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Emotional/Behavioral Problems and Functional Impairment in Clinic- and Community-Based Children with Attention-Deficit/Hyperactivity Disorder in Taiwan

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Abstract

Using a sample of 268 patients and 137 community-based children with DSM-IV ADHD, and 268 school controls, aged 6–15, this study aimed to compare the emotional/behavioral problems and functional impairment between clinic- and community-based children with ADHD. Children’s ADHD-related symptoms, a wide range of emotional/behavioral problems, and functional impairments were assessed by the psychiatric interviews and self-, parent- and teacher-reported questionnaires. Both ADHD groups scored higher in parent- and teacher-reported ADHD-related symptoms, wide-ranging emotional/behavioral problems, and impairments in the school, peer, family, and leisure time domains than school controls. However, clinic-based children with ADHD had more physical/developmental problems, more severe functional impairments and teacher-reported hyperactivity/impulsivity symptoms, and higher family burdens than their community counterparts. Our findings suggest that a higher maternal educational level, parent’s perceived child functional impairment, teacher’s perceived impaired peer relationship and hyperactivity-impulsivity, and child physical and developmental problems may be related to the psychiatric referrals of children with ADHD.

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References

  • Achenbach, T. M. (1991). Manual for the youth self-report and 1991 profile. University of Vermont Department of Psychiatry.

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: American Psychiatric Association.

    Google Scholar 

  • Angold, A., Messer, S. C., Stangl, D., Farmer, E. M., Costello, E. J., & Burns, B. J. (1998). Perceived parental burden and service use for child and adolescent psychiatric disorders. American Journal of Public Health, 88, 75–80.

    Article  PubMed  Google Scholar 

  • Angold, A., Erkanli, A., Farmer, E. M., Fairbank, J. A., Burns, B. J., Keeler, G., et al. (2002). Psychiatric disorder, impairment, and service use in rural African American and white youth. Archives of General Psychiatry, 59, 893–901.

    Article  PubMed  Google Scholar 

  • Barbaresi, W. J., Katusic, S. K., Colligan, R. C., Weaver, A. L., & Jacobsen, S. J. (2007). Long-term school outcomes for children with attention-deficit/hyperactivity disorder: a population-based perspective. Journal of Developmental and Behavioral Pediatrics, 28, 265–273.

    Article  PubMed  Google Scholar 

  • Barkley, R. A. (2002). Major life activity and health outcomes associated with attention-deficit/hyperactivity disorder. Journal of Clinical Psychiatry, 63(Suppl 12), 10–15.

    PubMed  Google Scholar 

  • Bauermeister, J. J., Shrout, P. E., Ramirez, R., Bravo, M., Alegria, M., Martinez-Taboas, A., et al. (2007). ADHD correlates, comorbidity, and impairment in community and treated samples of children and adolescents. Journal of Abnormal Child Psychology, 35, 883–898.

    Article  PubMed  Google Scholar 

  • Biederman, J. (2005). Attention-deficit/hyperactivity disorder: a selective overview. Biological Psychiatry, 57, 1215–1220.

    Article  PubMed  Google Scholar 

  • Biederman, J., Faraone, S., Milberger, S., Guite, J., Mick, E., Chen, L., et al. (1996). A prospective 4-year follow-up study of attention-deficit hyperactivity and related disorders. Archives of General Psychiatry, 53, 437–446.

    PubMed  Google Scholar 

  • Biederman, J., Monuteaux, M. C., Kendrick, E., Klein, K. L., & Faraone, S. V. (2005). The CBCL as a screen for psychiatric comorbidity in paediatric patients with ADHD. Archives of Disease in Childhood, 90, 1010–1015.

    Article  PubMed  Google Scholar 

  • Bourdon, K. H., Goodman, R., Rae, D. S., Simpson, G., & Koretz, D. S. (2005). The strengths and difficulties questionnaire: U.S. normative data and psychometric properties. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 557–564.

    Article  PubMed  Google Scholar 

  • Bussing, R., Zima, B. T., Gary, F. A., & Garvan, C. W. (2003). Barriers to detection, help-seeking, and service use for children with ADHD symptoms. The journal of Behavioral Health Services and Research, 30, 176–189.

    Article  Google Scholar 

  • Cheon-Seok, S., Jae-Won, K., Han-Ik, Y., Jun-Won, H., Boong-Nyun, K., Mm-Sup, S., et al. (2007). Comparison of the child behavior checklist profiles between community- and clinic-based children with attention deficit hyperactivity disorder in Korea. Canadian Journal of Psychiatry, 52, 61–65.

    Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Erlbaum.

