Abstract
Objective:
Cognitive disengagement syndrome (CDS; previously referred to as sluggish cognitive tempo) is a set of behaviors, including excessive mind-wandering, mental fogginess, and hypoactivity, that are separate from ADHD inattentive (ADHD-IN) symptoms and linked to functional outcomes. However, CDS and ADHD-IN symptoms are strongly associated, and our understanding of whether personality correlates are similarly or differentially linked to CDS and ADHD-IN is limited. The objective of the current study was to examine personality correlates of CDS and ADHD-IN symptoms across two independent samples of school-aged youth.
Method:
Study 1 included 207 school-aged children (ages 7–11; 63% male; 87.9% White) with or without teacher-reported elevations in CDS. Study 2 included 263 school-aged children (ages 8–12; 58% male; 75.3% White) with the full range of CDS symptomatology. Parents and teachers completed ratings of ADHD-IN and CDS, and parents also reported on their child’s personality dimensions.
Results:
Across two samples and controlling for demographic characteristics as well as ADHD-IN symptoms and other personality traits, higher levels of FFFS-fear/shyness were uniquely associated with higher levels of parent- and teacher-reported CDS symptoms. In most models, lower levels of BAS-drive were also uniquely associated with higher levels of CDS. In contrast, when controlling for demographic characteristics and CDS symptoms, higher levels of BAS-impulsivity/fun-seeking was uniquely associated with higher levels of parent- and teacher-reported ADHD-IN symptoms.
Discussion:
Findings provide the clearest evidence to date that personality dimensions are differentially associated with ADHD-IN and CDS symptoms in children, further underscoring CDS as a distinct construct from ADHD-IN.
Keywords: attention-deficit/hyperactivity disorder, cognitive disengagement syndrome, shyness, sluggish cognitive tempo, temperament
Introduction
Personality theories have a well-documented place in our understanding of attention-deficit/hyperactivity disorder (ADHD) heterogeneity, clinical severity, and treatment outcomes, with advantages over the nosology of DSM-based ADHD subtypes/presentations (Gomez & Corr, 2014; Nigg et al., 2020). Specifically, according to Gray’s Reinforcement Sensitivity Theory (RST), individual differences in the behavioral inhibition (BIS), behavioral activation (BAS), and flight, fight, freezing (FFFS) systems are thought to underlie ADHD inattentive and hyperactivity-impulsivity symptom domains (Bijttebier et al., 2009). However, it is increasingly clear that cognitive disengagement syndrome (CDS; previously referred to as “sluggish cognitive tempo”) marked by excessive mind-wandering, mental fogginess and confusion, and slowed behaviors, is also important for understanding ADHD heterogeneity (Sonuga-Barke et al., 2023). Specifically, CDS symptoms are strongly related yet empirically distinct from ADHD inattention (ADHD-IN) (Becker et al., 2016), and 25–40% of children with ADHD experience co-occurring CDS symptoms (Barkley, 2013; Burns & Becker, 2021; Servera et al., 2018). Additionally, considerable evidence links CDS symptoms, above and beyond ADHD-IN, to anxiety, depression, and peer withdrawal (Becker et al., 2023), suggesting that features of CDS may better explain the link between ADHD and internalizing domains of psychopathology. Although the research literature on CDS has recently grown, our current understanding of personality traits in relation to CDS behaviors remains scant. Advancing our understanding of personality traits in relation to CDS and ADHD-IN symptoms would contribute to improved conceptualization of possible developmental pathways, associated comorbidities and impairments, and treatment considerations for CDS.
Reinforcement Sensitivity Theory and ADHD
Although multiple personality theories exist, the current study used RST as a guiding framework given the longstanding history in psychopathology research and ADHD specifically (Bijttebier et al., 2009). RST proposes three biologically-based systems underpin individual differences in personality and psychopathology symptoms: BAS, BIS, and FFIS. The BAS is the approach motivation system which enables individuals to pursue rewarding and positively-valanced activities. Conversely, the FFIS is responsible for individuals’ avoidance and escape tendencies resulting in fight, flight, and freeze responses in the midst of aversive stimuli, and is thus sensitive to punishment. Finally, the BIS is thought to aid in resolving conflicts when both the BAS and FFIS systems are activated. Individuals with an active BAS are considered to have more extraverted personalities and reward pursuit, whereas individuals with an active BIS and FFIS are thought to have introverted features and are more sensitive to punishment. In relation to psychopathology, an overactive BAS portends risk for externalizing psychopathology, whereas a strong BIS is a vulnerability for internalizing psychopathology, particularly generalized anxiety (Bijttebier et al., 2009). The FFFS is hypothesized to underlie emotions of fear/shyness and has been related to internalizing symptoms of panic, phobia, and social anxiety (Colder et al., 2011).
Personality and temperamental frameworks have a longstanding history in the conceptualization and identification of biologically-based markers of ADHD (Nigg et al., 2020; Sonuga-Barke et al., 2023). Specifically, single pathway models highlight the role of inhibitory deficits in ADHD, whereas dual pathway models indicate that “top-down” processes (executive control) are more strongly linked to inattention and “bottom-up” processes (motivational system, delay aversion) are associated with hyperactive/impulsive symptoms (Gomez & Corr, 2014). Broadly speaking, ADHD symptoms appear to be linked to an overactive BAS and deficient modulation between the BIS and BAS. The BAS often includes subdomains of reward responsiveness (e.g., sensitivity to rewards, desire for praise), drive (e.g., pursuit of competitive activities, motivation for high social status), and impulsivity/fun-seeking (e.g., craving excitement). However, when examining specific ADHD symptom dimensions, the majority of work has included adult samples. For instance, findings in adults indicate that an overactive BAS is associated with hyperactive-impulsive symptoms (Gomez & Corr, 2010; Hundt et al., 2008; Mitchell & Nelson-Gray, 2006). Conversely, the BIS is more closely linked to inattentive symptoms (Gomez & Corr, 2010; Heym et al., 2015; Hundt et al., 2008), with mixed evidence for FFFS (Gomez & Corr, 2010). One study of school-aged youth with ADHD found support for differential effects of BAS and BIS on comorbidities associated with ADHD. Specifically, youth with ADHD and comorbid ODD had higher BAS-impulsivity/fun-seeking and drive (e.g., pursuit of competitive activities, motivation for high social status), whereas youth with ADHD and comorbid autism spectrum disorder had higher BIS and lower BAS-drive (Luman et al., 2012). However, this study did not test hyperactive-impulsive and inattentive symptoms separately. Taken together, findings point to BIS and FFS being more closely related to ADHD-IN symptoms, whereas high BAS is related to ADHD hyperactivity-impulsivity (HI) (Gomez et al., 2021).
