Skip to main content

Advertisement

Springer Nature Link
Log in

ADHD and the externalizing spectrum: direct comparison of categorical, continuous, and hybrid models of liability in a nationally representative sample

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Alcohol use disorders, substance use disorders, and antisocial personality disorder share a common externalizing liability, which may also include attention-deficit hyperactivity disorder (ADHD). However, few studies have compared formal quantitative models of externalizing liability, with the aim of delineating the categorical and/or continuous nature of this liability in the community. This study compares categorical, continuous, and hybrid models of externalizing liability.

Method

Data were derived from the 2004–2005 National Epidemiologic Survey on Alcohol and Related Conditions (N = 34,653). Seven disorders were modeled: childhood ADHD and lifetime diagnoses of antisocial personality disorder (ASPD), nicotine dependence, alcohol dependence, marijuana dependence, cocaine dependence, and other substance dependence.

Results

The continuous latent trait model provided the best fit to the data. Measurement invariance analyses supported the fit of the model across genders, with females displaying a significantly lower probability of experiencing externalizing disorders. Cocaine dependence, marijuana dependence, other substance dependence, alcohol dependence, ASPD, nicotine dependence, and ADHD provided the greatest information, respectively, about the underlying externalizing continuum.

Conclusions

Liability to externalizing disorders is continuous and dimensional in severity. The findings have important implications for the organizational structure of externalizing psychopathology in psychiatric nomenclatures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Beesdo-Baum K, Höfler M, Gloster AT, Klotsche J, Lieb R, Beauducel A et al (2009) The structure of common mental disorders: a replication study in a community sample of adolescents and young adults. Int J Methods Psychiatr Res 18:204–220

    PubMed  Google Scholar 

  2. Slade T, Watson D (2006) The structure of common DSM-IV and ICD-10 mental disorders in the Australian general population. Psychol Med 36:1593–1600

    Article  PubMed  Google Scholar 

  3. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). American Psychiatric Association, Washington, DC

    Google Scholar 

  4. Krueger RF, Markon KE, Patrick CJ, Benning SD, Kramer MD (2007) Linking antisocial behavior, substance use, and personality: an integrative quantitative model of the adult externalizing spectrum. J Abnorm Psychol 116:645–666

    Article  PubMed Central  PubMed  Google Scholar 

  5. Krueger RF, Markon KE, Patrick CJ, Iacono WG (2005) Externalizing psychopathology in adulthood: a dimensional-spectrum conceptualization and its implications for DSM-V. J Abnorm Psychol 114:537–550

    Article  PubMed Central  PubMed  Google Scholar 

  6. Markon K, Krueger RF (2005) Categorical and continuous models of liability to externalizing disorders: A direct comparison in NESARC. Arch Gen Psychiatry 62:1352–1359

    Article  PubMed Central  PubMed  Google Scholar 

  7. Eaton NR, Krueger RF, Keyes KM, Skodol AE, Markon KE, Grant BF, Hasin DS (2011) Borderline personality disorder co-morbidity: relationship to the internalizing-externalizing structure of common mental disorders. Psychol Med 41:1041–1050

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Eaton NR, Krueger RF, Markon KE, Keyes KM, Skodol AE, Wall M, Hasin DS, Grant BF (2013) The structure and predictive validity of the internalizing disorders. J Abnorm Psychol 122:86–92

    Article  PubMed Central  PubMed  Google Scholar 

  9. Kendler KS, Prescott CA, Myers J, Neale MC (2003) The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Arch Gen Psychiatry 60:929–937

    Article  PubMed  Google Scholar 

  10. Hasin D, Kilcoyne B (2012) Comorbidity of psychiatric and substance use disorders in the United States: current issues and findings from the NESARC. Curr Opin Psychiatry 25:165–171

    Article  PubMed Central  PubMed  Google Scholar 

  11. Arcos-Burgos M, Vélez JI, Solomon BD, Muenke M (2012) A common genetic network underlies substance use disorders and disruptive or externalizing disorders. Human Genet 131:917–929

