Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jun;44(8):1779-92.
doi: 10.1017/S0033291713002419. Epub 2013 Oct 8.

The effects of temporally secondary co-morbid mental disorders on the associations of DSM-IV ADHD with adverse outcomes in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A)

R C Kessler  1 , L A Adler  2 , P Berglund  3 , J G Green  4 , K A McLaughlin  5 , J Fayyad  6 , L J Russo  7 , N A Sampson  1 , V Shahly  1 , A M Zaslavsky  1
Affiliations

The effects of temporally secondary co-morbid mental disorders on the associations of DSM-IV ADHD with adverse outcomes in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A)

R C Kessler et al. Psychol Med. 2014 Jun.

Abstract

Background: Although DSM-IV attention deficit hyperactivity disorder (ADHD) is known to be associated with numerous adverse outcomes, uncertainties exist about how much these associations are mediated temporally by secondary co-morbid disorders.

Method: The US National Comorbidity Survey Replication Adolescent Supplement (NCS-A), a national survey of adolescents aged 13-17 years (n = 6483 adolescent-parent pairs), assessed DSM-IV disorders with the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Statistical decomposition was used to compare direct effects of ADHD with indirect effects of ADHD through temporally secondary mental disorders (anxiety, mood, disruptive behavior, substance disorders) in predicting poor educational performance (suspension, repeating a grade, below-average grades), suicidality (ideation, plans, attempts) and parent perceptions of adolescent functioning (physical and mental health, interference with role functioning and distress due to emotional problems).

Results: ADHD had significant gross associations with all outcomes. Direct effects of ADHD explained most (51.9-67.6%) of these associations with repeating a grade in school, perceived physical and mental health (only girls), interference with role functioning and distress, and significant components (34.5-44.6%) of the associations with school suspension and perceived mental health (only boys). Indirect effects of ADHD on educational outcomes were predominantly through disruptive behavior disorders (26.9-52.5%) whereas indirect effects on suicidality were predominantly through mood disorders (42.8-59.1%). Indirect effects on most other outcomes were through both mood (19.8-31.2%) and disruptive behavior (20.1-24.5%) disorders, with anxiety and substance disorders less consistently important. Most associations were comparable for girls and boys.

Conclusions: Interventions aimed at reducing the adverse effects of ADHD might profitably target prevention or treatment of temporally secondary co-morbid disorders.

PubMed Disclaimer

References

    1. Angold A, Costello EJ, Erkanli A. Comorbidity. Journal of Child Psychology and Psychiatry. 1999;40:57–87. - PubMed
    1. Angold A, Erkanli A, Farmer EM, Fairbank JA, Burns BJ, Keeler G, Costello EJ. Psychiatric disorder, impairment, and service use in rural African American and white youth. Archives of General Psychiatry. 2002;59:893–901. - PubMed
    1. Arias AJ, Gelernter J, Chan G, Weiss RD, Brady KT, Farrer L, Kranzler HR. Correlates of co-occurring ADHD in drug-dependent subjects: prevalence and features of substance dependence and psychiatric disorders. Addictive Behaviors. 2008;33:1199–1207. - PMC - PubMed
    1. Barkley RA. Distinguishing sluggish cognitive tempo from ADHD in children and adolescents: executive functioning, impairment, and comorbidity. Journal of Clinical Child and Adolescent Psychology. 2013;42:161–173. - PubMed
    1. Bauermeister JJ, Shrout PE, Ramirez R, Bravo M, Alegria M, Martinez-Taboas A, Chavez L, Rubio-Stipec M, Garcia P, Ribera JC, Canino G. ADHD correlates, comorbidity, and impairment in community and treated samples of children and adolescents. Journal of Abnormal Child Psychology. 2007;35:883–898. - PMC - PubMed

Publication types

MeSH terms