New ideas about ADHD
Today, we are examining two studies that suggest rethinking ideas about ADHD. First, Baardstu, Karevold, John, De Fruyt & von Soest (2025) published “Active During Childhood: Undercontrolled or extraverted in late adolescence? A longitudinal study distinguishing different conceptions of childhood activity” in Journal of Personality and Social Psychology. Here’s the edited abstract:
The role of childhood activity level in personality development is still poorly understood. Using data from a prospective study following 939 children from age 1.5 to 16.5 years, this study examined whether prospective associations of childhood activity with subsequent personality ratings in adolescence differ across two conceptualizations of childhood activity: energetic activity (defined by energy, vigor, and tempo) versus dysregulated activity (distractibility, hyperactivity, and poor self-regulation). We assessed energetic activity development (using latent growth curve modeling) at ages 1.5–8.5 years using the Activity scale from the Emotionality, Activity, and Sociability Temperament Survey, and dysregulated activity at age 8.5 using the Hyperactivity-Inattention scale from the Strengths and Difficulties Questionnaire. We then used these two kinds of activity measures (mother-reported) to predict personality self-descriptions on the Big Five Inventory 8 years later. Personality traits were first regressed on mean levels of energetic and dysregulated activity at age 8.5 years and subsequently regressed on the growth factors of energetic activity development. Results showed mean-level changes in the entire sample as energetic activity decreased by more than 1 SD across childhood (i.e., −0.18 SD per year). Energetic activity at age 8.5 positively predicted higher levels of both the Big Five extraversion domain and the self-discipline facet of conscientiousness at age 16.5. In contrast, dysregulated activity at age 8.5 predicted lower levels of both conscientiousness and agreeableness. The findings advocate for a distinction between energetic and dysregulated activity in temperament and personality theories, addressing inconsistencies in previous research.
I like the distinction between energetic activity and dysregulated activity. Clearly, the findings indicate the importance of distinguishing the two kinds of activity, acknowledging that both temperament and personality theories need to clarify the activity distinction in future research. Activity can mean engagement, not just dysregulation. The next study raises new questions. Peng, Stanton, Dominguez-Alvarez & Watts (2024) published “Where Does Attention-Deficit/Hyperactivity Disorder Fit in the Psychopathology Hierarchy? A symptom-focused analysis” in Journal of Psychopathology and Clinical Science. Here are the edited abstract and impact statements:
Modern psychopathology classification systems position attention-deficit/hyperactivity disorder (ADHD) with different groups of conditions, either with externalizing or neurodevelopmental. As such, the optimal placement of ADHD in modern classification systems remains unclear. We advanced the literature by mapping ADHD symptoms onto three transdiagnostic psychopathology spectra—externalizing, neurodevelopmental, and internalizing—and their symptoms. ADHD symptoms had varied associations with different spectra, with subsets of symptoms relating most strongly to externalizing, others to neurodevelopmental, and still others to internalizing. Impulsivity, poor schoolwork, and low perseverance were most closely tied to externalizing, cognitive disengagement symptoms (e.g., confused, stared blankly, daydreamed) and immaturity were most closely tied to neurodevelopment, and cognitive disengagement symptoms were also tied to internalizing. Our findings advise against conceptualizing and treating ADHD as a unitary construct and against placing ADHD exclusively under either externalizing or neurodevelopmental spectra. Symptom-focused approaches will better inform modern psychopathology classification systems.
Attention-deficit/hyperactivity disorder (ADHD) is classified either as a neurodevelopmental disorder or as an externalizing condition in contemporary classification systems of psychopathology. Our study shows that ADHD symptoms map differentially onto both externalizing and neurodevelopmental spectra, highlighting the heterogeneous nature of ADHD.
Just as energetic activity and dysregulated activity in elementary school predict different outcomes in adolescence, children with externalizing symptoms differ from those with neurodevelopmental symptoms. It’s important to recognize the heterogeneity in ADHD symptoms and correlates.