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The Shifting Subtypes of ADHD: Classification Depends on How Symptom Reports are Combined

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Abstract

Research on the correlates of ADHD subtypes has yielded inconsistent findings, perhaps because the procedures used to define subtypes vary across studies. We examined this possibility by investigating whether the ADHD subtype distribution in a community sample was sensitive to different methods for combining informant data. We conducted a study to screen all children in grades 1–5 (N = 7847) in a North Carolina County for ADHD. Teachers completed a DSM-IV behavior rating scale and parents completed a structured telephone interview. We found substantial differences in the distribution of ADHD subtypes depending on whether one or both sources were used to define the subtypes. When parent and teacher data were combined, the procedures used substantially influenced subtype distribution. We conclude the ADHD subtype distribution is sensitive to how symptom information is combined and that standardization of the subtyping process is required to advance our understanding of the correlates of different ADHD subtypes.

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Notes

  1. The study by Weiler in Table 1 reported on a referred sample and a community samples; we are counting these as two samples.

  2. In the single informant analyses, most of the children who were identified as cases for parents were not the same children identified as cases by teachers. Out of the 509 children in the random sample who had parent interviews, 35 were cases by teacher only, 67 were cases by parent only, and 15 were cases by both. Of those 15 cases, parents and teachers agreed on the subtype for only 3 children.

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Acknowledgements

We would like to thank Drs. Kristine Tollestrup, Kathy Wayland, Lewis P. Rowland, Lorraine Halinka Malcoe, Cathleen Willging, Frank Stallone, Deborah Helitzer and Linda Pfiffner for critical comments that improved this paper. This research was supported, in part, by the Intramural Research Programs of the NIH, National Institute of Environmental Health Sciences. Data analysis was supported, in part, by the NM NIEHS Center, P30 ES-012072, by a RAC grant from the University of New Mexico Health Sciences Center, and by 5 R01 MH071563-01 from the National Institute of Mental Health.

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Authors and Affiliations

  1. Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA

    Andrew S. Rowland & Betty Skipper

  2. Center for Child and Family Policy, Duke University, Durham, NC, 27707, USA

    David L. Rabiner

  3. Biostatistics Branch, NIEHS, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, 27709, USA

    David M. Umbach

  4. SES Division, formerly CODA, Inc., Social & Scientific Systems, Durham, NC, 27703, USA

    Lil Stallone

  5. Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA

    Richard A. Campbell

  6. Departments of Psychiatry and Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA

    Richard L. Hough

  7. Department of Psychiatry, Division of Child & Adolescent Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, 27514, USA

    A. J. Naftel

  8. Epidemiology Branch, NIEHS, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, 27709, USA

    Dale P. Sandler

  9. MPH Program, Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Mailstop 09 5060, 1 University of New Mexico, Albuquerque, NM, 87131, USA

    Andrew S. Rowland

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  1. Andrew S. Rowland
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Correspondence to Andrew S. Rowland.

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Rowland, A.S., Skipper, B., Rabiner, D.L. et al. The Shifting Subtypes of ADHD: Classification Depends on How Symptom Reports are Combined. J Abnorm Child Psychol 36, 731–743 (2008). https://doi.org/10.1007/s10802-007-9203-7

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