Adolescents with childhood ADHD and comorbid disruptive behavior disorders: aggression, anger, and hostility

This study examined the self-reported expression of overt aggressive behaviors and covert emotional and cognitive processes in adolescents diagnosed with ADHD and comorbid disruptive behavior disorders (DBDs) during childhood.

Participants were a clinically referred sample of 85 individuals diagnosed with ADHD, initially recruited in the early to mid 1990s when they were 7-11 years of age. At that time, 44 (52%) met criteria for a comorbid diagnosis of ODD and an additional 22 (26%) met criteria for a comorbid diagnosis of CD. Approximately 10 years later, these youth, along with an age-matched comparison sample (n=83), were re-evaluated to assess a wide array of outcomes including physical and verbal aggression, anger, and hostility.

Individuals diagnosed with ADHD + CD in childhood reported elevated levels of physical aggression when compared to Controls and the ADHD-only group. Individuals diagnosed with ADHD + ODD had elevated levels of verbal aggression compared to Controls. Additionally, both comorbid groups experienced significantly greater amounts of anger, but not hostility, as compared to Controls. Importantly, the persistence of ADHD symptoms into adolescence accounted for most group differences in verbal aggression and anger at follow-up, but not physical aggression, which was accounted for by childhood CD.

Adolescents diagnosed with ADHD and comorbid disruptive behavior disorders during childhood report high levels of aggression associated with increased emotionality in the form of anger, but not hostile cognitions. These findings suggest that in addition to inattention and hyperactivity/impulsivity, emotional dysregulation may be an important component of ADHD, particularly as it presents in adolescence.