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Developmental profiles of childhood attention‐deficit/hyperactivity disorder and irritability: association with adolescent mental health, functional impairment, and suicidal outcomes
Author(s) -
Galera Cedric,
Orri Massimiliano,
Vergunst Francis,
Melchior Maria,
Van der Waerden Judith,
Bouvard Manuel P.,
Collet Ophélie,
Boivin Michel,
Tremblay Richard E.,
Côté Sylvana M.
Publication year - 2021
Publication title -
journal of child psychology and psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.652
H-Index - 211
eISSN - 1469-7610
pISSN - 0021-9630
DOI - 10.1111/jcpp.13270
Subject(s) - irritability , psychology , psychiatry , child and adolescent psychiatry , attention deficit hyperactivity disorder , mental health , odds ratio , population , clinical psychology , medicine , anxiety , environmental health
Background Irritability is frequently comorbid with ADHD. Although irritability alone has been linked to deleterious mental health and adaptive issues, the joint developmental course of ADHD and irritability symptoms during childhood as well as its association with later mental health and suicidal outcomes is not fully understood. We aimed to describe the developmental trajectories of childhood ADHD and irritability symptoms and to quantify their association with adolescent mental health and suicidal outcomes. Methods The Quebec Longitudinal Study of Child Development (QLSCD) included 1407 participants from the general population followed up from age 5 months to 17 years. We used a multitrajectory approach to identify developmental trajectories of childhood (6–12 years) ADHD and irritability symptoms. Outcome measures were adolescent (13–17 years) mental health (psychiatric symptoms/functional impairment) and suicidal outcomes. Results We identified distinct developmental profiles: combined absent or very low ADHD and absent or very low irritability (940 [66.8%]; reference group), moderately high irritability and low ADHD (158 [11.2%]), moderately high ADHD and low irritability (198 [14.1%]), and combined high ADHD and high irritability (111 [7.9%]). Multivariate modeling showed that, compared to children in the reference group, those in the combined high ADHD and high irritability profile showed higher levels of ADHD continuity ( d ranges = 0.40–0.50), externalizing ( d ranges = 0.25–0.59), internalizing ( d ranges = 0.20–0.29), and functional impairments ( d ranges = 0.17–0.48) and suicidal behaviors (odds ratio (OR) = 2.12, confidence interval (CI) = 1.47–3.06) in adolescence. Conclusions The presence of persistently high levels of irritability along with ADHD symptoms during childhood significantly predicts adolescent ADHD continuity, externalizing, internalizing, and suicidal outcomes. Systematic consideration of irritability when assessing and treating ADHD may improve long‐term mental health outcomes.