; Hoza et al., 2000; Jensen, 2001; Jensen et al., 2001; March et al., 2000; MTA Cooperative Group, 1999b; Newcorn et al., 2001; Rieppi et al., 2002), in addition to the primary intention-to-treat analysis of the four treatment conditions (MTA Co…”
BackgroundResultPfiffner, L. J., McBurnett, K., Rathouz, P. J., & Judice, S. (2005) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-005-6737-4 · Cited by 157 · see citing works
“…also used the DISC interview for making diagnoses, when the same anxiety diagnoses (i.e., Simple Phobia, Generalized Anxiety Disorder, Separation Anxiety Disorder, and Social Phobia) were used as the basis for determining the presence or absence of anxiety in both studies (Jensen et al., 2001).”
MethodMental Disorders in Five Year Old Children With or Without Developmental Delay: Focus on ADHD
Baker, B., Neece, C. L., Fenning, R., Crnic, K., & Blacher, J. (2010) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2010.486321 · Cited by 173 · see citing works
“The two most common cooccurring disorders were ADHD and ODD, which is consistent with past research on TD children (Jensen et al., 2001).”
ResultBarbaresi, W. J., Campbell, L. A., Diekroger, E. A., Froehlich, T. E., Liu, Y. H., O'Malley, E., Pelham, W. E., Power, T. J., Zinner, S. H., & Chan, E. (2020) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000000770 · Cited by 155 · see citing works
“Stimulant medication and atomoxetine(188) have been shown to be effective for treatment of ADHD with and without coexisting internalizing disorders, but stimulants are generally more effective.(186,189) Stimulant medication typically does not exacerbate internalizing symptoms and may be associated with a reduction in…”
Self-citationExperience of stress in parents of children with ADHD: A qualitative study
Leitch, S., Sciberras, E., Post, B., Gerner, B., Rinehart, N., Nicholson, J. M., & Evans, S. (2019) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.1080/17482631.2019.1690091 · Cited by 151 · see citing works
“However, given 64% of children with ADHD have at least one comorbid mental health condition (Jensen et al., 2001), parents’ experiences of comorbid conditions are likely an accurate reflection of parenting the majority of children with ADHD.”
BackgroundInfluentialStorebø, O. J., Skoog, M., Damm, D., Thomsen, P. H., Simonsen, E., & Gluud, C. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008223.pub2 · Cited by 149 · see citing works
Blader, J. C., Schooler, N. R., Jensen, P. S., Pliszka, S. R., & Kafantaris, V. (2009) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2009.09020233 · Cited by 149 · see citing works
“However, a substantial proportion of children with ADHD do not experience satisfactory reductions in aggressive behavior with stimulant treatment (13).”
BackgroundSelf-citationFunctional Impairments in Children With ADHD
Booster, G. D., DuPaul, G. J., Eiraldi, R. B., & Power, T. J. (2010) · Journal of Attention Disorders · doi:10.1177/1087054710383239 · Cited by 146 · see citing works
“…performance are consistent with the studies suggesting a lack of difference between comorbid groups (Blackman et al., 2005; Drabick et al., 2006; Karustis et al., 2000) but in contrast to other research that has revealed group differences (Jensen et al., 2001; Kuhne, Schachar, & Tannock, 1997).”
BackgroundResultInfluentialHinshaw, S. P. (2007) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsl055 · Cited by 141 · see citing works
Self-citationAttention-Deficit/Hyperactivity Disorder: A Neuropsychological Perspective Towards DSM-V
Stefanatos, G. A., & Baron, I. S. (2007) · Neuropsychology Review · doi:10.1007/s11065-007-9020-3 · Cited by 142 · see citing works
“…(ODD), conduct disorder (CD), personality disorder, substance abuse, criminal behavior, and impairments in social adjustment, the latter three particularly evident in adolescence and adulthood (Angold, Costello, & Erkanli, 1999; Biederman, Newcorn, & Sprich, 1991; Jensen et al., 2001; Klein, 2002).”
BackgroundRommelse, N. N. J., Altink, M. E., Fliers, E. A., Martin, N. C., Buschgens, C. J. M., Hartman, C. A., Buitelaar, J. K., Faraone, S. V., Sergeant, J. A., & Oosterlaan, J. (2009) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-009-9312-6 · Cited by 138 · see citing works
“Since oppositional defiant behaviors with ADHD may significantly influence the type of treatment that can be best prescribed (Hechtman et al. 2005; Jensen et al. 2001), it is important to assess oppositional defiant behavior in ADHD-patients.”
BackgroundInfluentialWaxmonsky, J. G., Pelham, W. E., Gnagy, E. M., Cummings, M. R., O’Connor, B. C., Majumdar, A., Verley, J., Hoffman, M. T., Massetti, G. M., Burrows-MacLean, L. D., et al. (2008) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2008.065 · Cited by 138 · see citing works
“In the MTA, BMOD improved ADHD symptoms, and adding BMOD to stimulants improved symptoms of conduct disorder (CD), ODD, and parent–child and peer relations (Jensen et al. 2001; Swanson et al. 2001).”
