Christiansen H, Chen W, Oades R D, Asherson P, Taylor E A, Lasky-Su J, Zhou K, Banaschewski T, Buschgens C, Franke B, Gabriels I, Manor I, Marco R, Müller U C, Mulligan A, Psychogiou L, Rommelse N N J, Uebel H, Buitelaar J, Ebstein R P, Eisenberg J, Gill M, Miranda A, Mulas F, Roeyers H, Rothenberger A, Sergeant J A, Sonuga-Barke E J S, Steinhausen H-C, Thompson M, Faraone S V
Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Essen, Germany.
J Neural Transm (Vienna). 2008;115(2):163-75. doi: 10.1007/s00702-007-0837-y. Epub 2008 Jan 16.
Common disorders of childhood and adolescence are attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct disorder (CD). For one to two cases in three diagnosed with ADHD the disorders may be comorbid. However, whether comorbid conduct problems (CP) represents a separate disorder or a severe form of ADHD remains controversial. We investigated familial recurrence patterns of the pure or comorbid condition in families with at least two children and one definite case of DSM-IV ADHDct (combined-type) as part of the International Multicentre ADHD Genetics Study (IMAGE). Using case diagnoses (PACS, parental account) and symptom ratings (Parent/Teacher Strengths and Difficulties [SDQ], and Conners Questionnaires [CPTRS]) we studied 1009 cases (241 with ADHDonly and 768 with ADHD + CP), and their 1591 siblings. CP was defined as > or =4 on the SDQ conduct-subscale, and T > or = 65, on Conners' oppositional-score. Multinomial logistic regression was used to ascertain recurrence risks of the pure and comorbid conditions in the siblings as predicted by the status of the cases. There was a higher relative risk to develop ADHD + CP for siblings of cases with ADHD + CP (RRR = 4.9; 95%CI: 2.59-9.41); p < 0.001) than with ADHDonly. Rates of ADHDonly in siblings of cases with ADHD + CP were lower but significant (RRR = 2.9; 95%CI: 1.6-5.3, p < 0.001). Children with ADHD + CP scored higher on the Conners ADHDct symptom-scales than those with ADHDonly. Our finding that ADHD + CP can represent a familial distinct subtype possibly with a distinct genetic etiology is consistent with a high risk for cosegregation. Further, ADHD + CP can be a more severe disorder than ADHDonly with symptoms stable from childhood through adolescence. The findings provide partial support for the ICD-10 distinction between hyperkinetic disorder (F90.0) and hyperkinetic conduct disorder (F90.1).
儿童和青少年常见的疾病有注意力缺陷多动障碍（ADHD）、对立违抗性障碍（ODD）和品行障碍（CD）。在每三例被诊断为ADHD的病例中，就有一到两例可能存在共病情况。然而，共病的品行问题（CP）究竟是一种单独的疾病还是ADHD的一种严重形式，仍存在争议。作为国际多中心ADHD遗传学研究（IMAGE）的一部分，我们调查了至少有两个孩子且有一例确诊为DSM-IV ADHDct（混合型）的家庭中单纯型或共病情况的家族复发模式。我们使用病例诊断（PACS，家长报告）和症状评分（家长/教师优势与困难问卷[SDQ]以及康纳斯问卷[CPTRS]），对1009例病例（241例仅患ADHD，768例患ADHD + CP）及其1591名兄弟姐妹进行了研究。CP被定义为SDQ品行分量表得分≥4，以及康纳斯对立得分T≥65。使用多项逻辑回归来确定病例状态所预测的兄弟姐妹中单纯型和共病情况的复发风险。与仅患ADHD的病例的兄弟姐妹相比，患ADHD + CP的病例的兄弟姐妹患ADHD + CP的相对风险更高（相对风险率 = 4.9；95%置信区间：2.59 - 9.41；p < 0.001）。患ADHD + CP的病例的兄弟姐妹中仅患ADHD的比例较低，但具有统计学意义（相对风险率 = 2.9；95%置信区间：1.6 - 5.3，p < 0.001）。与仅患ADHD的儿童相比，患ADHD + CP的儿童在康纳斯ADHDct症状量表上得分更高。我们的研究发现，ADHD + CP可能代表一种家族性独特亚型，可能具有独特的遗传病因，这与共分离的高风险一致。此外，ADHD + CP可能是一种比仅患ADHD更严重的疾病，其症状从童年到青少年期都较为稳定。这些发现为ICD - 10中多动障碍（F90.0）和多动品行障碍（F90.1）的区分提供了部分支持。
