UUnniivveerrssiittyy ooff KKeennttuucckkyy UUKKnnoowwlleeddggee Theses and Dissertations--Psychology Psychology 2016 TTrraaiitt--BBaasseedd PPrroofifilleess ooff AADDHHDD iinn AAddoolleesscceennttss aanndd YYoouunngg AAdduullttss Tess E. Smith University of Kentucky, [email protected] Digital Object Identifier: http://dx.doi.org/10.13023/ETD.2016.268 RRiigghhtt cclliicckk ttoo ooppeenn aa ffeeeeddbbaacckk ffoorrmm iinn aa nneeww ttaabb ttoo lleett uuss kknnooww hhooww tthhiiss ddooccuummeenntt bbeenneefifittss yyoouu.. RReeccoommmmeennddeedd CCiittaattiioonn Smith, Tess E., "Trait-Based Profiles of ADHD in Adolescents and Young Adults" (2016). Theses and Dissertations--Psychology. 93. https://uknowledge.uky.edu/psychology_etds/93 This Master's Thesis is brought to you for free and open access by the Psychology at UKnowledge. It has been accepted for inclusion in Theses and Dissertations--Psychology by an authorized administrator of UKnowledge. 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I retain all other ownership rights to the copyright of my work. I also retain the right to use in future works (such as articles or books) all or part of my work. I understand that I am free to register the copyright to my work. RREEVVIIEEWW,, AAPPPPRROOVVAALL AANNDD AACCCCEEPPTTAANNCCEE The document mentioned above has been reviewed and accepted by the student’s advisor, on behalf of the advisory committee, and by the Director of Graduate Studies (DGS), on behalf of the program; we verify that this is the final, approved version of the student’s thesis including all changes required by the advisory committee. The undersigned agree to abide by the statements above. Tess E. Smith, Student Dr. Michelle M. Martel, Major Professor Dr. Mark Fillmore, Director of Graduate Studies TRAIT-BASED PROFILES OF ADHD IN ADOLESCENTS AND YOUNG ADULTS ____________________________________ THESIS ____________________________________ A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in the College of Arts and Sciences at the University of Kentucky By Tess E. Smith Director: Dr. Michelle M. Martel, Professor of Psychology Lexington, KY 2016 Copyright © Tess E. Smith 2016 ABSTRACT OF THESIS TRAIT-BASED PROFILES OF ADHD IN ADOLESCENTS AND YOUNG ADULTS Empirical work has examined the utility of using person-centered statistical approaches emphasizing traits to parsing Attention-Deficit/Hyperactivity disorder (ADHD) heterogeneity in preschool and school-aged children. However, trait-based profiles have not yet been examined in other age ranges, specifically adolescence and young adulthood. Therefore, the goal of the present study is to examine trait-based profiles in adolescents and young adults with ADHD in order to evaluate their similarity with trait-based profiles in preschoolers and children with ADHD and through comparison with external correlates (e.g., comorbidity). One hundred and eighty-two adolescents and 287 young adults completed measures of ADHD symptoms, personality and temperament traits, and comorbid internalizing and externalizing problems. Latent profile analysis suggested at least three consistent trait-based profiles related to ADHD within adolescents and young adults: low extraversion, high extraversion, and high neuroticism profiles. These profiles were largely similar to those found in preschool and middle childhood and demonstrated similar comorbidity patterns; namely, the low extraversion profile exhibited higher internalizing problems, the high extraversion profile exhibited higher externalizing problems, and the small high neuroticism profile exhibited descriptively higher levels of all comorbid problems. Such profiles may have utility for personalization of intervention based on trait profiles and comorbidity patterns, as well as – more speculatively – possible prognostic utility. Tess E. Smith May 31, 2016 TRAIT-BASED PROFILES OF ADHD IN ADOLESCENTS AND YOUNG ADULTS By Tess E. Smith Michelle Martel, Ph.D. Director of Thesis Mark Fillmore, Ph.D. Director of Graduate Studies May 31, 2016 TABLE OF CONTENTS List of Tables......................................................................................................................v List of Figures....................................................................................................................vi Chapter One: Review of the Literature...............................................................................1 Chapter Two: Study 1-Adolescents Methods.....................................................................7 Participants...................................................................................................................................7 Recruitment and Identification................................................................................................8 Measures......................................................................................................................................9 ADHD Symptoms....................................................................................................................9 Comorbid Adolescent Diagnoses.............................................................................................9 Temperament and Personality Traits.......................................................................................9 Data Analysis.............................................................................................................................10 Chapter Three: Study 1-Adolescents Results...................................................................11 Latent Profile Analysis...............................................................................................................11 Comparison with Preschool and Childhood Profiles.................................................................12 External Validation of Profiles...................................................................................................12 Chapter Four: Study 2- Young Adults Methods...............................................................20 Participants.................................................................................................................................20 Recruitment and Identification..............................................................................................20 