    Google Scholar 

  • Cuffe, S. P., Moore, C. G., & McKeown, R. E. (2005). Prevalence and correlates of ADHD symptoms in the national health interview survey. Journal of Attention Disorders, 9, 392–401.

    Article  PubMed  Google Scholar 

  • Gau, S. S. (2006). Prevalence of sleep problems and their association with inattention/hyperactivity among children aged 6–15 in Taiwan. Journal of Sleep Research, 15, 403–414.

    Article  Google Scholar 

  • Gau, S. S., & Chiang, H. L. (2009). Sleep problems and disorders among adolescents with persistent and subthreshold attention-deficit/hyperactivity disorders. Sleep, 32, 671–679.

    PubMed  Google Scholar 

  • Gau, S. S., Chong, M. Y., Chen, T. H., & Cheng, A. T. (2005). A 3-year panel study of mental disorders among adolescents in Taiwan. American Journal of Psychiatry, 162, 1344–1350.

    Article  PubMed  Google Scholar 

  • Gau, S. S., Shen, H. Y., Soong, W. T., & Gau, C. S. (2006). An open-label, randomized, active-controlled equivalent trial of osmotic release oral system methylphenidate in children with attention-deficit/hyperactivity disorder in Taiwan. Journal of Child and Adolescent Psychopharmacology, 16, 441–455.

    Article  PubMed  Google Scholar 

  • Gau, S. S., Huang, Y. S., Soong, W. T., Chou, M. C., Chou, W. J., Shang, C. Y., et al. (2007). A randomized, double-blind, placebo-controlled clinical trial on once-daily atomoxetine in taiwanese children and adolescents with attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 17, 447–460.

    Article  PubMed  Google Scholar 

  • Gau, S. S., Shang, C. Y., Liu, S. K., Lin, C. H., Swanson, J. M., Liu, Y. C., et al. (2008). Psychometric properties of the Chinese version of the Swanson, Nolan, and Pelham, version IV scale—parent form. International Journal of Methods in Psychiatric Research, 17, 35–44.

    Article  PubMed  Google Scholar 

  • Gau, S. S., Lin, C. H., Shang, C. Y., Swanson, J. M., Liu, Y. C., et al. (2009). Psychometric properties of the Chinese version of the Swanson, Nolan, and Pelham, version IV scale—Teacher Form. Journal of Pediatric Psychology, 34, 850–861.

    Article  Google Scholar 

  • Gaub, M., & Carlson, C. L. (1997). Gender differences in ADHD: a meta-analysis and critical review. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1036–1045.

    Article  PubMed  Google Scholar 

  • Goodman, R. (1999). The extended version of the strengths and difficulties questionnaire as a guide to child psychiatric caseness and consequent burden. Journal of Child Psychology and Psychiatry, 40, 791–801.

    Article  PubMed  Google Scholar 

  • Hoza, B., Gerdes, A. C., Hinshaw, S. P., Arnold, L. E., Pelham, W. E., Jr., Molina, B. S., et al. (2004). Self-perceptions of competence in children with ADHD and comparison children. Journal of Consulting and Clinical Psychology, 72, 382–391.

    Article  PubMed  Google Scholar 

  • Jensen, P. S., Bloedau, L., & Davis, H. (1990). Children at risk: II. Risk factors and clinic utilization. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 804–812.

    Article  PubMed  Google Scholar 

  • Klassen, A. F., Miller, A., & Fine, S. (2004). Health-related quality of life in children and adolescents who have a diagnosis of attention-deficit/hyperactivity disorder. Pediatrics, 114, e541–e547.

    Article  PubMed  Google Scholar 

  • Leibson, C. L., Katusic, S. K., Barbaresi, W. J., Ransom, J., & O’Brien, P. C. (2001). Use and costs of medical care for children and adolescents with and without attention-deficit/hyperactivity disorder. JAMA, the Journal of the American Medical Association, 285, 60–66.

    Article  Google Scholar 

  • Loe, I. M., & Feldman, H. M. (2007). Academic and educational outcomes of children with ADHD. Journal of Pediatric Psychology, 32, 643–654.

    Article  PubMed  Google Scholar 

  • Pliszka, S. R. (1998). Comorbidity of attention-deficit/hyperactivity disorder with psychiatric disorder: an overview. Journal of Clinical Psychiatry, 59(Suppl 7), 50–58.

    PubMed  Google Scholar 

  • Polanczyk, G., de Lima, M. S., Horta, B. L., Biederman, J., & Rohde, L. A. (2007). The worldwide prevalence of ADHD: a systematic review and metaregression analysis. American Journal of Psychiatry, 164, 942–948.