Self-citationSubjective and objective measures of sleep in children with attention-deficit/hyperactivity disorder
Owens, J., Sangal, R. B., Sutton, V. K., Bakken, R., Allen, A. J., & Kelsey, D. K. (2008) · Sleep Medicine · doi:10.1016/j.sleep.2008.03.013 · Cited by 138 · see citing works
Comorbidity of generalized social anxiety disorder and depression in a pediatric primary care sample
Chavira, D. A., Stein, M. B., Bailey, K. A., & Stein, M. T. (2003) · Journal of Affective Disorders · doi:10.1016/s0165-0327(03)00103-4 · Cited by 135 · see citing works
“The substantial comorbidity between ADHD and anxiety disorders remains an important issue given that comorbid disorders may influence baseline characteristics, functional impairment and treatment outcome (Greene et al., 2001; Jensen et al., 2001).”
BackgroundBowen, R., Chavira, D. A., Bailey, K. A., Stein, M. T., & Stein, M. B. (2007) · Psychiatry Research · doi:10.1016/j.psychres.2004.12.015 · Cited by 136 · see citing works
Co-existing psychiatric problems in ADHD in the ADORE cohort
Steinhausen, H., Nøvik, T., Baldursson, G., Curatolo, P., Lorenzo, M., Pereira, R., Ralston, S. J., & Rothenberger, A. (2006) · European Child and Adolescent Psychiatry · doi:10.1007/s00787-006-1004-y · Cited by 142 · see citing works
ADHD, Multimodal Treatment, and Longitudinal Outcome: Evidence, Paradox, and Challenge
Hinshaw, S. P., & Arnold, L. E. (2014) · Wiley Interdisciplinary Reviews: Cognitive Science · doi:10.1002/wcs.1324 · Cited by 78 · see citing works
Self-citationStorebø, O. J., Andersen, M. E., Skoog, M., Hansen, S. J., Simonsen, E. H., Pedersen, N. B., Tendal, B., Edemann-Callesen, H., Faltinsen, E. G., & Gluud, C. N. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008223.pub3 · Cited by 137 · see citing works
Ostrander, R. S., & Herman, K. C. (2006) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.74.1.89 · Cited by 134 · see citing works
Incremental Validity in the Psychological Assessment of Children and Adolescents.
Johnston, C., & Murray, C. (2003) · Psychological Assessment · doi:10.1037/1040-3590.15.4.496 · Cited by 133 · see citing works
Vaidya, C. J., You, X., Mostofsky, S., Pereira, F., Berl, M. M., & Kenworthy, L. (2020) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13114 · Cited by 126 · see citing works
Sonuga‐Barke, E. J. S., Oades, R. D., Psychogiou, L., Chen, W., Franke, B., Buitelaar, J., Banaschewski, T., Ebstein, R. P., Gil, M., Anney, R., et al. (2009) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2009.02095.x · Cited by 131 · see citing works
“Attention deficit/hyperactivity disorder (ADHD) frequently presents comorbid with conduct problems (CP; Biederman, 2005; Lahey, McBurnett, & Loeber, 2000) and emotional disorders (EMO; i.e., anxiety – Tannock, 2000; depression – Jensen et al., 2001).”
BackgroundSteiner, N. J., Frenette, E. C., Rene, K. M., Brennan, R. T., & Perrin, E. C. (2014) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000000009 · Cited by 130 · see citing works
Beauchaine, T. P., Neuhaus, E., Zalewski, M., Crowell, S. E., & Potapova, N. V. (2011) · Development and Psychopathology · doi:10.1017/s0954579411000459 · Cited by 129 · see citing works
“In the multimodal treatment of ADHD (MTA) study, comorbid anxiety predicted superior treatment response among children with ADHD and CD (Jensen et al., 2001).”
Background
- Authors
- JENSEN, P. S., HINSHAW, S. P., KRAEMER, H. C., LENORA, N., NEWCORN, J. H., ABIKOFF, H. B., MARCH, J. S., ARNOLD, L. E., CANTWELL, D. P., CONNERS, C. K., ELLIOTT, G. R., GREENHILL, L. L., HECHTMAN, L., HOZA, B., PELHAM, W. E., SEVERE, J. B., SWANSON, J. M., WELLS, K. C., WIGAL, T., & VITIELLO, B.
- Affiliations
- George Washington University (US)
- Corresponding author
- JENSEN, PETER S.
- ORCID
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2001-02
- Volume
- 40
- Issue
- 2
- Pages
- 147-158
- ISSN
- 0890-8567 (ISSN-L)
- OpenAlex
- W2144069128
- Cited by
- 974
- References
- 117
- Citations by year
- 2026: 5 · 2025: 25 · 2024: 16 · 2023: 28 · 2022: 36 · 2021: 34 · 2020: 56 · 2019: 40 · 2018: 31 · 2017: 52 · 2016: 46 · 2015: 52 · 2014: 51 · 2013: 46 · 2012: 55
- FWCI
- 15.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Funders
- National Institute of Mental Health (UO1 MH50453, UO1 MH50461, UO1 MH-50454, UO1 MH50440, U01MH050467, U01MH050447, U01MH050440, UO1MH50467, U01MH050453, UO1 MH50447, U01MH050461, U01MH050454)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- attention deficit hyperactivity disorder, ADHD comorbidity, disruptive behavior disorders, oppositional defiant disorder, conduct disorder, internalizing disorders, anxiety disorders, depression, ADHD subtypes, treatment response, stimulant medication, behavior therapy, children
- MeSH terms
- Analysis of Variance, Anxiety Disorders, Child, Cross-Sectional Studies, Female, Humans, Longitudinal Studies, Male, North America, Reproducibility of Results, Comorbidity, Attention Deficit and Disruptive Behavior Disorders
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