    Article  Google Scholar 

  12. Frodl T (2010) Comorbidity of ADHD and substance use disorder (SUD): a neuroimaging perspective. J Atten Disord 14:109–120

    Article  PubMed  Google Scholar 

  13. Lee SS, Humphreys KL, Flory K, Liu R, Glass K (2011) Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review. Clin Psychol Rev 31:328–341

    Article  PubMed Central  PubMed  Google Scholar 

  14. Charach A, Yeung E, Climans T, Lillie E (2011) Childhood attention-deficit/hyperactivity disorder and future substance use disorders: comparative meta-analyses. J Am Acad Child Adolesc Psychiatry 50:9–21

    Article  PubMed  Google Scholar 

  15. Cosgrove VE, Rhee SH, Gelhorn HL, Boeldt D, Corley RC, Ehringer MA et al (2011) Structure and etiology of co-occurring internalizing and externalizing disorders in adolescents. J Abnorm Child Psychol 39:109–123

    Article  PubMed Central  PubMed  Google Scholar 

  16. Farmer RF, Seeley JR, Kosty DB, Lewinsohn PM (2009) Refinements in the hierarchical structure of externalizing psychiatric disorders: patterns of lifetime liability from mid-adolescence through early adulthood. J Abnorm Psychol 118:699–710

    Article  PubMed Central  PubMed  Google Scholar 

  17. Forbush KT, Watson D (2013) The structure of common and uncommon mental disorders. Psychol Med 43:97–108

    Article  CAS  PubMed  Google Scholar 

  18. Lahey BB, Rathouz PJ, Van Hulle C, Urbano RC, Krueger RF, Applegate B et al (2008) Testing structural models of DSM-IV symptoms of common forms of child and adolescent psychopathology. J Abnorm Child Psychol 36:187–206

    Article  PubMed  Google Scholar 

  19. Almansa J, Vermunt JK, Forero CG, Vilagut G, De Graaf R, De Girolamo G et al (2011) Measurement and description of underlying dimensions of comorbid mental disorders using factor mixture models: results of the ESEMeD project. Int J Methods Psychiatr Res 20:116–133

    Article  PubMed  Google Scholar 

  20. Witkiewitz K, King K, McMahon RJ, Wu J, Luk J, Bierman KL et al (2013) Evidence for a multidimensional latent structural model of externalizing disorders. J Abnorm Child Psychol 41:233–237

    Article  Google Scholar 

  21. Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Smith SM et al (2008) Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 69:1033–1045

    Article  PubMed Central  PubMed  Google Scholar 

  22. Ruan WJ, Goldstein RB, Chou SP, Smith SM, Saha TD, Pickering RP et al (2008) The alcohol use disorder and associated disabilities interview schedule-IV (AUDADIS-IV): reliability of new psychiatric diagnostic modules and risk factors in a general population sample. Drug Alcohol Depend 92:27–36

    Article  PubMed Central  PubMed  Google Scholar 

  23. Canino G, Bravo M, Ramírez R, Febo VE, Rubio-Stipec M, Fernández RL et al (1999) The Spanish Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS): reliability and concordance with clinical diagnoses in a Hispanic population. J Stud Alcohol 60:790–799

    CAS  PubMed  Google Scholar 

  24. Grant BF, Dawson DA, Stinson FS, Chou PS, Kay W, Pickering R (2003) The alcohol use disorder and associated disabilities interview schedule-IV (AUDADIS-IV): reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug Alcohol Depend 71:7–16

    Article  PubMed  Google Scholar 

  25. Hasin D, Carpenter KM, McCloud S, Smith M, Grant BF (1997) The alcohol use disorder and associated disabilities interview schedule (AUDADIS): reliability of alcohol and drug modules in a clinical sample. Drug Alcohol Depend 44:133–141