Personality Traits and CDS
Although a number of studies have examined BAS, BIS, and FFFS personality dimensions in relation to ADHD presentations, very few studies have incorporated symptoms of CDS. Intriguingly, previous work conceptualizing ADHD heterogeneity from a personality framework identified a subset of youth with ADHD with an “introverted” profile, consisting of high inattentive symptoms and low hyperactive-impulsive (Martel et al., 2010). Researchers suggested that this might represent youth with elevated CDS, though CDS symptoms were not directly assessed in this study. Given the large body of literature in community and ADHD-specific samples documenting strong associations between CDS and depression, anxiety, shyness, and social withdrawal, above and beyond ADHD-IN symptoms (Becker et al., 2023; Fredrick & Becker, 2023), BIS and FFFS dimensions may be particularly linked to CDS. Moreover, considerable evidence indicates that an underactive BAS or hyporeactivity to reward represents a personality correlate specific to depression (Bijttebier et al., 2009). Thus, given strong links between CDS and depressive symptoms (Becker et al., 2021; Fredrick et al., 2022a) as well as overlapping symptoms reflecting hypoactivity (e.g., slow-moving, lethargic, trouble remaining alert), BAS-drive may be a unique personality feature of CDS.
To our knowledge, only two studies have examined personality correlates of CDS. In a sample of 89 school-aged youth ages 9 to 12, Becker and colleagues (2013) examined parent ratings of BIS, FFFS, and BAS in relation to parent ratings of CDS. Above and beyond ADHD symptoms and other personality dimensions, higher BIS-fear/shyness scores were uniquely associated with higher parent-reported CDS. In contrast, above and beyond CDS symptoms and other personality dimensions, higher BAS-impulsivity/fun seeking scores were uniquely related to higher parent-reported ADHD symptoms (Becker et al., 2013). These findings provided initial evidence for differential associations of punishment and reward sensitivity in relation to CDS and ADHD symptoms, though ADHD-IN symptoms were not specifically examined. Building on this study, in a sample of 3,172 college students, Becker and colleagues (2018) evaluated self-reported ratings of CDS and ADHD in relation to personality dimensions. When CDS, ADHD-IN, ADHD-HI, and anxiety/depression dimensions were simultaneously examined as predictor variables, findings showed that higher self-reported CDS symptoms were uniquely associated with higher BIS sensitivity scores in addition to lower extraversion, lower consciousness, and higher neuroticism scores, whereas self-reported ADHD-IN symptoms were uniquely associated with lower BAS drive, higher BIS sensitivity, and lower extraversion scores.
Although preliminary evidence suggests that punishment and reward sensitivity may be differential personality correlates of CDS and ADHD symptoms, a few key limitations of these studies highlight the need for additional research. Primarily, Becker and colleagues (2013) measured parent-reported CDS with three items taken from a broadband rating scale in a relatively small sample of school-aged children, and the measure of ADHD symptoms was likewise limited and did not capture all DSM-based ADHD-IN symptoms. Due to recent advancements in specific ratings scales capturing the multidimensional nature of CDS with strong internal and discriminative validity from ADHD-IN symptoms (Becker, 2021), a critical next step is to replicate findings in larger samples with well-validated rating scales. Further, as research highlights the importance of multi-informant ratings of CDS across the home and school context (Becker et al., 2019), we tested personality correlates of both parent and teacher ratings of CDS and ADHD-IN. Finally, as CDS is strongly associated with ADHD-IN, and CDS and ADHD-IN show differential unique relations with ADHD-HI symptoms (Becker et al., 20223), further specificity of CDS and ADHD-IN is needed.
Middle childhood is an important developmental period for examining the links between personality traits, ADHD-IN, and CDS symptoms. First, in contrast to the ADHD-HI symptom dimension, ADHD-IN and CDS symptoms often persist and remain stable (and perhaps increase) during middle childhood and adolescence (Leopold et al., 2016). Thus, individual differences in personality may be particularly meaningful in underlying the development and maintenance of ADHD-IN and CDS during this period. Along these lines, although temperament often refers to biological-based differences in emotionality measured via laboratory-based designs (Fox et al., 2005), the onset and development of biological, psychological, and social changes makes the childhood period critical for studying personality (Soto et al., 2011).
Collectively, we sought to advance the extant literature by examining personality traits in relation to CDS and ADHD-IN in two independent samples of children with different recruitment strategies. Specifically, Study 1 recruited children with and without elevations in teacher-reported CDS, whereas Study 2 used a dimensional approach to include a community-based sample of children with the full range of CDS symptoms. The main aims and questions of the current study were to determine whether there are similar or different personality traits in relation to ADHD-IN and CDS symptoms across parent and teacher ratings of children in middle childhood.
Study 1
Methods
Participants
Participants were 207 children in 2nd-5th grades (ages 7–11 years) with nearly half (n=103) being in the high CDS group. Further description of the sample and comparisons between the CDS and comparison groups can be found in Table 1. As expected given the design of the study to match both groups on age and sex, the groups did not differ on sex, grade, or age. The CDS group had lower family income, higher rate of ADHD diagnosis, and higher current medication use than the comparison group.
Table 1.
