Prediction of internalizing and externalizing symptoms in late childhood from attention-deficit/hyperactivity disorder symptoms in early childhood

Agnieszka Mlodnicka; Maxwell Mansolf; Aruna Chandran; Izzuddin M Aris; Catrina A Calub; Shaikh Ahmad; Allison Shapiro; David Cochran; Bibiana Restrepo; Rebecca Schmidt; Irva Hertz-Picciotto; Deborah Bennett; Diane R Gold; T Michael O'Shea; Leslie Leve; Julie B Schweitzer; program collaborators for Environmental influences on Child Health Outcomes*

doi:10.1017/S0954579424000695

Prediction of internalizing and externalizing symptoms in late childhood from attention-deficit/hyperactivity disorder symptoms in early childhood

Dev Psychopathol. 2024 Mar 27:1-10. doi: 10.1017/S0954579424000695. Online ahead of print.

Authors

Agnieszka Mlodnicka^{1

2}, Maxwell Mansolf³, Aruna Chandran⁴, Izzuddin M Aris⁵, Catrina A Calub^{1

2}, Shaikh Ahmad⁶, Allison Shapiro⁷, David Cochran⁸, Bibiana Restrepo^{2

9}, Rebecca Schmidt^{2

10}, Irva Hertz-Picciotto^{2

10}, Deborah Bennett¹⁰, Diane R Gold¹¹, T Michael O'Shea¹², Leslie Leve¹³, Julie B Schweitzer^{1

2}; program collaborators for Environmental influences on Child Health Outcomes*

Affiliations

¹ Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, CA, USA.
² MIND Institute, University of California Davis, Sacramento, CA, USA.
³ Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
⁴ Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
⁵ Department of Population Medicine at the Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA.
⁶ Division of Developmental Medicine University of California San Francisco, San Francisco, CA, USA.
⁷ Department of Pediatrics, University of Colorado Anschutz Medical Campus, Denver, CO, USA.
⁸ Department of Psychiatry, Eunice Kennedy Shriver Center, UMass Chan Medical School, Worcester, MA, USA.
⁹ Department of Pediatrics, University of California Davis, Sacramento, CA, USA.
¹⁰ Department of Public Health Sciences, University of California Davis, Davis, CA, USA.
¹¹ Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School; Harvard T.H. Chan School of Public Health. Boston, MA, USA.
¹² Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹³ Prevention Science Institute, University of Oregon, Eugene, OR, USA.

PMID: 38532736
PMCID: PMC11427612 (available on 2025-09-27)
DOI: 10.1017/S0954579424000695

Abstract

Limited analyses based on national samples have assessed whether early attention-deficit/hyperactivity disorder (ADHD) symptoms predict later internalizing and externalizing symptoms in youth and the influence of sex and pubertal timing on subsequent psychiatric symptoms. This study analyzed data (n = 2818) from the Environmental influences on Child Health Outcomes Program national cohort. Analyses used data from early childhood (mean age = 5.3 years) utilizing parent-reported ADHD symptoms to predict rates of internalizing and externalizing symptoms from late childhood/adolescence (mean age = 11.9 years). Within a subsample age at peak height velocity (APHV) acted as a proxy to assess pubertal timing from early childhood (mean age = 5.4 years) to adolescence (mean age = 12.3 years). Early-childhood ADHD symptoms predicted later psychiatric symptoms, including anxiety, depression, aggressive behavior, conduct problems, oppositional defiant disorder, and rule-breaking behavior. Earlier APHV was associated with increased Conduct Disorder symptoms from late childhood to adolescence for females only. A stronger relation between ADHD symptoms and later aggression was observed in females with earlier APHV, whereas this same pattern with aggression, conduct problems and depression was observed in males with later APHV. Clinicians should consider that both young girls and boys with elevated ADHD symptoms, particularly with off-set pubertal timing, may be at risk for later psychiatric symptoms.

Keywords: ADHD; conduct symptoms; depression; puberty; sex.

Abstract

Grants and funding