ARTICLES
Validity of DSM-IV Subtypes of Attention-Deficit/Hyperactivity Disorder: A Family Study Perspective

https://doi.org/10.1097/00004583-200003000-00011Get rights and content

ABSTRACT

Objective

To test the hypothesis that the clinical severity of subtypes paralleled a gradient of familial severity.

Method

One hundred forty children with attention-deficit/hyperactivity disorder (ADHD) and 120 normal control children and their biological relatives were studied. Because these data had been collected prior to the publication of DSM-IV, DSM-III-R symptoms were used to approximate DSM-IV subtypes using a method the authors had validated in prior work.

Results

The first prediction from the hypothesis was true: rates of ADHD among relatives of each subtype group were greater than rates among relatives of controls. But the second prediction did not hold: rates of ADHD were not significantly higher among relatives of combined-typed probands compared with relatives of other probands. The “gradient model” also predicted that subtypes would not “breed true” (i.e., the subtype of the relative would not be the same as that of the proband). The prediction of non-specificity was refuted for the inattentive and combined subtypes, but hyperactive-impulsive ADHD was found almost exclusively among relatives of hyperactive-impulsive probands.

Conclusions

Although the results are limited by some small subsamples along with the use of a DSM-III-R-ascertained sample, they provide little evidence for the idea that DSM-IV subtypes of ADHD correspond to familially distinct conditions. They also do not confirm the idea that the subtypes fall along a gradient of familial severity. Instead, they suggest that symptom differences among subtypes are due to nonfamilial, environmental causes.

Section snippets

Subjects

We studied 2 groups of families originally ascertained through DSM-III-R-defined ADHD boy probands (Faraone et al., 1993, 1995, 1997, 1998b): 140 children with ADHD and 120 normal control children. Potential subjects were excluded if they had been adopted or if their nuclear family was not available for study. We excluded children if they had major sensorimotor handicaps (e.g., paralysis, deafness, blindness), psychosis, autism, or an estimated Full Scale IQ less than 80. Each of the ADHD

RESULTS

Of the 140 children with ADHD, 139 (99%) met DSM-IV criteria for ADHD: 110 met criteria for the combined subtype, 6 for the hyperactive-impulsive subtype, and 23 for the inattentive subtype. These groups had 381, 19, and 74 first-degree relatives who participated in the study. The small number of hyperactive-impulsive subjects, which is consistent with prior studies, precludes us from drawing any conclusions about that subtype.

Table 1 shows that the ADHD families were of a somewhat lower social

DISCUSSION

We set out to test the hypothesis that the clinical severity of ADHD subtypes paralleled a gradient of familial severity. The first prediction from that hypothesis was true: rates of ADHD among relatives of each subtype group were greater than rates among relatives of controls. But the second prediction did not hold: rates of ADHD were not significantly higher among relatives of combined-typed probands compared with relatives of other probands. The gradient model also predicted that subtypes

REFERENCES (30)

  • J Biederman et al.

    Psychiatric correlates of behavioral inhibition in young children of parents with and without psychiatric disorders

    Arch Gen Psychiatry

    (1990)
  • S Faraone et al.

    Evidence for the independent familial transmission of attention deficit hyperactivity disorder and learning disabilities: results from a family genetic study

    Am J Psychiatry

    (1993)
  • SV Faraone et al.

    Genetic heterogeneity in attention deficit hyperactivity disorder: gender, psychiatric comorbidity and maternal ADHD

    J Abnorm Psychol

    (1995)
  • SV Faraone et al.

    Bipolar and antisocial disorders among relatives of ADHD children: parsing familial subtypes of illness

    Am J Med Genet

    (1998)
  • SV Faraone et al.

    Attention-deficit hyperactivity disorder with bipolar disorder: a familial subtype?

    J Am Acad Child Adolesc Psychiatry

    (1997)
  • Cited by (106)

    • Association between SYP with attention-deficit/hyperactivity disorder in Chinese Han subjects: Differences among subtypes and genders

      2013, Psychiatry Research
      Citation Excerpt :

      Although the present case-control study did not completely replicate the results of the family-based study, it suggested a possible association between SYP with female ADHD-I. Taken together our present and previous findings, we speculate that SYP may be involved in the etiology of ADHD inattentive subtype. This subtype-specific association also has been pointed out by others (Zhang et al., 2005; Roman et al., 2006; Guan et al., 2009; Shang et al., 2011; Liu et al., 2011; Sengupta et al., 2012), which is consistent with reports of heterogeneity among subtypes (Faraone et al., 1995, 2000; Carlson and Mann, 2000; Todd et al., 2001; Nigg et al., 2005; Diamond, 2005; Nikolas and Burt, 2010; Grizenko et al., 2010; Asherson and Gurling, 2012). Our data suggest that the heterogeneity between different subtypes may extend to associations of candidate genes with ADHD.

    • ADHD among adolescents with intellectual disabilities: Pre-pathway influences

      2013, Research in Developmental Disabilities
      Citation Excerpt :

      Our first research question examined parental ADHD symptoms. ADHD has been found to “run in families” and rates of ADHD among first-degree relatives of TD children with ADHD are significantly higher than rates among parents of children without ADHD (Faraone et al., 2000). Analyses examining ADHD symptoms among parents of adolescents in the present sample provided the same evidence of family aggregation.

    • A Pathophysiologic Approach to Growth Problems in Children with Attention-Deficit/Hyperactivity Disorder

      2012, Endocrinology and Metabolism Clinics of North America
      Citation Excerpt :

      Adoption studies found that the percentage of parents who were retrospectively hyperactive as children were 18% in the biologic parents versus 6% in the adopting parents, and 3% in the biological parents of the control group.21 With regard to family studies, 30% to 35% of full siblings of affected children also met ADHD criteria,22 and ADHD was present in more than 25% of first-degree relatives of families having children with ADHD.23 Although genetic studies unequivocally indicate that genes are risk factors for this disorder, they also show that environmental determinants have a strong influence on the development of the disorder.

    View all citing articles on Scopus

    This work was supported in part by NIMH grants R01 MH57934-01 (Dr. Faraone) and RO1 MH41314-07 (Dr. Biederman).

    View full text