Abstract
Children showing a comorbid behavior pattern of hyperactivity-impulsivity-inattention and conduct problems (HIA + CP) were contrasted to children having only an internalizing and externalizing behavior pattern (I + E) and matched controls. Children displaying the HIA + CP behavior pattern were at greater risk on a number of outcome measures in social and academic domains beginning in Grade 3 and continuing into Grade 4. The most marked differences among the three groups were found on peer measures of rejection and friendship and teacher ratings of social skills. On average, almost two-thirds of the HIA + CP group were rejected by their peers compared to one-third of the I + E group and only 12.5% controls. Over 70% of the HIA + CP group had no reciprocated friendships from Grade 3 to Grade 4 compared to less than half of the I + E group and approximately one-fourth of controls. Contrary to much theorizing in the literature, the HIA + CP and I + E groups showed average levels of academic self-concept and did not differ from controls in on measures of social self-concept and academic self-concept and general self-esteem. These findings were interpreted in light of positive illusory biases and the established link between aggressive behavior and egotism. The current article offers partial support for Lynam's (1996) notion of the “fledgling psychopath.”
Similar content being viewed by others
REFERENCES
Achenbach, T. (1991). “Comorbidity” in child and adolescent psychiatry: Categorical and quantitative perspectives. Journal of Child and Adolescent Psychopharmacology, 1, 271–278.
Achenbach, T. (1993). Taxonomy and comorbidity of conduct problems: Evidence from empirically based approaches. Development and Psychopathology, 5, 51–64.
Ackerman, P., Dykman, R, & Peters, J. (1977). Teenage status of hyperactive and nonhyperactive learning disabled boys. American Journal of Orthopsychiatry, 47, 577–596.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Anderson, J., Williams, S., McGee, R., & Silva, P. (1987). DSM-III disorders in preadolescent children: Prevalence in a large sample from the general population. Archives of General Psychiatry, 44, 69–76.
Asher, S., & Coie, J. (Eds.). (1990). Peer rejection in childhood. New York: Cambridge University Press.
Asher, S., Parkhurst, J., Hymel, S., & Williams, G. (1990). Peer rejection and loneliness in children. In S. Asher & J. Coie (Eds.), Peer rejection in childhood (pp. 253–273). New York: Cambridge University Press.
Asher, S., & Wheeler, V. (1985). Children's loneliness: A comparison of rejected and neglected peer status. Journal of Consulting and Clinical Psychology, 53, 500–505.
Barkley, R. (1989). Attention deficit-hyperactivity disorder. In E. Mash & R. Barkley (Eds.), Treatment of childhood disorders (pp. 39–72). New York: Guilford Press
Barkley, R. (1990). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York: Guilford Press.
Baumeister, R., Smart, L., & Boden, J. (1996). Relation of threatened egotism to violence and aggression: The dark side of high self-esteem. Psychological Review, 103, 5–33.
Bear, G., & Minke, K. (1996). Positive bias in maintenance of self-worth among children with LD. Learning Disability Quarterly, 19, 23–32.
Cleckley, H. (1976). The mask of sanity. St. Louis, MO: Mosbey.
Clever, A., Bear, G., & Juvonen, J. (1992). Discrepancies between competence and importance in self-perceptions of children in integrated classrooms. Journal of Special Education, 26, 125–138.
Coie, J., & Dodge, K., & Coppotelli, H. (1982). Dimensions and types of social status: A cross-age perspective. Developmental Psychology, 18, 557–570.
Colvin, C. R., & Block, J. (1994). Do positive illusions foster mental health? An examination of the Taylor and Brown formulation. Psychological Bulletin, 116, 3–20.
Del'Homme, M., Kasari, C., Forness, S., & Bagley, R. (1996). Preferral intervention and students at risk for emotional or behavioral disorders. Education and Treatment of Children, 19, 272–285.
Diener, M. B., & Milich, R. (1997). Effects of positive feedback on the social interactions of boys with attention deficit hyperactivity disorder: A test of the self-protective hypothesis. Journal of Clinical Child Psychology, 26, 256–265.
Forness, S. R., Kavale, K. A., King, B. H., & Kasari, C. (1994). Simple versus complex conduct disorders: Identification and phenomenology. Behavioral Disorders, 19, 306–312.
Forness, S. R., Kavale, K. A., & Walker, H. M. (in press). Identifying children at risk for antisocial behavior: The case for comorbidity. In R. G. Gallimore, C. Bernheimer, D. L. MacMillan, & D. Speece (Eds.), Developmental perspectives on children with high incidence disabilities. Mahwah, NJ: Erlbaum.