    Article  CAS  PubMed  Google Scholar 

  26. Schwartz G (1978) Estimating the dimension of a model. Ann Stat 6:461–464

    Article  Google Scholar 

  27. Akaike H (1974) A new look at the statistical model identification. IEEE Trans Autom Control 19:716–723

    Article  Google Scholar 

  28. Sclove SL (1987) Application of model-selection criteria to some problems in multivariate analysis. Psychometrika 52:333–343

    Article  Google Scholar 

  29. Conway C, Hammen C, Brennan P (2012) A comparison of latent class, latent trait, and factor mixture models of DSM-IV borderline personality disorder criteria in a community setting: implications for DSM-5. J Pers Disord 26:793–803

    Article  PubMed Central  PubMed  Google Scholar 

  30. Walton KE, Ormel J, Krueger RF (2011) The dimensional nature of externalizing behaviors in adolescence: evidence from a direct comparison of categorical, dimensional, and hybrid models. J Abnorm Child Psychol 39:553–561

    Article  PubMed  Google Scholar 

  31. Wright AG, Krueger RF, Hobbs MJ, Markon KE, Eaton NR, Slade T (2013) The structure of psychopathology: toward an expanded quantitative empirical model. J Abnorm Psychol 122:281–294

    Article  PubMed Central  PubMed  Google Scholar 

  32. Barron AR, Cover TM (1991) Minimum complexity density estimation. IEEE Trans Inf Theory 37:1034–1054

    Article  Google Scholar 

  33. Grunwald PD (2007) The minimum description length principle. MIT Press, Cambridge

    Google Scholar 

  34. Rissanen J (2007) Information and complexity in statistical modelling. Springer, New York

    Google Scholar 

  35. Markon KE, Krueger RF (2006) Information-theoretic latent distribution modelling: distinguishing between discrete and continuous latent variable models. Psychol Methods 11:228–243

    Article  PubMed  Google Scholar 

  36. Raftery AE (1995) Bayesian model selection in social research. Sociol Methodol 25:111–163

    Article  Google Scholar 

  37. Clark SL, Muthén BO, Kaprio J, D’Onofrio BM, Viken R, Rose RJ et al (2009) Models and strategies for factor mixture analysis: two examples concerning the structure of underlying psychological disorders. http://www.statmodel.com/download/FMA%20Paper_v142.pdf

  38. Kline RB (1998) Principles and practice of structural equation modeling. Guilford Press, New York

    Google Scholar 

  39. Millsap RE, Yun-Tein J (2004) Assessing factorial invariance in ordered-categorical measures. Multivar Behav Res 39:479–515

    Article  Google Scholar 

  40. Steiger JH (1990) Structural model evaluation and modification: an internal estimation approach. Multivar Behav Res 25:173–180

    Article  Google Scholar 

  41. Bentler PM (1990) Comparative fit indexes in structural models. Psychol Bull 107:238–246

    Article  CAS  PubMed  Google Scholar 

  42. Tucker LR, Lewis C (1973) A reliability coefficient for maximum likelihood factor analysis. Psychometrika 38:1–10

    Article  Google Scholar 

  43. Browne MW, Cudeck R (1993) Alternative ways of assessing model fit. Sociol Method Res 21:230–258

    Article  Google Scholar 

  44. Hu L, Bentler PM (1998) Fit indices in covariance structure modeling: sensitivity to under parameterized model misspecification. Psychol Methods 3:424–453

    Article  Google Scholar 

  45. Cheung GW, Rensvold RB (2002) Evaluating goodness-of-fit indexes for testing measurement invariance. Struct Equ Model 9:233–255

    Article  Google Scholar 

  46. Krueger RF (1999) The structure of common mental disorders. Arch Gen Psychiatry 56:921–926

    Article  CAS  PubMed  Google Scholar 

  47. Regier DA, Kuhl EA, Kupfer DJ (2013) The DSM-5: classification and criteria changes. World Psychiatry 12:92–98

    Article  PubMed Central  PubMed  Google Scholar 

  48. Andrews G, Pine DS, Hobbs MJ, Anderson TM, Sunderland M (2009) Neurodevelopmental disorders: cluster 2 of the proposed meta-structure for DSM-V and ICD-11. Psychol Med 39:2013–2023

