Correlates of behavior phenotypes of school-aged boys with Attention Deficit Hyperactivity Disorder (ADHD)

• Main Authors: Yuan-Chang Hsu, 許元彰
• Other Authors: Pesus Chou
• Format: Others
• Language: en_US
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/gazge5

博士 === 國立陽明大學 === 公共衛生研究所 === 107 === [Background] Although most studies of attention-deficit hyperactive disorder have focused on biological correlates, the role of other factors in this condition cannot be underrated. Therefore, we performed two study to evaluate the association of family, personal and parental factors with severe internalizing and externalizing behaviors and to evaluate the associations between family structure, birth order, and aggressive behaviors among school-aged boys with attention deficit hyperactivity disorder (ADHD). [Methods] In the first study, we performed a cross-sectional study with data retrieved retrospectively from the medical record database of a single psychiatric center. Boys diagnosed with ADHD, who were aged 6 to 11 years at their first visit to the center during 2000 to 2011, were identified. Information about family, personal, and parental factors and the measurement of internalizing and externalizing behaviors based on the Child Behavior Checklist (CBCL) were reviewed. A T score higher than 63 defined the presence of severe internalizing and externalizing behaviors. Multivariable logistic regression was performed to evaluate the effect of family, personal and parental factors on behavior problems of ADHD boys. In the second study, we used the same database to conduct a matched case-control study. School-aged boys with ADHD who first visited the outpatient department at the psychiatric center between 2000 and 2011 were identified. The Child Behavior Checklist was used for aggressive behavior assessment. Boys with ADHD with T scores higher than 70 on the aggressive subscale were classified as cases and others with T scores lower than 70 were classified as controls. Matching strategy by age and calendar year of first visit was performed by a 1:4 ratio. After controlling for other familial, personal, and parental factors, a multivariate conditional logistic regression was performed to evaluate the effects of family structure and birth order on aggressive behaviors of boys with ADHD. [Results] In the first study, multiple logistic regression analysis revealed that being first-born, living in a family not with both parents, having a family history of mental disorders, having prenatal complications, and having medical comorbidities were associated with both severe internalizing and externalizing behaviors in boys with ADHD. However, perinatal complications and having psychiatric comorbidities were associated with severe internalizing behaviors only, while paternal education level and maternal age at childbirth were associated with severe externalizing behaviors only. In the second study, 277 cases and 1108 controls were included in final analysis. Compared with living in a traditional family with both parents, living in a non-traditional family in which one or both parents were absent increased the risk of aggressive behaviors by 1.47-fold, with the highest risk for those in single parent families. Being the firstborn increased risk by 1.45-fold and the risk was higher when the firstborn had siblings. [Conclusions] In the first study, we found that the association of family, personal and parental factors with behavior disturbance of ADHD boys is complex and further investigation is needed. In the second study, living in non-traditional families in which one or both parents were absent, and being the firstborn increased risk of aggression in school-aged boys with ADHD. Identification of this high-risk population and development of adequate preventive strategies are warranted.