Differentiating Co-Occurring Behavior Problems in Children With ADHD: Patterns of Emotional Reactivity and Executive Functioning

Objective:This study examined whether top-down and bottom-up control processes can differentiate children with ADHD who exhibit co-occurring aggression and/or internalizing symptoms. Method: Participants included 74 children (M age = 10.7 years) with a Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) diagnosis of ADHD. The authors' top-down measure was executive functioning (EF) indexed via two neuropsychological tasks whereas their bottom-up measure was emotional reactivity. Parents also reported on children's aggression and internalizing symptoms. Results: Emotional reactivity was associated with co-occurring aggressive symptoms, regardless of the presence of internalizing symptoms or ADHD symptom severity, whereas EF deficits were less likely to occur in children with ADHD and co-occurring internalizing symptoms. Conclusion: The authors' findings highlight the importance of integrating top-down and bottom-up regulatory measures when studying the multipathway conception of ADHD and its co-occurring problems. (J. of Att. Dis. 2013; 17(3)249-260)