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Attention-Deficit Hyperactivity Disorder: A Category or a Continuum? Genetic Analysis of a Large-Scale Twin Study
Abstract
Objective To investigate heritability and continuum versus categorical approaches to attention-deficit hyperactivity disorder (ADHD), using a large-scale twin sample.Method A cohort of 1,938 families with twins and siblings aged 4 to 12 years, recruited from the Australian National Health and Medical Research Council Twin Registry, was assessed for ADHD using a DSM-III-R-based maternal rating scale. Probandwise concordance rates and correlations in monozygotic and dizygotic twins and siblings were calculated, and heritability was examined using the De Fries and Fulker regression technique.Results There was a narrow (additive) heritability of 0.75 to 0.91 which was robust across familial relationships (twin, sibling, and twin-sibling) and across definitions of ADHD as part of a continuum or as a disorder with various symptom cutoffs. There was no evidence for nonadditive genetic variation or for shared family environmental effects.Conclusions These findings suggest that ADHD is best viewed as the extreme of a behavior that varies genetically throughout the entire population rather than as a disorder with discrete determinants. This has implications for the classification of ADHD and for the identification of genes for this behavior, as well as implications for diagnosis and treatment.
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Family, twin and adoption studies show ADHD is familial with high heritability, indicating significant genetic component.
“Family, twin and adoption studies show that ADHD is a familial disorder with high heritability, indicating that a significant genetic component influences risk for the disorder [46-54].”
From European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD (2010) · cites this paper as [54]
ADHD symptoms can be considered dimensionally rather than only categorically.
“although ADHD is typically discussed as a categorical diagnosis, symptoms of ADHD can be considered from a dimensional perspective (Frazier, Youngstrom, & Naugle, 2007; Levy, Hay, McStephen, Wood, & Waldman, 1997).”
From Mindfulness Meditation Training for Attention-Deficit/Hyperactivity Disorder in Adulthood: Current Empirical Support, Treatment Overview, and Future Directions (2015) · cites this paper as Levy, Hay, McStephen, Wood, & Waldman, 1997
Twin studies have supported high levels of heritability for ADHD, indicating a strong genetic basis for the disorder.
“Etiologically, twin studies have supported high levels of heritability (Levy et al, 1997) for ADHD, indicating a strong genetic basis for the disorder.”
From Deviations from the expectable environment in early childhood and emerging psychopathology (2015) · cites this paper as Levy et al, 1997
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Metadata
- Authors
- LEVY, F., HAY, D. A., McSTEPHEN, M., WOOD, C., & WALDMAN, I.
- Affiliations
- Emory University (US)
- UNSW Sydney (AU)
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 1997-06
- Volume
- 36
- Issue
- 6
- Pages
- 737-744
- ISSN
- 0890-8567 (ISSN-L)
- OpenAlex
- W1989251017
- Cited by
- 956
- References
- 55
- Citations by year
- 2026: 11 · 2025: 7 · 2024: 9 · 2023: 16 · 2022: 11 · 2021: 14 · 2020: 21 · 2019: 22 · 2018: 17 · 2017: 32 · 2016: 48 · 2015: 36 · 2014: 29 · 2013: 29 · 2012: 50
- FWCI
- 24.92
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Keywords
- attention deficit hyperactivity disorder, heritability, monozygotic twins, dizygotic twins, additive genetic effects, shared family environment, ADHD classification, gene identification
- MeSH terms
- Attention Deficit Disorder with Hyperactivity, Child, Child, Preschool, Family Health, Female, Humans, Male, Twins, Dizygotic, Twins, Monozygotic
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