Forness, S. R., & Knitzer, J. (1992). A new proposed definition and terminology to replace “Serious Emotional Disturbance” in the Individuals With Disabilities Education Act. School Psychology Review, 21, 12–20.
Gresham, F. M., & Elliott, S. N. (1990). Social Skills Rating System. Circle Pines, MN: American Guidance Service.
Gresham, F. M., Elliott, S. N., & Evans-Fernandez, S. (1992). Student Self-Concept Scale. Circle Pines, MN: American Guidance Service.
Gresham, F. M., & Little, S. G. (1993). Peer-referenced assessment strategies. In T. Ollendick & M. Hersen (Eds.), Handbook of child and adolescent assessment (pp. 165–179). Boston: Allyn & Bacon.
Gresham, F. M., MacMillan, D. L., & Bocian, K. M. (1996). “Behavioral earthquakes”: Low frequency, salient behavioral events that differentiate students at-risk for behavioral disorders. Behavioral Disorder, 21, 277–292.
Gresham, F. M., MacMillan, D. J., & Bocian, K. M. (1997). Teachers as “tests”: Differential validity of teacher judgments in identifying students at-risk for learning difficulties. School Psychology Review, 26, 47–60.
Gresham, F. M., & Reschly, D. J. (1988). Issues in the conceptualization and assessment of social skills in the mildly handicapped. In T. Kratochwill (Ed.), Advances in school psychology (Vol. 6, pp. 203–247). Hillsdale, NJ: Erlbaum.
Hare, R. D. (1986). Twenty years of experience with the Cleckley psychopath. In W. H. Reid, D. Dorr, J. I. Walker, & J. W. Bonner (Eds.), Unmasking the psychopath: Antisocial personality and related syndromes. New York: Norton.
Hartup, W. W. (1992). Friendships and their developmental significance. In H. McGurk (Ed.), Contemporary issues in childhood social development (pp. 175–205). London, England: Routledge.
Hersh, R., & Walker, H. (1983). Great expectations: Making schools effective for all students. Policy Studies Review, 2, 147–188.
Hieronymous, A., Linquist, E., & Hoover, H. D. (1986). Iowa Test of Basic Skills. Chicago: Riverside.
Hinshaw, S. (1987). On the distinction between attention deficits/hyperactivity and conduct problems/aggression in child psychopathology. Psychological Bulletin, 101, 443–463.
Hinshaw, S. (1992a). Externalizing behavior problems and academic underachievement in childhood and adolescence: Causal relationships and underlying mechanisms. Psychological Bulletin, 111, 127–155.
Hinshaw, S. (1992b). Academic underachievement, attention deficits, and aggression: Comorbidity and implications for intervention. Journal of Consulting and Clinical Psychology, 60, 893–903.
Hoza, B., Pelham, W., Milich, R., Pillow, D., & McBride, K. (1993). The self-perceptions and attributions of attention deficit hyperactivity disordered and nonreferred boys. Journal of Abnormal Child Psychology, 21, 271–286.
Hughes, J., Cavell, T., & Grossman, P. (1997). A positive view of self: Risk or protection for aggressive children. Development and Psychopathology, 9, 75–94.
Jensen, P. S., Martin, D., & Cantwell, D. (1997). Comorbidity in ADHD: Implications for research, practice, and DSM-V. Journal of American Academy of Child and Adolescent Psychiatry, 36, 1065–1079.
Kauffman, J., Cullinan, D., & Epstein, M. (1987). Characteristics of students placed in special programs for the seriously emotionally disturbed. Behavioral Disorders, 5, 175–184.
Kazdin, A. (1987). Treatment of antisocial behavior in children: Current status and future directions. Psychological Bulletin, 102, 187–203.
Kistner, J., Haskett, M., White, K., & Robbins, F. (1987). Perceived competence and self-worth of LD and normally achieving students. Learning Disability Quarterly, 10, 37–44.
Kistner, J., & Osborne, M. (1987). A longitudinal study of LD children's self-evaluations. Learning Disability Quarterly, 10, 258–266.
Kupersmidt, J., Coie, J., & Dodge, K. (1990). The role of peer relationships in the development of disorder. In S. Asher & J. Coie (Eds.), Peer rejection in childhood (pp. 274–308). New York: Cambridge University Press.