Study 1 Sample Characteristics
| Total Sample (N = 207) | CDS Group (n = 103) | Comparison Group (n = 104) | Difference between CDS and Comparison | ||
|---|---|---|---|---|---|
| M (SD) | M (SD) | M (SD) | t | p | |
| Age | 8.85 (1.22) | 8.85 (1.29) | 8.85 (1.15) | t(205) = 0.05 | .961 |
| N (%) | N (%) | N (%) | χ2 | p | |
| Sex | χ2(1) = 0.06 | .814 | |||
| Female | 76 (36.7%) | 37 (35.9%) | 39 (37.5%) | ||
| Male | 131 (63.3%) | 66 (64.1%) | 65 (63.1%) | ||
| Race | χ2(2) = 3.11 | .211 | |||
| White | 182 (87.9%) | 89 (86.4%) | 93 (89.4%) | ||
| Black | 9 (4.3%) | 7 (6.8%) | 2 (1.9%) | ||
| Multiracial | 16 (7.7%) | 7 (6.8%) | 9 (8.7%) | ||
| Hispanic/Latinx | 9 (4.3%) | 4 (3.9%) | 5 (4.8%) | χ2(1) = 0.11 | .744 |
| Family Income | χ2(6) = 16.58 | .011 | |||
| Up to $20,000 | 20 (9.7%) | 17 (16.5%) | 3 (2.9%) | ||
| $20,001 - $40,000 | 29 (14.0%) | 14 (13.6%) | 15 (14.6%) | ||
| $40,001 - $60,000 | 31 (15.0%) | 16 (15.5%) | 16 (15.4%) | ||
| $60,001 - $80,000 | 26 (12.6%) | 16 (15.5%) | 10 (9.6%) | ||
| $80,001 - $100,000 | 34 (16.4%) | 16 (15.5%) | 18 (17.3%) | ||
| $100,001 - $120,000 | 32 (15.5%) | 10 (9.7%) | 22 (21.2%) | ||
| Over $120,000 | 35 (16.9%) | 15 (14.6%) | 20 (19.2%) | ||
| Grade | χ2(3) = 0.24 | .971 | |||
| 2nd | 60 (29.0%) | 31 (30.1%) | 29 (27.9%) | ||
| 3rd | 48 (23.2%) | 24 (23.3%) | 24 (23.1%) | ||
| 4th | 51 (24.6%) | 24 (23.3%) | 27 (26.0%) | ||
| 5th | 48 (23.2%) | 24 (23.3%) | 24 (23.1%) | ||
| Psychiatric diagnoses | |||||
| ADHD | 124 (59.9%) | 81 (78.6%) | 43 (41.3%) | χ2(1) = 29.97 | <.001 |
| ODD/CD | 29 (14.0%) | 17 (16.5%) | 12 (11.5%) | χ2(1) = 1.06 | .303 |
| Anxiety | 27 (13.0%) | 16 (15.5%) | 11 (10.6%) | χ2(1) = 1.12 | .290 |
| Depression | 3 (1.4%) | 2 (1.9%) | 1 (1.0%) | χ2(1) = 0.35 | .555 |
| Medication use (any) | 67 (32.4%) | 46 (44.7%) | 21 (20.2%) | χ2(1) = 14.15 | <.001 |
| ADHD methylphenidate | 37 (17.9%) | 27 (26.2%) | 10 (9.6%) | χ2(1) = 9.71 | .002 |
| ADHD amphetaminea | 17 (8.2%) | 12 (11.7%) | 5 (4.8%) | χ2(1) = 3.21 | .073 |
| ADHD nonstimulantb | 19 (9.2%) | 15 (14.6%) | 4 (3.8%) | χ2(1) = 7.13 | .008 |
| Anti-depressant/anxiety | 7 (3.4%) | 5 (4.9%) | 2 (1.9%) | χ2(1) = 1.36 | .279c |
| Antipsychotic | 7 (3.4%) | 3 (2.9%) | 4 (3.8%) | χ2(1) = 0.14 | 1.00c |
| Melatonin | 12 (5.8%) | 9 (8.7%) | 3 (2.9%) | χ2(1) = 3.25 | .072 |
Note. ADHD=attention-deficit/hyperactivity disorder. CDS=cognitive disengagement syndrome. ODD/CD=oppositional defiant disorder/conduct disorder. For anxiety=presence of generalized anxiety disorder, social phobia, specific phobia, and/or posttraumatic stress disorder (PTSD). For depression=presence of major depression, dysthymia, and/or disruptive mood dysregulation disorder.
Includes amphetamine and mixed amphetamine salts.
Includes guanfacine, atomoxetine, and clonidine.
Significance based on Fisher’s exact test since at least one cell had an expected count less than 5.
For eligibility in the study, teachers completed the CDS scale of the Child and Adolescent Behavior Inventory (CABI; described below) via Research Electronic Data Capture (REDCap), a secure, web-based application (Harris et al., 2009). Teachers only completed the survey for students who 1) did not have significant uncorrected visual, hearing, or speech impairments, 2) were not known to be on the autism spectrum, and 3) did not spend the majority of the day outside of the general classroom. CABI data was collected for 7,613 participants (Becker et al., 2020, 2022). For purposes of the larger study, the CABI CDS data from the six cohorts recruited for this study were combined and a CDS T-score was calculated to establish high and low CDS groups. Children with a T-score >70 were considered to be clinically elevated on the CDS scale (n = 471) and children with a T-score in the 47–53 range were considered as potential comparison participants (n = 1,425). After identifying potential participants in both groups based on teacher screening and determining eligibility (see below), 114 individuals with clinically elevated CDS consented to participate and 103 participants met inclusion criteria, and 112 comparison families consented and 104 met inclusion criteria.
Procedures
All procedures were approved by the Cincinnati Children’s Hospital Medical Center Institutional Review Board. Study participants completed an in-person visit in which parents provided informed consent and children provided assent. Children were recruited from 24 elementary schools in three school districts in the Midwestern United States. All teachers of 2nd to 5th grade classrooms were invited to participate in the project. Approximately 400 teachers agreed to participate, and parents of all children in their classroom (n = 10,275) were sent an opt-out letter which indicated that their school was participating in a study to learn more about how children’s concentration at school impacts academic and behavioral functioning. A school liaison at each school (e.g., school counselor) was provided with a list of those students and served as the contact between the school and the research team. The school liaison attempted to contact caregivers of students in the CDS and comparison groups to obtain permission to share contact information with the study team so the family could learn more about the study if interested. After the school liaison contacted and identified families willing to be contacted by the research team, participants in the clinically elevated CDS group were invited by the research team to participate on a first-come, first-serve basis. Once a parent of a child with a clinically elevated CDS score agreed to participate, the research staff then attempted to match the child with a comparison child of the same sex and in the same grade. Inclusion criteria for both groups were being in 2nd-5th grades, receiving education in a general education classroom for the majority of the day, and a standardized score >75 for overall intelligence on the KBIT-2. In addition, children were excluded if the parent reported a previous diagnosis of autism spectrum disorder or the child met threshold for an autism symptom on the K-SADS autism module screener given that students with autism have distinct educational challenges and needs. Other mental health disorders (i.e., ADHD, oppositional defiant disorder/conduct disorder, anxiety, depression) were not exclusionary in either group to promote generalizability and to avoid concerns with recruiting a “supernormal” comparison group. See Becker et al. (2019, 2020, 2022) for additional details.
