Journal of Abnormal Child Psychology

, Volume 24, Issue 5, pp 571–595 | Cite as

Prevalence of ADHD and comorbid disorders among elementary school children screened for disruptive behavior

  • Gerald J. August
  • George M. Realmuto
  • Angus W. MacDonaldIII
  • Sean M. Nugent
  • Ross Crosby


In the context of a school-based prevention of conduct disorder program, 7,231 first- through fourth-grade children were screened for cross-setting disruptive behavior. Frequencies of DSM-III-R psychiatric disorders and patterns of comorbidity were assessed. We also examined the association of psychiatric diagnosis with child and parent characteristics to determine differential risk based on diagnostic subgroups. Attention deficit hyperactivity disorder (ADHD) and oppositional-defiant disorder (ODD) were the most frequent diagnoses. Mood and anxiety disorders were infrequent as single diagnoses. Patterns of comorbidity demonstrated that both externalizing and internalizing disorders commonly cooccurred with ADHD. More severe degrees of psychopathology and psychosocial risk accrued to the subgroup of youths with ADHD plus a comorbid externalizing disorder.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Abikoff, H., & Klein, R. G. (1992). Attention-deficit hyperactivity and conduct disorder: Comorbidity and implications for treatment.Journal of Consulting Clinical Psychology, 60, 881–892.Google Scholar
  2. Abikoff, H. W., Courtney, M., Pelham, W. E., & Koplewicz, H. S. (1993). Teacher's ratings of disruptive behaviors: The influence of halo effects.Journal of Abnormal Child Psychology, 21, 519–533.Google Scholar
  3. Achenbach, T. M. (1991).Manual for the Child Behavior Checklist/4-18 and profile. Burlington: University of Vermont, Department of Psychiatry.Google Scholar
  4. Anderson, J. C., Williams, S., McGee, R., & Silva, P. A. (1987). DSM-III disorders in pre-adolescent children: Prevalence in a large sample from the general population.Archives of General Psychiatry, 44, 69–76.Google Scholar
  5. August, G. J., Realmuto, G. M., Crosby, R. D., & MacDonald, A. W. (1995). Community-based multiple-gate screening of children at risk for conduct disorder.Journal of Abnormal Child Psychology, 23, 521–544.Google Scholar
  6. August, G. J., & Stewart, M. A. (1983). Familial subtypes of childhood hyperactivity.Journal of Nervous and Mental Disorders, 171, 362–368.Google Scholar
  7. August, G. J., Stewart, M. A., & Holmes, C. S. (1983). A four-year follow-up of hyperactive boys with and without conduct disorder.British Journal of Psychiatry, 143, 192–198.Google Scholar
  8. Barkley, R. A. (1990).Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York: Guilford Press.Google Scholar
  9. Biederman, J., Faraone, V., Doyle, A., Lehman, B. K., Kraus, I., Perrin, J., & Tsuang, M. T. (1993). Convergence of the Child Behavior Checklist with structured interview-based psychiatric diagnoses of ADHD children with and without comorbidity.Journal of Child Psychology and Psychiatry, 34, 1241–1251.Google Scholar
  10. Biederman, J., Munir, K., Knee, D., Armentano, M., Autor, S., Waternax, C., & Tsuang, M. (1987). High rate of affective disorders in probands with attention deficit disorder and in their relatives: A controlled family study.American Journal of Psychiatry 144, 330–333.Google Scholar
  11. Biederman, J., Newcorn, J., & Sprich, S. (1991). Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders.American Journal of Psychiatry, 148, 564–577.Google Scholar
