Attention-deficit/hyperactivity disorder in neurofibromatosis type 1
Yang Hou1, Jiaxiu Song1, Dan Liu1
1Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, USA.
Insights
Children with neurofibromatosis type 1 (NF1) exhibit higher attention-deficit/hyperactivity disorder (ADHD) symptoms, peaking in middle childhood. Understanding these age-specific ADHD patterns and profiles is crucial for early intervention in NF1.
Area of Science:
- Pediatric Neurology
- Neurodevelopmental Disorders
- Genetics
Background:
- Neurofibromatosis type 1 (NF1) is a genetic disorder associated with various neurodevelopmental challenges.
- Attention-deficit/hyperactivity disorder (ADHD) is a common comorbidity in children with NF1, impacting cognitive and behavioral functions.
- Limited research exists on age-specific ADHD symptom trajectories and distinct symptom profiles in this population.
Purpose of the Study:
- To characterize age-specific patterns of ADHD symptoms in children with NF1.
- To identify distinct ADHD symptom profiles within this cohort.
- To explore associations between ADHD symptom presentation and demographic/disease-specific factors.
Main Methods:
- A cross-sectional design was employed, analyzing observational data from 656 children with NF1 (ages 3-18).
- Time-varying effect modeling was used to examine age-varying ADHD symptom patterns.
- Latent profile analysis classified children into distinct ADHD symptom profiles.
Main Results:
- Children with NF1 consistently showed elevated inattention and hyperactivity/impulsivity symptoms compared to normative data.
- ADHD symptom patterns followed an inverted U-shaped trajectory, peaking around age 10 years.
- Four ADHD profiles were identified: typical range, severe combined, mild combined, and predominantly inattentive. Female sex and lower parental education correlated with greater symptom severity.
Conclusions:
- ADHD symptoms are prevalent and elevated across childhood in individuals with NF1, with a peak in middle childhood.
- Significant heterogeneity exists in ADHD symptom presentation among children with NF1.
- Early identification, continuous monitoring, and tailored interventions are essential to address the long-term academic, social, and functional consequences of ADHD in NF1.
Aim:
To characterize age-specific patterns of attention-deficit/hyperactivity disorder (ADHD) symptoms and identify symptom profiles, as well as their associations with demographic and disease-specific factors, in a large international sample of children with neurofibromatosis type 1 (NF1).
Method:
Observational data from 904 assessments in 656 children with NF1 (age mean [SD] 9 years 6 months [3 years 11 months]; range 3-18 years; 43.4% female) across eight institutions were pooled. With a cross-sectional design, age-varying ADHD symptom patterns were examined using time-varying effect modeling; latent profile analysis was used to classify symptom profiles.
Results:
Across ages 3 to 17 years, children with NF1 showed elevated inattention and hyperactivity/impulsivity relative to the normative mean, with inverted U-shaped age patterns peaking around age 10 years. Four ADHD profiles emerged: typical range (n = 416; 46.0%); severe combined (n = 199; 22.0%); mild combined (n = 181; 20.0%); and predominantly inattentive (n = 108; 12.0%). Greater symptom severity was associated with female sex and lower parental education.
Interpretation:
ADHD symptoms in children with NF1 were elevated across ages, with the greatest symptom burden in middle childhood, alongside substantial heterogeneity in symptom presentation. These findings underscore the need for early recognition, ongoing monitoring, and individualized interventions to mitigate long-term academic, social, and functional impacts.
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