Personality Traits Elucidate Sex Differences in Attention-Deficit/Hyperactivity Disorder Comorbidity During Early Childhood

  • Michelle M. Martel
  • Monica L. Gremillion
  • Jennifer L. Tackett
Article

Abstract

Attention-Deficit/Hyperactivity Disorder (ADHD) is highly comorbid with other childhood disorders, and there are striking sex differences in this comorbidity, particularly during early childhood. For example, boys with ADHD are more likely to exhibit comorbid disruptive behavior and neurodevelopmental disorders, compared to girls, during early childhood. Yet, explanations for these well-established sex differences remain in short supply. The current study evaluated the novel hypothesis that personality traits may serve as intermediate phenotypes that help explain sex differences in common ADHD comorbidity profiles during early childhood. Study participants were 109 children between the ages of 3 and 6 and their primary caregivers and teachers/daycare providers, recruited from the community and over-recruited for ADHD-related problems. Primary caregivers completed the Child Behavior Checklist, and teachers/daycare providers completed the Teacher Report Form as a measure of child behavior problems. Examiners completed the California Q-Sort as a measure of child personality traits. Moderated mediation analyses suggested that personality traits explain associations between ADHD and oppositional-defiance, aggression, and language problems in a sex-specific manner. While high neuroticism mediated associations between ADHD and oppositional-defiance in girls, disagreeableness mediated associations between ADHD and aggression and low conscientiousness mediated associations between ADHD and neurodevelopmental language problems in boys. Sex differences in trait-psychopathology associations may help explain sex differences in comorbidity profiles with possible implications for child assessment and personalized early intervention.

