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Co-Occurrence Patterns of ADHD Symptoms and Reactive and Proactive Aggression in Chinese Adolescents: Associations with Parenting Practices

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Title: Co-Occurrence Patterns of ADHD Symptoms and Reactive and Proactive Aggression in Chinese Adolescents: Associations with Parenting Practices
Language: English
Authors: Zhengqian Yang (ORCID 0009-0002-8530-6609), Yuhan Luo, Fumei Chen, Rui Luo, Qian Pu, Yun Wang
Source: Journal of Attention Disorders. 2026 30(4):542-551.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 10
Publication Date: 2026
Document Type: Journal Articles
Reports - Research
Descriptors: Attention Deficit Hyperactivity Disorder, Symptoms (Individual Disorders), Aggression, Adolescents, Parenting Styles, Mothers, Discipline, Punishment, Foreign Countries, Behavior Problems
Geographic Terms: China
Assessment and Survey Identifiers: Strengths and Difficulties Questionnaire
DOI: 10.1177/10870547251405074
ISSN: 1087-0547
1557-1246
Abstract: Objective: Previous studies have found that ADHD symptoms often co-occur with aggressive behavior in adolescents, and that reactive aggression is more closely related to ADHD symptoms than proactive aggression. However, the specific co-occurrence patterns of ADHD symptoms and different functions of aggression remain unclear, as does their relationship with parenting practices. This study used a person-centered approach to examine the co-occurrence patterns of ADHD symptoms, reactive aggression, and proactive aggression and their associations with parenting practices. Method: A total of 1,152 mother-adolescent dyads participated in this study (adolescents: M[subscript age]=14.29; 48.0% girls). Latent profile analysis was conducted to identify adolescent profiles of ADHD, reactive, and proactive aggression, followed by multinomial logistic regression to examine relationships between these profiles and auxiliary variables. Results: Latent profile analysis identified three patterns of adolescent- and mother-reported ADHD symptoms, reactive aggression, and proactive aggression: "low symptom" (84.4%), "reactive co-occurrence" (10.0%), and "complete co-occurrence" (5.6%). Multinomial logistic regression revealed that adolescents in the complete co-occurrence group had higher rates of corporal punishment, while adolescents in the reactive co-occurrence group exhibited higher rates of verbal hostility. Conclusion: These findings highlight the importance of distinguishing between reactive and proactive aggression in the context of ADHD and suggest that different co-occurrence patterns may be shaped by distinct parenting practices. Addressing specific parenting behaviors could help mitigate aggression in adolescents with ADHD symptoms.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1499935
Database: ERIC
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  Value: <anid>AN0192008571;gs001apr.26;2026Mar05.05:44;v2.2.500</anid> <title id="AN0192008571-1">Co-occurrence Patterns of ADHD Symptoms and Reactive and Proactive Aggression in Chinese Adolescents: Associations With Parenting Practices </title> <p>Objective: Previous studies have found that ADHD symptoms often co-occur with aggressive behavior in adolescents, and that reactive aggression is more closely related to ADHD symptoms than proactive aggression. However, the specific co-occurrence patterns of ADHD symptoms and different functions of aggression remain unclear, as does their relationship with parenting practices. This study used a person-centered approach to examine the co-occurrence patterns of ADHD symptoms, reactive aggression, and proactive aggression and their associations with parenting practices. Method: A total of 1,152 mother-adolescent dyads participated in this study (adolescents: M <sub>age</sub> = 14.29; 48.0% girls). Latent profile analysis was conducted to identify adolescent profiles of ADHD, reactive, and proactive aggression, followed by multinomial logistic regression to examine relationships between these profiles and auxiliary variables. Results: Latent profile analysis identified three patterns of adolescent- and mother-reported ADHD symptoms, reactive aggression, and proactive aggression: low symptom (84.4%), reactive co-occurrence (10.0%), and complete co-occurrence (5.6%). Multinomial logistic regression revealed that adolescents in the complete co-occurrence group had higher rates of corporal punishment, while adolescents in the reactive co-occurrence group exhibited higher rates of verbal hostility. Conclusion: These findings highlight the importance of distinguishing between reactive and proactive aggression in the context of ADHD and suggest that different co-occurrence patterns may be shaped by distinct parenting practices. Addressing specific parenting behaviors could help mitigate aggression in adolescents with ADHD symptoms.</p> <p>Keywords: ADHD symptoms; reactive and proactive aggression; co-occurrence; parenting practices; adolescents</p> <hd id="AN0192008571-2">Key Points</hd> <p></p> <ulist> <item> This study used a person-centered approach to identify different co-occurrence patterns of ADHD symptoms, reactive aggression, and proactive aggression in adolescents.</item> <p></p> <item> Three co-occurrence patterns were identified: <emph>low symptoms</emph>, <emph>reactive co-occurrence</emph>, and <emph>complete co-occurrence</emph>.</item> <p></p> <item> Different parenting practices were associated with different co-occurrence patterns: corporal punishment was more common in the <emph>complete co-occurrence group</emph>, while verbal hostility was more frequent in the r<emph>eactive co-occurrence</emph> group.</item> <p></p> <item> These findings underscore the role of parenting practices in shaping ADHD-aggression co-occurrence, offering insights for targeted intervention strategies.</item> </ulist> <hd id="AN0192008571-3">Introduction</hd> <p>The co-occurrence of ADHD and aggressive behavior is common and may increase the risk of development and adjustment problems ([<reflink idref="bib11" id="ref1">11</reflink>]; [<reflink idref="bib18" id="ref2">18</reflink>]). It should be noted, however, that not all youth with ADHD exhibit high levels of aggressive behavior. Among the different functions of aggression, reactive aggression is more strongly associated with ADHD symptoms than proactive aggression ([<reflink idref="bib4" id="ref3">4</reflink>]). Previous studies have found that ADHD symptoms often co-occur with different functions of aggressive behavior from both a variable and symptomatic perspective ([<reflink idref="bib22" id="ref4">22</reflink>]; [<reflink idref="bib32" id="ref5">32</reflink>]). In addition, previous research has found that some adolescents with ADHD exhibit resilience ([<reflink idref="bib9" id="ref6">9</reflink>]), and that positive parenting practices promote optimal development across a range of functional domains ([<reflink idref="bib13" id="ref7">13</reflink>]). This suggests that there may be different patterns of co-occurrence between ADHD symptoms and aggression in adolescents. The person-centered approach assumes heterogeneity within the populations ([<reflink idref="bib5" id="ref8">5</reflink>]), which helps to identify different patterns of co-occurrence. Thus, this study uses a person-centered approach to examine patterns of co-occurrence between ADHD symptoms and reactive and proactive aggression.