[go: up one dir, main page]
More Web Proxy on the site http://driver.im/ Skip to main content
Springer Nature Link
Log in

Internalizing and externalizing behavior in adult ADHD

  • Original Article
  • Published:
ADHD Attention Deficit and Hyperactivity Disorders

Abstract

Although there are many studies available investigating internalizing and externalizing behavior in childhood and adolescent manifestations of attention-deficit/hyperactivity disorder, there is limited information about their relevance in adults featuring persistence of the disease. We examined a large sample of 910 adults affected with attention-deficit/hyperactivity disorders (AADHD) for internalizing and externalizing behavior. Regarding correlates of internalizing behavior, AADHD probands showed significantly higher scores of the anxiety- and depression-related personality traits Neuroticism and Harm Avoidance, compared with reference values. The lifetime comorbidity of depressive disorders, anxiety disorders, and anxious or fearful Cluster C personality disorders (PDs) is elevated in AADHD patients compared with general population. Regarding correlates of externalizing behavior, patients affected with AADHD show significantly lower scores of Conscientiousness and significantly higher scores of Novelty Seeking than the published German reference values. Emotional, dramatic, or erratic Cluster B PDs were most frequent in AADHD. Internalizing and externalizing behavior notably affected psychosocial status to a similar extent. The frequency of both internalizing and externalizing behavior in AADHD might reflect an underlying emotional regulation disorder.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
£29.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (United Kingdom)

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Achenbach TM (1966) The classification of children`s psychiatric symptoms: a factor analytic study. Psychol Monogr 80(7):1–37

    Article  CAS  PubMed  Google Scholar 

  • Achenbach TM (1991) Manual for the youth self-report and 1991 profile. University of Vermont, Burlington

    Google Scholar 

  • Achenbach TM (1997) Manual for the young adult self-report and young adult behavior checklist. University of Vermont, Burlington

    Google Scholar 

  • Armistead L, Wierson M, Forehand R, Frame C (1992) Psychopathology in incarcerated juvenile delinquents: does it extend beyond externalizing problems? Adolescence 27(106):309–314

    CAS  PubMed  Google Scholar 

  • Beelmann A, Schneider N (2003) Effectiveness of psychotherapy in Children and adolescents. A review and meta-analysis to inventory and results of the effectiveness research in Germany, 32:129–143

    Google Scholar 

  • Bernardi S, Faraone SV, Cortese S, Kerridge BT, Pallanti S, Wang S, Blanco C (2012) The lifetime impact of attention deficit hyperactivity disorder: results from the national epidemiologic survey on alcohol and related conditions (NESARC). Psychol Med 42(4):875–887

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Carswell K, Maughan B, Davis H, Davenport F, Goddard N (2004) The psychosocial needs of young offenders and adolescents from an inner city area. J Adolesc 27(4):415–428

    Article  PubMed  Google Scholar 

  • Cloninger CR, Svrakic DM, Przybeck TR (1993) A psychobiological model of temperament and character. Arch Gen Psychiatry 50(12):975–990

    Article  CAS  PubMed  Google Scholar 

  • Connor DF, Ford JD (2012) Comorbid symptom severity in attention-deficit/hyperactivity disorder: a clinical study. J Clin Psychiatry 73(5):711–717

    Article  PubMed  Google Scholar 

  • Costa PT, McCrae RR (eds) (1992) Revised NEO personality inventory (NEO-PI-R) and NEO five factor inventory, professional manual. PAR Odessa, Florida

    Google Scholar 

  • Downey KK, Pomerleau CS, Pomerleau OF (1996) Personality differences related to smoking and adult attention deficit hyperactivity disorder. J Subst Abuse 8(1):129–135

    Article  CAS  PubMed  Google Scholar 

  • Downey KK, Stelson FW, Pomerleau OF, Giordani B (1997) Adult attention deficit hyperactivity disorder: psychological test profiles in a clinical population. J Nerv Ment Dis 185(1):32–38

