Centre for Brain and Cognitive Development, Birkbeck, University of London.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet.
J Abnorm Psychol. 2014 May;123(2):440-51. doi: 10.1037/a0036088. Epub 2014 Apr 14.
Autism spectrum disorders (ASD) and attention deficit hyperactivity disorder (ADHD) show high comorbidity. The following questions were addressed regarding their specific symptoms: What is the factor structure of ASD and ADHD symptoms, to what degree do different symptom domains cluster together, to what extent are these domains caused by the same genetic and environmental influences, and what is the best model of their co-occurrence? A population-based twin cohort of over 17,000 9- and 12-year-olds were assessed using the Autism-Tics, AD/HD, and other Comorbidities parental interview inventory. Principal component analyses were conducted, and symptom domain clustering was assessed. Four multivariate twin models were compared. Factors split into three ASD (social impairments, communication impairments, and restricted repetitive behaviors and interests), and three ADHD (inattention, hyperactivity, and impulsivity) symptom domains. Some ASD-ADHD symptom domain combinations clustered together often, although others not at all. A two-factor common pathway model fit the data, suggesting that ASD and ADHD symptom domains tap into separate "ASD" and "ADHD" latent factors that showed high genetic overlap. All subdomains also showed significant specific genetic and environmental influences, reflecting the etiological heterogeneity both within and between ASD and ADHD. These findings support the conceptual distinction of ASD and ADHD, and demonstrate the considerable natural co-occurrence of particular ASD/ADHD symptom domains. The results imply that more children with 1 condition show features of the other condition than show complete comorbidity. Emphasis on symptom co-occurrence, rather than complete comorbidity between disorders, may help focus clinical approaches and advance molecular genetic research.
自闭症谱系障碍 (ASD) 和注意缺陷多动障碍 (ADHD) 具有很高的共病率。本研究针对其特定症状提出了以下问题：ASD 和 ADHD 症状的因子结构是什么，不同的症状领域聚集在一起的程度如何，这些领域在多大程度上受到相同的遗传和环境影响，以及它们共同发生的最佳模型是什么？本研究使用自闭症-抽搐、AD/HD 及其他共病父母访谈量表，对一个超过 17000 名 9 岁和 12 岁儿童的基于人群的双胞胎队列进行了评估。进行了主成分分析，并评估了症状领域的聚类情况。比较了四种多变量双胞胎模型。因子分为三个 ASD（社交障碍、沟通障碍和受限的重复行为和兴趣）和三个 ADHD（注意力不集中、多动和冲动）症状领域。一些 ASD-ADHD 症状领域组合经常聚集在一起，而另一些则完全没有。一个两因素共同途径模型拟合数据，表明 ASD 和 ADHD 症状领域涉及到单独的“ASD”和“ADHD”潜在因素，这些因素具有很高的遗传重叠。所有子领域也显示出显著的特定遗传和环境影响，反映了 ASD 和 ADHD 内部和之间的病因异质性。这些发现支持 ASD 和 ADHD 的概念区分，并表明特定的 ASD/ADHD 症状领域存在相当大的自然共同发生。结果表明，患有 1 种疾病的儿童中，有更多的儿童表现出另一种疾病的特征，而不是完全共病。强调症状共同发生，而不是疾病之间的完全共病，可能有助于集中临床方法和推进分子遗传学研究。