  12. Bird, H. R., Canino, G., Rubio-Stipec, M., Gould, M. S., Ribera, J., Sesman, M., Woodbury, M., Huertas-Goldman, S., Pagan, A., Sanchez-Lacay, A., & Moscoso, M. A. (1988). Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico.Archives of General Psychiatry, 45, 1120–1126.Google Scholar
  13. Campbell, S. E. (1995). Behavior problems in preschool children: A review of recent research.Journal of Child Psychology and Psychiatry, 36, 113–149.Google Scholar
  14. Campis, L. K., Lyman, R. D., & Prentice-Dunn, S. (1986). The parental locus of control scale: Development and validation.Journal of Clinical Child Psychology, 15, 260–267.Google Scholar
  15. Caron, C., & Rutter, M. (1991). Comorbidity in child psychopathology: Concepts, issues and research strategies.Journal of Child Psychology and Psychiatry, 32, 1063–1080.Google Scholar
  16. Conduct Problems Prevention Research Group. (1992). A developmental and clinical model for the prevention of conduct disorder: The FAST Track Program.Development and Psychopathology, 4, 509–527.Google Scholar
  17. Costello, E. J., Costello, A. J., Edelbrock, C., Burns, B. J., Dulcan, M. K., Brent, D., & Janiszewski, S. (1988). Psychiatric disorders in pediatric primary care: Prevalence and risk factors.Archives of General Psychiatry, 45, 1107–1116.Google Scholar
  18. Dryfoos, J. G. (1990).Adolescents at risk. New York: Oxford University Press.Google Scholar
  19. Farrington, D. F. (1987). Early precursors of frequent offending. In J. Q. Wilson & G. C. Coury (Eds.),From children to citizens: Families, schools, and delinquency prevention (Vol. 3, pp. 27–50). New York: Springer-Verlag.Google Scholar
  20. Farrington, D. P., Loeber, R., & Van Kammen, W. B. (1990). Long-term criminal outcomes of hyperactivity, impulsivity, attention deficit and conduct problems in children. In N. L. Robins & M. Rutter (Eds.),Straight and deviant pathways from childhood to adulthood (pp. 62–81). Cambridge, England: Cambridge University Press.Google Scholar
  21. Fergusson, L., Horwood, L. J., & Lynskey, M. T. (1993). The effects of conduct disorder and attention deficit in middle childhood on offending and scholastic ability at age 13.Journal of Child Psychology and Psychiatry, 34, 899–916.Google Scholar
  22. Frick, P. J., Kamphaus, R. W., Lahey, B. B., Loeber, R., Christ, M. A. G., Hart, E. L., & Tonnenbaum, L. E. (1991). Academic underachievement and the disruptive behavior disorders.Journal of Consulting and Clinical Psychology, 59, 289–294.Google Scholar
  23. Gittelman, R., Mannuzza, S., Schenker, R., & Bonagura, N. (1985). Hyperactive boys almost grown up: I. Psychiatric status.Archives of General Psychiatry, 42, 937–947.Google Scholar
  24. Goyette, C. H., Conners, C. K., & Ulrich, R. F. (1978). Normative data on Revised Conners Parent and Teacher Rating Scales.Journal of Abnormal Child Psychology, 6, 221–236.Google Scholar
  25. Hawkins, J. D., Catalano, R. F., Morrison, D. M., O'Donnell, J., Abbott, R. D., & Day, L. E. (1992). The Seattle Developmental Project: Effects of the first four years on protective factors and problem behaviors. In J. M. McCord & R. E. Tremblay (Eds.).Preventing antisocial behavior: Interventions from birth through adolescence (pp. 139–161). New York: Guilford Press.Google Scholar
  26. Hechtman, L., Weiss, G., & Perlman, T. (1984). Hyperactives as young adults: Past and current substance abuse and antisocial behavior.American Journal of Orthopsychiatry, 54, 532–539.Google Scholar
  27. Hinshaw, S. P. (1992). Academic underachievement, attention deficits, and aggression: Comorbidity and implications for intervention.Journal of Consulting and Clinical Psychology, 60, 893–903.Google Scholar
  28. Hollingshead, A. (1975).Four-factor Index of Social Status. Unpublished manuscript.Google Scholar