Measures....................................................................................................................................21 ADHD Symptoms..................................................................................................................21 Comorbid Adult Diagnoses...................................................................................................21 Temperament and Personality Traits.....................................................................................22 Data Analysis.............................................................................................................................22 Chapter Five: Study 2- Young Adults Results..................................................................23 Latent Profile Analysis...............................................................................................................23 Comparison with Preschool and Childhood Profiles.................................................................24 External Validation of Profiles...................................................................................................24 Chapter Six: Discussion....................................................................................................32 Appendices........................................................................................................................38 References.........................................................................................................................40 Vita....................................................................................................................................52 iv LIST OF TABLES Table 1 Latent Profile Analysis Fit Indices: Adolescents………………………………..15 Table 2 Latent Profile Solutions Using Adolescent Traits: Descriptive Statistics………16 Table 3 Adolescent External Validation: Five Profiles………………………………….17 Table 4 Comparisons of Relative Percentage of Individuals Falling into Each Profile Through Adolescence……………………………………………………………………18 Table 5 Latent Profile Analysis Fit Indices: Young Adults……………………………...27 Table 6 Latent Profile Solutions Using Young Adult Traits: Descriptive Statistics…….28 Table 7 Young Adult External Validation: Five Profiles………………………………..29 Table 8 Comparisons of Relative Percentage of Individuals Falling into Each Profile. Through Young Adulthood………………………………………………………………30 v LIST OF FIGURES Figure 1 Five-profile solution in Adolescents……………………………………...……19 Figure 2 Five-profile solution in Young Adults…………………………………………31 vi Trait-based Profiles of ADHD in Adolescents and Young Adults Chapter One: Review of the Literature Attention-Deficit/Hyperactivity disorder (ADHD) is a neurodevelopmental disorder that begins early and is characterized by symptoms of inattention and/or hyperactivity- impulsivity, according to the Diagnostic and Statistical Manual of Mental Disorders— Fifth Edition (DSM-5; APA, 2013). ADHD affects about 5% of children and 2.5% of adults across most cultures (Polanczyk et al., 2007). Furthermore, ADHD is associated with substantial societal costs including treatment, other health care costs, and educational and legal expenses (Pelham, Foster, & Robb, 2007). In addition, individuals with ADHD exhibit difficulties with academic achievement, social relationships, comorbidity, accidental injury or death, and higher rates of unemployment and divorce as adults (reviewed by Barkley, 2014). Although ADHD was historically considered a childhood disorder, current work validates it into adulthood (Biederman et al., 2010; Faraone et al., 2005). Yet prominent developmental changes in symptoms occur (e.g., hyperactivity declines after preschool; Hart et al., 1995; Lahey et al., 2005; Martel, von Eye, & Nigg, 2012). In addition to developmental change in symptomatology, there is substantial inter-individual heterogeneity in the symptom presentation of those diagnosed with ADHD, historically labeled with subtypes (DSM-IV-TR, 2000). DSM-5 distinguishes three subtypes, or presentations: predominantly inattentive presentation (i.e., six or more symptoms of inattention), predominately hyperactive/impulsive presentation (i.e., six or more symptoms of hyperactivity-impulsivity, and combined (i.e., six or more symptoms in both domains; APA, 2013). Yet, these subtypes have failed to demonstrate external 1 validity in that they lack temporal stability (Lahey et al., 2005) and do not have distinct external correlates (Nigg et al., 2002; Chhabildas, Pennington, & Willcutt, 2001). Furthermore, the DSM-5 presentations do not exhibit distinct neuropsychological or neurobiological patterns (Chhabildas, Pennington, & Willcutt, 2001; Fair et al., 2012; Nigg et al., 2005). For this reason, it has been suggested that some subtypes might be better broken down into additional groups such as a restrictive inattentive subtype (six or more symptoms of inattention and two or fewer hyperactive-impulsive symptoms; Goth- Owens et al., 2010) or sluggish cognitive tempo (inconsistent alertness or orientation characterized by sluggishness, drowsiness, and apparent daydreaming; Barkley, 2012; McBurnett, Pfiffner & Frick, 2001). Yet, this work remains inconclusive and, for that reason, was not included in DSM-5. An alternative and particularly promising method of subtyping ADHD involves temperament and personality trait profiles, consistent with the new National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) initiative, which seeks to develop a research classification of mental disorders based on dimensions of neurobiology and psychology, including affect and behavior (Insel et al., 2010). Such a continuous approach integrating affective traits would allow for more powerful study of normal and abnormal behavior and the continuum in between, as well as allowing more sensitive tracking of developmental changes in behavior and neurobiology. Temperament traits provide one means by which to sensitively track developmental changes in behavior as they are defined as individual differences in reactivity and self-regulation (Rothbart, 1991). Historically, temperament has been viewed as being primarily inherited, or biological, in nature (Frick, 2004; Rothbart, 1989). Personality traits, on the other hand, 2