Journal of the American Academy of Child & Adolescent Psychiatry
New ResearchSimple Identification of Complex ADHD Subtypes Using Current Symptom Counts
Section snippets
Description of Samples
Data for this study came from three distinct population-based samples (Table 1): the population-representative Missouri Adolescent Female Twin Study (MOAFTS) examined risk factors for alcoholism in young women and adolescents; Missouri Twin Study (MOTWIN) identified both male and female twins from the Missouri Twin Registry for a genetic epidemiological study of ADHD; and Australian Twin ADHD Project (ATAP) is a large mail survey of child and adolescent twins and siblings participating in the
Statistical Methods
Analyses were conducted using Stata Version 10 (StataCorp, College Station, TX). To validate the use of symptom counts in later analyses and provide a template onto which DSM-IV and latent class subtypes can be compared, we first applied principal components analysis (PCA) to the 18 DSM-IV ADHD symptoms, starting from the polychoric correlation matrix and using only observations from the training sample. Extracted factors were not rotated to avoid placing any preexisting diagnostic conventions
Sample Characteristics
The final analysis sample (Table 1) consisted of 4,079 individual monozygotic twins, 4,532 individual dizygotic twins, and 1,127 nontwin siblings with a mean age of 12.5 ± 3.3 years at assessment. The predominantly female (69%) characteristic is largely due to MOAFTS being 100% female, whereas the ATAP and MOTWIN samples exhibit a more equal sex distribution (50% female in ATAP; 35% in MOTWIN).
Overall, 4% of the subjects were assigned to the SI latent class, and 4.6% of the subjects were
Discussion
These results show that it is possible to identify clinically relevant latent class ADHD subtypes using symptom counts only (Table 4, Table 5). Symptom use estimates from the DSM-IV field trials indicated similar predictive ability for all 18 ADHD symptoms. Inattentive and hyperactive-impulsive items were found to better identify subjects with those named characteristics (e.g., inattentive symptom 1 with primarily inattentive type) than cross-dimension (e.g., inattentive symptom 1 with
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This article was reviewed under and accepted by Ad Hoc Editor F. Xavier Castellanos, M.D.
The authors gratefully acknowledge the support of National Institutes of Health grants MH52813 (R. T), MH083823 (A. T), ES013678 (H. V), and MH074272 (H.V.). The Australian work has been supported by the National Health and Medical Research Council (Australia) and the Australian Twin Registry.
The authors thank Andrew C Heath for access to the Missouri Adolescent Female Twin Study (MOAFTS) data set and the Missouri Department of Vital Statistics for access to Missouri Birth Records. This work was conceived and conducted under the guidance of Dr. Richard D. Todd, who passed away from complications of leukemia.