(PS6-88) Predictors of Internalizing Symptoms in Children with ADHD During Puberty

Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) are at elevated risk for developing co-occurring internalizing disorders, such as anxiety and depression. The pubertal transition represents a critical period where family and social factors may exacerbate internalizing symptoms in this population. This prospective study aimed to elucidate the role of family conflict, parental mental health problems, social difficulties, and ADHD symptom domains in predicting trajectories of internalizing symptoms among youth with ADHD during puberty.

Data were drawn from the Adolescent Brain Cognitive Development StudySM (ABCD Study®), a large, longitudinal investigation of child health and brain development in the United States which enrolled 11,878 children 9-10 years at baseline. The analytic sample comprised 708 youth with ADHD who completed assessments of family environment via the Family Environment Scale and pubertal stage via the Pubertal Development Scale. Parents completed the Child Behavior Checklist (CBCL), which included data on their child’s social functioning (Social Problems Syndrome Scale) and internalizing symptoms (Anxious/Depressed, Withdrawn/Depressed, and Overall Internalizing Subscales). Parent report on the Adult Self-Report (ASR) was used to measure parental mental health problems (Total Problems Score). All measures were administered at baseline and two-year follow-up.

Hierarchical linear regression analyses were conducted to examine associations between baseline predictors and internalizing symptom subscales (anxious/depressed, withdrawn/depressed, overall internalizing) at follow-up, controlling for baseline internalizing symptoms. The predictor models accounted for significant variance in anxious/depressed (F (9, 558) = 40.55, p < .001, adj R2 = .39), withdrawn/depressed (F(9, 558) = 24.55, p < .001, adj R2 = .27), and internalizing symptoms (F(9, 558) = 40.18, p < .001, adj R2 = .38) at two-year follow-up.

Baseline anxious/depressed symptoms robustly predicted anxious/depressed symptoms at follow-up (std β = .6, p < .001). Withdrawn/depressed (std β = .25, p < .001) and inattentive symptoms (std β = .09, p = .02) at baseline predicted withdrawn/depressed symptoms. For overall internalizing symptoms, baseline predictors included internalizing symptoms (std β = .4, p < .001), anxious/depressed symptoms (std β = .15, p = .01), parental mental health problems (std β = .09, p = .02), and hyperactive/impulsive symptoms (std β = -.07, p = .04).

These results highlight the need to evaluate and target co-occurring internalizing disorders in children with ADHD, especially for youth showing indicators like severe anxiety/depression, inattention, family conflict, and parental psychopathology. Supplementing ADHD interventions with adjunctive components addressing internalizing psychopathology warrants consideration for high-risk children. Enhancing family functioning is also a priority given family conflict's potential impact on internalizing during this developmental period. Further longitudinal research is needed to inform prevention and intervention strategies.