</p> <p>ADHD is one of the most common neurodevelopmental disorders in children, and the persistence of ADHD into adolescence is well documented ([<reflink idref="bib3" id="ref9">3</reflink>]). Adolescents with ADHD often develop comorbid mental health conditions such as suicidal symptoms and emotional dysregulation ([<reflink idref="bib34" id="ref10">34</reflink>]). Aggressive behavior is a significant associated with ADHD ([<reflink idref="bib18" id="ref11">18</reflink>]). Previous studies have suggested that aggressive behavior plays a significant role in a variety of negative outcomes associated with ADHD ([<reflink idref="bib11" id="ref12">11</reflink>]; [<reflink idref="bib18" id="ref13">18</reflink>]). Such aggressive behavior can exacerbate further problems in emotional, social, and academic functioning ([<reflink idref="bib7" id="ref14">7</reflink>]). Due to the severity of symptoms and the lack of targeted interventions, co-occurrence often leads to referrals to health care providers for treatment ([<reflink idref="bib18" id="ref15">18</reflink>]). Therefore, understanding the co-occurrence of ADHD symptoms and aggressive behavior is crucial to clarifying the impact and treatment of ADHD.</p> <p>Aggressive behavior includes reactive and proactive aggression, and ADHD may co-occur differently with these two types of aggressive behavior, possibly because reactive and proactive aggression have different functions ([<reflink idref="bib7" id="ref16">7</reflink>]). According to the frustration-aggression hypothesis, reactive aggression is characterized by hostility, emotionality, and impulsivity and often occurs in response to frustration ([<reflink idref="bib17" id="ref17">17</reflink>]). ADHD symptoms and reactive aggression may share a common neurocognitive basis related to deficits in impulse control and emotion regulation ([<reflink idref="bib30" id="ref18">30</reflink>]; [<reflink idref="bib31" id="ref19">31</reflink>]). On the other hand, social learning theory posits that proactive aggression is instrumental, premeditated, and often motivated by the perpetrator's anticipation of positive outcomes (e.g., money and status) ([<reflink idref="bib17" id="ref20">17</reflink>]). The relationship between ADHD symptoms and proactive aggression is thought to be indirect. For example, adolescents with symptoms of hyperactivity may imitate the aggressive behavior of delinquent peers ([<reflink idref="bib4" id="ref21">4</reflink>]; [<reflink idref="bib31" id="ref22">31</reflink>]). Previous studies have consistently found a stronger association between ADHD symptoms and reactive aggression than proactive aggression ([<reflink idref="bib4" id="ref23">4</reflink>]; [<reflink idref="bib22" id="ref24">22</reflink>]). However, the pattern of ADHD symptoms that co-occur with reactive and proactive aggression remains poorly understood.</p> <p>Person-centered approach assume that the sample is inherently heterogeneous, allowing for the possibility of different patterns of mental health problems ([<reflink idref="bib5" id="ref25">5</reflink>]; [<reflink idref="bib36" id="ref26">36</reflink>]). Focusing on the heterogeneity within populations can facilitate understanding of adaptive issues in adolescent development ([<reflink idref="bib12" id="ref27">12</reflink>]). And identifying the different subgroups and their corresponding risk factors can more effectively help adolescents ([<reflink idref="bib25" id="ref28">25</reflink>]). For example, research has identified different subtypes of ADHD, and interventions tailored to different subtypes may have better outcomes ([<reflink idref="bib16" id="ref29">16</reflink>]). However, previous studies have primarily examined the co-occurrence of ADHD symptoms and various functions of aggressive behavior using variable-centered analyses ([<reflink idref="bib4" id="ref30">4</reflink>]; [<reflink idref="bib22" id="ref31">22</reflink>]). These variable-centered analyses can reveal differences in the degree of association between symptoms but do not identify distinct symptom patterns ([<reflink idref="bib5" id="ref32">5</reflink>]). Therefore, the present study aims to examine the co-occurrence patterns of ADHD symptoms and reactive and proactive aggression.</p> <p>Previous research has shown that parenting practices have a significant impact on ADHD and aggressive behavior ([<reflink idref="bib10" id="ref33">10</reflink>]; [<reflink idref="bib27" id="ref34">27</reflink>]). These parenting practices may also influence the co-occurrence of ADHD symptoms and aggressive behavior. According to cycle of violence theories ([<reflink idref="bib37" id="ref35">37</reflink>]) and social learning theory ([<reflink idref="bib2" id="ref36">2</reflink>]), witnessing or experiencing violence may undermine secure attachment and distort social information processes, which are critical determinants of aggressive behavior. Previous studies have found that the family environment to be a significant predictor of both school and home-based aggressive behavior in children with ADHD ([<reflink idref="bib18" id="ref37">18</reflink>]; [<reflink idref="bib20" id="ref38">20</reflink>]). A meta-analysis review found an association between positive parenting practices, such as sensitivity and warmth, and reductions in ADHD symptoms and subsequent problems ([<reflink idref="bib10" id="ref39">10</reflink>]). However, a meta-analysis of parenting and adolescent externalizing behaviors found that positive parenting, such as parental warmth, was only weakly associated with externalizing behaviors, while negative parenting, such as harsh control, was strongly associated with externalizing behaviors ([<reflink idref="bib27" id="ref40">27</reflink>]). It remains unclear how parenting practices influence the co-occurrence of ADHD symptoms and aggressive behavior. This study aims to examine the associations between parenting practices and different patterns of co-occurrence of ADHD symptoms and aggressive behavior.