Comparing ADHD symptom network structure in Chinese youth with ADHD: ADHD alone vs. ADHD with comorbidities

Background

ADHD is often comorbid with other psychiatric conditions, but it remains unclear whether comorbidities influence the structure of ADHD symptoms. This study examines ADHD symptom profiles in individuals with ADHD and comorbidities (AC) and individuals with ADHD only (AP).

Methods

The study used a secondary dataset obtained from a mental health survey of 1906 Chinese youth with ADHD, comprising AP (n = 897) and AC (n = 1009). Symptoms were assessed using the caregiver-rated CBCL DSM-oriented ADHD scale (CBCL-ADH). Partial correlation networks were estimated using the EBICglasso algorithm. Network Comparison Tests (NCTs) were conducted to compare the structure of CBCL-ADH items between the AP and AC groups, as well as across subgroups (e.g., gender and age groups).

Results

The network of CBCL-ADH items remained largely invariant across groups, despite higher ADHD severity observed in the AC group (p < .001). Subgroup analyses were generally consistent, with some exceptions: a marginal difference in network structure between age groups (p = .07) and an elevated risk of developing comorbidities among older participants (12–16 years) and female participants.

Conclusion

While comorbid conditions appear unrelated to the structure of caregiver-informed ADHD symptoms, further investigation is warranted to examine ADHD structure using multi-informant assessments, as well as the complex interactions between ADHD and comorbid symptom profiles. Variations in subgroups highlight the need for developmental and sociocultural considerations in managing comorbidities. These findings suggest that targeting central ADHD symptoms (e.g., hyperactivity) may offer benefits for ADHD improvement across comorbid presentations, though further validation is needed.