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Severity of the Aggression/Anxiety-Depression/Attention Child Behavior Checklist Profile Discriminates Between Different Levels of Deficits in Emotional Regulation in Youth With Attention-Deficit Hyperactivity Disorder

Biederman, Joseph MD*,†; Petty, Carter R. MA*; Day, Helen BA*; Goldin, Rachel L. BA*; Spencer, Thomas MD*,†; Faraone, Stephen V. PhD‡,§; Surman, Craig B. H. MD*,†; Wozniak, Janet MD*,†

Journal of Developmental & Behavioral Pediatrics: April 2012 - Volume 33 - Issue 3 - p 236–243
doi: 10.1097/DBP.0b013e3182475267
Original Articles

Objective: We examined whether severity scores (1 SD vs 2 SDs) of a unique profile of the Child Behavior Checklist (CBCL) consisting of the Anxiety/Depression, Aggression, and Attention (AAA) scales would help differentiate levels of deficits in children with attention-deficit hyperactivity disorder (ADHD). Study Design: Subjects were 197 children with ADHD and 224 without ADHD. We defined deficient emotional self-regulation (DESR) as an aggregate cutoff score of >180 but <210 (1 SD) on the AAA scales of the CBCL (CBCL-DESR) and Severe Dysregulation as an aggregate cutoff score of ≥210 on the same scales (CBCL-Severe Dysregulation). All subjects were assessed with structured diagnostic interviews and a range of functional measures. Results: Thirty-six percent of children with ADHD had a positive CBCL-DESR profile versus 2% of controls (p < .001) and 19% had a positive CBCL-Severe Dysregulation profile versus 0% of controls (p < .001). The subjects positive for the CBCL-Severe Dysregulation profile differed selectively from those with the CBCL-DESR profile in having higher rates of unipolar and bipolar mood disorders, oppositional defiant and conduct disorders, psychiatric hospitalization at both baseline and follow-up assessments, and a higher rate of the CBCL-Severe Dysregulation in siblings. In contrast, the CBCL-DESR was associated with higher rates of comorbid disruptive behavior, anxiety disorders, and impaired interpersonal functioning compared with other ADHD children. Conclusion: Severity scores of the AAA CBCL profiles can help distinguish 2 groups of emotional regulation problems in children with ADHD.

From the *Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Yawkey Center for Outpatient Care, Boston, MA; †Department of Psychiatry, Harvard Medical School, Cambridge, MA; and Departments of ‡Psychiatry and §Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY.

Received August 2011; accepted December 2011.

This study was supported in part by grants from the National Institute of Health (R01 HD36317 and R01 MH50657; to J.B.) and from Shire Pharmaceuticals (to T.S.) and the Pediatric Psychopharmacology Research Council Fund.

Address for reprints: Joseph Biederman, MD, Pediatric Psychopharmacology, Massachusetts General Hospital, 55 Fruit Street, YAW6A, Boston, MA 02114; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.