Clinical Subtypes in Children with Attention-Deficit Hyperactivity Disorder According to Their Child Behavior Checklist
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ORIGINAL ARTICLE
Clinical Subtypes in Children with Attention‑Deficit Hyperactivity Disorder According to Their Child Behavior Checklist Profile Daisuke Katsuki1,3 · Hiroshi Yamashita1 · Kenichi Yamane1 · Shigenobu Kanba2,3 · Keiko Yoshida3,4
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract This study sought to identify subgroups of attention-deficit hyperactivity disorder (ADHD) defined by specific patterns of emotional and behavioral symptoms according to the parent-rated Child Behavior Checklist (CBCL). Our clinical sample comprised 314 children (aged 4 to 15 years) diagnosed with ADHD according to the DSM-5. In addition, comorbid psychiatric disorders, general functioning, and medication status were assessed. Cluster analysis was performed on the CBCL syndrome subscales and yielded a solution with four distinct subgroups. The “High internalizing/externalizing” group displayed an overlap between internalizing and externalizing problems in the CBCL profile. In addition, the “High internalizing/ externalizing” group revealed a high rate of comorbid autism spectrum disorder and elevated autistic traits. The “Inattention and internalizing” group revealed a high rate of the predominantly inattentive presentation according to ADHD specifier from the DSM-5. The “Aggression and externalizing” group revealed a high rate of comorbid oppositional defiant disorder and conduct disorder. The “Less psychopathology” group scored low on all syndrome scales. Children with ADHD were subdivided into four distinct subgroups characterized by psychopathological patterns, with and without internalizing and externalizing problems. The overlap between internalizing and externalizing problems may be mediated with emotional dysregulation and associated neurobiological bases. Keywords Attention-deficit hyperactivity disorder · Child behavior checklist · Classification · Cluster analysis · Comorbidity
Introduction Attention-deficit/hyperactivity disorder (ADHD) has been evaluated in a variety of ways: using informants [1], symptom counts [2], and scales [3]. The diversity of the findings of those studies reflects the heterogeneity of ADHD. Concerning such heterogeneity [4], previous researchers have tried to identify homogenous subgroups [5, 6] on the basis of categorical diagnosis. However, over the past decade, the
* Daisuke Katsuki [email protected]‑u.ac.jp 1
Department of Child Psychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
2
Japan Depression Center, Tokyo, Japan
3
Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, 3‑1‑1, Maidashi, Higashiku, Fukuoka City, Fukuoka 8128582, Japan
4
Iris Psychiatric Clinic, Fukuoka, Japan
diagnostic system for the neurodevelopmental disorders, specifically ADHD, has evolved [7]. In the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM5; American Psychiatric Association 2013), the inclusion in the category of Neurodevelopmental Disorders was in and of
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