  29. Jastak, S., & Wilkinson, G. S. (1984).The Wide Range Achievement Test-Revised. Wilmington, DE: Jastak Associates.Google Scholar
  30. Johnson, C., & Pelham, W. E. (1986). Teacher ratings predict peer ratings of aggression at 3-year follow-up in boys with attention deficit disorder with hyperactivity.Journal of Consulting and Clinical Psychology, 54, 571–572.Google Scholar
  31. Kaufman, A. S., & Kaufman, N. L. (1990).Kaufman Brief Intelligence Test (K-BIT). Circle Pines, MN: American Guidance Service.Google Scholar
  32. Kellam, S. G., Ensminger, M. E., & Simon, M. B. (1980). Mental health in first-grade and teenage drug, alcohol and cigarette use.Drug Alcohol Dependence, 5, 273–304.Google Scholar
  33. Kellam, S. G., Rebok, G. W., Ialongo, N., & Mayer, L. S. (1994). The course and malleability of aggressive behavior from early first grade into middle school years: Results of a developmental epidemiologically-based preventive trial.Journal of Child Psychology and Psychiatry, 35, 259–281.Google Scholar
  34. Kovacs, M. (1981). Rating scales to assess depression in school-aged children.Acta Paedopsychiatry, 20, 358–378.Google Scholar
  35. Kovacs, M. (1992).Children's Depression Inventory manual. New York: Multi-Health Systems.Google Scholar
  36. Lahey, B. B., Piacentini, J. C., McBurnett, K., Stone, P., Hartdagen, S., & Hynd, G. (1988). Psychopathology in the parents of children with conduct disorder and hyperactivity.Journal of the American Academy of Child and Adolescent Psychiatry, 27, 163–170.Google Scholar
  37. Lochman, J. E. (1992). Cognitive-behavioral intervention with aggressive boys: Three-year follow-up and preventive effects.Journal of Consulting and Clinical Psychology, 60, 426–432.Google Scholar
  38. Loeber, R. (1988). The natural histories of juvenile conduct problems, substance use, and delinquency: Evidence for developmental progressions. In B. B. Lahey & A. E. Kazdin (Eds.),Advances in clinical child psychology (Vol. 11, pp. 73–124). New York: Plenum Press.Google Scholar
  39. Loeber, R. (1990). Development and risk factors of juvenile antisocial behavior and delinquency.Clinical Psychology Review, 10, 1–41.Google Scholar
  40. Loeber, R., Brinthaupt, V. P., & Green, S. M. (1990). Attention deficits, impulsivity, and hyperactivity with or without conduct problems: Relationships to delinquency and unique contextual factors. In R. J. McMahon & R. V. Peters (Eds.),Behavior disorders of adolescence: Research, intervention and policy in clinical and school settings (pp. 39–61). Plenum Press: New York.Google Scholar
  41. Loeber, R., Keenan, K., Lahey, B. B., Green, S. M., & Thomas, C. (1993). Evidence for developmentally based oppositional defiant disorder and conduct disorder.Journal of Abnormal Child Psychology, 21, 377–410.Google Scholar
  42. Loney, J., Kramer, J., & Milich, R. S. (1981). The hyperactive child grows up: Predictors of symptoms, delinquency and achievement at follow-up. In K. W. Gadow & J. L. Loney (Eds.),Psychological aspects of drug treatment in hyperactivity, (pp. 381–416). Boulder, CO: Westview Press.Google Scholar
  43. Meyer, M. (1981).Applications and generalizations of the iterative proportional fitting procedure. Unpublished doctoral dissertation, School of Statistics, University of Minnesota.Google Scholar
  44. Milich, R., & Dodge, K. A. (1984). Social information processing in child psychiatric populations,Journal of Abnormal Child Psychology, 12, 471–490.Google Scholar
  45. Moffit, T. E. (1990). Juvenile delinquency and attention deficit disorder: Boys' developmental trajectories from age 3 to age 15.Child Development, 61, 893–910.Google Scholar
