Faculty of Medicine, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund University, Sofiavägen 2D, 22241, Lund, Sweden.
Eur Child Adolesc Psychiatry. 2023 Oct;32(10):1969-1978. doi: 10.1007/s00787-022-02024-4. Epub 2022 Jun 24.
Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are neurodevelopmental disorders with an early onset. Guidelines recommend a careful evaluation of developmental history when assessing the disorders, but it is unclear how children with ADHD and ASD differ from their peers growing up. In this study, physical, family, psychological, social, and educational information were examined in 3623 ethnically diverse children that were prospectively followed from birth to age 15 as part of the Fragile Families and Child Wellbeing Study. Fifteen-thousand variables were screened, and 506 variables included in the final analyses. Accuracy of the most indicative information to predict ADHD and ASD diagnoses in adolescence was evaluated. Adolescents with ADHD (n = 627) and ASD (n = 91) differed from their peers on a plethora of developmental signs, with signs closely related to the core symptoms of the disorders after age 5 being most indicative of the disorders. Predictive models correctly identified 66% of individuals with ADHD and 81% of those with ASD, but 62-88% of identified cases were false positives. The mean proportion of developmental deviations was 18.7% in the ADHD group, 20.0% in the ASD group, and 15.6% in peers; youth with both ADHD and ASD (n = 50) deviated on 21.8% of all developmental signs and had more pronounced deviations than those with ADHD or ASD alone. ADHD and ASD are characterized by broad and non-specific developmental deviations. Developmental information alone cannot be used to accurately predict diagnostic status in adolescence and false positives are likely if the diagnostic process relies heavily on such information. Developmental deviations are part of normal development and common in children without ADHD and ASD. Etiological heterogeneity and considerable temporal fluctuation in the core characteristics of ADHD and ASD may explain the lack of distinct developmental patterns.
注意缺陷多动障碍（ADHD）和自闭症谱系障碍（ASD）是具有早期发病的神经发育障碍。指南建议在评估这些障碍时仔细评估发育史，但目前尚不清楚患有 ADHD 和 ASD 的儿童与同龄人在成长过程中有何不同。在这项研究中，对 3623 名来自不同种族的儿童进行了身体、家庭、心理、社会和教育信息的检查，这些儿童是作为脆弱家庭和儿童健康研究的一部分从出生到 15 岁进行前瞻性随访的。筛选了 15000 个变量，最终分析中包含 506 个变量。评估了最具指示意义的信息预测青少年 ADHD 和 ASD 诊断的准确性。患有 ADHD（n=627）和 ASD（n=91）的青少年与同龄人在许多发育迹象上存在差异，5 岁后与疾病核心症状密切相关的迹象最能提示疾病。预测模型正确识别了 66%的 ADHD 患者和 81%的 ASD 患者，但 62-88%的确诊病例为假阳性。ADHD 组的平均发育偏差比例为 18.7%，ASD 组为 20.0%，对照组为 15.6%；同时患有 ADHD 和 ASD 的青少年（n=50）在所有发育迹象中偏离了 21.8%，比仅患有 ADHD 或 ASD 的青少年偏离更为明显。ADHD 和 ASD 的特征是广泛和非特异性的发育偏差。仅凭发育信息无法准确预测青春期的诊断情况，如果诊断过程严重依赖于此类信息，则可能会出现假阳性。发育偏差是正常发育的一部分，在没有 ADHD 和 ASD 的儿童中也很常见。ADHD 和 ASD 的病因异质性和核心特征的相当大的时间波动可能解释了缺乏独特发育模式的原因。
