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The Relationship Between ADHD Symptom Dimensions, Clinical Correlates, and Functional Impairments

Garner, Annie A. PhD; O'Connor, Briannon C. MA; Narad, Megan E. MA; Tamm, Leanne PhD; Simon, John MA; Epstein, Jeffery N. PhD

Journal of Developmental & Behavioral Pediatrics: September 2013 - Volume 34 - Issue 7 - p 469–477
doi: 10.1097/DBP.0b013e3182a39890
Original Articles

Objective: To better understand how heterogeneity in attention-deficit hyperactivity disorder (ADHD) symptoms relates to heterogeneity in functional impairment domains in children with ADHD after accounting for demographic variables and comorbidities, in particular oppositionality and internalizing symptoms.

Methods: Parents and teachers (n = 5663) rated child/adolescent impairments across impairment domains in the International Classification of Functioning, Disability and Health as well as symptoms of ADHD and comorbidities. Hierarchical regressions were conducted to assess the relationship between parent and teacher ratings of ADHD symptom domains and functional impairments after accounting for personal factors and comorbid disorders.

Results: Symptoms of inattention were the strongest predictors of ratings of academic (math, writing, and so on) functioning, while hyperactivity/impulsivity symptoms were the strongest predictor of classroom disruption even after accounting for the presence of learning disorders and oppositional symptoms. Symptoms of ADHD accounted for minimal variance in interpersonal functioning or participation in organized activities after controlling oppositional symptoms.

Conclusion: The ADHD symptom domains demonstrate domain-specific relations with various ADHD-related functional impairments. In addition, the results highlight the role of oppositionality in interpersonal relationship difficulties and participation in organized activities.

*Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH;

Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH;

Department of Psychology, The State University of New York at Buffalo, Buffalo, NY.

Address for reprints: Annie A. Garner, PhD, Divisions of Behavioral Medicine and Clinical Psychology, and General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 10006, Cincinnati, OH 45229; e-mail:

A. A. Garner was supported by funds from the Bureau of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS), under grant number T32HT10027 National Research Service Award for $40,764. The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by the BHPR, HRSA, DHHS or the U.S. Government. Data used in this study was in part obtained through NIH grant funded projects in which Dr Epstein was PI (R01 MH083665 and R21 MH082714). The remaining authors declare no conflict of interest.

Received January , 2013

Accepted June , 2013

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.