Keywords

ADHD Aggression Temperament 

References

  1. Achenbach, T. M., & Rescorla, L. A. (2000). Manual for the ASEBA preschool forms & profiles. Burlington: University of Vermont, Research Center for Children, Youth, & Families.Google Scholar
  2. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders–Fourth ed., text rev. Washington, D.C.: American Psychiatric Association.Google Scholar
  3. Angold, A., Costello, E. J., & Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40(1), 57–87.PubMedCrossRefGoogle Scholar
  4. Arnold, L. E. (1996). Sex differences in ADHD: conference summary. Journal of Abnormal Psychology, 24(5), 555–569.CrossRefGoogle Scholar
  5. Barkley, R. A., & Murphy, K. R. (2006). Attention-deficit hyperactivity disorder: A clinical workbook (3rd ed.). New York: The Guilford Press.Google Scholar
  6. Blair, C., & Razza, R. P. (2007). Relating effortful control, executive function, and false belief understanding to emerging math and literacy ability in kindergarten. Child Development, 78, 647–663.PubMedCrossRefGoogle Scholar
  7. Block, J. H., & Block, J. (1980). The role of ego-control and ego-resiliency in the organization of behavior. In W. A. Collins (Ed.), Minnesota symposia on child psychology (Vol. 13, pp. 39–101). Hillsdale: Erlbaum.Google Scholar
  8. Chronis-Tuscano, A., Molina, B. S. G., Pelham, W. E., Applegate, B., Dahlke, A., Overmyer, M., & Lahey, B. B. (2010). Very early predictors of adolescent depression and suicide attempts in children with attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 67(10), 1044–1051.PubMedCentralPubMedCrossRefGoogle Scholar
  9. Conrod, P. J., Castellanos, N., & Mackie, C. (2008). Personality-targeted interventions delay the growth of adolescent drinking and binge eating. Journal of Child Psychology and Psychiatry, 49, 181–190.PubMedGoogle Scholar
  10. De Bolle, M., Beyers, W., De Clerq, B., & De Fruyt, F. (2012). General personality and psychopathology in referred and nonreferred children and adolescents: an investigation of continuity, pathoplasty, and complication models. Journal of Abnormal Psychology, 121, 958–970.PubMedCrossRefGoogle Scholar
  11. De Fruyt, F., Bartels, M., Van Leeuwen, K. G., De Clercq, B., Decuyper, M., & Mervielde, I. (2006). Five types of personality continuity in childhood and adolescence. Journal of Personality and Social Psychology, 91(3), 538–552.PubMedCrossRefGoogle Scholar
  12. De Pauw, S. S. W., & Mervielde, I. (2011). The role of temperament and personality in problem behaviors of children with ADHD. Journal of Abnormal Child Psychology, 39(2), 277–291.PubMedCrossRefGoogle Scholar
  13. De Pauw, S. S., Mervielde, I., & Van Leeuwen, K. G. (2009). How are traits related to problem behavior in preschoolers? Similarities and contrasts between temperament and personality. Journal of Abnormal Child Psychology, 37(3), 309–325.PubMedCrossRefGoogle Scholar
  14. Dougherty, L. R., Bufferd, S. J., Carlson, G. A., Dyson, M., Olino, T. M., Durbin, C. E., & Klein, D. N. (2011). Preschoolers’ observed temperament and psychiatric disorders assessed with a parent diagnostic interview. Journal of Clinical Child & Adolescent Psychology, 40(2), 295–306.CrossRefGoogle Scholar
  15. Dunn, L. M., & Dunn, D. M. (2007). Peabody picture vocabulary test, fourth edition, manual. Minneapolis: NCS Pearson, Inc.Google Scholar
  16. Eisenberg, N., Cumberland, A., Spinrad, T. L., Fabes, R. A., Shepard, S. A., Reiser, M., Murphy, B. C., Losoya, S. H., & Guthrie, I. K. (2001). The relations of regulation and emotionality to children’s externalizing and internalizing problem behavior. Child Development, 72, 1112–1134.PubMedCrossRefGoogle Scholar
  17. Else-Quest, N. M., Hyde, J. S., Goldsmith, H. H., & Van Hulle, C. A. (2006). Sex differences in temperament: a meta-analysis. Psychological Bulletin, 132(1), 33–72.PubMedCrossRefGoogle Scholar
  18. Frick, P. J., & Nigg, J. T. (2012). Current issues in the diagnosis of attention-deficit hyperactivity disorder, oppositional defiant disorder and conduct disorder. Annual Review of Clinical Psychology, 8, 77–107.PubMedCrossRefGoogle Scholar
  19. Frick, P. J., O’Brien, B. S., Wootton, J. M., & McBurnett, K. (1994). Psychopathy and conduct problems in children. Journal of Abnormal Psychology, 103(4), 700–707.PubMedCrossRefGoogle Scholar
  20. Frick, P. J., Cornell, A. H., Bodin, S. D., Dane, H. E., Barry, C. T., & Loney, B. R. (2003). Callous-unemotional traits and developmental pathways to severe conduct problems. Developmental Psychology, 39(2), 246–260.PubMedCrossRefGoogle Scholar
  21. Frick, P. J., Stickle, T. R., Dandreaux, D. M., Farrell, J. M., & Kimonis, E. R. (2005). Callous-unemotional traits in predicting the severity and stability of conduct problems and delinquency. Journal of Abnormal Child Psychology, 33, 471–487.PubMedCrossRefGoogle Scholar
  22. Gartstein, M. A., & Rothbart, M. K. (2003). Studying infant temperament via the revised infant behavior questionnaire. Infant Behavior and Development, 26, 64–86.CrossRefGoogle Scholar
  23. Gaub, M., & Carlson, C. L. (1997). Sex differences in ADHD: a meta-analysis and critical review. Journal of the American Academy of Child & Adolescent Psychiatry, 36(8), 1036–1045.CrossRefGoogle Scholar