    Article  CAS  PubMed  Google Scholar 

  • Esser G, Ihle W, Schmidt MH, Blanz B (2000) Der Verlauf psychischer Störungen vom Kindes- zum Erwachsenenalter. Zeitschrift für klinische Psychologie und Psychotherapie 29:276–283

    Article  Google Scholar 

  • First MB, Gibbon M, Spitzer RL, Williams JBW, Benjamin LS (1997) Structured clinical interview for DSM-IV axis II personality disorders (SCID-II). American Psychiatric Press, Washington, DC

    Google Scholar 

  • First MB, Spitzer RL, Gibbon M, Williams JBW (1996) Structured clinical interview for DSM-IV axis I disorders, clinician version (SCID-CV). American Psychiatric Press, Washington, DC

    Google Scholar 

  • Griffith JW, Zinbarg RE, Craske MG, Mineka S, Rose RD, Waters AM, Sutton JM (2010) Neuroticism as a common dimension in the internalizing disorders. Psychol Med 40(7):1125–1136. doi:10.1017/S0033291709991449

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Hinshaw SP (1987) On the distinction between attentional deficits/hyperactivity and conduct problems/aggression in child psychopathology. Psychol Bull 101(3):443–463

    Article  CAS  PubMed  Google Scholar 

  • Hughes EK, Gullone E (2008) Internalizing symptoms and disorders in families of adolescents: a review of family systems literature. Clin Psychol Rev 28(1):92–117

    Article  PubMed  Google Scholar 

  • Jacob CP, Romanos J, Dempfle A, Heine M, Windemuth-Kieselbach C, Kruse A, Reif A, Walitza S, Romanos M, Strobel A, Brocke B, Schäfer H, Schmidtke A, Böning J, Lesch KP (2007) Co-morbidity of adult attention-deficit/hyperactivity disorder with focus on personality traits and related disorders in a tertiary referral center. Eur Arch Psychiatry Clin Neurosci 257(6):309–317

    Article  PubMed  Google Scholar 

  • Jacob CP, Philipsen A, Ebert D, Deckert J (2008) Multimodal treatment of adult attention-deficit hyperactivity disorder. Nervenarzt 79(7):801–808

    Article  CAS  PubMed  Google Scholar 

  • Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, Faraone SV, Greenhill LL, Howes MJ, Secnik K, Spencer T, Ustun TB, Walters EE, Zaslavsky AM (2006) The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry 163(4):716–723

    Article  PubMed Central  PubMed  Google Scholar 

  • Landaas ET, Johansson S, Jacobsen KK, Ribasés M, Bosch R, Sánchez-Mora C, Jacob CP, Boreatti-Hümmer A, Kreiker S, Lesch KP, Kiemeney LA, Kooij JJ, Kan C, Buitelaar JK, Faraone SV, Halmøy A, Ramos-Quiroga JA, Cormand B, Reif A, Franke B, Mick E, Knappskog PM, Haavik J (2010) An international multicenter association study of the serotonin transporter gene in persistent ADHD. Genes Brain Behav 9(5):449–458

    Article  CAS  PubMed  Google Scholar 

  • Lehrl S (1977) Mehrfachwahl-Wortschatz-Intelligenztest Form B. Straube, Erlangen

    Google Scholar 

  • Lesch KP, Timmesfeld N, Renner TJ, Halperin R, Röser C, Nguyen TT, Craig DW, Romanos J, Heine M, Meyer J, Freitag C, Warnke A, Romanos M, Schäfer H, Walitza S, Reif A, Stephan DA, Jacob C (2008) Molecular genetics of adult ADHD: converging evidence from genome-wide association and extended pedigree linkage studies. J Neural Transm 115(11):1573–1585

    Article  CAS  PubMed  Google Scholar 

  • Liu J (2003) Childhood externalizing behavior: theory and implications. J Child Adolesc Psychiatr Nurs 17(3):93–103

    Article  Google Scholar 

  • Matthies S, van Elst LT, Feige B, Fischer D, Scheel C, Krogmann E, Perlov E, Ebert D, Philipsen A (2011) Severity of childhood attention-deficit hyperactivity disorder–a risk factor for personality disorders in adult life? J Pers Disord 25(1):101–114