Measures
Demographic Characteristics and Medication Use
Parents completed a demographic form to gather the information reported in Table 1 regarding their child’s sex, age, race, and ethnicity, and family income. A clinician administered an adaptation of the Services Use in Children and Adolescents – Parent Interview (SCA-PI) (Eaton Hoagwood et al., 2004) to assess any current medication use.
Child and Adolescent Behavior Inventory (CABI)
Parent and teacher ratings of CDS and ADHD-IN were assessed using the CDS and ADHD-IN scales on the CABI (Burns et al., 1997–2021). The scores from the 15-item CDS module have shown well-documented internal consistency, discriminative validity from ADHD-IN and other psychopathology symptoms, and test-retest reliability (e.g., Burns & Becker, 2021; Burns, Montaño, Becker, & Servera, 2023; for a review, see Becker, 2021). The 9-item ADHD-IN scale corresponds to the 9 DSM-5 items for assessing ADHD-IN. Items were rated on a 6-point scale for the past month (almost never, seldom, sometimes, often, very often, and almost always). In the present study, internal consistency scores were: parent-reported CDS (α = .96), parent-reported ADHD-IN (α = .95), teacher-reported CDS (α = .96) and teacher-reported ADHD-IN (α = .95).
Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ-C)
The SPSRQ-C was used to evaluate parent ratings of children’s punishment and reward sensitivity (Colder & O’Connor, 2004). The SPSRQ-C includes 48 items rated on a 5-point scale (1=strongly disagree, 5=strongly agree). Based on factor analytic evidence (Colder et al., 2011), we examined the five subscales on the SPSRQ-C: FFFS-fear/shyness (α = .88; 9 items; e.g., “your child is a shy person”), BIS-anxiety (α = .70; 5 items; e.g., “in unfamiliar tasks, your child worries about failure), BAS-drive (α = .76; 5 items; e.g., “your child likes competitive activities”), BAS-impulsivity/fun-seeking (α = .68; 6 items; e.g., “your child sometimes does things for a quick reward”), and BAS-responsiveness to social approval (α = .68; 4 items; e.g., “your child does a lot of things for approval”). The scores from the SPSRQ-C have shown adequate internal consistency and external validity with internalizing and externalizing psychopathology dimensions in previous research (Colder & O’Connor, 2004; Luman et al., 2012). Importantly, none of the items on the SPSRQ-C directly overlap with CDS or ADHD-IN items on the CABI; two items on the SPSRQ-C assess somewhat related content to CDS and ADHD-IN but are situation-specific in what they assess (i.e., “when in a group, your child has difficulty thinking of something to say”; “your child has difficulty staying focused on their school work in the presence of an attractive alternative”).
Analytic Approach
Analyses were conducted in Mplus (version 8.1) using manifest variables given the sample size. First, zero-order correlations were conducted to test relations between CDS, ADHD-IN symptoms, and personality traits. A correlation of .10 is generally considered a small effect, .30 is considered a medium effect, and .50 is considered a large effect. Demographic variables which significantly differed between the CDS and comparison groups were included as covariates in analyses for both studies. Additionally, due to sex differences in personality dimensions (Hyde, 2014), child sex was also included as a covariate. Next, structural regression analyses were conducted to examine the unique contribution of personality traits in relation to CDS and ADHD-IN symptoms. For analyses determining unique relations between personality traits with CDS, ADHD-IN symptoms were included as a covariate, and CDS was included as a covariate in the models examining personality traits in relation to ADHD-IN symptoms.
Results
Preliminary Analyses
Primary study variables were normally distributed (skewness < 2.0, kurtosis < 4.0). As presented in Table 2, higher parent-reported BIS-anxiety, FFFS-fear/shyness, BAS-impulsivity/fun-seeking were each significantly correlated with higher parent ratings of CDS, whereas lower BAS-drive was negatively associated with higher parent-reported CDS. Conversely, lower BAS-drive was the only personality dimension significantly correlated with higher teacher-reported CDS. Similar to results for parent-reported CDS, higher BIS-anxiety, FFFS-fear/shyness, and BAS-impulsivity/fun-seeking were significantly correlated with higher parent-reported ADHD-IN. Finally, higher BAS-impulsivity/fun-seeking was significantly associated with higher teacher-reported ADHD-IN symptoms.
Table 2.
Study 1 Intercorrelations and Descriptive Statistics of Study Variables
| Variable | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1. Sex | -- | |||||||||||
| 2. Income | 0.03 | -- | ||||||||||
| 3. Medication | −0.12 | 0.11 | -- | |||||||||
| 4. Anxiety | 0.00 | −0.08 | 0.12 | -- | ||||||||
| 5. Fear/Shyness | −0.00 | −0.05 | 0.02 | 0.53** | -- | |||||||
| 6. Drive | −0.06 | 0.11 | −0.02 | 0.09 | −0.18** | -- | ||||||
| 7. Impulsive/Fun Seek | −0.11 | −0.09 | 0.22* | 0.40** | 0.34** | 0.34** | -- | |||||
| 8. Response. | 0.07 | −0.05 | −0.03 | 0.38** | 0.11 | 0.14* | 0.23** | -- | ||||
| 9. PR CDS | 0.11 | −0.14* | 0.16* | 0.19** | 0.33** | −0.23** | 0.27** | 0.10 | -- | |||
| 10. PR ADHD-IN | −0.02 | −0.07 | 0.32** | 0.26** | 0.26** | 0.00 | 0.49** | 0.01 | 0.70** | -- | ||
| 11. TR CDS | 0.04 | −0.13 | 0.08 | 0.10 | 0.13 | −0.26** | 0.04 | 0.11 | 0.22** | 0.14* | -- | |
| 12. TR ADHD-IN | −0.08 | −0.13 | 0.10 | 0.07 | −0.03 | −0.02 | 0.22** | 0.05 | 0.08 | 0.22* | 0.64** | -- |
| M | -- | -- | -- | 2.84 | 2.58 | 2.96 | 2.88 | 3.17 | 1.03 | 2.16 | 2.36 | 2.71 |
| SD | -- | -- | -- | .73 | .80 | .74 | .63 | .66 | .93 | 1.37 | 1.21 | 1.38 |
Note. For sex, 0 = male, 1 = female. For medication, 0= not taking a prescribed psychiatric medication, 1= taking a prescribed psychiatric medication.
Response. = responsive to social approval. CDS = cognitive disengagement syndrome. TR = teacher-report.