</p> <p>ADHD symptoms and aggressive behavior often co-occur ([<reflink idref="bib18" id="ref41">18</reflink>]). Previous research has found that ADHD symptoms are more strongly associated with reactive aggression than with proactive aggression ([<reflink idref="bib22" id="ref42">22</reflink>]; [<reflink idref="bib32" id="ref43">32</reflink>]). However, some adolescents with ADHD exhibit resilience ([<reflink idref="bib9" id="ref44">9</reflink>]), suggesting heterogeneity in the co-occurrence of ADHD and aggression. Despite these findings, little is known about different co-occurrence patterns of ADHD symptoms, reactive aggression, and proactive aggression. To address this gap, this study used a person-centered approach to identify co-occurrence patterns of ADHD symptoms and aggression in adolescents. Additionally, we examined how different patterns were associated with specific parenting practices, providing insights into potential environmental influences on ADHD and aggression co-occurrence. Based on a review of the literature, this study hypothesizes that there are four symptom patterns, namely low symptom, co-occurrence of ADHD symptoms with reactive aggression, co-occurrence of ADHD symptoms with proactive aggression, and co-occurrence of ADHD symptoms with both reactive and proactive aggression (<bold>H1</bold>). For the relationships between parenting practices and co-occurrence patterns, it is expected that positive parenting will be negatively associated with all co-occurrence patterns compared to low symptom pattern (<bold>H2a</bold>), and negative parenting will be significantly positively associated with all co-occurrence patterns compared to low symptom pattern (<bold>H2b</bold>).</p> <hd id="AN0192008571-4">Methods</hd> <p></p> <hd id="AN0192008571-5">Participants</hd> <p>Data were drawn from a longitudinal study aimed at understanding adolescents' social adjustment and development. A total of 1,156 adolescents and their mothers from three middle schools in northeastern China were invited to participate in the study in November 2019. Participants who did not respond were excluded, resulting in a final sample of 1,152 mother-adolescent dyads. Adolescents had a mean age of 14.29 years (<emph>SD</emph> = 0.73), and 48.0% of them were female. Nearly all participants identified as Chinese Han ethnicity, which is the majority ethnic group in China, comprising 92% of the total population. Demographic information about the participants is shown in Table 1.</p> <p>Table 1. Demographic Information of Participants (N = 1,152).</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /></colgroup><thead><tr><th align="left">Characteristics</th><th align="center"><italic>M (SD)</italic>/<italic>N</italic> (%)</th></tr></thead><tbody><tr><td colspan="2">Adolescent's sex</td></tr><tr><td> Girls</td><td>553 (48.0%)</td></tr><tr><td> Boys</td><td>598 (52.0%)</td></tr><tr><td colspan="2">Adolescent's age</td></tr><tr><td align="center">—</td><td>14.29 (0.73)</td></tr><tr><td colspan="2">Adolescent's grade</td></tr><tr><td> Grade 8</td><td>627 (54.4)</td></tr><tr><td> Grade 9</td><td>525 (45.6)</td></tr><tr><td colspan="2">Registered residence</td></tr><tr><td> Rural</td><td>446 (42.3%)</td></tr><tr><td> Urban</td><td>609 (57.7%)</td></tr><tr><td colspan="2">Mother's age</td></tr><tr><td align="center">—</td><td>39.87 (4.47)</td></tr><tr><td colspan="2">Father's age</td></tr><tr><td align="center">—</td><td>41.30 (4.76)</td></tr><tr><td colspan="2">Mother's education</td></tr><tr><td> Middle school or less</td><td>664 (59.6%)</td></tr><tr><td> High school</td><td>192 (17.2%)</td></tr><tr><td> College graduate or higher</td><td>259 (23.2%)</td></tr><tr><td colspan="2">Father's education</td></tr><tr><td> Middle school or less</td><td>616 (55.4%)</td></tr><tr><td> High school</td><td>231 (20.8%)</td></tr><tr><td> College graduate or higher</td><td>264 (23.8%)</td></tr></tbody></table> </ephtml> </p> <hd id="AN0192008571-6">Procedure</hd> <p>Adolescents and their mothers were recruited and informed that they could choose not to participate. Prior to data collection, informed consent was obtained from adolescents and parents, and consent was obtained from school principals. Adolescents completed questionnaires about ADHD symptoms and aggressive behavior in the classroom, while mothers completed questionnaires about their children's ADHD symptoms and their parenting practices at home. Demographic information was reported by the adolescents and their mothers. The current study was approved by the Institutional Review Board of Beijing Normal University.</p> <hd id="AN0192008571-7">Measures</hd> <p></p> <hd id="AN0192008571-8">ADHD Symptoms</hd> <p>Previous studies have demonstrated that the hyperactivity-inattention (HI) subscale of the Strengths and Difficulties Questionnaire (SDQ HI subscale) can be used to evaluate and initially diagnose ADHD symptoms in adolescents ([<reflink idref="bib6" id="ref45">6</reflink>]; [<reflink idref="bib15" id="ref46">15</reflink>]). And multi-informant ratings have the better predictive accuracy ([<reflink idref="bib15" id="ref47">15</reflink>]). Therefore, the HI subscale of the SDQ was used in this study to assess ADHD symptoms in adolescents. Adolescents and their mother completed self-report and parent-report versions of the SDQ HI subscale, respectively. The SDQ HI subscale consists of five items rated on a three-point scale (0 = not true, 1 = somewhat true, and 2 = certainly true), and high scores represent a high degree of ADHD symptoms. The psychometric properties of the SDQ HI subscale have been found to be satisfactory (parent-report version: α =.73; self-report version: α =.67).</p> <hd id="AN0192008571-9">Aggressive Behavior</hd> <p>Adolescents completed the Reactive-Proactive Aggression Questionnaire (RPQ; [<reflink idref="bib28" id="ref48">28</reflink>]). The RPQ is a 23-item scale that measures two types of aggressive behavior in adolescents: reactive aggression (11 items) and proactive aggression (12 items). Example items include "gets angry easily when teased or threatened" (reactive aggression) and "gets other kids to gang up on someone they do not like" (proactive aggression). Each subscale has items rated on a scale of 0 to 2, with higher mean scores indicating more frequent aggressive behavior. The RPQ has demonstrated cross-cultural consistency and good validity in previous research with Chinese adolescents ([<reflink idref="bib35" id="ref49">35</reflink>]). In the present study, both subscales showed good internal consistency (reactive aggression: α =.84; proactive aggression: α =.91).</p> <hd id="AN0192008571-10">Parenting Practices</hd> <p>Mothers reported their parenting practices in three dimensions: warmth and involvement, verbal hostility, and corporal punishment. Warmth and involvement were assessed by 11 items (e.g., Give comfort and understanding when our child is upset) adapted from the Parenting Practices Questionnaire (PPQ; [<reflink idref="bib29" id="ref50">29</reflink>]). Verbal hostility was assessed by four items (e.g., explodes in anger toward child) adapted from the PRQ ([<reflink idref="bib29" id="ref51">29</reflink>]). Corporal punishment was assessed by six items (e.g., spank on bottom with hand) adapted from the Parent-Child Conflict Tactics Scale ([<reflink idref="bib33" id="ref52">33</reflink>]). Each item is rated on a 5-point Likert scale ranging from "never" to "always." A higher score indicates more frequent engagement in behaviors consistent with the parenting practice being assessed. The factor structure of each scale was confirmed to be a good fit, and the internal consistency reliability was acceptable for the present sample. The alpha coefficient was.86 for warmth and involvement,.80 for verbal hostility, and.81 for corporal punishment.