Loeber, R., Brinthaupt, V., & Green, S. (1990). Attention deficits, impulsivity, and hyperactivity with or without conduct problems: Relationships to delinquency and unique contextual factors. In R. J. McMahon & R. D. Peters (Eds.), Behavior disorders of adolescence: Research, intervention, and policy in clinical and school settings (pp. 39–61). New York: Plenum Press.
Loeber, R., & Dishion, T. (1983). Early predictors of male delinquency: A review. Psychological Bulletin, 94, 68–99.
Lopez, M. F., Forness, S. R., MacMillan, D. L., Bocian, K. M., & Gresham, F. M. (1996). Children with attention deficit hyperactivity disorder and emotional or behavioral disorders in the primary grades: Inappropriate placement in the learning disability category. Education and Treatment of Children, 19, 286–299.
Lynam, D. R. (1996). Early identification of chronic offenders: Who is the fledgling psychopath? Psychological Bulletin, 120, 209–234.
MacDonald, V. M., & Achenbach, T. (1996). Attention problems versus conduct problems as six-year predictors of problem scores in a national sample. Journal of American Academy of Child and Adolescent Psychiatry, 35, 1237–1246.
Mannuzza, S., Klein, R., Konig, P., & Giampino, T. (1989). Hyperactive boys almost grown up, IV: Criminality and its relationship to psychiatric status. Archives of General Psychiatry, 46, 1073–1079.
McConaughy, S., & Skiba, R. (1993). Comorbidity of externalizing and internalizing problems. School Psychology Review, 22, 421–436.
McConnell, S., & Odom, S. (1986). Sociometrics: Peer-referenced measures and the assessment of social competence. In P. Strain, M. Guralnick, & H. Walker (Eds.), Children's social behavior: Development, assessment, and modification (pp. 215–284). Orlando: Academic Press.
Moffitt, T. (1990). Juvenile delinquency and attention deficit disorder: Boys' developmental trajectories from age 3 to age 15. Child Development, 61, 893–910.
Newcomb, A., & Bagwell, C. (1995). Children's friendship relations: A meta-analytic review. Psychological Bulletin, 117, 306–347.
Newcomb, A., Bukowski, W., & Pattee, L. (1993). Children's peer relations: A meta-analytic review of popular, rejected, neglected, controversial, and average sociometric status. Psychological Bulletin, 113, 99–128.
Nunnally J., & Bernstein, I. (1994). Psychometric theory (3rd ed.). New York: McGraw-Hill.
Oleweus, D. (1979). Stability of aggressive reaction patterns in males: A review. Psychological Bulletin, 86, 852–875.
Parker, J. G., & Asher, S. R. (1987). Peer relations and later personal adjustment: Are low-accepted children at risk? Psychological Bulletin, 102, 357–389.
Patterson, G. (1986). Performance models for antisocial boys. American Psychologist, 41, 432–444.
Patterson, G., DeBaryshe, B., & Ramsey, E. (1989). A developmental perspective on antisocial behavior. American Psychologist, 44, 329–335.
Prescott, G., Balow, I., Hogan, T., & Farr, R. (1987). Metropolitan Achievement Tests. San Antonio, TX: Psychological Corporation.
Robins, L. (1966). Deviant children grown up. Baltimore: Williams & Wilkins.
Schneider, M., & Leitenberg, H. (1989). A comparison of aggressive and withdrawn children's self-esteem, optimism, and pessimism, and causal attributions for success and failure. Journal of Abnormal Child Psychology, 17, 133–144.
Taylor, S. E., & Brown, J. D. (1988). Illusion and well-being: A social psychological perspective on mental health. Psychological Bulletin, 103, 193–210.
Walker, H., Block-Pedego, A., Todis, B., & Severson, H. (1991). School Archival Records Search. Longmont, CO: Sopris West.
Walker, H., Colvin, G., & Ramsey, E. (1995). Antisocial behavior in schools: Strategies and best practices. Pacific Grove, CA: Brooks/Cole.
Walker, H. M., & Severson, H. (1992). Systematic screening for behavior disorders. Longmont, CO: Sopris West.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Gresham, F.M., MacMillan, D.L., Bocian, K.M. et al. Comorbidity of Hyperactivity-Impulsivity-Inattention and Conduct Problems: Risk Factors in Social, Affective, and Academic Domains. J Abnorm Child Psychol 26, 393–406 (1998). https://doi.org/10.1023/A:1021908024028
Issue Date:
DOI: https://doi.org/10.1023/A:1021908024028