Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Dev Psychol. 2012 Mar;48(2):567-74. doi: 10.1037/a0026564. Epub 2011 Dec 19.
There is great variability in the degree to which children with attention deficit/hyperactivity disorder (ADHD) improve through behavioral treatments. This study investigates the influence of the dopamine transporter gene (SCL6A3/DAT1) on outcome of behavioral parent training (BPT). Study subjects were a subsample (n = 50, for whom DAT1 genotypes were available) of a randomized controlled BPT effectiveness study (N = 94) comparing BPT plus ongoing routine clinical care (RCC) versus RCC alone in referred children (4-12 years old) with ADHD. Treatment outcome was based on parent-reported ADHD symptoms and behavioral problems. Presence of 2 versus no or 1 DAT1 10-repeat allele served as moderator variable. Time × Treatment × Genotype effect was analyzed with repeated-measures analysis of variance, controlling for baseline medication status. Results indicate that DAT1 moderated treatment response (p = .009). In children with no or 1 DAT1 10-repeat allele, superior treatment effects of BPT + RCC compared with RCC alone were present (p = .005), which was not the case in children with 2 DAT1 10-repeat alleles (p = .57). Our findings suggest that genetic differences in DAT1 in children with ADHD influence their susceptibility to a behavioral intervention directed at shaping their environment through their parents. The role of the dopamine system in motivation and learning and in the aberrant sensitivity to reinforcement in children with ADHD may explain this moderating effect, given that the management of contingencies is typically addressed in BPT.
患有注意缺陷多动障碍（ADHD）的儿童通过行为治疗改善的程度存在很大差异。本研究调查了多巴胺转运蛋白基因（SCL6A3/DAT1）对行为家长培训（BPT）结果的影响。研究对象是一项随机对照 BPT 有效性研究的亚组（n=50，其中可获得 DAT1 基因型）（N=94），该研究比较了 BPT 加持续常规临床护理（RCC）与单独 RCC 对有 ADHD 的转诊儿童（4-12 岁）的疗效。治疗结果基于父母报告的 ADHD 症状和行为问题。存在 2 个而不是 0 个或 1 个 DAT1 10 重复等位基因作为调节变量。采用重复测量方差分析分析时间×治疗×基因型的影响，同时控制基线药物状态。结果表明，DAT1 调节了治疗反应（p=0.009）。在没有或只有 1 个 DAT1 10 重复等位基因的儿童中，BPT+RCC 治疗的效果优于单独 RCC（p=0.005），而在有 2 个 DAT1 10 重复等位基因的儿童中则不然（p=0.57）。我们的发现表明，ADHD 儿童中 DAT1 的遗传差异影响了他们对通过父母塑造环境的行为干预的敏感性。多巴胺系统在动机和学习中的作用以及在 ADHD 儿童中对强化的异常敏感可能解释了这种调节作用，因为 BPT 通常涉及到对偶然事件的管理。