  24. Goldberg, L. R. (2001). Analyses of Digman’s child-personality data: derivation of big five factor scores from each of six samples. Journal of Personality, 69, 709–743.PubMedCrossRefGoogle Scholar
  25. Halverson, C. F., Havill, V. L., Deal, J., Baker, S. R., Victor, J. B., Pavlopoulos, V., et al. (2003). Personality structure as derived from parental ratings of free descriptions of children: the inventory of child individual differences. Journal of Personality, 71(6), 995–1026.PubMedCrossRefGoogle Scholar
  26. Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., Sanislaw, C., & Wang, P. (2010). Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. American Journal of Psychiatry, 167(7), 749–751.CrossRefGoogle Scholar
  27. James, A., & Taylor, E. (1990). Sex differences in the hyperkinetic syndrome of childhood. Journal of Child Psychology & Psychiatry, 31(3), 437–446.CrossRefGoogle Scholar
  28. John, O. P., Caspi, A., Robins, R. W., Moffitt, T. E., & Stouthamer-Loeber, M. (1994). The “little five”: exploring the nomological network of the five-factor model of personality in adolescent boys. Child Development, 65(1), 160–178.PubMedCrossRefGoogle Scholar
  29. Klein, D. N., Kotov, R., & Bufferd, S. J. (2011). Personality and depression: explanatory models and review of the evidence. Annual Review of Clinical Psychology, 7, 269–295.PubMedCentralPubMedCrossRefGoogle Scholar
  30. Kochanska, G., Barry, R. A., Jimenez, N. B., Hollatz, A. L., & Woodard, J. (2009). Guilt and effortful control: two mechanisms that prevent disruptive developmental trajectories. Journal of Personality and Social Psychology, 97, 322–333.PubMedCentralPubMedCrossRefGoogle Scholar
  31. Kotov, R., Gamez, W., Schmidt, F., & Watson, D. (2010). Linking “big” personality traits to anxiety, depressive, and substance use disorders: a meta-analysis. Psychological Bulletin, 136(5), 768–821.PubMedCrossRefGoogle Scholar
  32. Lahey, B. B. (2009). Public health significance of neuroticism. American Psychologist, 64(4), 241–256.PubMedCentralPubMedCrossRefGoogle Scholar
  33. Leblanc, N., Boivin, M., Dionne, G., Brendgen, M., Vitaro, F., Tremblay, R. E., et al. (2008). The development of hyperactive-impulsive behaviors during the preschool years: the predictive validity of parental assessments. Journal of Abnormal Child Psychology, 36, 977–987.PubMedCrossRefGoogle Scholar
  34. Lemery, K. S., Essex, M. J., & Smider, N. A. (2002). Revealing the relation between temperament and behavior problem symptoms by eliminating measurement confounding: expert ratings and factor analyses. Child Development, 73(3), 867–882.PubMedCrossRefGoogle Scholar
  35. Lengua, L. J., West, S. G., & Sandler, I. N. (1998). Temperament as a predictor of symptomatology in children: addressing contamination of measures. Child Development, 69(1), 164–181.PubMedCrossRefGoogle Scholar
  36. Levy, F., Hay, D. A., Bennett, K. S., & McStephen, M. (2004). Gender differences in ADHD subtype comorbidity. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 368–376.CrossRefGoogle Scholar
  37. MacKinnon, D. P., & Fairchild, A. J. (2009). Current directions in mediation analysis. Current Directions in Psychological Science, 18(1), 16–20.PubMedCentralPubMedCrossRefGoogle Scholar
  38. Marcus, D. K., & Barry, T. D. (2011). Does attention-deficit/hyperactivity disorder have a dimensional latent structure: a taxometric analysis. Journal of Abnormal Psychology, 120(2), 427–442.PubMedCentralPubMedCrossRefGoogle Scholar
  39. Martel, M. M. (2009). A new perspective on attention-deficit/hyperactivity disorder: emotion dysregulation and trait models. Journal of Child Psychology & Psychiatry, 50(9), 1042–1051.CrossRefGoogle Scholar
  40. Martel, M. M., & Nigg, J. T. (2006). Child ADHD and personality/temperament traits of reactive and effortful control, resiliency, and emotionality. Journal of Child Psychology and Psychiatry, 47(11), 1175–1183.PubMedCrossRefGoogle Scholar
  41. Martel, M. M., Nikolas, M., Jernigan, K., Friderici, K., & Nigg, J. T. (2010). Personality mediation of genetic effects on attention-deficit/hyperactivity disorder. Journal of Abnormal Child Psychology, 38, 633–643.PubMedCrossRefGoogle Scholar
  42. Martel, M. M., Gremillion, M. L., & Roberts, B. (2012). Temperament and common disruptive behavior problems in preschool. Personality and Individual Differences, 53, 874–879.PubMedCentralPubMedCrossRefGoogle Scholar
  43. McCrae, R. R., & Costa, P. T. (1987). Validation of the five-factor model of personality across instruments and observers. Journal of Personality and Social Psychology, 52(1), 81–90.PubMedCrossRefGoogle Scholar
  44. McCrae, R. R., Costa, P. T., Ostendorf, F., Angleitner, A., Hrebickova, M., Avia, M. D., et al. (2000). Nature over nurture: temperament, personality, and life span development. Journal of Personality and Social Psychology, 78(1), 173–186.PubMedCrossRefGoogle Scholar
  45. Nigg, J. T. (2006). Temperament and developmental psychopathology. Journal of Child Psychology & Psychiatry, 47(3/4), 395–422.CrossRefGoogle Scholar