</p> <hd id="AN0192008571-11">Covariates</hd> <p>Adolescents' age, sex (0 for boys and 1 for girls), and socioeconomic status (SES) were included as covariates. SES was measured using the four-item Family Affluence Scale II ([<reflink idref="bib19" id="ref53">19</reflink>]) to assess family wealth with questions such as "Does your family own a car, van, or truck?" (No = 0; Yes, one = 1; Yes, two or more = 2).</p> <hd id="AN0192008571-12">Analysis Plan</hd> <p>The study used Mplus 8.3 ([<reflink idref="bib23" id="ref54">23</reflink>]) for the analyses. First, a latent profile analysis (LPA) was conducted to identify the symptom patterns (profiles) of ADHD symptoms, reactive aggression, and proactive aggression in adolescents. The LPA estimated the probability of adolescents being in each profile membership and classified individuals into the most appropriate class based on the maximum probability ([<reflink idref="bib24" id="ref55">24</reflink>]). To select the optimal solution, we considered fit indices, substantive meaning, and theoretical conformity. We evaluated different models using the following statistical indices ([<reflink idref="bib24" id="ref56">24</reflink>]): (<reflink idref="bib1" id="ref57">1</reflink>) low values for Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and Sample Size Adjusted Bayesian Information Criterion (aBIC); (<reflink idref="bib2" id="ref58">2</reflink>) high entropy (>0.70); and (<reflink idref="bib3" id="ref59">3</reflink>) significant results for the Lo-Mendel-Rubin Likelihood Ratio Test (LMR-LRT). A significant LMR-LRT indicates that a model with k profiles provides a better fit than a model with k-1 profiles.</p> <p>Next, multinomial logistic regression was preformed using R3STEP to analyze the relationships between symptom patterns and auxiliary variables, including parenting practices and demographic covariates. R3STEP regresses the categorical latent profiles on the variables of interest in an automated 3-step process. This process includes estimating an LPA solution, storing posterior probabilities of profile membership, and conducting multinomial logistic regression ([<reflink idref="bib1" id="ref60">1</reflink>]). R3STEP is widely accepted and recommended in Mplus for the correction of classification errors ([<reflink idref="bib1" id="ref61">1</reflink>]).</p> <hd id="AN0192008571-13">Results</hd> <p></p> <hd id="AN0192008571-14">Descriptive Statistics</hd> <p>Table 2 presents the descriptive statistics and bivariate correlations between variables. The study found significant positive correlations between adolescent-reported ADHD symptoms, mother-reported ADHD symptoms, reactive aggression, and proactive aggression (<emph>r</emph> =.19–.53), indicating the co-occurrence of these symptoms at the variable-centered level. In addition, warmth and involvement were positively correlated with all ADHD symptoms and aggressive behavior; corporal punishment and verbal hostility were negatively correlated with all ADHD symptoms and aggressive behavior.</p> <p>Table 2. Descriptive Statistics and Bivariate Correlations Between Key Variables.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left">Variable</th><th align="center">1</th><th align="center">2</th><th align="center">3</th><th align="center">4</th><th align="center">5</th><th align="center">6</th><th align="center">7</th><th align="center">8</th><th align="center">9</th><th align="center">10</th></tr></thead><tbody><tr><td>1. ADHD symptoms (A)</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>2. ADHD symptoms (M)</td><td>.41<xref ref-type="table-fn" rid="tfn2">***</xref></td><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>3. Reactive aggression</td><td>.37<xref ref-type="table-fn" rid="tfn2">***</xref></td><td>.19<xref ref-type="table-fn" rid="tfn2">***</xref></td><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>4. Proactive aggression</td><td>.21<xref ref-type="table-fn" rid="tfn2">***</xref></td><td>.15<xref ref-type="table-fn" rid="tfn2">***</xref></td><td>.53<xref ref-type="table-fn" rid="tfn2">***</xref></td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>5. Warmth and involvement</td><td>−.17<xref ref-type="table-fn" rid="tfn2">***</xref></td><td>−.28<xref ref-type="table-fn" rid="tfn2">***</xref></td><td>−.12<xref ref-type="table-fn" rid="tfn2">***</xref></td><td>−.09<xref ref-type="table-fn" rid="tfn2">**</xref></td><td /><td /><td /><td /><td /><td /></tr><tr><td>6. Corporal punishment</td><td>.13<xref ref-type="table-fn" rid="tfn2">***</xref></td><td>.22<xref ref-type="table-fn" rid="tfn2">***</xref></td><td>.16<xref ref-type="table-fn" rid="tfn2">***</xref></td><td>.09<xref ref-type="table-fn" rid="tfn2">**</xref></td><td>−.20<xref ref-type="table-fn" rid="tfn2">***</xref></td><td /><td /><td /><td /><td /></tr><tr><td>7. Verbal hostility</td><td>.19<xref ref-type="table-fn" rid="tfn2">***</xref></td><td>.39<xref ref-type="table-fn" rid="tfn2">***</xref></td><td>.18<xref ref-type="table-fn" rid="tfn2">***</xref></td><td>.06<xref ref-type="table-fn" rid="tfn2">*</xref></td><td>−.25<xref ref-type="table-fn" rid="tfn2">***</xref></td><td>.49<xref ref-type="table-fn" rid="tfn2">***</xref></td><td /><td /><td /><td /></tr><tr><td>8. Sex (0 = boys)</td><td>.00</td><td>−.11<xref ref-type="table-fn" rid="tfn2">***</xref></td><td>−.04</td><td>−.20<xref ref-type="table-fn" rid="tfn2">***</xref></td><td>.07<xref ref-type="table-fn" rid="tfn2">*</xref></td><td>−.09<xref ref-type="table-fn" rid="tfn2">**</xref></td><td>.03</td><td /><td /><td /></tr><tr><td>9. Age</td><td>.02</td><td>−.04</td><td>.12<xref ref-type="table-fn" rid="tfn2">***</xref></td><td>.06<xref ref-type="table-fn" rid="tfn2">*</xref></td><td>−.02</td><td>−.01</td><td>−.09<xref ref-type="table-fn" rid="tfn2">**</xref></td><td>−.09<xref ref-type="table-fn" rid="tfn2">**</xref></td><td /><td /></tr><tr><td>10. SES</td><td>−.11<xref ref-type="table-fn" rid="tfn2">**</xref></td><td>−.11<xref ref-type="table-fn" rid="tfn2">***</xref></td><td>−.04</td><td>−.04</td><td>.14<xref ref-type="table-fn" rid="tfn2">***</xref></td><td>−.07<xref ref-type="table-fn" rid="tfn2">**</xref></td><td>.06</td><td>.05</td><td>−.09<xref ref-type="table-fn" rid="tfn2">**</xref></td><td /></tr><tr><td><italic>M</italic></td><td>0.78</td><td>0.80</td><td>0.53</td><td>0.14</td><td>3.67</td><td>1.33</td><td>2.36</td><td align="center">—</td><td>14.29</td><td>0.00</td></tr><tr><td><italic>SD</italic></td><td>0.42</td><td>0.49</td><td>0.37</td><td>0.25</td><td>0.76</td><td>0.50</td><td>0.77</td><td align="center">—</td><td>0.73</td><td>1.00</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note. N</emph> = 1,152. <emph>M</emph> = mother-reported; A = adolescent-reported; SES = socioeconomic Status.</p> <p>2 <emph>p</emph> <.05. **<emph>p</emph> <.01. ***<emph>p</emph> <.001.