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Attention-Deficit/Hyperactivity Disorder: Restricted Phenotypes Prevalence, Comorbidity, and Polygenic Risk

Michaela M Cordova1, Dylan M Antovich2, Peter Ryabinin2

  • 1UC San Diego and San Diego State University, California.

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Attention-Deficit/Hyperactivity Disorder (ADHD) affects 3.5% of US children aged 9-10. Stringent diagnostic criteria reveal genetic links and high comorbidity with disruptive behavior and anxiety disorders.

Keywords:
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Area of Science:

  • Child and Adolescent Psychiatry
  • Neurodevelopmental Disorders
  • Genetics and Genomics

Background:

  • Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder impacting children.
  • Understanding ADHD prevalence and comorbidities is crucial for effective intervention and research.
  • Operational definitions significantly influence ADHD diagnosis and associated conditions.

Purpose of the Study:

  • To determine the prevalence and major comorbidities of ADHD in US children using diverse operational definitions.
  • To assess the utility of these definitions against genetic risk and cognitive executive functions.
  • To leverage the national US Adolescent Brain Cognitive Development (ABCD) Study dataset.

Main Methods:

  • Analysis of the ABCD Study dataset (n=11,878) for children aged 9-10 years.
  • Calculation of ADHD prevalence and comorbidity across four phenotype restrictiveness thresholds.
  • Assessment of polygenic risk scores and executive functions in relation to ADHD phenotypes.
  • Statistical control for missingness, sampling, and nesting biases.

Main Results:

  • ADHD prevalence was 3.53% (95% CI 3.14%-3.92%) using a stringent definition requiring convergent parent, teacher, and clinical ratings.
  • Approximately 70% of ADHD cases exhibited comorbid psychiatric disorders.
  • Comorbid disruptive behavior disorders (30.9%) and anxiety/fear disorders (27.4%) were most common.
  • A stringent ADHD phenotype definition identified a significant association with polygenic risk (p < .01).

Conclusions:

  • The DSM-5 definition, requiring multiple informants, yields an ADHD prevalence of approximately 3.5% in 9-10 year olds.
  • ADHD diagnosis is strongly influenced by the chosen operational definition.
  • Findings support the utility of stringent definitions for exploring genetic and cognitive correlates of ADHD.