Age-Specific ADHD and Internalizing/Externalizing Comorbidity in Children with Neurofibromatosis Type 1: A Multi-Site Study

Authors

• Dan Liu, Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL 32306, USA.
• Pamela L. Wolters, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
• Bonita P. Klein-Tasman, Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA.
• Karin S. Walsh, Children's National Hospital, Washington, DC 20010, USA.
• Jonathan M. Payne, Murdoch Children's Research Institute, Melbourne 3052, Australia.
• Natalie Pride, Children's Hospital at Westmead, Sydney 2145, Australia.
• Stephanie M. Morris, Kennedy Krieger Institute, Baltimore, MD 21211, USA.
• Yang Hou, Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL 32306, USA.

Document Type

Journal Article

Publication Date

2-6-2026

Journal

Cancers

Volume

18

Issue

3

DOI

10.3390/cancers18030529

Keywords

ADHD; age-varying associations; familial versus sporadic NF1; mental health; neurofibromatosis type 1

Abstract

: The current study tested (1) how ADHD symptoms and internalizing or externalizing problems covaried across ages 3-18 in children with neurofibromatosis type 1 (NF1), and (2) whether demographic and NF1-specific factors moderated the associations. : We analyzed integrated cross-sectional data of 685 observations from 455 children and adolescents with NF1 (M = 9.79 years, SD = 3.88; 43% female) across six institutions in the United States and Australia. ADHD symptoms (inattention and hyperactivity/impulsivity) and internalizing/externalizing problems were assessed via parent-report measures. Time-varying effect modeling was employed to examine the age-specific associations between ADHD symptoms and internalizing/externalizing problems. Moderation analyses tested effects of sex, parental education, and NF1 inheritance mode (familial vs. sporadic). : Inattention and hyperactivity/impulsivity symptoms were associated with greater internalizing and externalizing problems across ages 3-17. Inattention links were similar across ages, while the hyperactivity/impulsivity-externalizing link was stronger in early childhood than during adolescence. NF1 inheritance mode significantly moderated the inattention-externalizing link, with stronger associations observed among children with familial NF1. Other moderators were nonsignificant. : ADHD symptoms are robustly linked to internalizing and externalizing problems from childhood to middle adolescence in children with NF1, with familial NF1 emerging as a potentially elevated risk factor. Future longitudinal and experimental research is needed to inform integrated intervention approaches, especially for those with familial NF1.

APA Citation

Liu, Dan; Wolters, Pamela L.; Klein-Tasman, Bonita P.; Walsh, Karin S.; Payne, Jonathan M.; Pride, Natalie; Morris, Stephanie M.; and Hou, Yang, "Age-Specific ADHD and Internalizing/Externalizing Comorbidity in Children with Neurofibromatosis Type 1: A Multi-Site Study" (2026). GW Authored Works. Paper 8738.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8738

Department

Psychiatry and Behavioral Sciences