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  49. Widiger TA (1993) The DSM-III-R categorical personality disorder diagnoses: a critique and an alternative. Psychol Inq 4:75–90

    Article  Google Scholar 

  50. Helzer JE, Bucholz KK, Gossop M (2007) A dimensional option for the diagnosis of substance dependence in DSM-V. Int J Methods Psychiatr Res 16:S24–S33

    Article  PubMed  Google Scholar 

  51. Peralta V, Cuesta MJ, Giraldo C, Cardenas A, Gonzalez F (2002) Classifying psychotic disorders: issues regarding categorical vs. dimensional approaches and time frame to assess symptoms. Eur Arch Psychiatry Clin Neurosci 252:12–18

    Article  PubMed  Google Scholar 

  52. Rosenman S, Korten A, Medway J, Evans M (2003) Dimensional vs. categorical diagnosis in psychosis. Acta Psychiatr Scand 107:378–384

    Article  CAS  PubMed  Google Scholar 

  53. van Os J, Gilvarry C, Bale R, Van Horn E, Tattan T, White I et al (1999) A comparison of the utility of dimensional and categorical representations of psychosis. Psychol Med 29:595–606

    Article  PubMed  Google Scholar 

  54. Widiger TA, Mullins-Sweatt SN (2010) Clinical utility of a dimensional model of personality disorder. Prof Psychol Res Pr 41:488–494

    Article  Google Scholar 

  55. Kessler RC (2002) The categorical versus dimensional assessment controversy in the sociology of mental illness. J Health Soc Behav 43:171–188

    Article  PubMed  Google Scholar 

  56. Miller CJ, Newcorn JH, Halperin JM (2010) Fading memories: retrospective recall inaccuracies in ADHD. J Atten Disord 14:7–14

    Article  PubMed  Google Scholar 

  57. Mesman J, Koot HM (2001) Early preschool predictors of preadolescent internalizing and externalizing DSM-IV diagnoses. J Am Acad Child Adolesc Psychiatry 40:1029–1036

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This work was funded by NIH grants U01AA018111 and K05AA014223 and the New York State Psychiatric Institute (Dr. Hasin).

Conflict of interest

None declared.

Author information

Authors and Affiliations

  1. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2052, Australia

    Natacha Carragher

  2. Department of Psychology, University of Minnesota, 75 East River Road, Minneapolis, MN, 55455-0344, USA

    Robert F. Krueger

  3. Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA

    Nicholas R. Eaton

  4. Department of Psychology, University of Iowa, Iowa City, IA, 52242, USA

    Kristian E. Markon

  5. Department of Epidemiology, Mailman School of Public Health, Columbia University, 1051 Riverside Drive 123, New York, NY, 10032, USA

    Katherine M. Keyes

  6. New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, Unit 69, New York, NY, 10032, USA

    Carlos Blanco

  7. Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Bethesda, USA

    Tulshi D. Saha

  8. Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive No. 123, New York, NY, 10032, USA

    Deborah S. Hasin

Authors
  1. Natacha Carragher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert F. Krueger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicholas R. Eaton
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kristian E. Markon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Katherine M. Keyes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carlos Blanco
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tulshi D. Saha
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Deborah S. Hasin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Natacha Carragher.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Carragher, N., Krueger, R.F., Eaton, N.R. et al. ADHD and the externalizing spectrum: direct comparison of categorical, continuous, and hybrid models of liability in a nationally representative sample. Soc Psychiatry Psychiatr Epidemiol 49, 1307–1317 (2014). https://doi.org/10.1007/s00127-013-0770-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-013-0770-3

Keywords