Abstract
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.
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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.
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.
Achenbach, T. M. (1991).Manual for the Child Behavior Checklist/4-18 and profile. Burlington: University of Vermont, Department of Psychiatry.
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.
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.
August, G. J., & Stewart, M. A. (1983). Familial subtypes of childhood hyperactivity.Journal of Nervous and Mental Disorders, 171, 362–368.
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.
Barkley, R. A. (1990).Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York: Guilford Press.
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.
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.
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.
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.
Campbell, S. E. (1995). Behavior problems in preschool children: A review of recent research.Journal of Child Psychology and Psychiatry, 36, 113–149.
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.
Caron, C., & Rutter, M. (1991). Comorbidity in child psychopathology: Concepts, issues and research strategies.Journal of Child Psychology and Psychiatry, 32, 1063–1080.
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.
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.
Dryfoos, J. G. (1990).Adolescents at risk. New York: Oxford University Press.
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.
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.
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.
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.
Gittelman, R., Mannuzza, S., Schenker, R., & Bonagura, N. (1985). Hyperactive boys almost grown up: I. Psychiatric status.Archives of General Psychiatry, 42, 937–947.
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.
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.
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.
Hinshaw, S. P. (1992). Academic underachievement, attention deficits, and aggression: Comorbidity and implications for intervention.Journal of Consulting and Clinical Psychology, 60, 893–903.
Hollingshead, A. (1975).Four-factor Index of Social Status. Unpublished manuscript.
Jastak, S., & Wilkinson, G. S. (1984).The Wide Range Achievement Test-Revised. Wilmington, DE: Jastak Associates.
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.
Kaufman, A. S., & Kaufman, N. L. (1990).Kaufman Brief Intelligence Test (K-BIT). Circle Pines, MN: American Guidance Service.
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.
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.
Kovacs, M. (1981). Rating scales to assess depression in school-aged children.Acta Paedopsychiatry, 20, 358–378.
Kovacs, M. (1992).Children's Depression Inventory manual. New York: Multi-Health Systems.
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.
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.
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.
Loeber, R. (1990). Development and risk factors of juvenile antisocial behavior and delinquency.Clinical Psychology Review, 10, 1–41.
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.
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.
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.
Meyer, M. (1981).Applications and generalizations of the iterative proportional fitting procedure. Unpublished doctoral dissertation, School of Statistics, University of Minnesota.
Milich, R., & Dodge, K. A. (1984). Social information processing in child psychiatric populations,Journal of Abnormal Child Psychology, 12, 471–490.
Moffit, T. E. (1990). Juvenile delinquency and attention deficit disorder: Boys' developmental trajectories from age 3 to age 15.Child Development, 61, 893–910.
Moffitt, T. E. (1993). Adolescent-limited and life-course persistent antisocial behavior: A developmental taxonomy.Psychological Review, 100, 674–701.
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.
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.
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.
Reynolds, C. R., & Kamphaus, R. W. (1992).BASC: Behavioral Assessment System for Children. Circle Pines, MN: American Guidance Service.
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.
Reynolds, C. R., & Richmond, B. O. (1985).Revised Children's Manifest Anxiety Scale. Los Angeles: Western Psychological Services.
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.
Schachar, R., & Wachsmuth, R. (1990). Hyperactivity and parental psychopathology.Journal of Child Psychology and Psychiatry, 33, 381–392.
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.
Spivak, G., Marcus, J., & Swift, M. (1986). Early classroom behavior and later misconduct.Developmental Psychology, 22, 125–131.
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.
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.
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.
Winer, B. (1971).Statistical principles in experimental design. New York: McGraw-Hill.
Woodcock, R. W., & Johnson, M. B. (1990).Woodcock-Johnson Psychoeducational Battery-Revised: Tests of achievement. Allen, TX: DML Teaching Resources.
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This study was supported by grant MN-46584 from the National Institute of Mental Health.
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August, G.J., Realmuto, G.M., MacDonald, A.W. et al. Prevalence of ADHD and comorbid disorders among elementary school children screened for disruptive behavior. J Abnorm Child Psychol 24, 571–595 (1996). https://doi.org/10.1007/BF01670101
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DOI: https://doi.org/10.1007/BF01670101