A network analysis approach to ADHD symptoms: More than the sum of its parts

PLoS One. 2019 Jan 18;14(1):e0211053. doi: 10.1371/journal.pone.0211053. eCollection 2019.

Abstract

In interpreting attention-deficit/hyperactivity disorder (ADHD) symptoms, categorical and dimensional approaches are commonly used. Both employ binary symptom counts which give equal weighting, with little attention to the combinations and relative contributions of individual symptoms. Alternatively, symptoms can be viewed as an interacting network, revealing the complex relationship between symptoms. Using a novel network modelling approach, this study explores the relationships between the 18 symptoms in the Diagnostic Statistical Manual (DSM-5) criteria and whether network measures are useful in predicting outcomes. Participants were from a community cohort, the Children's Attention Project. DSM ADHD symptoms were recorded in a face-to-face structured parent interview for 146 medication naïve children with ADHD and 209 controls (aged 6-8 years). Analyses indicated that not all symptoms are equal. Frequencies of endorsement and configurations of symptoms varied, with certain symptoms playing a more important role within the ADHD symptom network. In total, 116,220 combinations of symptoms within a diagnosis of ADHD were identified, with 92% demonstrating a unique symptom configuration. Symptom association networks highlighted the relative importance of hyperactive/impulsive symptoms in the symptom network. In particular, the 'motoric'-type symptoms as well as interrupts as a marker of impulsivity in the hyperactive domain, as well as loses things and does not follow instructions in the inattentive domain, had high measures of centrality. Centrality-measure weighted symptom counts showed significant association with clinical but not cognitive outcomes, however the relationships were not significantly stronger than symptom count alone. The finding may help to explain heterogeneity in the ADHD phenotype.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attention Deficit Disorder with Hyperactivity / diagnosis*
  • Attention Deficit Disorder with Hyperactivity / psychology*
  • Child
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Humans
  • Impulsive Behavior
  • Longitudinal Studies
  • Male
  • Severity of Illness Index
  • Surveys and Questionnaires

Grants and funding

The Children’s Attention Project was as funded by the National Medical Health and Research Council of Australia (Project grant #1008522) and a grant from the Collier Foundation. The research was supported by the Murdoch Children’s Research Institute, The Royal Children’s Hospital, The Royal Children’s Hospital Foundation, Department of Paediatrics at The University of Melbourne and the Victorian Government's Operational Infrastructure Support Program. TS and CM were supported by NHMRC project grant (1065895). VA was supported by an NHMRC Senior Practitioner Fellowship (1079478). JN was funded by the Australian Communities Foundation through the Roberta Holmes Chair for the Transition to Contemporary Parenthood Program (Coronella sub-fund). ES was supported by NHMRC Early Career (1037159) and Career Development (1110688) Fellowships. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.