</p> <hd id="AN0192008571-15">Latent Profiles of ADHD Symptoms and Reactive Proactive Aggression</hd> <p>We conducted LPAs to identify the profiles of adolescent- and mother-reported ADHD symptoms, reactive aggression, and proactive aggression. Table 3 presents the goodness of fit indices of latent profile models containing one to five profiles. As the number of profiles increased, the AIC, BIC, and aBIC continued to decrease. The LMR-LRT supported the three-profile and four-profile solutions. However, the entropy was less than 0.80 for the four-profile solution. Additionally, the smallest profile in the five-profile solution was less than 4%. Therefore, the three-profile solution was selected as the statistically and conceptually superior solution.</p> <p>Table 3. Model Fit Statistics for Latent Profile Analyses.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left">Profiles</th><th align="center">AIC</th><th align="center">BIC</th><th align="center">aBIC</th><th align="center">LMR-LRT <italic>p</italic></th><th align="center">Entropy</th><th align="center"><italic>n</italic> (%) in profiles</th></tr></thead><tbody><tr><td>1</td><td>3,874.93</td><td>3,915.33</td><td>3,889.91</td><td /><td /><td>1,152 (100%)</td></tr><tr><td>2</td><td>2,699.80</td><td>2,765.44</td><td>2,724.14</td><td>0.000</td><td>0.981</td><td>1,062 92.2%); 90 (7.8%)</td></tr><tr><td><bold>3</bold></td><td><bold>2,205.66</bold></td><td><bold>2,296.55</bold></td><td><bold>2,239.38</bold></td><td><bold>0.074</bold></td><td><bold>0.958</bold></td><td><bold>973 (84.4%); 64 (5.6%); 115 (10.0%)</bold></td></tr><tr><td>4</td><td>1,958.35</td><td>2,074.48</td><td>2,001.43</td><td>0.004</td><td>0.778</td><td>565 (49.0%); 64 (5.6%); 102 (8.9%); 421 (36.5%)</td></tr><tr><td>5</td><td>1,789.39</td><td>1,930.77</td><td>1,841.84</td><td>0.271</td><td>0.812</td><td>2 (0.2%); 576 (50.0%); 409 (35.5%); 103 (8.9%); 62 (5.4%)</td></tr></tbody></table> </ephtml> </p> <p>3 <emph>Note.</emph> Information criteria values for the best fitting profile are shown in bold. AIC = Akaike information criterion; BIC = Bayesian information criterion; aBIC = sample size–adjusted Bayesian information criterion; LMR-LRT = Lo-Mendell-Rubin likelihood ratio test.</p> <p>The three profiles can be distinguished by examining the mean scores of indicator variables including adolescent- and mother-reported ADHD symptoms, reactive aggression, and proactive aggression (see Figure 1). After confirming that mother- and adolescent-reported ADHD symptoms were consistent across profiles, no further distinction was made between reporters. The first and largest profile, labeled <emph>low symptom</emph> (<emph>N</emph> = 973, 84.4%), was characterized by adolescents with lower levels of ADHD symptoms, reactive aggression, and proactive aggression. The study identified two co-occurrence profiles among the participants. The second profile, termed <emph>reactive co-occurrence</emph> (<emph>N</emph> = 115, 10.0%), was characterized by adolescents with higher levels of ADHD symptoms and reactive aggression, and average levels of proactive aggression. The third and smallest profile, named <emph>complete co-occurrence</emph> (<emph>N</emph> = 64, 5.6%), was characterized by adolescents with higher levels of ADHD symptoms, reactive aggression, and proactive aggression. However, there was no group in which only ADHD and proactive aggression co-occurred (nor was it present in the four-profile solution).</p> <p>Graph: Figure 1. Co-occurrence patterns of ADHD symptoms and reactive and proactive aggression (mean scores).</p> <hd id="AN0192008571-16">Associations Between Parenting Practices and Symptom Profiles</hd> <p>The results of the multinomial logistic regression (profile on parenting practices and covariates) are presented in Table 4. Regarding parenting practices during adolescence, the study found that adolescents in the <emph>complete co-occurrence</emph> profile experienced more corporal punishment than those in the <emph>reactive co-occurrence</emph> profile (OR = 2.17, 95% CI [1.10, 4.26]). Adolescents in the <emph>reactive co-occurrence</emph> profile experienced more verbal hostility than those in the <emph>low symptom</emph> profile (OR = 1.62, 95% CI [1.19, 2.19]) or the <emph>complete co-occurrence</emph> profile (OR = 0.55, 95% CI [0.32, 0.95], which is the comparison group). There were no differences in warmth and involvement between symptom profiles.</p> <p>Table 4. Multinomial Logistic Regression of Parenting Practices on Profiles.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th align="center" colspan="2">Complete co-occurrence vs. low symptom</th><th align="center" colspan="2">Reactive co-occurrence vs. low symptom</th><th align="center" colspan="2">Complete co-occurrence vs. reactive co-occurrence</th></tr><tr><th align="left">Variable</th><th align="center"><italic>OR</italic></th><th align="center">95% CI</th><th align="center"><italic>OR</italic></th><th align="center">95% CI</th><th align="center"><italic>OR</italic></th><th align="center">95% CI</th></tr></thead><tbody><tr><td>Sex (0 = boys)</td><td><bold>0.17</bold></td><td><bold>[0.08, 0.39]</bold></td><td><bold>0.39</bold></td><td><bold>[0.23, 0.64]</bold></td><td>0.46</td><td>[0.19, 1.15]</td></tr><tr><td>Age</td><td><bold>1.50</bold></td><td><bold>[1.05, 2.14]</bold></td><td>1.07</td><td>[0.78, 1.46]</td><td>1.40</td><td>[0.90, 2.19]</td></tr><tr><td>SES</td><td>0.94</td><td>[0.67, 1.29]</td><td>1.04</td><td>[0.83, 1.30]</td><td>0.90</td><td>[0.62, 1.31]</td></tr><tr><td>Warmth and involvement</td><td>0.98</td><td>[0.68, 1.41]</td><td>0.83</td><td>[0.61, 1.10]</td><td>1.20</td><td>[0.77, 1.87]</td></tr><tr><td>Corporal punishment</td><td>0.98</td><td>[0.96, 2.68]</td><td>0.74</td><td>[0.43, 1.28]</td><td><bold>2.17</bold></td><td><bold>[1.10, 4.26]</bold></td></tr><tr><td>Verbal hostility</td><td>0.90</td><td>[0.55, 1.45]</td><td><bold>1.62</bold></td><td><bold>[1.19, 2.19]</bold></td><td><bold>0.55</bold></td><td><bold>[0.32, 0.95]</bold></td></tr></tbody></table> </ephtml> </p> <p>4 <emph>Note.</emph> "Comparison group vs. Reference group." An OR greater than 1 represents a positive logistic regression coefficient, indicating an increased likelihood of target memberships (comparison group), and vice versa. Significant coefficients are shown in bold. SES = socioeconomic status; OR = odds ratio; CI = confidence interval.</p> <p>In addition, we found that boys were more likely to be classified in the <emph>complete co-occurrence</emph> profile or <emph>reactive co-occurrence</emph> profile than in the <emph>low symptom</emph> profile (OR = 0.17, 95% CI [0.08, 0.39]; OR = 0.39, 95% CI [0.23, 0.64]). Older adolescents were more likely to be classified in the <emph>complete co-occurrence</emph> profile than the <emph>low symptom</emph> profile (OR = 1.50, 95% CI [1.05, 2.14]).