    Article  PubMed  Google Scholar 

  • Puig-Antich, J., & Chambers, W. J. (1978). The schedule for affective disorders and schizophrenia for school-age children—epidemiologic version (K-SADS-E). New York: New York State Psychiatric Institute, Biometrics Research.

    Google Scholar 

  • Rowland, A. S., Lesesne, C. A., & Abramowitz, A. J. (2002). The epidemiology of attention-deficit/hyperactivity disorder (ADHD): a public health view. Mental Retardation and Developmental Disabilities Research Reviews, 8, 162–170.

    Article  PubMed  Google Scholar 

  • Sawyer, M. G., Rey, J. M., Arney, F. M., Whitham, J. N., Clark, J. J., & Baghurst, P. A. (2004). Use of health and school-based services in Australia by young people with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 1355–1363.

    Article  PubMed  Google Scholar 

  • Sayal, K., Goodman, R., & Ford, T. (2006). Barriers to the identification of children with attention deficit/hyperactivity disorder. Journal of Child Psychology and Psychiatry and Allied Disciplines, 47, 744–750.

    Article  Google Scholar 

  • Shang, C. Y., Gau, S. S., & Soong, W. T. (2006). Association between childhood sleep problems and perinatal factors, parental mental distress and behavioral problems. Journal of Sleep Research, 15, 63–73.

    Article  PubMed  Google Scholar 

  • Spencer, T. J. (2006). ADHD and comorbidity in childhood. Journal of Clinical Psychiatry, 67(Suppl 8), 27–31.

    PubMed  Google Scholar 

  • Spencer, T. J., Biederman, J., & Mick, E. (2007). Attention-deficit/hyperactivity disorder: diagnosis, lifespan, comorbidities, and neurobiology. Journal of Pediatric Psychology, 32, 631–642.

    Article  PubMed  Google Scholar 

  • Strine, T. W., Lesesne, C. A., Okoro, C. A., McGuire, L. C., Chapman, D. P., Balluz, L. S., et al. (2006). Emotional and behavioral difficulties and impairments in everyday functioning among children with a history of attention-deficit/hyperactivity disorder. Preventing Chronic Disease, 3, A52.

    PubMed  Google Scholar 

  • Swanson, J. M., Kraemer, H. C., Hinshaw, S. P., Arnold, L. E., Conners, C. K., Abikoff, H. B., et al. (2001). Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 168–179.

    Article  Google Scholar 

  • Yang, H. J., Chen, W. J., & Soong, W. T. (2001). Rates and patterns of comorbidity of adolescent behavioral syndromes as reported by parents and teachers in a Taiwanese nonreferred sample. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 1045–1052.

    Article  Google Scholar 

  • Yochman, A., Ornoy, A., & Parush, S. (2006). Co-occurrence of developmental delays among preschool children with attention-deficit-hyperactivity disorder. Developmental Medicine and Child Neurology, 48, 483–488.

    Article  PubMed  Google Scholar 

  • Yoo, H. I., Cho, S. C., Kim, B. N., Kim, S. Y., Shin, M. S., & Hong, K. E. (2005). Psychiatric morbidity of second and third grade primary school children in Korea. Child Psychiatry and Human Development, 36, 215–225.

    Article  PubMed  Google Scholar 

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Acknowledgements

This work was supported by grants from the National Taiwan University Hospital Taiwan (NTUH 95–301), and National Health Research Institute (NHRI-EX94-9407PC, NHRI-EX95-9407PC), Taiwan. We would like to express our thanks to Chi-Mei Lee for her assistance in data analysis; and we also thank the participants, and their teachers and parents for their kindly providing their precious reports.

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Authors and Affiliations

  1. Department of Psychiatry, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan, 10002

    Susan Shur-Fen Gau, Yu-Ju Lin, Chi-Yung Shang, Yen-Nan Chiu & Wei-Tsuen Soong

  2. Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan

    Susan Shur-Fen Gau, Chi-Yung Shang & Wei-Tsuen Soong

  3. Department of Child and Adolescent Psychiatry, Taoyuan Mental Hospital, Department of Health Executive Yuan, Tao-Yuan, Taiwan

    Shih-Kai Liu

  4. St. Joseph’s Hospital, Yunlin County, Taiwan

    Wei-Tsuen Soong

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  1. Susan Shur-Fen Gau
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Correspondence to Susan Shur-Fen Gau.

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Gau, S.SF., Lin, YJ., Shang, CY. et al. Emotional/Behavioral Problems and Functional Impairment in Clinic- and Community-Based Children with Attention-Deficit/Hyperactivity Disorder in Taiwan. J Abnorm Child Psychol 38, 521–532 (2010). https://doi.org/10.1007/s10802-009-9381-6

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  • DOI: https://doi.org/10.1007/s10802-009-9381-6

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