Discontinuities in ADHD Symptoms from Grade 3 through Grade 12: The Role of Life Stress, Parenting Practices, and Child Emotional Vulnerabilities

Introduction: Attention deficit hyperactivity disorder (ADHD) symptoms and diagnoses in childhood have been linked with poorer academic, employment, relationship, and mental health outcomes. Some have challenged the simplistic disease model of ADHD, which would suggest fixed and stable dysfunction, and examined discontinuous trajectories of ADHD in some children, including groups who show reductions or increases in ADHD symptoms in early and middle childhood. This study adds to the very limited research on this topic by examining continuities and discontinuities in ADHD symptoms across childhood and adolescence. Specifically, (1) developmental trajectories of parent-reported inattention and hyperactivity-impulsivity symptoms were estimated, and (2) child internalizing and externalizing behaviors, emotion regulation, and context variables (consistent parenting, life stress, urban) were examined that might account for discontinuities. 

Methods:Three hundred and eighty-three children were followed longitudinally from kindergarten through grade 12. The Diagnostic Interview Schedule for Children (DISC) was administered to parents to assess ADHD symptoms when children were in grades 3, 6, 9, and 12. Risk and protective factors were assessed in kindergarten through grade 2.

Results:ADHD symptoms were submitted to longitudinal latent class analysis. Four developmental trajectory patterns emerged for ADHD symptoms: 1) no problems, 2) childhood limited (i.e., grade 3 only), 3) adolescent limited (i.e., elevated ADHD symptoms in grades 6 and 9 only), and 4) stable high problems. Multinomial logistic regression examined risk and protective factors associated with the discontinuous trajectories (childhood limited, adolescent limited). Results suggested that relative to the “stable high problems” trajectory, the “childhood limited” trajectory was associated with internalizing tendencies and lower levels of early life stress. Relative to the “no problems” trajectory, the “adolescent limited” trajectory was associated with an urban demographic (i.e., more disadvantaged), more inconsistent parenting, and elevated emotional vulnerability to stress.

Conclusions: The current study demonstrated that ADHD symptoms from grade 3 through grade 12 are characterized by continuities and discontinuities that are meaningfully associated with risk and protective factors. These preliminary findings suggest that multiple environmental, family context, and emotional vulnerabilities may affect the developmental course of ADHD symptoms. Additional analyses will consider a larger set of risk and protective factors across multiple levels and raters.