Reiersen Angela M, Constantino John N, Volk Heather E, Todd Richard D
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110-1093, USA.
J Child Psychol Psychiatry. 2007 May;48(5):464-72. doi: 10.1111/j.1469-7610.2006.01720.x.
Most diagnostic nomenclatures do not allow for the concurrent diagnosis of autism and attention-deficit/hyperactivity disorder (ADHD). Clinic-based studies suggest autistic symptoms are common in children with ADHD, but such studies are prone to referral bias. This study assesses whether children with ADHD selected from the general twin population have elevated levels of autistic traits.
Nine hundred forty-six twins identified by Missouri birth records were assigned to DSM-IV ADHD diagnoses and seven population-derived ADHD subtypes defined through latent class analysis of DSM-IV ADHD symptoms. The Social Responsiveness Scale (SRS) was used as a quantitative measure of autistic traits. Linear regression was used to evaluate whether mean SRS scores differed between ADHD diagnostic groups.
Mean SRS scores for DSM-IV predominantly inattentive subtype and combined subtype ADHD groups were significantly higher than for subjects without DSM-IV ADHD (p < .001, both comparisons). Five of the population-derived ADHD subtypes (talkative-impulsive, mild and severe inattentive, mild and severe combined) had significantly higher mean SRS scores compared to the latent class subtype with few ADHD symptoms (p < .001, all comparisons). DSM-IV combined subtype and the population-derived severe combined subtype had the highest mean total SRS scores and the highest mean scores for each of the three autism symptom domains, with a substantial proportion of individuals scoring in the clinically significant range.
This study provides population-based evidence for clinically significant elevations of autistic traits in children meeting diagnostic criteria for ADHD. These results have implications for the design and interpretation of studies of both disorders.
大多数诊断术语不允许同时诊断自闭症和注意力缺陷/多动障碍（ADHD）。基于临床的研究表明，自闭症症状在ADHD儿童中很常见，但此类研究容易出现转诊偏倚。本研究评估了从一般双胞胎人群中选出的ADHD儿童是否具有较高水平的自闭症特征。
通过密苏里州出生记录识别出的946对双胞胎被诊断为DSM-IV ADHD，并通过对DSM-IV ADHD症状进行潜在类别分析定义了七种源自人群的ADHD亚型。社会反应量表（SRS）被用作自闭症特征的定量测量工具。采用线性回归来评估ADHD诊断组之间的平均SRS分数是否存在差异。
DSM-IV主要为注意力不集中亚型和混合型ADHD组的平均SRS分数显著高于无DSM-IV ADHD的受试者（p <.001，两项比较均如此）。与ADHD症状较少的潜在类别亚型相比，五种源自人群的ADHD亚型（健谈冲动型、轻度和重度注意力不集中型、轻度和重度混合型）的平均SRS分数显著更高（p <.001，所有比较均如此）。DSM-IV混合型和源自人群的重度混合型具有最高的平均SRS总分以及三个自闭症症状领域中每个领域的最高平均分数，相当一部分个体的得分处于临床显著范围内。
本研究为符合ADHD诊断标准的儿童自闭症特征在临床上的显著升高提供了基于人群的证据。这些结果对这两种疾病的研究设计和解释具有启示意义。
