ADHD In Twins Sample Paper Keiser University

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ADHD IN TWINS 9

ADHD In Twins

Barbara Maclure

Keiser University

ADHD in Twins

Research indicates that genes play an integral role in the etiology of ADHD, attention deficit hyperactivity disorder. Genes also affect the disorder’s comorbidity with other disorders. Adoption, family, and twin studies indicate that ADHD can be inherited. Its heritability is rated around seventy four percent and this led to research in susceptibility genes for the condition (Willcutt, 2019). Studies in genetic linkage indicate that there are minimal effects of DNA risk variants on ADHD.

In nature, ADHD is a condition that commences in childhood and works to induce hyperactivity, impulsivity, and inattention. Research over the years has replicated and documented key knowledge on the disorder. It strikes in nearly five percent of children and varies across cultures or geographies. The disorder also tends to occur together with other conditions including substance abuse disorders, learning disorders, conduct disorders, anxiety, and mood disorders. Studies that are longitudinal in nature indicate that over two thirds of children with ADHD carry the disorder into their adult lives (Chen et al., 2018). The disorder increases the risk for numerous functional impairments.

Clinical Course and Features

The clinical course and features of the disorder are as follows.

Psychiatric comorbidity. Numerously variated studies into siblings and twins indicate a general genetic underpinning and feature that impacts the disorder, and numerous other neuropsychiatric disorders. Research indicates that a latent shared genetic feature is attributed for the following. Thirty one percent of covariance in neurodevelopmental symptoms during childhood. Forty five percent of covariance across phobia, internalizing, and externalizing childhood symptoms. Likened results have been reported for diagnoses that are register based and clinical. Studies show that a common genetic factor was accountable for ten to thirty six percent of disorder liability across numerous psychiatric diagnoses. Research indicates that there have been assessments of the contribution of measured genetic variants for a general psychopathology dimension. There were also estimations of SNP heritability that was rated at eighteen percent for maternal rating of total problems, on the checklist for child behavior. This heritability is a metric for attention, externalizing, and internalizing shortcomings (Greven et al., 2016). For a general psychopathology factors, an estimation of thirty eight percent for the SNP heritability was made from assessment of childhood symptoms, by numerous raters.

Developmental effects. The initial twin studies for the disorder utilized self-reported data and made heritability estimates ranging from thirty to forty percent. These estimates are lower than those of adolescents and children. On the other hand, studies indicated heritability to be at an estimated eighty percent when the data was combined with that of parent ratings. For adults clinically diagnosed with the disorder, the heritability was estimated at around seventy two percent. These discoveries indicate that the heritability of the condition remains stable as the individual moves from childhood to adulthood. Measurement errors attributed to rater effects caused previous reports of minimal heritability, for the disorder’s symptoms in adults (Willcutt, 2019). The set of genetic variabilities accounting for the development of the disorder is differentiated to those accounting for its remission and persistence.

Reporter effects. Teacher and parent rating of the disorder and its symptoms lead to increased heritability that is anywhere between seventy and eighty percent. Self-reporting or rating, on the other hand, has lower heritability for adults and adolescents that is at about fifty percent (Gregory et al., 2017). Studies of twins looked into rater effects and found out that different teacher and parent rating, and self-rating led to lower heritability of the disorder.

Genetic Overlaps

Studies into twins have looked in genetic overlaps between ASD, autism spectrum disorders, and ADHD. Research indicates that genetic factors have an impact on this comorbidity with more than zero point five correlation between the two. The same has been observed in adult twins. Studies all over the world indicate that people with ASD and their loved ones are at a higher risk of developing ADHD (Park et al., 2017). The patterns of associativity between relatives reiterated the existence of a genetic overlap between the disorder and ASD that has been clinically ascertained.

Only a few researches have looked into how genetic factors add to the co-occurrence between an internalizing disorder and ADHD. Studies of large families indicated increases in risk for completed and attempted suicide, in second and first degree relatives of the disorder’s probands. Such patterns of familial risk indicate that common genetic underpinnings are important for ADHD and internalizing disorder associations (Elkins et al., 2018). Similar studies with association to depression in families indicate an association that is also caused by shared genetic and familial underpinnings.

Genetic Heterogeneity

There may be genetic heterogeneity that could make it difficult to study multigenerational families. This is due to a high probability of bi-linearity where ADHD genes emanate from both sides of the family, where both parents have these genes and not just one. Additionally, ADHD susceptibility could emanate from different populations who possess different genes. The risk of protection could be conferred by different alleles in the same locus, as in allelic heterogeneity. Incomplete penetrance could also lead the gene variant to fail to cause a phenotype, and this could be another contributing factor. According to studies, ADHD risk alleles can be common variants in populations leading susceptibility being the norm (Agnew-Blais et al., 2018). Other factors could include epistasis and make it difficult to point out the exact cause and method of inheritance of the disorder in families.

Studies of twins play an integral role in the assessment of the contribution of genetic factors on the etiology of the disorder. The approach was formulated to stifle debate on whether environmental or genetic factors can determine behavioral disorders. The theoretical underpinnings of these studies look into dizygotic or DZ twins and monozygotic or MZ twins (Chen et al., 2018). The former share near half of their genes while the latter share all of their genes. Similar diagnoses or phenotypes between both types could, therefore, be instrumental in analyzing the relative importance of genetic factors in ADHD. Theoretically, DZ twins have a zero point five concordance rate while MZ twins have a rate of one. For the former the rate is for a fully penetrating autosomal dominant gene and a further rate of zero point two five, for a similar recessive gene. This is a rarity due to complex genetic inheritance and environmental effects, leading to concordance ranging at these figures. Alternatively concordance could be greater in MZ twins on instances where genetics play a role in the disorder. Numerous studies have been undertaken globally and the concordance rate averages zero point seven six (Barkley, 2015). This indicates that the environment leads to twenty to thirty percent of ADHD while seventy to eighty percent is emanating from genetic factors.

