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Childhood maltreatment and attention deficit hyperactivity disorder symptoms in adults: a large twin study

Published online by Cambridge University Press:  05 July 2016

A. J. Capusan ,
R. Kuja-Halkola ,
P. Bendtsen ,
E. Viding ,
E. McCrory ,
I. Marteinsdottir  and
H. Larsson
A. J. Capusan*
Affiliation:
Department of Psychiatry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
R. Kuja-Halkola
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
P. Bendtsen
Affiliation:
Department of Medical specialist and Department of Medical and Health Sciences, Linköping, University, Motala, Sweden
E. Viding
Affiliation:
Developmental Risk and Resilience Unit, University College, London UK
E. McCrory
Affiliation:
Developmental Risk and Resilience Unit, University College, London UK
I. Marteinsdottir
Affiliation:
Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience (CSAN), Linköping University, Linköping, Sweden
H. Larsson
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Department of Medical Sciences, Örebro University, Örebro, Sweden
*
*Address for correspondence: Dr A. J. Capusan, Department of Psychiatry and Department of Clinical and Experimental Medicine, Linköping University, SE-581 83 Linköping, Sweden. (Email: andrea.johansson.capusan@liu.se)
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Abstract

Background

Childhood maltreatment (CM) has been associated with increased risk of attention deficit hyperactivity disorder (ADHD) in children and adults. It is, however, unclear whether this association is causal or due to familial confounding.

Method

Data from 18 168 adult twins, aged 20–46 years, were drawn from the population-based Swedish twin registry. Retrospective self-ratings of CM (emotional and physical neglect, physical and sexual abuse and witnessing family violence), and self-ratings for DSM-IV ADHD symptoms in adulthood were analysed. Possible familial confounding was investigated using a within twin-pair design based on monozygotic (MZ) and dizygotic (DZ) twins.

Results

CM was significantly associated with increased levels of ADHD symptom scores in adults [regression coefficient: 0.40 standard deviations, 95% confidence interval (CI) 0.37–0.43]. Within twin-pair analyses showed attenuated but significant estimates within DZ (0.29, 95% CI 0.21–0.36) and MZ (0.18, 95% CI 0.10–0.25) twin pairs. Similar results emerged for hyperactive/impulsive and inattentive ADHD symptom scores separately in association with CM. We conducted sensitivity analyses for early maltreatment, before age 7, and for abuse and neglect separately, and found similarly reduced estimates in DZ and MZ pairs. Re-traumatization after age 7 did not significantly influence results.

Conclusions

CM was significantly associated with increased ADHD symptoms in adults. Associations were partly due to familial confounding, but also consistent with a causal interpretation. Our findings support cognitive neuroscience studies investigating neural pathways through which exposure to CM may influence ADHD. Clinicians treating adults with ADHD should be aware of the association with maltreatment.

Keywords

Adult ADHDchildhood maltreatmentenvironmental riskfamilial confoundingtwins
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 12 , September 2016 , pp. 2637 - 2646
Copyright
Copyright © Cambridge University Press 2016 

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