    Article  PubMed  Google Scholar 

  • Merikangas KR, Avenevoli S (2002) Epidemiology of mood and anxiety disorders in children and adolescents. In: Tsuang MT, Tohen M (eds) Textbook in epidemiology, 2nd edn. Wiley, New York, pp 657–704

    Chapter  Google Scholar 

  • Meinzer MC, Lewinsohn PM, Pettit JW, Seeley JR, Gau JM, Chronis-Tuscano A, Waxmonsky JG (2013) Attentions-deficit/hyperactivity disorders in adolescents predicts onset of major depressive disorder through early adulthood. Depress Anxiety 30(6):546–555

    Article  PubMed  Google Scholar 

  • Miller TW, Nigg JT, Faraone SV (2007) Axis I and II comorbidity in adults with ADHD. J Abnorm Psychol 116(3):519–528

    Article  PubMed  Google Scholar 

  • Musser ED, Galloway-Long HS, Frick PJ, Nigg JT (2013) Emotion regulation and heterogeneity in attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 52(2):163–171

    Article  PubMed  Google Scholar 

  • Ostendorf F, Angleitner A (2004) NEO-PI-R, Neo-Persönlichkeitsinventar nach Costa und McCrae. Hogrefe-Verlag GmbH Co, KG

    Google Scholar 

  • Ranseen JD, Campbell DA, Baer RA (1998) NEO-PI-R profiles of adults with attention deficit disorder. Assessment 5(1):19–24

    Article  CAS  PubMed  Google Scholar 

  • Reif A, Nguyen TT, Weißflog L, Jacob C, Romanos M, Renner TJ, Buttenschon HN, Kittel-Schneider S, Gessner A, Weber H, Neuner M, Gross-Lesch S, Zamzow K, Kreiker S, Walitza S, Meyer J, Freitag CM, Bosch R, Casas M, Gómez N, Ribasès M, Bayès M, Buitelaar JK, Kiemeney LA, Kooij JJ, Kan CC, Hoogman M, Johansson S, Jacobsen KK, Knappskog PM, Fasmer OB, Asherson P, Warnke A, Grabe HJ, Mahler J, Teumer A, Völzke H, Mors ON, Schäfer H, Ramos-Quiroga JA, Cormand B, Haavik J, Franke B, Lesch KP (2011) DIRAS2 is associated with adult ADHD and related personality traits. Neuropsychopharmacology 36(11):2318–2327

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Reif A, Lesch KP (2003) Toward a molecular architecture of personality. Behav Brain Res 139(1–2):1–20

    Article  CAS  PubMed  Google Scholar 

  • Reimherr FW, Marchant BK, Strong RE, Hedges DW, Adler L, Spencer TJ, West SA, Soni P (2005) Emotional dysregulation in adult ADHD and response to atomoxetine. Bioll Psychiatry 58(125–3):1

    Google Scholar 

  • Reimherr FW, Williams ED, Strong RE, Mestas R, Soni P, Marchant BK (2007) A double-blind, placebo-controlled, crossover study of osmotic release oral system methylphenidate in adults with ADHD with assessment of oppositional and emotional dimensions of the disorder. J Clin Psychiatry 68(1):93–101

    Article  CAS  PubMed  Google Scholar 

  • Retz W, Retz-Junginger P, Hengesch G, Schneider M, Thome J, Pajonk FG, Salahi-Disfan A, Rees O, Wender PH, Rösler M (2004) Psychometric and psychopathological characterization of young male prison inmates with and without attention deficit/hyperactivity disorder. Eur Arch Psychiatry Clin Neurosci 254(6):201–208

    PubMed  Google Scholar 

  • Rösler M, Retz W, Retz-Junginger P, Hengesch G, Schneider M, Supprian T, Schwitzgebel P, Pinhard K, Dovi-Akue N, Wender P, Thome J (2004) Prevalence of attention deficit-/hyperactivity disorder (ADHD) and comorbid disorders in young male prison inmates. Eur Arch Psychiatry Clin Neurosci 254(6):365–371

