Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris, France.
Centre de Psychiatrie et Neurosciences, INSERM U894 Team 1, Paris, France.
Eur Child Adolesc Psychiatry. 2019 Feb;28(2):281-288. doi: 10.1007/s00787-018-1206-0. Epub 2018 Sep 28.
Attention Deficit and Hyperactive Disorder (ADHD) and Autism Spectrum Disorders (ASD) are frequent comorbid neurodevelopmental conditions and the overlap between both disorders remains to be delineated. A more complete understanding of the shared genetic and environmental factors is needed. Using a family-based method, we evaluated the risk of ADHD in a group of relatives with an ASD proband (ASD-) and a group of relatives with an ASD and ADHD proband (ASD+). We enrolled 1245 individuals in the study: 499 probands, their 746 first-degree relatives and 140 controls. We used a multivariate generalized estimating equation (GEE) model, in which the dependent variable was the ADHD diagnosis in the relatives and the independent variable the ASD+ or ASD- in probands. We adjusted for sociodemographic factors (age, sex, IQ) and for the nature of the familial relationship with the affected proband (parent or sibling). Among the probands, there were 287 ASD- and 212 ASD+ individuals. ADHD was more frequent in relatives (19%) than in the control group (7%) (p = 0.001). The risk of ADHD was higher in the ASD+ relatives group than in the ASD- relatives group (GEE model OR 1.58 [95% CI 1.04-2.38], p = 0.032). This result was found in parents (OR 1.96 [95% CI 1.14-3.36], but not in siblings (OR 1.28 [95% CI 0.84-1.94], p = 0.434). Our study provides a representative estimate of the family distribution of ADHD in relatives of ASD probands but supports the modest effect of shared genetic and environmental factors between both disorders.
注意缺陷多动障碍(ADHD)和自闭症谱系障碍(ASD)是常见的共患神经发育障碍,两者之间的重叠仍有待阐明。需要更全面地了解两者共有的遗传和环境因素。我们采用基于家庭的方法,评估了一组 ASD 先证者(ASD-)亲属和一组 ASD 合并 ADHD 先证者(ASD+)亲属中 ADHD 的发病风险。我们共纳入了 1245 名研究对象:499 名先证者、746 名一级亲属和 140 名对照者。我们使用多元广义估计方程(GEE)模型,因变量为亲属的 ADHD 诊断,自变量为先证者的 ASD+或 ASD-。我们调整了社会人口统计学因素(年龄、性别、智商)和与受影响先证者的亲属关系性质(父母或兄弟姐妹)。先证者中,287 名为 ASD-,212 名为 ASD+。与对照组(7%)相比,亲属中 ADHD 的发病率更高(19%)(p=0.001)。在 ASD+亲属组中,ADHD 的发病风险高于 ASD-亲属组(GEE 模型 OR 1.58[95%CI 1.04-2.38],p=0.032)。这一结果在父母中发现(OR 1.96[95%CI 1.14-3.36]),但在兄弟姐妹中未发现(OR 1.28[95%CI 0.84-1.94],p=0.434)。我们的研究提供了 ASD 先证者亲属中 ADHD 家族分布的代表性估计值,但支持这两种疾病之间存在共同遗传和环境因素的适度影响。