Department of Psychiatry, Oregon Health & Science University.
Department of Psychology, Florida International University.
Psychol Assess. 2019 Feb;31(2):236-247. doi: 10.1037/pas0000664. Epub 2018 Oct 25.
Attention deficit hyperactivity disorder (ADHD) is emblematic of unresolved heterogeneity in psychiatric disorders-the variation in biological, clinical, and psychological correlates that impedes progress on etiology. One approach to this problem is to characterize subgroups using measures rooted in biological or psychological theory, consistent with the National Institute of Mental Health's research domain criteria initiative. Within ADHD, a promising application involves using emotion trait profiles that can address the role of irritability as a complicating feature for ADHD. Here, a new sample of 186 children with ADHD was evaluated using community detection analysis to determine if meaningful subprofiles existed and if they replicated those previously identified. The new sample and a prior sample were pooled for evaluation of (a) method dependence, (b) longitudinal assessment of the stability of classifications, and (c) clinical prediction 2 years later. Three temperament profiles were confirmed within the ADHD group: one with normative emotional functioning ("mild"), one with high surgency ("surgent"), and one with high negative affect ("irritable"). Profiles were similar across statistical clustering approaches. The irritable group had the highest external validity: It was moderately stable over time and it enhanced prospective prediction of clinical outcomes beyond standard baseline indicators. The irritable group was not reducible to ADHD + oppositional defiant disorder, ADHD + disruptive mood dysregulation disorder, or other patterns of comorbidity. Among the negative affect domains studied, trait proneness to anger uniquely contributed to clinical prediction. Results extend our understanding of chronic irritability in psychiatric disorders and provide prospects for a fresh approach to assessing ADHD heterogeneity focused on the distinction between ADHD with and without anger/irritability. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
注意缺陷多动障碍（ADHD）是精神障碍中未解决的异质性的典型代表-生物、临床和心理相关因素的变化阻碍了病因学的进展。解决这个问题的一种方法是使用基于生物或心理理论的措施来描述亚组，这与国家心理健康研究所的研究领域标准倡议一致。在 ADHD 中，一个有前途的应用涉及使用情绪特征谱，这可以解决易激惹作为 ADHD 复杂特征的作用。在这里，使用社区检测分析评估了 186 名新的 ADHD 儿童样本，以确定是否存在有意义的亚组，以及它们是否复制了以前确定的亚组。新样本和以前的样本被合并用于评估：（a）方法依赖性，（b）分类稳定性的纵向评估，以及（c）2 年后的临床预测。在 ADHD 组内确认了三种气质特征谱：一种具有正常情绪功能（“轻度”），一种具有高冲动性（“冲动”），一种具有高负性情绪（“易怒”）。特征谱在统计聚类方法上相似。易怒组具有最高的外部有效性：它在时间上具有中等稳定性，并且在标准基线指标之外增强了对临床结果的前瞻性预测。易怒组不能简化为 ADHD+对立违抗性障碍、ADHD+情绪障碍调节障碍或其他共病模式。在所研究的负性情绪领域中，特质易愤怒独特地有助于临床预测。结果扩展了我们对精神障碍中慢性易激惹的理解，并为一种新的方法提供了前景，该方法侧重于 ADHD 伴或不伴愤怒/易激惹的区别，以评估 ADHD 的异质性。（PsycINFO 数据库记录（c）2019 APA，保留所有权利）。
