Links between co-occurring social-communication and hyperactive-inattentive trait trajectories

Abstract

Objective: There is overlap between an autistic and hyperactive-inattentive symptomatology when studied cross-sectionally. This study is the first to examine the longitudinal pattern of association between social-communication deficits and hyperactive-inattentive symptoms in the general population, from childhood through adolescence. We explored the interrelationship between trajectories of co-occurring symptoms, and sought evidence for shared prenatal/perinatal risk factors.

Method: Study participants were 5,383 singletons of white ethnicity from the Avon Longitudinal Study of Parents and Children (ALSPAC). Multiple measurements of hyperactive-inattentive traits (Strengths and Difficulties Questionnaire) and autistic social-communication impairment (Social Communication Disorder Checklist) were obtained between 4 and 17 years. Both traits and their trajectories were modeled in parallel using latent class growth analysis (LCGA). Trajectory membership was subsequently investigated with respect to prenatal/perinatal risk factors.

Results: LCGA analysis revealed two distinct social-communication trajectories (persistently impaired versus low-risk) and four hyperactive-inattentive trait trajectories (persistently impaired, intermediate, childhood-limited and low-risk). Autistic symptoms were more stable than those of attention-deficit/hyperactivity disorder (ADHD) behaviors, which showed greater variability. Trajectories for both traits were strongly but not reciprocally interlinked, such that the majority of children with a persistent hyperactive-inattentive symptomatology also showed persistent social-communication deficits but not vice versa. Shared predictors, especially for trajectories of persistent impairment, were maternal smoking during the first trimester, which included familial effects, and a teenage pregnancy.

Conclusions: Our longitudinal study reveals that a complex relationship exists between social-communication and hyperactive-inattentive traits. Patterns of association change over time, with corresponding implications for removing exclusivity criteria for ASD and ADHD, as proposed for DSM-5.

FIGURE 1

Parallel latent class growth analysis model structure for social-communication and hyperactive-inattentive traits. Note: C = latent trajectory classes; HI = hyperactive-inattentive symptoms; I = intercept growth parameter; Q = quadratic growth parameter; S = slope growth parameter; SC = social-communication deficits; y = years (children's age at measurement).

FIGURE 2

Trajectories of social-communication deficits (A) and hyperactive-inattentive symptoms (B). Note: Each trait trajectory shows the probability of expressing social-communication deficits (A) or hyperactive-inattentive symptoms (B), with respect to the selected cut-off for high-scoring individuals. CL = childhood-limited; IM = intermediate; LR = low-risk; PI = persistently impaired.