    Article  PubMed  Google Scholar 

  • Ross SR, Benning SD, Patrick CJ, Thompson A, Thurston A (2009) Factors of the psychopathic personality inventory: criterion-related validity and relationship to the BIS/BAS and five-factor models of personality. Assessment 16(1):71–87

    Article  PubMed  Google Scholar 

  • Sarris A, Winefield HR, Cooper C (2000) Behaviour problems in adolescence: a comparison of juvenile offenders and adolescents referred to a mental health service. Aust J Psychol 52:17–22

    Article  Google Scholar 

  • Shaw DS, Winslow EB (1997) Precursors and correlates of antisocial behavior from infancy to preschool. In: Stoff DM, Breiling J, Maser J (eds) Handbook of antisocial behavior. Wiley, New York, pp 148–158

    Google Scholar 

  • Spijkers W, Jansen DE, Reijneveld SA (2013) Parental internalizing problems in a community sample: association with child psychosocial problems. Eur J Public Health Mar 23 [Epub ahead of print]

  • Sobanski E (2006) Psychiatric comorbidity in adults with attention-deficit/hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci 256(Suppl 1):i26–i31

    Article  PubMed  Google Scholar 

  • Torgersen S, Kringlen E, Cramer V (2001) The prevalence of personality disorders in a community sample. Arch Gen Psychiatry 58(6):590–596

    Article  CAS  PubMed  Google Scholar 

  • Weißflog L, Scholz CJ, Jacob C, Nguyen TT, Groß-Lesch S, Renner TJ, Romanos M, Rujescu D, Walitza S, Kneitz S, Lesch KP, Reif A (2012) KCNIP4 as a candidate gene for personality disorders and adult ADHD. Eur Neuropsychopharmacol 23(6):436–447

    Article  PubMed  Google Scholar 

  • Wender PH (1995) Attention-deficit hyperactivity disorder in adults. Oxford University Press, New York

    Google Scholar 

  • Weyers P, Krebs H, Janke W (1998) Reliability and construct validity of the German version of Cloninger’s tridimensional personality questionnaire. Pers Individ Diff 19:853–861

    Article  Google Scholar 

  • Williams ED, Reimherr FW, Marchant BK, Strong RE, Halls C, Soni P, Gale PD, Robison RJ (2010) Personality disorder in ADHD Part 1: assessment of personality disorder in adult ADHD using data from a clinical trial of OROS methylphenidate. Ann Clin Psychiatry 22(2):84–93. http://www.ncbi.nlm.nih.gov/pubmed/20445835

    Google Scholar 

  • Wittchen HU, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jönsson B, Olesen J, Allgulander C, Alonso J, Faravelli C, Fratiglioni L, Jennum P, Lieb R, Maercker A, van Os J, Preisig M, Salvador-Carulla L, Simon R, Steinhausen HC (2010) The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 21(9):655–679

    Article  Google Scholar 

  • Wittchen HU, Zaudig M, Fydrich T (1997) SKID—Strukturiertes Klinisches interview fuer DSM IV. Achse I und II, Hogrefe

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Fuechsleinstr. 15, 97080, Würzburg, Germany

    Christian Jacob, Silke Gross-Lesch, Andreas Reif & Klaus-Peter Lesch

  2. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Fuechsleinstr. 15, 97080, Würzburg, Germany

    Thomas Jans & Julia Geissler

  3. Institute of Medical Biometry and Epidemiology, Philipps-University Marburg, Bunsenstrasse 3, 35037, Marburg, Germany

    Astrid Dempfle

Authors
  1. Christian Jacob
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Silke Gross-Lesch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Jans
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Julia Geissler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andreas Reif
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Astrid Dempfle
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Klaus-Peter Lesch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christian Jacob.

Additional information

Astrid Dempfle and Klaus-Peter Lesch have contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jacob, C., Gross-Lesch, S., Jans, T. et al. Internalizing and externalizing behavior in adult ADHD. ADHD Atten Def Hyp Disord 6, 101–110 (2014). https://doi.org/10.1007/s12402-014-0128-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12402-014-0128-z

Keywords

Search

Navigation