</p> <hd id="AN0192008571-17">Discussion</hd> <p>The purpose of this study was to examine the co-occurrence patterns of ADHD symptoms with reactive and proactive aggression, as well as the associations between parenting behaviors and co-occurrence patterns. This study identified three distinct patterns of co-occurrence of ADHD symptoms and reactive and proactive aggression. The majority of adolescents were classified in the low-symptom group (84.4%), followed by the reactive co-occurrence group (10.0%) and the complete co-occurrence group (5.6%). Adolescents in the complete co-occurrence group had higher rates of corporal punishment, whereas adolescents in the reactive co-occurrence group had higher rates of verbal hostility. In addition, boys were more likely to be classified in these two co-occurrence groups; older adolescents were more likely to be classified in the complete co-occurrence group.</p> <p>The current study identified three patterns of symptoms, including two co-occurrence patterns and one low symptom pattern. In two co-occurrence patterns, ADHD symptoms co-occurred with both reactive and proactive aggression in the <emph>complete co-occurrence</emph> group, while ADHD symptoms only co-occurred with reactive aggression only in the reactive co-occurrence group. Both co-occurrence patterns had high levels of ADHD symptoms and reactive aggression. Previous research has found common emotional regulation difficulties and neurocognitive underpinnings between ADHD symptoms and reactive aggression ([<reflink idref="bib21" id="ref62">21</reflink>]; [<reflink idref="bib30" id="ref63">30</reflink>]). Additionally, we did not find a symptom pattern in which ADHD symptoms were present in isolation. This indicates that ADHD symptoms and reactive aggression consistently co-occur, and future research may consider reactive aggression as one of the secondary symptoms of ADHD.</p> <p>The difference between the two co-occurrence patterns lies in the level of proactive aggression. Compared to the stable co-occurrence of ADHD symptoms with reactive aggression, high levels of proactive aggression are present only in the <emph>complete co-occurrence</emph> group. This is consistent with previous findings indicating a lower frequency of proactive aggression than reactive aggression in the co-occurrence ([<reflink idref="bib4" id="ref64">4</reflink>]; [<reflink idref="bib22" id="ref65">22</reflink>]). Proactive aggression may represent a relatively independent behavioral characteristic, and the unstable co-occurrence of ADHD symptoms and proactive aggression could be influenced by environmental factors. When adolescents with ADHD symptoms are exposed to violent environment or imitate the aggressive behavior of delinquent peers, they may exhibit high levels of proactive aggression ([<reflink idref="bib31" id="ref66">31</reflink>]). Proactive aggression may be considered a critical indicator of ADHD symptom severity; adolescents in the <emph>reactive co-occurrence</emph> group are relatively resilient. Future research should focus on the risk factors and mechanisms for the co-occurrence of ADHD symptoms and proactive aggression. Interventions targeting the ADHD symptoms should pay special attention to proactive aggression in order to promote individual resilience.</p> <p>Contrary to our hypothesis, the results did not reveal a symptom pattern in which ADHD symptoms co-occurred only with proactive aggression. This may be due to the lack of an intrinsic correlation between proactive aggression and ADHD symptoms. For instance, there may be an indirect relationship between ADHD symptoms and proactive aggression through imitation of delinquent peers ([<reflink idref="bib31" id="ref67">31</reflink>]). In addition, previous studies and our findings consistently indicate a stable co-occurrence of ADHD symptoms with reactive aggression ([<reflink idref="bib22" id="ref68">22</reflink>]; [<reflink idref="bib30" id="ref69">30</reflink>]). Therefore, one possible explanation is that when adolescents with co-occurring ADHD symptoms and reactive aggression are exposed to environmental risks and violence, they are more likely to exhibit proactive aggression.</p> <p>We found that adolescents in the <emph>complete co-occurrence</emph> group were subjected to more corporal punishment than those in the <emph>low symptom</emph> and <emph>reactive co-occurrence</emph> groups. In families where corporal punishment is used, adolescents with ADHD may be more likely to exhibit proactive aggression. One possible explanation, based on social learning theory ([<reflink idref="bib2" id="ref70">2</reflink>]; [<reflink idref="bib17" id="ref71">17</reflink>]), is that adolescents may imitate violent behaviors observed during corporal punishment and subsequently engage in more proactive aggression in order to obtain positive rewards. A meta-analysis found a mild yet significant correlation between corporal punishment and subsequent violent tendencies, such as aggressive behavior ([<reflink idref="bib26" id="ref72">26</reflink>]). This suggests that corporal punishment may be a risk factor for exacerbating co-occurring ADHD symptoms and aggressive behavior. Future practical interventions should focus not only on adolescents, but also on reducing corporal punishment through family guidance programs.</p> <p>Verbal hostility did not yield findings such as corporal punishment; adolescents in the <emph>reactive co-occurrence</emph> group were subjected to more verbal hostility compared to those in the <emph>low symptom</emph> and <emph>complete co-occurrence</emph> groups. This suggests a closer relationship between verbal hostility and the co-occurrence of ADHD symptoms and reactive aggression. Consistent with the frustration-aggression hypothesis, instances of maternal criticism may evoke perceptions of failure and frustration in children, potentially leading to increased impulsivity and reactive aggression. In addition, we did not find protective effects of warmth and involvement. The effectiveness of positive parenting behaviors in mitigating the co-occurring symptoms of ADHD, a neurodevelopmental disorder, may be limited. Previous research has also found that negative parenting has a greater destructive effect on children with ADHD symptoms compared to the protective effects of positive parenting ([<reflink idref="bib10" id="ref73">10</reflink>]; [<reflink idref="bib14" id="ref74">14</reflink>]). In practical interventions targeting the co-occurrence of ADHD symptoms and aggressive behavior in youth, it is critical to prioritize helping parents modify negative parenting practices, such as corporal punishment and verbal hostility.</p> <p>The study found some demographic differences between symptom groups. Compared to the <emph>low symptom</emph> group, boys were more likely to be classified in the <emph>reactive co-occurrence</emph> or <emph>complete co-occurrence</emph> groups. This is consistent with previous research indicating that boys exhibit more aggressive behavior during adolescence ([<reflink idref="bib8" id="ref75">8</reflink>]). Our findings further emphasize the need to pay more attention to boys in interventions targeting the co-occurrence of ADHD symptoms and aggressive behavior. Older adolescents were more likely to be classified in the <emph>complete co-occurrence</emph> group than in the <emph>low symptom</emph> group, but no age differences were observed in the other groups. The relatively narrow age range of the adolescent sample in this study may contribute to the instability of the observed age differences. The majority of the sample consists of individuals in the early stages of adolescence.