Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-19T10:35:19.524Z Has data issue: false hasContentIssue false
  • English
  • Français

The heritability of clinically diagnosed attention deficit hyperactivity disorder across the lifespan

Published online by Cambridge University Press:  10 October 2013

H. Larsson ,
Z. Chang ,
B. M. D'Onofrio  and
P. Lichtenstein
H. Larsson*
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Z. Chang
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
B. M. D'Onofrio
Affiliation:
Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
P. Lichtenstein
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
*
*Address for correspondence: Dr H. Larsson, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, Stockholm SE-171 77, Sweden. (Email: Henrik.Larsson@ki.se)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

No prior twin study has explored the heritability of clinically diagnosed attention deficit hyperactivity disorder (ADHD). Such studies are needed to resolve conflicting results regarding the importance of genetic effects for ADHD in adults. We aimed to estimate the relative contribution of genetic and environmental influences for clinically diagnosed ADHD across the lifespan with a specific focus on ADHD in adults.

Method

Information on zygosity and sex was obtained from 59514 twins born between 1959 and 2001 included in the nationwide population-based Swedish Twin Registry. Clinical data for ADHD diagnoses (i.e. stimulant or non-stimulant medication for ADHD) were obtained from the Swedish Prescribed Drug Register (PDR) and from the National Patient Register (i.e. ICD-10 diagnosis of ADHD). Twin methods were applied to clinical data of ADHD diagnoses using structural equation modeling with monozygotic (MZ) and dizygotic (DZ) twins.

Results

The best-fitting model revealed a high heritability of ADHD [0.88, 95% confidence interval (CI) 0.83–0.92] for the entire sample. However, shared environmental effects were non-significant and of minimal importance. The heritability of ADHD in adults was also substantial (0.72, 95% CI 0.56–0.84).

Conclusions

This study shows that the heritability of clinically diagnosed ADHD is high across the lifespan. Our finding of high heritability for clinically diagnosed ADHD in adults indicates that the previous reports of low heritability are best explained by rater effects, and that gene-identification studies of ADHD in adults need to consider pervasiveness (e.g. multiple raters) and developmentally (e.g. childhood-onset criteria) informative data.

