Genetic and Environmental Influences on the Developmental Course of Attention-Deficit/Hyperactivity Disorder Symptoms From Childhood to Adolescence

Abstract

Importance: Attention-deficit/hyperactivity disorder (ADHD) is conceptualized as a neurodevelopmental disorder that is strongly heritable. However, to our knowledge, no study to date has examined the genetic and environmental influences explaining interindividual differences in the developmental course of ADHD symptoms from childhood to adolescence (ie, systematic decreases or increases with age). The reason ADHD symptoms persist in some children but decline in others is an important concern, with implications for prognosis and interventions.

Objective: To assess the proportional impact of genes and the environment on interindividual differences in the developmental course of ADHD symptom domains of hyperactivity/impulsivity and inattention between ages 8 and 16 years.

Design, setting, and participants: A prospective sample of 8395 twin pairs from the Twins Early Development Study, recruited from population records of births in England and Wales between January 1, 1994, and December 31, 1996. Data collection at age 8 years took place between November 2002 and November 2004; data collection at age 16 years took place between February 2011 and January 2013.

Main outcomes and measures: Both DSM-IV ADHD symptom subscales were rated 4 times by participants' mothers.

Results: Estimates from latent growth curve models indicated that the developmental course of hyperactivity/impulsivity symptoms followed a sharp linear decrease (mean score of 6.0 at age 8 years to 2.9 at age 16 years). Interindividual differences in the linear change in hyperactivity/impulsivity were under strong additive genetic influences (81%; 95% CI, 73%-88%). More than half of the genetic variation was specific to the developmental course and not shared with the baseline level of hyperactivity/impulsivity. The linear decrease in inattention symptoms was less pronounced (mean score of 5.8 at age 8 years to 4.9 at age 16 years). Nonadditive genetic influences accounted for a substantial amount of variation in the developmental course of inattention symptoms (54%; 95% CI, 8%-76%), with more than half being specific to the developmental course.

Conclusions and relevance: The large genetic influences on the developmental course of ADHD symptoms are mostly specific and independent of those that account for variation in the baseline level of symptoms. Different sets of genes may be associated with the developmental course vs the baseline level of ADHD symptoms and explain why some children remit from ADHD, whereas others persist. Recent longitudinal imaging data indicate that the maintenance or increase in symptoms is underpinned by atypical trajectories of cortical development. This may reflect a specific genetic liability, distinct from that which contributes to baseline ADHD symptoms, and warrants closer follow-up.

Figure 1. Genetic and Environmental Influences on the Intercept and Slope of Hyperactivity/Impulsivity

Observed mean values of hyperactivity/impulsivity (squares) and model-fitted linear decrease (black line) are represented. The intercept (I), slope (S), and their loadings are indicated (slope loadings equal distance in years from the first measurement, divided by 10 to facilitate computations). The heritability (A), shared environment (C), and nonshared environment (E) standardized components of variance and 95% bootstrapped confidence estimates are provided for I and S (except for the nonsignificant dotted arrows). The width of the arrows is proportional to the effect.

Figure 2. Genetic and Environmental Influences on the Intercept and Slope of Inattention

Observed mean values of inattention (squares) and model-fitted linear decrease (black line) are represented. The intercept (I), slope (S), and their loadings are indicated (slope loadings equal distance in years from the first measurement, divided by 10 to facilitate computations). The additive genetic influences (A), nonadditive genetic influences (D), and nonshared environment (E) standardized components of variance and 95% bootstrapped confidence estimates are provided for I and S (except for the nonsignificant dotted arrows). The width of the arrows is proportional to the effect.