学前发展、气质和遗传易感性作为儿童多动症的早期标志物：一项队列研究。
Preschool development, temperament and genetic liability as early markers of childhood ADHD: A cohort study.
作者信息
Tobarra-Sanchez Esther, Riglin Lucy, Agha Sharifah S, Stergiakouli Evie, Thapar Anita, Langley Kate
机构信息
Child and Adolescent Psychiatry Section Division of Psychological Medicine and Clinical Neurosciences and MRC Centre for Neuropsychiatric Genetics and Genomics School of Medicine Cardiff University Cardiff UK.
Cwm Taf Morgannwg University Health Board Cardiff UK.
出版信息
JCPP Adv. 2022 Sep;2(3):e12099. doi: 10.1002/jcv2.12099. Epub 2022 Sep 2.
BACKGROUND
ADHD is associated with multiple adverse outcomes and early identification is important. The present study sets out to identify early markers and developmental characteristics during the first 30 months of life that are associated with ADHD 6 years later.
METHODS
9201 participants from the prospective Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort were included. Outcome measures were parent-rated ADHD symptom scores (Strengths and Difficulties Questionnaire, SDQ) and ADHD diagnosis (Development and Wellbeing Assessment, DAWBA) at age 7. Seventeen putative markers were identified from previous literature and included: pre- and peri-natal risk factors, genetic liability (ADHD polygenic risk scores, PRS), early development, temperament scores and regulatory problems. Associations were examined using regression analysis.
RESULTS
Univariable regression analysis showed that multiple early life factors were associated with future ADHD outcomes, even after controlling for sex and socio-economic status. In a multivariable linear regression model; temperament activity scores ( = 0.107, CI = 0.083-0.132), vocabulary delay ( = 0.605, CI = 0.211-0.988), fine motor delay ( = 0.693, CI = 0.360-1.025) and ADHD PRS ( = 0.184, CI = 0.074-0.294) were associated with future symptoms ( = 10.7%). In a multivariable logistic regression model, ADHD PRS (OR = 1.39, CI = 1.10-1.77) and temperament activity scores (OR = 1.09, CI = 1.04-1.16) showed association with ADHD diagnosis.
CONCLUSION
As well as male sex and lower socio-economic status, high temperament activity levels and motor and speech delays in the first 30 months of life, are associated with childhood ADHD. Intriguingly, given that genetic risk scores are known to explain little of the variance of ADHD outcomes, we found that ADHD PRS added useful predictive information. Future research needs to test whether predictive models incorporating aspects of early development and genetic risk scores are useful for predicting ADHD in clinical practice.
背景
注意力缺陷多动障碍（ADHD）与多种不良后果相关，早期识别很重要。本研究旨在确定生命最初30个月内与6年后ADHD相关的早期标志物和发育特征。
方法
纳入来自阿冯父母与儿童纵向研究（ALSPAC）出生队列的9201名参与者。结局指标为7岁时父母评定的ADHD症状评分（长处与困难问卷，SDQ）和ADHD诊断（发育与幸福评估，DAWBA）。从以往文献中确定了17个假定标志物，包括：产前和围产期危险因素、遗传易感性（ADHD多基因风险评分，PRS）、早期发育、气质评分和调节问题。使用回归分析检验关联性。
结果
单变量回归分析表明，即使在控制了性别和社会经济地位之后，多种早期生活因素仍与未来的ADHD结局相关。在多变量线性回归模型中；气质活动评分（β = 0.107，CI = 0.083 - 0.132）、词汇延迟（β = 0.605，CI = 0.211 - 0.988）、精细运动延迟（β = 0.693，CI = 0.360 - 1.025）和ADHD PRS（β = 0.184，CI = 0.074 - 0.294）与未来症状相关（R² = 10.7%）。在多变量逻辑回归模型中，ADHD PRS（OR = 1.39，CI = 1.10 - 1.77）和气质活动评分（OR = 1.09，CI = 1.04 - 1.16）与ADHD诊断相关。
结论
除了男性性别和较低的社会经济地位外，生命最初30个月内较高的气质活动水平以及运动和语言延迟与儿童期ADHD相关。有趣的是，鉴于已知遗传风险评分对ADHD结局的变异解释很少，我们发现ADHD PRS增加了有用的预测信息。未来的研究需要测试纳入早期发育和遗传风险评分方面的预测模型在临床实践中对预测ADHD是否有用。
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