Childhood attention‐deficit hyperactivity disorder as an extreme of a continuous trait: a quantitative genetic study of 8,500 twin pairs
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Background: Although the clinical utility of categorically defined attention‐deficit hyperactivity disorder (ADHD) is well established, there is also strong evidence supporting the notion of ADHD as an extreme of a continuous trait. Nevertheless, the question of whether the etiology is the same for different levels of DSM–IV ADHD symptoms remains to be investigated. The aim of this study was to assess genetic links between the extreme and the subthreshold range of ADHD symptoms. Method: Parents of all Swedish 9‐ and 12‐year‐old twins born between 1992 and 2000 were interviewed for DSM–IV ADHD symptoms and associated conditions. Two validated cutoff values were used for screening and assigning research diagnoses. Response rate was 80%. Twin methods were applied to investigate the extent to which ADHD is etiologically distinct from subthreshold variations in ADHD symptoms. Results: Extremes analyses indicated a strong genetic link between the extreme and the subthreshold variation, with almost identical group heritability estimates around .60 for the diagnostic (prevalence 1.78%) and screening (prevalence 9.75%) criteria of ADHD. Conclusion: A strong genetic link between the extreme and the subthreshold variation of DSM–IV based assessments of ADHD symptoms was found. The data suggest that ADHD is best viewed as the quantitative extreme of genetic and environmental factors operating dimensionally throughout the distribution of ADHD symptoms, indicating that the same etiologic factors are involved in the full range of symptoms of inattention, hyperactivity and impulsivity.
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Results from twin studies suggest that ADHD is the extreme and impairing tail of one or more heritable quantitative traits.
“Although ADHD is a categorical diagnosis, results from twin studies suggest that it is the extreme and impairing tail of one or more heritable quantitative traits 27 .”
From Attention-deficit/hyperactivity disorder (2015) · cites this paper as [27]
Use of a nonclinical sample may limit the generalizability of these findings.
“In addition, use of a nonclinical sample may limit generalizability of these findings, despite a consensus that ADHD is best conceptualized dimensionally (Barkley, 2006; Haslam et al., 2006; Larsson et al., 2012; Marcus & Barry, 2011).”
From Reproductive steroids and ADHD symptoms across the menstrual cycle (2018) · cites this paper as Larsson et al., 2012
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- Authors
- Larsson, H., Anckarsater, H., Råstam, M., Chang, Z., & Lichtenstein, P.
- Affiliations
- Karolinska Institutet (SE)
- Lund University (SE)
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2011-09-16
- Volume
- 53
- Issue
- 1
- Pages
- 73-80
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- OpenAlex
- W2108644876
- Cited by
- 254
- References
- 44
- Citations by year
- 2026: 8 · 2025: 12 · 2024: 15 · 2023: 23 · 2022: 14 · 2021: 10 · 2020: 19 · 2019: 19 · 2018: 21 · 2017: 20 · 2016: 20 · 2015: 24 · 2014: 24 · 2013: 17 · 2012: 7
- FWCI
- 10.72
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Funders
- Forskningsrådet för Arbetsliv och Socialvetenskap
- Karolinska Institutet
- Vetenskapsrådet (2010-03184)
- 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, twin studies, genetic etiology, inattention, hyperactivity, impulsivity, childhood ADHD
- MeSH terms
- Attention Deficit Disorder with Hyperactivity, Child, Diseases in Twins, Female, Genetic Testing, Health Surveys, Humans, Genetic Linkage, Male, Psychiatric Status Rating Scales, Psychometrics, Severity of Illness Index, Sweden, Twins, Dizygotic, Twins, Monozygotic, Cohort Studies, Prevalence
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