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Examining the comorbidity of ADHD-related behaviours and conduct problems using a twin study design

Child and Adolescent Psychiatry Section, Department of Psychological Medicine, University of Wales College of Medicine, Cardiff, UK

RICHARD HARRINGTON, FRCPsych

University of Manchester Department of Child and Adolescent Psychiatry, Royal Manchester Children's Hospital, Manchester, UK

PETER McGUFFIN, FRCPsych

Social Genetic and Developmental Psychiatry Research Centre, Institute of Psychiatry, London, UK

Correspondence: Professor Anita Thapar, Department of Psychological Medicine, University of Wales College of Medicine, Heath Park, Cardiff C14 4xN, UK

Declaration of interest This study was funded by the Medical Research Council (UK) G9608217.

See editorial, pp. 189–190, this issue.

ABSTRACT

Background Although attention-deficit hyperactivity disorder (ADHD) and conduct disorder (CD) frequently co-occur, the underlying mechanisms for this comorbidity are not well understood.

Aims To examine whether ADHD and conduct problems share common risk factors and whether ADHD+CD is a more heritable variant of ADHD.

Method Questionnaires were sent to 2846 families. Parent-rated data were obtained for 2082 twin pairs and analysed using bivariate genetic analysis and a liability threshold model approach.

Results The overlap of ADHD and conduct problems was explained by common genetic and non-shared environmental factors influencing both categories. Nevertheless, the two categories appeared to be partly distinct in that additional environmental factors influenced conduct problems. It appeared that ADHD+CD was a genetically more severe variant of ADHD.

Conclusions Conduct problems and ADHD share a common genetic aetiology; ADHD+CD appears to be a more severe subtype in terms of genetic loading as well as clinical severity.

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