Study: Symptoms of Inattention and Irritability Predict Internalizing Disorders in Adolescents

October 19, 2021

Symptoms of inattention and irritability uniquely predict an increased likelihood of internalizing disorders, like anxiety and depression, from childhood to adolescence, according to a new study published in the Journal of Attention Disorders¹ that examined the dimensions of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) linked to these comorbidities.

The study’s authors noted that, while childhood ADHD and ODD are separate risk factors for internalizing problems, unique dimensions of each disorder — like inattention and hyperactivity in ADHD, and irritability and opposition in ODD – differently predict the incidence of these comorbid conditions. The study aimed to simultaneously and independently discern these dimensions over time to improve understanding of the risk factors behind internalizing problems.

For the study, researchers followed 230 children with and without ADHD over 7 years, and assessed symptoms like inattention, hyperactivity, irritability, and oppositionality based on parent-teacher responses to rating scales. Parents and teachers also rated emotional and behavioral problems at ease phase. Follow-up assessments were conducted every 2 to 3 years, for a total of 3 “waves.”

Findings show that escalating symptoms of inattention, but not hyperactivity, uniquely and positively predicted internalizing problems overall. And escalating irritability, but not oppositionality, positively predicted parent-rated internalizing and anxiety problems.

These results, according to the authors, demonstrate the importance of a dimensional approach to evaluating risk for internalizing disorders. Most research for ADHD’s ties to internalizing problems, for example, is often based on ADHD vs. non-ADHD designations, which limits the role of subclinical ADHD and specific symptoms. Most studies also treat childhood ADHD as a fixed predictor for internalizing problems, which assumes invariance in symptoms, even though symptoms are known to change and fluctuate over time.

The findings also have important clinical implications. The authors suggest that inattention and irritability may reflect an early phenotypic presentation for internalizing problems in adolescence and that screenings for anxiety and depression should begin in childhood.

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