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. 2023 Nov;64(11):1596-1607.
doi: 10.1111/jcpp.13851. Epub 2023 Jun 22.

Co-development of attention deficit hyperactivity disorder and autistic trait trajectories from childhood to early adulthood

Amy Shakeshaft  1   2 , Jon Heron  3 , Rachel Blakey  3 , Lucy Riglin  1   2 , George Davey Smith  3 , Evie Stergiakouli  3 , Kate Tilling  3 , Anita Thapar  1   2
Affiliations

Co-development of attention deficit hyperactivity disorder and autistic trait trajectories from childhood to early adulthood

Amy Shakeshaft et al. J Child Psychol Psychiatry. 2023 Nov.

Abstract

Background: Attention deficit hyperactivity disorder (ADHD) and autism, defined as traits or disorders, commonly co-occur. Developmental trajectories of ADHD and autistic traits both show heterogeneity in onset and course, but little is known about how symptom trajectories co-develop into adulthood.

Methods: Using data from a population cohort, the Avon Longitudinal Study of Parents and Children, we examined correlations between ADHD and autistic traits across development, using the Social Communication Disorders Checklist and ADHD subscale of the Strengths and Difficulties Questionnaire. We modelled joint developmental trajectories of parent-reported ADHD and autistic traits between 4 and 25 years, then characterised trajectory classes based on sociodemographic, perinatal, psychopathology, cognition and social functioning variables and tested for associations with neurodevelopmental/psychiatric polygenic scores (PGS).

Results: Three classes of trajectories were identified; a typically developing majority with low-stable ADHD-autistic traits (87%), a male-predominant subgroup with child/adolescent-declining traits (6%) and a subgroup with late-emerging traits (6%). ADHD-autistic trait correlations were greatest in young adulthood for the two nontypically developing classes. There were higher rates of emotional and conduct problems, low IQ, childhood seizures and poor social functioning in the declining and late-emerging classes compared to the low-stable class. Emotional, conduct and peer problems were more prevalent during childhood in the childhood/adolescent-declining class compared to other classes, but were more prevalent in young adulthood in the late-emerging class. Neurodevelopmental/psychiatric PGS also differed: both nontypically developing classes showed elevated ADHD PGS compared to the low-stable group, and the late-emerging group additionally showed elevated schizophrenia PGS and decreased executive function PGS, whereas the declining group showed elevated broad depression PGS.

Conclusions: Distinct patterns of ADHD-autism co-development are present across development in the general population, each with different characterising factors and genetic signatures as indexed by PGS.

Keywords: ADHD; ALSPAC; Autism; genetic; longitudinal; trajectories.

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Figures

Figure 1
Figure 1
Correlation between autistic traits (measured using the SCDC) and ADHD traits (measured using SDQ‐ADHD subscale) at different timepoints throughout development, using Spearman's rank, in total cohort and stratified by trajectory class
Figure 2
Figure 2
Mean trajectories of 3‐class GMM model. The blue line shows SDQ‐ADHD subscale mean values and orange line shows SCDC mean values. Recommended SCDC and SDQ‐ADHD cut‐points are shown with dashed lines of the same colours. Note the change in threshold for SDQ‐ADHD between childhood and late‐adolescence/adulthood
Figure 3
Figure 3
Results from bias‐adjusted three‐step associations of variables with trajectory classes
Figure 4
Figure 4
PGS for neurodevelopmental and psychiatric traits stratified by trajectory class. Means (±95% confidence intervals) for each trajectory class were calculated using the BCH method in MPlus. Note PGS have been Z‐score standardised to aid interpretation
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