Mental Health Effects

The mental health symptomatology of children heightens the risk for sexual and peer victimization and maltreatment. Research indicates disruptive behaviors such as conduct disorder and ADHD, can lead to increased future risk of exposure to neglect and abuse. Symptoms of the disruptive behaviors including noncompliance, impulsiveness, and aggressiveness, may lead to caregiving problems making children vulnerable to numerous forms of victimization. These findings build on previous findings that indicate that the disorder increases the risk for future neglect or abuse in adolescence. The theories that try to explain this are as follows. The association could be due to the continuation of conduct problems and ADHD symptoms into adult life. This theory only accounts for longitudinal association but fails to elaborate the significance of the association of the disorder’s symptoms, for individuals above eighteen years of age. This means that these individuals with remitted ADHD are at risk for neglect or abuse. The other theory and effect is that on relationships (Johansson et al., 2018). Regardless of the remission of the disorder, it can be the case that presumptions by others on an individual’s behavior are preserving, of relationship patterns that may be difficult to change.

Research indicates that the behavior and temperament of children influence the reactions and responses of others to them. There is also emphasis on the importance of the role of preventive monitoring for children with conduct problems and the disorder. Monitoring works to reduce their risk of harm as their parents could struggle to keep up with the children’s demands and behaviors. This could impact the children’s risk of undergoing adversity. Close monitoring of this risk should be entailed as part of regular assessments, with health professionals (Godinez et al., 2015). Research conducted in the future should look into the part played by possible mediators including distress tolerance and parenting skills.

References

Agnew-Blais, J. C., Polanczyk, G. V., Danese, A., Wertz, J., Moffitt, T. E., & Arseneault, L. (2018). Young adult mental health and functional outcomes among individuals with remitted, persistent and late-onset ADHD. The British Journal of Psychiatry, 213(3), 526-534. Retrieved from https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/young-adult-mental-health-and-functional-outcomes-among-individuals-with-remitted-persistent-and-lateonset-adhd/F01BAC7B7D8A7264D004701BFE55544B

Barkley, R. A. (2015). History of ADHD. Retrieved from https://psycnet.apa.org/record/2014-57877-001

Chen, Y. C., Sudre, G., Sharp, W., Donovan, F., Chandrasekharappa, S. C., Hansen, N., … & Shaw, P. (2018). Neuroanatomic, epigenetic and genetic differences in monozygotic twins discordant for attention deficit hyperactivity disorder. Molecular psychiatry, 23(3), 683. Retrieved from https://www.nature.com/articles/mp201745

Elkins, I. J., Saunders, G. R., Malone, S. M., Keyes, M. A., McGue, M., & Iacono, W. G. (2018). Associations between childhood ADHD, gender, and adolescent alcohol and marijuana involvement: A causally informative design. Drug and alcohol dependence, 184, 33-41. Retrieved from https://www.sciencedirect.com/science/article/pii/S0376871617305999

Godinez, D. A., Willcutt, E. G., Burgess, G. C., Depue, B. E., Andrews-Hanna, J. R., & Banich, M. T. (2015). Familial risk and ADHD-specific neural activity revealed by case-control, discordant twin pair design. Psychiatry Research: Neuroimaging, 233(3), 458-465. Retrieved from https://www.sciencedirect.com/science/article/pii/S0925492715300421

Gregory, A. M., Agnew-Blais, J. C., Matthews, T., Moffitt, T. E., & Arseneault, L. (2017). Associations between ADHD and sleep quality: Longitudinal analyses from a nationally-representative cohort of twins. Journal of clinical child and adolescent psychology: the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 46(2), 284. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5484392/

Greven, C. U., Merwood, A., van der Meer, J. M., Haworth, C. M., Rommelse, N., & Buitelaar, J. K. (2016). The opposite end of the attention deficit hyperactivity disorder continuum: genetic and environmental aetiologies of extremely low ADHD traits. Journal of Child Psychology and Psychiatry, 57(4), 523-531. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/jcpp.12475

Johansson, V., Norén Selinus, E., Kuja-Halkola, R., Lundström, S., Durbeej, N., Anckarsäter, H., … & Hellner, C. (2018). The Quantified Behavioral Test Failed to Differentiate ADHD in Adolescents With Neurodevelopmental Problems. Journal of attention disorders, 1087054718787034. Retrieved from https://journals.sagepub.com/doi/abs/10.1177/1087054718787034

Park, S. H., Guastella, A. J., Lynskey, M., Agrawal, A., Constantino, J. N., Medland, S. E., … & Colodro-Conde, L. (2017). Neuroticism and the overlap between autistic and ADHD traits: findings from a population sample of young adult Australian twins. Twin Research and Human Genetics, 20(4), 319-329. Retrieved from https://www.cambridge.org/core/journals/twin-research-and-human-genetics/article/neuroticism-and-the-overlap-between-autistic-and-adhd-traits-findings-from-a-population-sample-of-young-adult-australian-twins/6811AE6B78809CDA9B78E450BEFB147F

Willcutt, E. G. (2019). The Etiology of ADHD in Adolescents. ADHD in Adolescents: Development, Assessment, and Treatment, 36. Retrieved from https://books.google.com/books?hl=en&lr=&id=FbG9DwAAQBAJ&oi=fnd&pg=PA36&dq=ADHD+in+twins&ots=Bqb6SR4G4T&sig=tAGOkwoBGq-yn2bvUQdhzopCw14

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