ADHD-IN = attention-deficit/hyperactivity disorder inattention symptoms.
p < .01;
p < .05
Unique Associations of Personality Dimensions in Relation to CDS and ADHD-IN Symptoms
Given group-based differences in reported annual family income and medication status, these variables were included as covariates along with sex in analyses. In regression analyses with covariates (i.e., child sex, family income, medication status), personality dimensions, and parent-reported ADHD-IN symptoms as predictors of CDS symptoms, higher FFFS-fear/shyness and BAS-responsiveness to social approval were uniquely associated with higher parent-reported CDS symptoms (Table 3, left panel). Moreover, lower BAS-drive was uniquely related to higher parent-reported CDS symptoms. Conversely, in the model predicting ADHD-IN symptoms, higher BAS-impulsivity/fun-seeking and lower BAS-responsiveness to social approval were uniquely associated with higher parent-reported ADHD-IN symptoms (Table 3, left panel).
Table 3.
Personality Dimensions in Relation to Parent-Reported CDS and ADHD-IN Symptoms
| DV = Parent-reported CDS Symptoms | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Study 1 | Study 2 | ||||||||
| b | β | SE | p | b | β | SE | p | ||
| Sex | 0.19 | 0.10 | 0.05 | 0.033 | −0.10 | −0.04 | 0.03 | 0.269 | |
| Income | −0.04 | −0.07 | 0.05 | 0.107 | 0.00 | 0.00 | 0.03 | 0.912 | |
| Medication | −0.04 | −0.02 | 0.05 | 0.716 | −0.26 | −0.09* | 0.04 | 0.012 | |
| Anxiety | −0.12 | −0.10 | 0.06 | 0.104 | 0.07 | 0.04 | 0.04 | 0.366 | |
| Fear/Shyness | 0.20 | 0.17** | 0.06 | 0.003 | 0.23 | 0.14*** | 0.04 | <0.001 | |
| Drive | −0.21 | −0.17*** | 0.05 | <0.001 | −0.08 | −0.05 | 0.04 | 0.235 | |
| Impulsivity/Fun-Seeking | −0.11 | −0.07 | 0.06 | 0.237 | −0.27 | −0.14** | 0.05 | 0.004 | |
| Responsiveness to Approval | 0.21 | 0.15** | 0.05 | 0.003 | 0.29 | 0.15*** | 0.04 | <0.001 | |
| ADHD-IN Symptoms | 0.48 | 0.72*** | 0.05 | <0.001 | 0.79 | 0.85*** | 0.03 | <0.001 | |
| DV = Parent-reported ADHD-IN Symptoms | |||||||||
| Study 1 | Study 2 | ||||||||
| b | β | SE | p | b | β | SE | p | ||
| Sex | −0.08 | −0.03 | 0.04 | 0.495 | 0.12 | 0.04 | 0.03 | 0.204 | |
| Income | 0.02 | 0.03 | 0.04 | 0.486 | −0.01 | −0.03 | 0.03 | 0.341 | |
| Medication | 0.36 | 0.12** | 0.05 | 0.006 | 0.35 | 0.11** | 0.03 | 0.001 | |
| Anxiety | 0.18 | 0.10 | 0.06 | 0.083 | 0.04 | 0.02 | 0.04 | 0.592 | |
| Fear/Shyness | −0.14 | −0.08 | 0.05 | 0.133 | −0.19 | −0.11** | 0.03 | 0.003 | |
| Drive | 0.07 | 0.04 | 0.05 | 0.470 | −0.12 | −0.06 | 0.04 | 0.077 | |
| Impulsivity/Fun-Seeking | 0.67 | 0.31*** | 0.06 | <0.001 | 0.71 | 0.34*** | 0.04 | <0.001 | |
| Responsiveness to Approval | −0.32 | −0.16** | 0.04 | 0.001 | −0.26 | −0.13*** | 0.04 | <0.001 | |
| CDS Symptoms | 0.95 | 0.64*** | 0.04 | <0.001 | 0.77 | 0.71*** | 0.03 | <0.001 | |
Note. b = unstandardized regression coefficient. β = standardized regression coefficient. For sex, 0 = male, 1 = female. For medication, 0= not taking a prescribed psychiatric medication, 1= taking a prescribed psychiatric medication. PR = parent-report. CDS = cognitive disengagement syndrome. ADHD-IN = attention-deficit/hyperactivity disorder inattention symptoms.
p < .001;
p < .01;
p < .05
In the teacher-report model, higher FFFS-fear/shyness and lower BAS-drive were uniquely associated with higher teacher ratings of CDS (Table 4, left panel). Finally, and in contrast to the model predicting CDS, lower FFFS-fear/shyness and higher BAS-impulsivity/fun-seeking were uniquely associated with higher teacher-reported ADHD-IN symptoms (Table 4, left panel).
Table 4.