Keywords

ADHDadultsheritabilitytwin study
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 10 , July 2014 , pp. 2223 - 2229
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Biederman, J, Faraone, S, Milberger, S, Curtis, S, Chen, L, Marrs, A, Ouellette, C, Moore, P, Spencer, T (1996). Predictors of persistence and remission of ADHD into adolescence: results from a four-year prospective follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry 35, 343–351.CrossRefGoogle ScholarPubMed
Biederman, J, Faraone, SV, Mick, E, Spencer, T, Wilens, T, Kiely, K, Guite, J, Ablon, JS, Reed, E, Warburton, R (1995). High risk for attention deficit hyperactivity disorder among children of parents with childhood onset of the disorder: a pilot study. American Journal of Psychiatry 152, 431–435.Google Scholar
Boomsma, DI, Saviouk, V, Hottenga, JJ, Distel, MA, de Moor, MH, Vink, JM, Geels, LM, van Beek, JH, Bartels, M, de Geus, EJ, Willemsen, G (2010). Genetic epidemiology of attention deficit hyperactivity disorder (ADHD index) in adults. PLoS One 5, e10621.Google Scholar
Burt, SA (2009). Rethinking environmental contributions to child and adolescent psychopathology: a meta-analysis of shared environmental influences. Psychological Bulletin 135, 608–637.CrossRefGoogle ScholarPubMed
Chang, Z, Lichtenstein, P, Asherson, PJ, Larsson, H (2013). Developmental twin study of attention problems: high heritabilities throughout development. JAMA Psychiatry 70, 311–318.Google Scholar
Chen, W, Zhou, K, Sham, P, Franke, B, Kuntsi, J, Campbell, D, Fleischman, K, Knight, J, Andreou, P, Arnold, R, Altink, M, Boer, F, Boholst, MJ, Buschgens, C, Butler, L, Christiansen, H, Fliers, E, Howe-Forbes, R, Gabriels, I, Heise, A, Korn-Lubetzki, I, Marco, R, Medad, S, Minderaa, R, Muller, UC, Mulligan, A, Psychogiou, L, Rommelse, N, Sethna, V, Uebel, H, McGuffin, P, Plomin, R, Banaschewski, T, Buitelaar, J, Ebstein, R, Eisenberg, J, Gill, M, Manor, I, Miranda, A, Mulas, F, Oades, RD, Roeyers, H, Rothenberger, A, Sergeant, J, Sonuga-Barke, E, Steinhausen, HC, Taylor, E, Thompson, M, Faraone, SV, Asherson, P (2008). DSM-IV combined type ADHD shows familial association with sibling trait scores: a sampling strategy for QTL linkage. American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics 147B, 1450–1460.CrossRefGoogle ScholarPubMed
Faraone, SV (2004). Genetics of adult attention-deficit/hyperactivity disorder. Psychiatric Clinics of North America 27, 303–321.CrossRefGoogle ScholarPubMed
Faraone, SV, Biederman, J, Monuteaux, MC (2000). Toward guidelines for pedigree selection in genetic studies of attention deficit hyperactivity disorder. Genetic Epidemiology 18, 1–16.Google Scholar
Faraone, SV, Perlis, RH, Doyle, AE, Smoller, JW, Goralnick, JJ, Holmgren, MA, Sklar, P (2005). Molecular genetics of attention-deficit/hyperactivity disorder. Biological Psychiatry 57, 1313–1323.Google Scholar
Franke, B, Faraone, SV, Asherson, P, Buitelaar, J, Bau, CH, Ramos-Quiroga, JA, Mick, E, Grevet, EH, Johansson, S, Haavik, J, Lesch, KP, Cormand, B, Reif, A (2012). The genetics of attention deficit/hyperactivity disorder in adults, a review. Molecular Psychiatry 17, 960–987.CrossRefGoogle ScholarPubMed
Kan, KJ, Dolan, CV, Nivard, MG, Middeldorp, CM, van Beijsterveldt, CE, Willemsen, G, Boomsma, DI (2013). Genetic and environmental stability in attention problems across the lifespan: evidence from the Netherlands Twin Register. Journal of the American Academy of Child and Adolescent Psychiatry 52, 12–25.Google Scholar
Larsson, H, Anckarsater, H, Rastam, M, Chang, Z, Lichtenstein, P (2012). Childhood attention-deficit hyperactivity disorder as an extreme of a continuous trait: a quantitative genetic study of 8,500 twin pairs. Journal of Child Psychology and Psychiatry and Allied Disciplines 53, 73–80.Google Scholar
Larsson, H, Asherson, P, Chang, Z, Ljung, T, Friedrichs, B, Larsson, JO, Lichtenstein, P (2013 a). Genetic and environmental influences on adult attention deficit hyperactivity disorder symptoms: a large Swedish population-based study of twins. Psychological Medicine 43, 197–207.Google Scholar
Larsson, H, Dilshad, R, Lichtenstein, P, Barker, ED (2011). Developmental trajectories of DSM-IV symptoms of attention-deficit/hyperactivity disorder: genetic effects, family risk and associated psychopathology. Journal of Child Psychology and Psychiatry and Allied Disciplines 52, 954–963.CrossRefGoogle ScholarPubMed
Larsson, H, Lichtenstein, P, Larsson, JO (2006). Genetic contributions to the development of ADHD subtypes from childhood to adolescence. Journal of the American Academy of Child and Adolescent Psychiatry 45, 973–981.CrossRefGoogle Scholar
Larsson, H, Ryden, E, Boman, M, Langstrom, N, Lichtenstein, P, Landen, M (2013 b). Risk of bipolar disorder and schizophrenia in relatives of people with attention-deficit hyperactivity disorder. British Journal of Psychiatry 203, 103–106.Google Scholar
Levy, F, Hay, DA, McStephen, M, Wood, C, Waldman, I (1997). Attention-deficit hyperactivity disorder: a category or a continuum? Genetic analysis of a large-scale twin study. Journal of the American Academy of Child and Adolescent Psychiatry 36, 737–744.Google Scholar
Lichtenstein, P, Carlstrom, E, Rastam, M, Gillberg, C, Anckarsater, H (2010). The genetics of autism spectrum disorders and related neuropsychiatric disorders in childhood. American Journal of Psychiatry 167, 1357–1363.CrossRefGoogle ScholarPubMed
Lichtenstein, P, Sullivan, PF, Cnattingius, S, Gatz, M, Johansson, S, Carlstrom, E, Bjork, C, Svartengren, M, Wolk, A, Klareskog, L, de Faire, U, Schalling, M, Palmgren, J, Pedersen, NL (2006). The Swedish Twin Registry in the third millennium: an update. Twin Research and Human Genetics 9, 875–882.Google Scholar
Merwood, A, Greven, CU, Price, TS, Rijsdijk, F, Kuntsi, J, Mcloughlin, G, Larsson, H, Asherson, PJ (2013). Different heritabilities but shared etiological influences for parent, teacher and self-ratings of ADHD symptoms: an adolescent twin study. Psychological Medicine 43, 1973–1984.Google Scholar
Neale, MC, Boker, SM, Xie, G, Maes, HH (2003). Mx Statistical Modeling. Department of Psychiatry, VCU Box 900126: Richmond, VA 23298.Google Scholar
Nikolas, MA, Burt, SA (2010). Genetic and environmental influences on ADHD symptom dimensions of inattention and hyperactivity: a meta-analysis. Journal of Abnormal Psychology 119, 1–17.Google Scholar
Reiersen, AM, Constantino, JN, Grimmer, M, Martin, NG, Todd, RD (2008). Evidence for shared genetic influences on self-reported ADHD and autistic symptoms in young adult Australian twins. Twin Research and Human Genetics 11, 579–585.Google Scholar
Rijsdijk, FV, Sham, PC (2002). Analytic approaches to twin data using structural equation models. Briefings in Bioinformatics 3, 119–133.Google Scholar
Sherman, DK, McGue, MK, Iacono, WG (1997). Twin concordance for attention deficit hyperactivity disorder: a comparison of teachers’ and mothers’ reports. American Journal of Psychiatry 154, 532–535.Google ScholarPubMed
Thapar, A, Harrington, R, Ross, K, McGuffin, P (2000). Does the definition of ADHD affect heritability? Journal of the American Academy of Child and Adolescent Psychiatry 39, 1528–1536.CrossRefGoogle ScholarPubMed
van den Berg, SM, Willemsen, G, de Geus, EJ, Boomsma, DI (2006). Genetic etiology of stability of attention problems in young adulthood. American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics 141B, 55–60.CrossRefGoogle ScholarPubMed
Wettermark, B, Hammar, N, Fored, CM, Leimanis, A, Otterblad Olausson, P, Bergman, U, Persson, I, Sundstrom, A, Westerholm, B, Rosen, M (2007). The new Swedish Prescribed Drug Register – opportunities for pharmacoepidemiological research and experience from the first six months. Pharmacoepidemiology and Drug Safety 16, 726–735.Google Scholar
WHO (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organization: Geneva.Google Scholar