  46. Moffitt, T. E. (1993). Adolescent-limited and life-course persistent antisocial behavior: A developmental taxonomy.Psychological Review, 100, 674–701.Google Scholar
  47. Munir, K., Biederman, J., & Knee, D. (1987). Psychiatric comorbidity in patients with attention deficit disorder: A controlled study.Journal of the American Academy of Child and Adolescent Psychiatry, 26, 844–848.Google Scholar
  48. Prinz, R. J., Blechman, E. A., & Dumas, J. E. (1994). An evaluation of peer coping-skills training for childhood aggression.Journal of Clinical Child Psychology, 23, 193–203.Google Scholar
  49. Reich, W., Shayla, J. J., & Taibelson, C. (1992).The Diagnostic Interview for Children and Adolescents—Revised (DICA-R) (Structured psychiatric interview). St Louis, MO: Washington University.Google Scholar
  50. Reynolds, C. R., & Kamphaus, R. W. (1992).BASC: Behavioral Assessment System for Children. Circle Pines, MN: American Guidance Service.Google Scholar
  51. Reynolds, C. R., & Richmond, B. O. (1978). What I think and feel: A revised measure of children manifest anxiety.Journal of Abnormal Psychology, 6, 271–280.Google Scholar
  52. Reynolds, C. R., & Richmond, B. O. (1985).Revised Children's Manifest Anxiety Scale. Los Angeles: Western Psychological Services.Google Scholar
  53. Roberts, M. W., Joe, V. C., & Rowe-Hallbert, A. (1992). Oppositional child behavior and parent locus of control.Journal of Clinical Child Psychology, 21, 170–177.Google Scholar
  54. Schachar, R., & Wachsmuth, R. (1990). Hyperactivity and parental psychopathology.Journal of Child Psychology and Psychiatry, 33, 381–392.Google Scholar
  55. Spitzer, R. L., Davies, M., & Barkley, R. A. (1990). The DSM-III-R trial of disruptive behavior disorders.Journal of the American Academy of Child and Adolescent Psychiatry, 29, 690–697.Google Scholar
  56. Spivak, G., Marcus, J., & Swift, M. (1986). Early classroom behavior and later misconduct.Developmental Psychology, 22, 125–131.Google Scholar
  57. Strayhorn, J. M., & Weidman, C. S. (1988). A parent practices scale and its relation to parent and child mental health.Journal of the American Academy of Child and Adolescent Psychiatry, 27, 613–618.Google Scholar
  58. Szatmari, P., Offord, D. R., & Boyle, M. H. (1989). Ontario Child Health Study: Prevalence of attention deficit disorder with hyperactivity.Journal of Child Psychology and Psychiatry, 30, 219–230.Google Scholar
  59. Tremblay, R. E., Vitaro, R., Betrand, L., LeBlanc, M., Beauchesne, H., Bolieau, H., & David, L. (1992). Parent and child training to prevent early onset of delinquency: The Montreal Longitudinal Experimental Study. In J. McCord & R. E. Tremblay (EDS.),Preventing antisocial behavior: Interventions from birth through adolescence (pp. 117–138). New York: Guilford Press.Google Scholar
  60. Winer, B. (1971).Statistical principles in experimental design. New York: McGraw-Hill.Google Scholar
  61. Woodcock, R. W., & Johnson, M. B. (1990).Woodcock-Johnson Psychoeducational Battery-Revised: Tests of achievement. Allen, TX: DML Teaching Resources.Google Scholar

Copyright information

© Plenum Publishing Corporation 1996

Authors and Affiliations

  • Gerald J. August
    • 1
    • 3
  • George M. Realmuto
    • 1
  • Angus W. MacDonaldIII
    • 1
  • Sean M. Nugent
    • 2
  • Ross Crosby
    • 1
  1. 1.Department of Psychiatry, Division of Child and Adolescent PsychiatryUniversity of MinnesotaMinneapolisUSA
  2. 2.Department of PsychiatryVeterans HospitalMinneapolisUSA
  3. 3.Department of PsychiatryUniversity of MinnesotaMinneapolis

Personalised recommendations