Personality Dimensions in Relation to Teacher-Reported CDS and ADHD-IN Symptoms
| DV = Teacher-reported CDS Symptoms | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Study 1 | Study 2 | ||||||||
| b | β | SE | p | b | β | SE | p | ||
| Sex | 0.17 | 0.07 | 0.05 | 0.175 | −0.03 | −0.01 | 0.04 | 0.789 | |
| Income | −0.02 | −0.03 | 0.05 | 0.581 | −0.01 | −0.03 | 0.04 | 0.487 | |
| Medication | 0.11 | 0.04 | 0.05 | 0.410 | −0.02 | −0.01 | 0.04 | 0.834 | |
| Anxiety | 0.00 | 0.00 | 0.07 | 0.992 | 0.17 | 0.09* | 0.05 | 0.045 | |
| Fear/Shyness | 0.20 | 0.13* | 0.06 | 0.038 | 0.11 | 0.07 | 0.04 | 0.102 | |
| Drive | −0.32 | −0.20*** | 0.06 | <0.001 | −0.20 | −0.12** | 0.04 | 0.004 | |
| Impulsivity/Fun-Seeking | −0.20 | −0.10 | 0.06 | 0.103 | −0.03 | −0.02 | −0.05 | 0.720 | |
| Responsiveness to Approval | 0.19 | 0.10 | 0.05 | 0.058 | −0.01 | −0.01 | 0.04 | 0.899 | |
| ADHD-IN Symptoms | 0.58 | 0.66*** | 0.04 | <0.001 | 0.70 | 0.79*** | 0.03 | <0.001 | |
| DV = Teacher-reported ADHD-IN Symptoms | |||||||||
| Study 1 | Study 2 | ||||||||
| b | β | SE | p | b | β | SE | p | ||
| Sex | −0.22 | −0.08 | 0.05 | 0.130 | −0.09 | −0.03 | 0.04 | 0.452 | |
| Income | −0.03 | −0.04 | 0.05 | 0.479 | −0.04 | −0.10* | 0.04 | 0.015 | |
| Medication | −0.03 | −0.01 | 0.05 | 0.872 | 0.05 | 0.02 | 0.04 | 0.664 | |
| Anxiety | 0.04 | 0.02 | 0.07 | 0.748 | −0.20 | −0.10* | 0.05 | 0.036 | |
| Fear/Shyness | −0.32 | −0.19** | 0.06 | 0.004 | −0.13 | −0.07 | 0.04 | 0.088 | |
| Drive | 0.10 | 0.05 | 0.06 | 0.372 | 0.06 | 0.03 | 0.04 | 0.422 | |
| Impulsivity/Fun-Seeking | 0.50 | 0.23*** | 0.06 | <0.001 | 0.34 | 0.16** | 0.05 | 0.001 | |
| Responsiveness to Approval | −0.13 | −0.06 | 0.05 | 0.259 | −0.00 | −0.00 | 0.04 | 0.973 | |
| CDS | 0.77 | 0.68*** | 0.04 | <0.001 | 0.87 | 0.76*** | 0.03 | <0.001 | |
Note. b = unstandardized regression coefficient. β = standardized regression coefficient. For sex, 0 = male, 1 = female. For medication, 0= not taking a prescribed psychiatric medication, 1= taking a prescribed psychiatric medication. TR = teacher-report. CDS = cognitive disengagement syndrome. ADHD-IN = attention-deficit/hyperactivity disorder inattention symptoms.
p < .001;
p < .01;
p < .05.
Study 2
Methods
Participants were 263 children ages 8–12 years. See Table 5 for sample characteristics. Of the 263 children, 168 (63.9%) met criteria for ADHD. The majority of children (n=181, 68.8%) were not on stimulant medications for ADHD, and all children taking medication for ADHD were required to not take medication on the day of their study visit. Exclusionary criteria included taking non-stimulant psychotropic medications or being unwilling to wash out of stimulant medications for the assessment visit, IQ <80, parent report of the child having psychosis, bipolar disorder, autism spectrum disorder, or obsessive-compulsive disorder, or history of brain injury resulting in loss of consciousness, epilepsy, or seizures.
Table 5.
Study 2 Sample Characteristics (N=263)
| M (SD) or N (%) | |
|---|---|
| Age | 9.83 (1.42) |
| IQ | 108.1 (13.9) |
| Sex | |
| Female | 111 (42.2%) |
| Male | 152 (57.8%) |
| Race | |
| Asian | 3 (1.1%) |
| Black | 37 (14.1%) |
| White | 198 (75.3%) |
| Multiracial | 17 (6.5%) |
| Hispanic/Latinx | 8 (3.0%) |
| Family Income | |
| Up to $30,000 | 23 (8.7%) |
| $30,001 - $50,000 | 21 (8.0%) |
| $50,001 - $80,000 | 50 (19.0%) |
| $80,001 - $100,000 | 40 (15.2%) |
| $100,001 - $120,000 | 54 (20.5%) |
| Over $120,000 | 73 (27.85%) |
| Declined to answer | 2 (0.8%) |
| Psychiatric diagnoses | |
| ADHD Combined Presentation | 53 (20.2%) |
| ADHD Predominantly Inattentive Presentation | 113 (43.0%) |
| ADHD Predominantly Hyperactive-Impulsive Presentation | 2 (0.8%) |
| Oppositional Defiant Disorder | 21 (8.0%) |
| Conduct Disorder | 2 (0.8%) |
| Anxiety Disorder | 23 (8.7%) |
| Dysthymia | 1 (0.4%) |
| ADHD stimulant medication usea | 82 (31.2%) |
Note. ADHD=attention-deficit/hyperactivity disorder. For anxiety=presence of generalized anxiety disorder, social phobia, specific phobia, separation anxiety disorder, panic disorder, and/or posttraumatic stress disorder (PTSD).
Children did not take medication on the day of the assessment
Procedures
The study was reviewed and approved by the Cincinnati Children’s Hospital Medical Center Institutional Review Board. Flyers and emails were distributed throughout the community, local schools, and the medical center where the study was conducted using advertisements describing children with attention problems, children with daydreaming or sluggish behaviors, and children without attention problems. Interested families completed a phone screen assessing inclusion and exclusion criteria (e.g., age, diagnoses, medication status). Eligible participants were invited for an in-person evaluation during which informed consent, assent, and a release of information to gather teacher ratings were obtained, a diagnostic interview was administered to the caregiver who also completed the rating scales of CDS/ADHD. Teacher ratings of CDS/ADHD were collected via mail or email. See Tamm et al. (2023) for additional details.
Measures
Demographics
Parents reported on child’s sex, medication status (e.g., any psychiatric medication taken), and family income.
Child and Adolescent Disruptive Behavior Inventory (CADBI)
The CADBI (Burns et al., 2014) is a parent- and teacher-report rating scale that includes 9 CDS items and 9 DSM-IV items of ADHD-IN rated on a six-point scale: Almost never, Seldom, Sometimes, Often, Very often, and Almost always. The scores from the CADBI have demonstrated high internal consistency and discriminative validity from ADHD-IN symptoms (e.g., Lee et al., 2018; for a review, see Becker, 2021). Of note, the CABI used in Study 1 is a revision of the CADBI used in this study (which started prior to the measure’s revision), and so the CADBI and CABI include very similar item content. In the current sample, internal consistency for parent-reported CDS was α = .95, parent-reported ADHD-IN was α = .96, teacher-reported CDS was α = .94, and teacher-reported ADHD-IN was α = .96.
Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ-C)
The SPSRQ-C used in Study 1 was also used in Study 2. In this sample, internal consistency was as follows: FFFS-fear/shyness (α = .90), BIS-anxiety (α = .69), BAS-drive (α = .77), BAS-impulsivity/fun-seeking (α = .75), and BAS-responsiveness to social approval (α = .70).
