Childhood maltreatment and attention deficit hyperactivity disorder symptoms in adults: a large twin study
Childhood maltreatment and attention deficit hyperactivity disorder symptoms in adults: a large twin study
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DOI：
10.1017/s0033291716001021
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发表时间：
2016-09-01
影响因子：
6.9
通讯作者：
Larsson, H.
中科院分区：
文献类型：
--
作者：
Capusan, A. J.;Kuja-Halkola, R.;Larsson, H.
儿童虐待（CM）与儿童和成人注意力缺陷多动障碍（ADHD）的风险增加有关。然而，目前尚不清楚这种联系是因果关系还是由于家族混杂。方法数据来自18168对年龄在20-46岁的成年双胞胎，来自瑞典以人口为基础的双胞胎登记处。分析了CM（情绪和身体忽视、身体和性虐待以及目睹家庭暴力）的回顾性自评，以及DSM-IV ADHD成年期症状的自评。使用基于单卵双胞胎（MZ）和异卵双胞胎（DZ）的双胞胎内设计来调查可能的家族性混淆。结果CM与成人ADHD症状评分水平升高显著相关[回归系数：0.40标准差，95%置信区间（CI） 0.37 ~ 0.43]。在对双胞胎的分析中，DZ （0.29, 95% CI 0.21-0.36）和MZ （0.18, 95% CI 0.10-0.25）对双胞胎的估计值减弱但显著。多动/冲动和注意力不集中多动症症状评分分别与CM相关，也出现了类似的结果。我们分别对7岁前的早期虐待以及虐待和忽视进行了敏感性分析，发现DZ和MZ对的估计也同样降低了。7岁以后的再创伤对结果没有显著影响。结论CM与成人ADHD症状增加显著相关。关联部分是由于家族混杂，但也与因果解释一致。我们的研究结果支持认知神经科学研究，研究CM暴露可能影响ADHD的神经通路。治疗成人ADHD的临床医生应该意识到ADHD与虐待的关系。
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.