  46. Nigg, J. T., John, O. P., Blaskey, L. G., Huang-Pollock, C. L., Willcutt, E. G., Hinshaw, S. P., & Pennington, B. (2002). Big five dimensions and ADHD symptoms: links between personality traits and clinical symptoms. Journal of Personality and Social Psychology, 83(2), 451–469.PubMedCrossRefGoogle Scholar
  47. Parker, J. D. A., Majeski, S. A., & Collin, V. T. (2004). ADHD symptoms and personality: relationships with the five-factor model. Personality and Individual Differences, 36, 977–987.CrossRefGoogle Scholar
  48. Pelham, W. E., Jr., Fabiano, G. A., & Massetti, G. M. (2005). Evidence based assessment of attention-deficit/hyperactivity disorder in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 34(3), 449–476.PubMedCrossRefGoogle Scholar
  49. Pelham, W. E., Foster, E. M., & Robb, J. A. (2007). The economic impact of attention-deficit/hyperactivity disorder in children and adolescents. Ambulatory Pediatrics, 7, 121–131.PubMedCrossRefGoogle Scholar
  50. Polanczyk, G., de Lima, M. S., Horta, B. L., Biederman, J., & Rohde, L. A. (2007). The worldwide prevalence of ADHD: a systematic review and metaregression analysis. American Journal of Psychiatry, 164, 942–948.PubMedCrossRefGoogle Scholar
  51. Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, and Computers, 36(4), 717–731.PubMedCrossRefGoogle Scholar
  52. Preacher, K. J., Rucker, D. D., & Hayes, A. F. (2007). Addressing moderated mediation hypotheses: theory, methods, and prescriptions. Multivariate Behavioral Research, 42(1), 185–227.CrossRefGoogle Scholar
  53. Putnam, S. P., & Rothbart, M. K. (2006). Development of short and very short forms of the children’s behavior questionnaire. Journal of Personality Assessment, 87(1), 103–113.CrossRefGoogle Scholar
  54. Rhee, S. H., Waldman, I. D., Hay, D. A., & Levy, F. (1999). Sex differences in genetic and environmental influences on DSM-III-R attention-deficit/hyperactivity disorder. Journal of Abnormal Psychology, 108(1), 24–41.PubMedCrossRefGoogle Scholar
  55. Rothbart, M. K. (2011). Becoming who we are: Temperament and personality in development. The Guilford Press.Google Scholar
  56. Schmitt, D. P., Realo, A., Voracek, M., & Allik, J. (2008). Why can’t a man be more like a woman? Sex differences in big five personality traits across 55 cultures. Journal of Personality and Social Psychology, 94(1), 168–182.PubMedCrossRefGoogle Scholar
  57. Shiner, R., & Caspi, A. (2003). Personality differences in childhood and adolescence: measurement, development, and consequences. Journal of Child Psychology and Psychiatry, 44(1), 2–32.PubMedCrossRefGoogle Scholar
  58. Soto, C. J., John, O. P., Gosling, S. D., & Potter, J. (2011). Age differences in personality traits from 10 to 65: big five domains and facets in a large cross-sectional sample. Journal of Personality and Social Psychology, 100, 230–348.CrossRefGoogle Scholar
  59. Stringaris, A., & Goodman, R. (2009). Longitudinal outcome of youth oppositionality: irritable, headstrong, and hurtful behaviors have distinctive predictions. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 404–412.PubMedCrossRefGoogle Scholar
  60. Stringaris, A., Maughan, B., & Goodman, R. (2010). What’s in a disruptive disorder? Temperamental antecedents of oppositional defiant disorder: findings from the Avon longitudinal study. Journal of the American Academic of Child & Adolescent Psychiatry, 49(5), 474–483.Google Scholar
  61. Tackett, J. L. (2006). Evaluating models of the personality-psychopathology relationship in children and adolescents. Clinical Psychology Review, 26, 584–599.PubMedCrossRefGoogle Scholar
  62. Tackett, J. L., Waldman, I. D., Van Hulle, C. A., & Lahey, B. B. (2011). Shared genetic influences on negative emotionality and major depression/conduct disorder comorbidity. Journal of the American Academy of Child & Adolescent Psychiatry, 50, 818–827.CrossRefGoogle Scholar
  63. Tackett, J. L., Martel, M., & Kushner, S. (2012a). Temperament, externalizing disorders, and ADHD. In R. Shiner & M. Zentner (Eds.), The handbook of temperament (pp. 562–580). New York: Guilford.Google Scholar
  64. Tackett, J. L., Slobodskaya, H. R., Mar, R. A., Deal, J., Halverson, C. F., Baker, S. R., & Besevegis, E. (2012b). The hierarchical structure of childhood personality in five countries: continuity from early childhood to early adolescence. Journal of Personality, 80, 847–879.PubMedCrossRefGoogle Scholar
  65. Tackett, J. L., Lahey, B. B., Van Hulle, C., Waldman, I., Krueger, R. F., & Rathouz, P. J. (2013). Common genetic influences on negative emotionality and a general psychopathology factor in childhood and adolescence. Manuscript under review.Google Scholar
  66. Watson, D., Kotov, R., & Gamez, W. (2006). Basic dimensions of temperament in relation to personality and psychopathology. In R. F. Krueger & J. L. Tackett (Eds.), Personality and psychopathology (pp. 7–38). New York: Guildford Press.Google Scholar
  67. Zentner, M., & Shiner, R. L. (2012). Handbook of temperament. New York: Guilford Press.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Michelle M. Martel
    • 1
  • Monica L. Gremillion
    • 1
  • Jennifer L. Tackett
    • 2
  1. 1.Psychology DepartmentUniversity of KentuckyLexingtonUSA
  2. 2.Psychology DepartmentUniversity of HoustonHoustonUSA

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