Links Between Co-occurring Social-Communication and Hyperactive-Inattentive Trait Trajectories

Beate St Pourcain,William P Mandy,Jon Heron,Jean Golding,George Davey Smith,David H Skuse

doi:10.1016/j.jaac.2011.05.015

Abstract

ObjectiveThere 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.MethodStudy 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.ResultsLCGA 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.ConclusionsOur 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.

Highlights

The expression of autism spectrum disorder (ASD) traits and attention-deficit/hyperactivity disorder (ADHD) traits in children from the general population is nonindependent.[1,2,3] This is consistent with the high levels of comorbidity observed between ASD and ADHD, each of which is presumed to lie at the
Given the possibility that the effect of maternal smoking may manifest through familial influences,[39,40] we investigated the association with paternal smoking[41] as part of a sensitivity analysis
ADHD-related developmental pathways during childhood and adolescence were described by four distinct trajectory classes (Figure 2B): 1) persistently impaired children with a high probability of expressing hyperactive-inattentive symptoms (3.94%); 2) children with an intermediate probability (0.2 Ͻ probability Ͻ 0.4) of expressing these symptoms (8.07%); 3) a group of children with a childhoodlimited expression pattern of hyperactive-inattentive symptoms (5.25%); and 4) a low-risk group (82.75%)

Summary

Objective

There is overlap between an autistic and hyperactive-inattentive symptomatology when studied cross-sectionally. Genetic effects are strongly implicated in the co-development of ASD and ADHD traits, they do not account for all of their phenotypic covariation,[1,2,3] implying that environmental risk factors could be common to both conditions Support for this latter hypothesis comes from several epidemiological studies, which suggested the existence of overlapping prenatal/perinatal influences. The selection of autistic symptoms focussed exclusively on the social-communication spectrum of ASD, which is likely to be etiologically distinct from the repetitive behavioral spectrum.[35] Investigated ADHD symptoms comprised the entire ADHD triad, including symptoms of inattention, hyperactivity, and impulsivity.[36] In the presented work, we a) interrogated the interrelationship between co-occurring socialcommunication and hyperactive-inattentive trait trajectories to explore links between trait-specific trajectory types; and b) investigated the evidence for shared prenatal/perinatal risk factors, in particular those that have been previously related to both social-communication and hyperactive-inattentive symptoms on an individual trait basis

METHOD

RESULTS

DISCUSSION