Results
Preliminary Analyses
Primary study variables were normally distributed (skewness < 2.0, kurtosis < 4.0). Intercorrelations among study variables are provided in Table 6. As shown in Table 6, lower family income was associated with higher teacher-reported CDS and ADHD-IN symptoms, whereas medication status was correlated to higher parent-reported ADHD-IN symptoms. Regarding zero-order correlations, higher BIS-anxiety, FFFS-fear/shyness, BAS-impulsivity/fun-seeking, and BAS-responsiveness to social approval were each significantly correlated with higher parent-reported CDS and ADHD-IN symptoms. Higher FFFS-fear/shyness and BAS-impulsivity/fun-seeking were significantly associated with higher teacher-reported CDS symptoms, whereas lower BAS drive was associated with higher teacher-reported CDS symptoms. Finally, higher BAS-impulsivity/fun-seeking was significantly associated with higher teacher-reported ADHD-IN.
Table 6.
Study 2 Intercorrelations and Descriptive Statistics of Study Variables
| Variable | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1. Sex | -- | |||||||||||
| 2. Income | −0.06 | -- | ||||||||||
| 3. Medication | −0.05 | −0.01 | -- | |||||||||
| 4. Anxiety | 0.00 | 0.07 | 0.03 | -- | ||||||||
| 5. Fear/Shyness | 0.04 | −0.16* | −0.07 | 0.41** | -- | |||||||
| 6. Drive | −0.04 | 0.04 | 0.02 | 0.13* | −0.11 | -- | ||||||
| 7. Impulsive/Fun Seek | −0.11 | −0.05 | 0.21** | 0.32** | 0.23** | 0.36** | -- | |||||
| 8. Response. | 0.12* | 0.01 | −0.06 | 0.47** | 0.19** | 0.31** | 0.34** | -- | ||||
| 9. PR CDS | 0.02 | −0.13 | 0.04 | 0.33** | 0.36** | −0.11 | 0.38** | 0.27** | -- | |||
| 10. PR ADHD-IN | −0.03 | −0.10 | 0.25** | 0.23** | 0.19** | −0.02 | 0.57** | 0.14* | 0.72** | -- | ||
| 11. TR CDS | −0.08 | −0.29** | 0.06 | 0.09 | 0.19** | −0.20** | 0.16* | 0.02 | 0.41** | 0.40** | -- | |
| 12. TR ADHD-IN | −0.11 | −0.32** | 0.11 | −0.01 | 0.09 | −0.02 | 0.32** | 0.01 | 0.34** | 0.45** | 0.76** | -- |
| M | -- | -- | -- | 2.83 | 2.49 | 2.87 | 2.75 | 3.10 | 1.48 | 2.48 | 1.49 | 1.81 |
| SD | -- | -- | -- | .73 | .82 | .80 | .70 | .75 | 1.13 | 1.49 | 1.28 | 1.49 |
Note. For sex, 0 = male, 1 = female. For medication, 0= not taking a prescribed psychiatric medication, 1= taking a prescribed psychiatric medication.
Response. = responsive to social approval subscale. CDS = cognitive disengagement
syndrome. TR = teacher-report. ADHD-IN = attention-deficit/hyperactivity disorder inattention symptoms.
p < .01;
p < .05
Unique Associations of Personality Dimensions in Relation to CDS and ADHD-IN Symptoms
As in Study 1, child sex, medication status, and family income were included as covariates in Study 2 regression analyses. Higher FFFS-fear/shyness and BAS-responsiveness to social approval were uniquely associated with higher parent-reported CDS symptoms, whereas lower BAS-impulsivity/fun-seeking was uniquely associated with higher parent-reported CDS symptoms (Table 3, right panel). In the model for ADHD-IN, higher BAS-impulsivity/fun-seeking and lower BAS-responsiveness to social approval were uniquely associated with higher parent-reported ADHD-IN symptoms. However, lower FFFS-fear/shyness was uniquely associated with higher parent-reported ADHD-IN symptoms.
In the teacher-report model, lower BAS-drive was uniquely associated with higher teacher-reported CDS symptoms (Table 4, right panel). High BIS-anxiety was uniquely associated with higher teacher-reported CDS symptoms, whereas lower BIS-anxiety was uniquely associated with higher teacher-reported ADHD-IN symptoms. Finally, higher BAS-impulsivity/fun-seeking was uniquely associated with higher teacher-reported ADHD-IN symptoms (Table 4).
Discussion
The current study is the most comprehensive test to date of personality correlates of CDS and ADHD-IN symptoms, using two independent samples of school-aged children and a multi-informant design with both parent and teacher ratings. Using Grey’s Reinforcement Sensitivity Theory (RST) as a conceptual framework, findings provide clear evidence for differential personality correlates of CDS and ADHD-IN symptoms. Specifically, across two studies totaling 470 school-aged youth, in regression analyses with covariates (i.e., child sex, family income, medication status), personality dimensions, and parent-reported ADHD-IN symptoms as predictors of CDS symptoms, there were generally consistent findings (in three of four models examined) that higher ratings of FFFS-fear/shyness and lower ratings of BAS-drive were uniquely associated with higher parent- and teacher-reported CDS symptoms. Further, higher BAS-responsiveness to social approval was associated with higher parent ratings of CDS. In contrast, in regression analyses with covariates, personality dimensions, and parent-reported CDS symptoms as predictors of ADHD-IN symptoms, higher BAS-impulsivity-fun/seeking was consistently uniquely associated with parent- and teacher-reported ADHD-IN symptoms (in all four models examined). Finally, higher BIS-anxiety was uniquely associated with higher CDS symptoms and with lower ADHD-IN symptoms, though these findings were only found in Study 2 when using teacher ratings of CDS and ADHD-IN symptoms. Considered together, these findings largely replicate the one prior study in school-aged youth (Becker et al., 2013) and support personality dimensions being differentially associated with CDS and ADHD-IN symptoms.
Personality Dimensions in Relation to ADHD-IN Symptoms
Across both studies and informant ratings of ADHD-IN symptoms, ratings of BAS-impulsivity/fun-seeking were associated with ADHD-IN symptoms. This finding replicates the previous study in school-aged youth demonstrating consistent evidence for BAS-impulsivity/fun-seeking being associated with parent ratings of ADHD symptoms, although symptom domains were not separated (Becker et al., 2013). Although a few studies in adults find the BIS domain to be more closely associated with ADHD-IN symptoms than an overactive BAS (Gomez & Corr, 2010; Heym et al., 2015; Hundt et al., 2008), others find an overactive BAS (particularly fun-seeking/impulsivity) to be associated with ADHD-IN symptoms (Gomez et al., 2021; Mitchell & Nelson-Gray, 2006). As these adult studies did not incorporate CDS symptoms, findings from the current study are consistent with a handful of studies find ADHD-IN symptoms to remain associated with hyperactivity-impulsivity and externalizing symptoms when controlling for CDS, but not vice versa (Becker et al., 2016). Moreover, findings also showed the FFFS-fear/shyness domain was negatively related to ADHD-IN symptoms, consistent with the previous study in youth (Becker et al., 2013). An overactive BAS and underactive BIS is consistent with the dual-pathway model of ADHD and likely underlies the behavioral characteristics of poor inhibitory control (Bijttebier et al., 2009).
