Identifying Symptoms of ADHD and Disruptive Behavior Disorders Most Strongly Associated with Functional Impairment in Children: A Symptom-Level Approach

Abstract To enhance the understanding of how symptoms attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders such as oppositional defiant (ODD), conduct (CD), including callous-unemotional (CU) traits, differentially relate to functional impairment (FI). Participants were 474 German school-age children (age: M = 8.90, SD 1.49, 81% male) registered for participation in ESCAschool trial (ESCAschool: Evidence-based, Stepped Care ADHD school-aged ). Clinicians assessed severity individual five FI domains specifically associated with or ODD/CD/CU using a semi-structured clinical interview. We conducted two multiple linear regression analyses, combined relative importance determine impact on global symptoms. Next, we estimated networks identified strongest associations domains. Symptoms varied substantially their FI. The symptom Easily Distracted (15%) ODD Argues Adults (10%) contributed most strongly total explained variance. related academic performance, home life family members, psychological strain inattention symptoms, whereas relationships adults recreational activities hyperactivity-impulsivity By comparison, closely linked originated from CD dimensions. Our findings contribute growing body literature analyzing highlight that symptom-based approaches can be clinically useful.