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Multicenter Study
. 2017 Jun;47(6):1595-1604.
doi: 10.1007/s10803-017-3083-7.

A Causal and Mediation Analysis of the Comorbidity Between Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD)

Elena Sokolova  1   2 , Anoek M Oerlemans  3   4 , Nanda N Rommelse  5   6 , Perry Groot  7 , Catharina A Hartman  3 , Jeffrey C Glennon  4 , Tom Claassen  7 , Tom Heskes  7 , Jan K Buitelaar  4   5
Affiliations
Multicenter Study

A Causal and Mediation Analysis of the Comorbidity Between Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD)

Elena Sokolova et al. J Autism Dev Disord. 2017 Jun.

Abstract

Autism spectrum disorder (ASD) and Attention-deficit/hyperactivity disorder (ADHD) are often comorbid. The purpose of this study is to explore the relationships between ASD and ADHD symptoms by applying causal modeling. We used a large phenotypic data set of 417 children with ASD and/or ADHD, 562 affected and unaffected siblings, and 414 controls, to infer a structural equation model using a causal discovery algorithm. Three distinct pathways between ASD and ADHD were identified: (1) from impulsivity to difficulties with understanding social information, (2) from hyperactivity to stereotypic, repetitive behavior, (3) a pairwise pathway between inattention, difficulties with understanding social information, and verbal IQ. These findings may inform future studies on understanding the pathophysiological mechanisms behind the overlap between ASD and ADHD.

Keywords: ADHD; ASD; Comorbidity; Inattention; Social interaction.

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Conflict of interest statement

Conflict of interest

Jan K. Buitelaar has been in the past 3 years a consultant to / member of advisory board of / and/or speaker for Janssen Cilag BV, Eli Lilly, Shire, Lundbeck, Medice and Servier. He is not an employee of any of these companies, and not a stock shareholder of any of these companies. He has no other financial or material support, including expert testimony, patents, royalties. All other authors report no biomedical financial interests or potential conflicts of interest.

Ethical Approval

The study was approved by the local medical ethics board and parents and children (12 years and older) signed for informed consent.

Figures

Fig. 1
Fig. 1
Causal model representing causal relationships between variables in our combined ADHD and ASD data set. Edge directions represent either a causal effect (“A → B”), an unobserved common cause “A ↔ B” or a selection bias “A − B”. Non-identifiable edge directions are marked with a circle mark “∘”. Notation “A ∘ B” is either a causal effect “A → B”, or a selection bias “A − B”; “A ∘ → B” is either a causal effect “A → B”, or a common cause “A ↔ B”; “A ∘ −∘ B” (“A ∘ − ∘ B”) is either a causal effect “A → B” or “A ← B”, a selection bias “A − B” or a common cause “A ↔ B”. No edge between variables means that these variables are conditionally independent given the other variables in the network. Reliability estimates for the presence of an edge are depicted as percentages. Direct links between ASD, ADHD, and IQ are marked in red. (Color figure online)
Fig. 2
Fig. 2
Regression model for mediation analysis that predicts dependent variable (in grey) social ineptness using inattention and impulsivity as a mediator and hyperactivity as independent predictor. The regression model is presented at the top of the figure, the significance of the regression coefficient is shown next to the edge
See this image and copyright information in PMC

References

    1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). Arlington: American Psychiatric Pub.
    1. Alarcon M, Cantor RM, Liu J, Gilliam TC, Autism Genetic Research Exchange Evidence for a language quantitative trait locus on chromosome 7q in multiplex autism families. American Journal of Human Genetics. 2002;70:60–71. doi: 10.1086/338241. - DOI - PMC - PubMed
    1. Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology. 1986;51:1173. doi: 10.1037/0022-3514.51.6.1173. - DOI - PubMed
    1. Biederman J, Mick E, Faraone SV. Age-dependent decline of symptoms of attention deficit hyperactivity disorder: Impact of remission definition and symptom type. American Journal of Psychiatry. 2000;157:816–818. doi: 10.1176/appi.ajp.157.5.816. - DOI - PubMed
    1. Cantwell DP. Attention deficit disorder: A review of the past 10 years. Journal of the American Academy of Child & Adolescent Psychiatry. 1996;35:978–987. doi: 10.1097/00004583-199608000-00008. - DOI - PubMed

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