Personality Dimensions in Relation to CDS Symptoms
Clear support was found for higher scores in the FFFS-fear/shyness domain being uniquely associated with higher parent-rated CDS symptoms in both studies and teacher-rated CDS in one study. This finding replicates the previous studies in youth (Becker et al., 2013) and college students (Becker et al., 2018) documenting higher BIS/FFFS (punishment sensitivity) to be more consistently associated in regression analyses with CDS than with ADHD-IN. Further, a recent study finding greater sympathetic nervous reactivity during social stress, but not during a complex cognitive task, to be associated with CDS symptoms specifically (Becker & McQuade, 2020). These findings map onto the growing body of evidence linking CDS to shyness and social withdrawal, above and beyond ADHD symptoms (Becker et al., in press; Fredrick & Becker, 2023).
Finally, we found higher scores on the BAS-drive scale were uniquely associated with lower teacher-reported CDS across both studies and parent-reported CDS in one study, whereas this scale was not bivariately or uniquely associated with ADHD-IN symptoms. Interestingly, these findings are in contrast to the study in youth finding no relation between BAS-drive and CDS (Becker et al., 2013) and a unique association between ADHD-IN and less BAS-drive in college students (Becker et al., 2018). Potentially, since the previous youth study included a few ad-hoc items to assess CDS, findings from our study may reflect that the CDS construct as measured with a larger symptom set is uniquely related to lower drive. Research on the conceptualization of CDS has identified under-arousal, such as hypoactivity and daytime sleepiness, as a potential bio-behavioral marker of CDS (Fredrick et al., 2022b; Lunsford-Avery et al., 2021). Moreover, given evidence for the BAS-drive being linked to depressive symptoms (Bijttebier et al., 2009), these findings further support the strong link between CDS and depressive symptoms in youth (Barkley, 2013; Becker et al., 2021; Fredrick et al., 2022a; Willcutt et al., 2014). Future research is encouraged to examine BAS-drive as a potential mechanism of the CDS and depression link.
Taken together, findings for differential personality correlates using the RST framework coincide with growing evidence supporting the differentiation of CDS and ADHD-IN in school-aged children. It is possible that CDS symptoms may better account for the previous established link between ADHD-IN and BIS/internalizing psychopathology (Martel et al., 2010). As researchers have recommended conceptualizing CDS in the internalizing realm of psychopathology (Becker & Willcutt, 2019; Smith et al., 2019), findings provide an initial starting point for identifying unique features of punishment and reward sensitivity related to CDS. Potentially, in youth with and without ADHD, FFFS-fear/shyness may explain the association of CDS with shyness and social withdrawal, whereas BAS-drive may underpin the link between CDS and depression (Bijttebier et al., 2009).
Clinical Implications
Personality traits have been key in understanding developmental pathways, mechanisms of comorbidity, symptom expression, and clinical progress of ADHD in children (Nigg, 2022). Findings from this study have the potential to extend our assessment and intervention of ADHD by identifying specific personality traits related to the presentation of CDS symptoms. Specifically, assessing individual personality differences in behavioral activation, behavioral inhibition, and fight-flight-freeze systems may aid in the conceptualization and differentiation of ADHD-IN and CDS symptom presentation. Further, the presence of differences in fear/shyness and lower activity levels/reward drive may represent key mechanisms in the unique differences of ADHD and CDS with internalizing and externalizing psychopathology that can be leveraged in future intervention work (Becker et al., 2023).
Strengths, Limitations, and Future Directions
The current study includes many strengths, such as use of parent and teacher ratings of symptoms and two independent samples of school-aged youth with different recruitment strategies. Nevertheless, several limitations are important to note. Primarily, our reliance on a parent-reported rating scale of personality features is limited and future research is encouraged to incorporate additional rating scales of personality. For instance, the current study used two scales from the SPSRQ-C to measure BIS and FFFS and is a narrow representation of these personality domains. Future research incorporating other personality frameworks, like the Five Factor Model (Martel et al., 2010), would provide a more comprehensive assessment of shared and distinct personality features of CDS and ADHD heterogeneity. Further, although personality and temperament overlap considerably, the measurement of temperament often includes combinations of rating scale and laboratory-based assessment of reactivity and regulation across infancy and toddlerhood (Fox et al., 2005). Thus, although one may assume that behavioral inhibition may be a temperamental correlate of CDS, there is no study to date assessing CDS in young children with observational measurement of temperament. In addition, the present studies were both cross-sectional in design, and so temporal ordering could not be examined. There is a need for longitudinal research examining the extent to which temperament and personality predict the development, maintenance, or course of CDS symptoms over time (or vice versa). Finally, our samples were disproportionately White (88% in Study 1 and 75% in Study 2), and there is a broad need to examine CDS in more diverse and representative samples.
Conclusions
The current study provides the clearest evidence to date that personality dimensions are differentially associated with CDS and ADHD-IN symptoms in school-aged children. Findings were largely consistent for higher FFFS-fear/shyness and lower BAS-drive being specifically related to CDS symptoms, whereas BAS-impulsivity/fun-seeking was associated with ADHD-IN symptoms. This study highlights the importance of considering co-occurring symptoms of CDS when seeking to understand the heterogeneity of ADHD presentations and comorbidities.
Funding.
This research was supported by award number R305A160064 from the Institute of Education Sciences (IES; U.S. Department of Education), award number K23MH108603 from the National Institute of Mental Health (NIMH), a Trustee Award from the Cincinnati Children’s Research Foundation (CCRF), and a Cincinnati Children’s Endowed Scholar Award. The content is solely the responsibility of the authors and does not necessarily represent the official views of the IES, NIH, or the CCRF.
Footnotes
Disclosure statement. The authors declare no potential conflicts of interest with respect to the research, authorship, or publication of this article.
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