</p> <p>Despite these promising findings and implications for practice, this study had several limitations. First, the study did not differentiate the dimensions of ADHD symptoms due to instrumental limitations. However, compared to previous studies, this study identified different co-occurrence patterns of ADHD symptoms and reactive and proactive aggression through a person-centered approach. Future research could further focus on the relationship between the inattention and hyperactivity dimensions of ADHD symptoms and reactive and proactive aggression. Second, the study used cross-sectional data and could not infer a causal relationship between parenting practices and co-occurrence patterns. However, this study focused on identifying different co-occurrence patterns. In addition, previous studies have identified a significant correlation between parenting practices and subsequent adolescent ADHD symptoms and aggressive behavior ([<reflink idref="bib10" id="ref76">10</reflink>]; [<reflink idref="bib26" id="ref77">26</reflink>]). Future research could use longitudinal data to explore possible causal relationships as well as mechanisms. The study used a community sample, and it is not clear whether similar results would be found in clinical samples. However, continuous measures based on community samples rather than dichotomous diagnostic status may capture the full range of changes in symptom levels and provide a more comprehensive and accurate picture of symptom patterns ([<reflink idref="bib21" id="ref78">21</reflink>]). In addition, findings from community-based samples may help to prevent symptom worsening in adolescents with subthreshold ADHD in practice and facilitate their developmental adjustment. Co-morbidity patterns of ADHD with reactive and proactive aggression can be explored in clinical samples in the future, providing new insights for clinical treatment.</p> <hd id="AN0192008571-18">Conclusion</hd> <p>This study examined the symptom patterns of ADHD symptoms with reactive and proactive aggression in adolescents, as well as the associations between different symptom patterns and parenting practices. Latent profile analysis identified a low symptom pattern and two distinct co-occurrence patterns. These two co-occurrence patterns are as follows: the first is reactive co-occurrence, in which ADHD symptoms co-occurred with reactive aggression alone; the second is complete co-occurrence, in which ADHD symptoms co-occurred with both reactive and proactive aggression. In both co-occurrence patterns, ADHD symptoms co-occurred stably with reactive aggression. Proactive aggression appeared only in the complete co-occurrence group, and served as an indicator of co-occurrence exacerbation. The study also found that these different co-occurrence patterns were associated with different parenting practices among adolescents. Corporal punishment may be a risk factor for the complete co-occurrence; verbal hostility may be a risk factor for the reactive co-occurrence. Future research should examine possible mechanisms that influence the co-occurrence of ADHD symptoms and reactive and proactive aggression. 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Springer.</bibtext> </blist> </ref> <ref id="AN0192008571-20"> <title> Footnotes </title> <blist> <bibtext> Zhengqian Yang</bibtext> </blist> <blist> <bibtext>Graph https://orcid.org/0009-0002-8530-6609</bibtext> </blist> <blist> <bibtext> This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of the Faculty of Psychology, Beijing Normal University (CNL_A_0003_004).</bibtext> </blist> <blist> <bibtext> Informed consent was obtained from the parents or legal guardians of all participants, and assent was obtained from the participating adolescents and mothers.</bibtext> </blist> <blist> <bibtext> Z. Yang conceived and designed the analysis and wrote the paper. Y. Luo and F. Chen contributed to the design of the analysis and wrote the paper. R. Luo, Q. Pu, and Y. Wang reviewed the manuscript and contributed to the writing. All authors have contributed to and have approved the final manuscript.</bibtext> </blist> <blist> <bibtext> The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Major Program of the National Social Science Fund of China (Grant Number: 20&ZD153), and was funded by Open Research Fund of the State Key Laboratory of Cognitive Neuroscience and Learning.</bibtext> </blist> <blist> <bibtext> The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> The data used in the current study is not publicly available, but can be obtained from the authors upon reasonable request.</bibtext> </blist> </ref> <aug> <p>By Zhengqian Yang; Yuhan Luo; Fumei Chen; Rui Luo; Qian Pu and Yun Wang</p> <p>Reported by Author; Author; Author; Author; Author; Author</p> <p></p> <p>Zhengqian Yang is a PhD candidate at the State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, China.</p> <p>Yuhan Luo is a Lecturer in the School of Education, Minzu University of China.</p> <p>Fumei Chen is an Associate Professor at the Collaborative Innovation Center of Assessment for Basic Education Quality, Beijing Normal University.</p> <p>Rui Luo is a PhD candidate at the State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University.</p> <p>Qian Pu is a Master's student at the Collaborative Innovation Center of Assessment for Basic Education Quality, Beijing Normal University.</p> <p>Yun Wang is a Professor at the State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University.</p> </aug> <nolink nlid="nl1" bibid="bib11" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib18" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib22" firstref="ref4"></nolink> <nolink nlid="nl4" bibid="bib32" firstref="ref5"></nolink> <nolink nlid="nl5" bibid="bib13" firstref="ref7"></nolink> <nolink nlid="nl6" bibid="bib34" firstref="ref10"></nolink> <nolink nlid="nl7" bibid="bib17" firstref="ref17"></nolink> <nolink nlid="nl8" bibid="bib30" firstref="ref18"></nolink> <nolink nlid="nl9" bibid="bib31" firstref="ref19"></nolink> <nolink nlid="nl10" bibid="bib36" firstref="ref26"></nolink> <nolink nlid="nl11" bibid="bib12" firstref="ref27"></nolink> <nolink nlid="nl12" bibid="bib25" firstref="ref28"></nolink> <nolink nlid="nl13" bibid="bib16" firstref="ref29"></nolink> <nolink nlid="nl14" bibid="bib10" firstref="ref33"></nolink> <nolink nlid="nl15" bibid="bib27" firstref="ref34"></nolink> <nolink nlid="nl16" bibid="bib37" firstref="ref35"></nolink> <nolink nlid="nl17" bibid="bib20" firstref="ref38"></nolink> <nolink nlid="nl18" bibid="bib15" firstref="ref46"></nolink> <nolink nlid="nl19" bibid="bib28" firstref="ref48"></nolink> <nolink nlid="nl20" bibid="bib35" firstref="ref49"></nolink> <nolink nlid="nl21" bibid="bib29" firstref="ref50"></nolink> <nolink nlid="nl22" bibid="bib33" firstref="ref52"></nolink> <nolink nlid="nl23" bibid="bib19" firstref="ref53"></nolink> <nolink nlid="nl24" bibid="bib23" firstref="ref54"></nolink> <nolink nlid="nl25" bibid="bib24" firstref="ref55"></nolink> <nolink nlid="nl26" bibid="bib21" firstref="ref62"></nolink> <nolink nlid="nl27" bibid="bib26" firstref="ref72"></nolink> <nolink nlid="nl28" bibid="bib14" firstref="ref74"></nolink>
