ATTENTION-DEFICIT/HYPERACTIVITY DISORDER AND ADVERSE CHILDHOOD EXPERIENCES: A CLUSTER ANALYSIS DIFFERENTIATING INTERNALIZING AND EXTERNALIZING BEHAVIORS OF CHILDREN

While decades of research have identified an association between Attention-Deficit/Hyperactivity Disorder (ADHD) and exposure to adverse childhood experiences (ACEs), minimal research focuses on differentiating the two phenomena. This can make assessing and treating symptoms of ADHD and exposure to childhood trauma a challenging and confusing process. The present study used cluster analysis to determine children’s behavior profiles based on internalizing and externalizing behaviors at age nine and examined whether these behavioral profiles differentiate the following four groups of children: children not exposed to ACEs or who were exposed to a low number of ACEs and indicate little to no ADHD symptoms, children exposed to a high number of ACEs and are reported to have a high level of ADHD symptoms, children exposed to a low number of ACEs and are reported to have elevated ADHD symptoms, and children exposed to an increased number of ACEs and are reported to have a low level of ADHD symptoms. A sample of 1,834 participants was derived from the year nine wave (2007-2010) of the Fragile Families and Child Wellbeing Study (FFCWS) public dataset. Based on five subscales from the Child Behavior Checklist/6-18 (CBCL/6-18; Achenbach & Rescorla, 2001), three behavioral profiles emerged: low internalizing/externalizing behaviors, high externalizing behaviors, and high internalizing behaviors. The three behavioral groups were further characterized by children not exposed to ACEs and indicated little to no ADHD symptoms, children exposed to a moderate number of ACEs and indicated a moderate level of ADHD symptoms, and children exposed to an increased number of ACEs and indicated a low level of ADHD symptoms. The low internalizing/externalizing cluster showed relatively low to no ADHD symptoms and exposure to ACEs. In contrast, the high externalizing cluster was characterized by children with higher ADHD symptoms and exposed to ≥ 2 ACEs. Children in the high internalizing cluster were mainly exposed to one ACE and scored low on ADHD symptoms but displayed more ADHD symptoms than the low internalizing/externalizing group and fewer ADHD symptoms than the high externalizing group. These findings suggest distinct behavioral subgroups of ADHD and ACEs, and these groups can be differentiated based on their level of internalizing and externalizing symptoms