Comorbidity of hyperactivity-impulsivity-inattention and conduct problems: risk factors in social, affective, and academic domains.

Children showing a comorbid behavior pattern of hyperactivity-impulsivity-inattention and conduct problems (HIA + CP) were contrasted to children having only an internalizing and externalizing behavior pattern (I + E) and matched controls. Children displaying the HIA + CP behavior pattern were at greater risk on a number of outcome measures in social and academic domains beginning in Grade 3 and continuing into Grade 4. The most marked differences among the three groups were found on peer measures of rejection and friendship and teacher ratings of social skills. On average, almost two-thirds of the HIA + CP group were rejected by their peers compared to one-third of the I + E group and only 12.5% controls. Over 70% of the HIA + CP group had no reciprocated friendships from Grade 3 to Grade 4 compared to less than half of the I + E group and approximately one-fourth of controls. Contrary to much theorizing in the literature, the HIA + CP and I + E groups showed average levels of academic self-concept and did not differ from controls in on measures of social self-concept and academic self-concept and general self-esteem. These findings were interpreted in light of positive illusory biases and the established link between aggressive behavior and egotism. The current article offers partial support for Lynam's (1996) notion of the "fledgling psychopath."