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Co-Occurrence Patterns of ADHD Symptoms and Reactive and Proactive Aggression in Chinese Adolescents: Associations with Parenting Practices
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Zhengqian+Yang%22">Zhengqian Yang</searchLink> (ORCID <externalLink term="https://orcid.org/0009-0002-8530-6609">0009-0002-8530-6609</externalLink>)<br /><searchLink fieldCode="AR" term="%22Yuhan+Luo%22">Yuhan Luo</searchLink><br /><searchLink fieldCode="AR" term="%22Fumei+Chen%22">Fumei Chen</searchLink><br /><searchLink fieldCode="AR" term="%22Rui+Luo%22">Rui Luo</searchLink><br /><searchLink fieldCode="AR" term="%22Qian+Pu%22">Qian Pu</searchLink><br /><searchLink fieldCode="AR" term="%22Yun+Wang%22">Yun Wang</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Attention+Disorders%22"><i>Journal of Attention Disorders</i></searchLink>. 2026 30(4):542-551.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 10
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2026
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Attention+Deficit+Hyperactivity+Disorder%22">Attention Deficit Hyperactivity Disorder</searchLink><br /><searchLink fieldCode="DE" term="%22Symptoms+%28Individual+Disorders%29%22">Symptoms (Individual Disorders)</searchLink><br /><searchLink fieldCode="DE" term="%22Aggression%22">Aggression</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescents%22">Adolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Parenting+Styles%22">Parenting Styles</searchLink><br /><searchLink fieldCode="DE" term="%22Mothers%22">Mothers</searchLink><br /><searchLink fieldCode="DE" term="%22Discipline%22">Discipline</searchLink><br /><searchLink fieldCode="DE" term="%22Punishment%22">Punishment</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Problems%22">Behavior Problems</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22China%22">China</searchLink>
– Name: SubjectThesaurus
  Label: Assessment and Survey Identifiers
  Group: Su
  Data: <searchLink fieldCode="SU" term="%22Strengths+and+Difficulties+Questionnaire%22">Strengths and Difficulties Questionnaire</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1177/10870547251405074
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1087-0547<br />1557-1246
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: Previous studies have found that ADHD symptoms often co-occur with aggressive behavior in adolescents, and that reactive aggression is more closely related to ADHD symptoms than proactive aggression. However, the specific co-occurrence patterns of ADHD symptoms and different functions of aggression remain unclear, as does their relationship with parenting practices. This study used a person-centered approach to examine the co-occurrence patterns of ADHD symptoms, reactive aggression, and proactive aggression and their associations with parenting practices. Method: A total of 1,152 mother-adolescent dyads participated in this study (adolescents: M[subscript age]=14.29; 48.0% girls). Latent profile analysis was conducted to identify adolescent profiles of ADHD, reactive, and proactive aggression, followed by multinomial logistic regression to examine relationships between these profiles and auxiliary variables. Results: Latent profile analysis identified three patterns of adolescent- and mother-reported ADHD symptoms, reactive aggression, and proactive aggression: "low symptom" (84.4%), "reactive co-occurrence" (10.0%), and "complete co-occurrence" (5.6%). Multinomial logistic regression revealed that adolescents in the complete co-occurrence group had higher rates of corporal punishment, while adolescents in the reactive co-occurrence group exhibited higher rates of verbal hostility. Conclusion: These findings highlight the importance of distinguishing between reactive and proactive aggression in the context of ADHD and suggest that different co-occurrence patterns may be shaped by distinct parenting practices. Addressing specific parenting behaviors could help mitigate aggression in adolescents with ADHD symptoms.
– Name: AbstractInfo
  Label: Abstractor
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  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2026
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1499935
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1499935
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1177/10870547251405074
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 10
        StartPage: 542
    Subjects:
      – SubjectFull: Attention Deficit Hyperactivity Disorder
        Type: general
      – SubjectFull: Symptoms (Individual Disorders)
        Type: general
      – SubjectFull: Aggression
        Type: general
      – SubjectFull: Adolescents
        Type: general
      – SubjectFull: Parenting Styles
        Type: general
      – SubjectFull: Mothers
        Type: general
      – SubjectFull: Discipline
        Type: general
      – SubjectFull: Punishment
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Behavior Problems
        Type: general
      – SubjectFull: China
        Type: general
      – SubjectFull: Strengths and Difficulties Questionnaire
        Type: general
    Titles:
      – TitleFull: Co-Occurrence Patterns of ADHD Symptoms and Reactive and Proactive Aggression in Chinese Adolescents: Associations with Parenting Practices
        Type: main
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            NameFull: Zhengqian Yang
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            NameFull: Yuhan Luo
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            NameFull: Fumei Chen
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            NameFull: Rui Luo
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            NameFull: Qian Pu
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            NameFull: Yun Wang
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          Dates:
            – D: 01
              M: 04
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-print
              Value: 1087-0547
            – Type: issn-electronic
              Value: 1557-1246
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            – Type: volume
              Value: 30
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            – TitleFull: Journal of Attention Disorders
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