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A Twin Study of the Relationships among Inattention, Hyperactivity/Impulsivity and Sluggish Cognitive Tempo Problems

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Abstract

We investigated the etiological relationships between the three ADHD dimensions of Inattentive Problems (INP), Hyperactivity-Impulsivity Problems (HIP) and Sluggish Cognitive Tempo (SCT) as measured by the CBCL 6–18 questionnaire. Multivariate models were applied to 398 twin pairs (374 boys and 422 girls) aged 8 to 17 years (M = 13.06, SD = 2.59) belonging to the population-based Italian Twin Registry. The INP, HIP and SCT problem scores were moderately-to-substantially (range 0.29–0.47) intercorrelated. The best fitting model showed that these 3 dimensions are correlated both at the genetic (correlations’ range: 0.65–0.83) and the environmental (correlations: 0.29 and 0.44) levels, but they are also distinct. While SCT showed moderate heritability and large non-shared environmental influences, variance for both INP and HIP was substantially explained by genetic influences. We also found evidence of negative sibling interaction for INP, implying that a given behavior in one twin leads to an opposite behavior in the co-twin. Our results support at the etiological level the findings of previous psychometric and longitudinal studies of ADHD, which yielded evidence of the 3 distinct—albeit correlated—problem dimensions of inattentiveness, hyperactivity-impulsivity, and sluggish cognitive tempo.

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References

  • Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-age forms & profiles. Burlington, VT: University of Vermont, Research: ASEBA.

    Google Scholar 

  • Achenbach, T. M., Dumenci, L., & Rescorla, L. A. (2003). DSM-oriented and empirically based approaches to constructing scales from the same item pools. Journal of Clinical Child and Adolescent Psychology, 32, 328–340.

    Article  PubMed  Google Scholar 

  • Achenbach, T. M., Becker, A., Dopfner, M., Heiervang, E., Roessner, V., Steinhausen, H. C., et al. (2008). Multicultural assessment of child and adolescent psychopathology with ASEBA and SDQ instruments: research findings, applications, and future directions. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 49, 251–275.

    Article  PubMed  Google Scholar 

  • Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Thousand Oaks: Sage.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edn. Text Revision ed). Washington, DC, USA: American.

    Google Scholar 

  • Barkley, R. A. (1997). Advancing age, declining ADHD. The American Journal of Psychiatry, 154, 1323–1325.

    PubMed  Google Scholar 

  • Barkley, R. A. (2011). Distinguishing sluggish cognitive tempo from attention-deficit/hyperactivity disorder in adults. Journal of Abnormal Psychology, 121, 978–990.

    Article  PubMed  Google Scholar 

  • Bauermeister, J. J., Barkley, R. A., Bauermeister, J. A., Martinez, J. V., & McBurnett, K. (2011). Validity of the sluggish cognitive tempo, inattention, and hyperactivity symptom dimensions: neuropsychological and psychosocial correlates. Journal of Abnormal Child Psychology, 40, 683–697.

    Article  Google Scholar 

  • Becker, S. P., & Langberg, J. M. (2012). Sluggish cognitive tempo among young adolescents with ADHD: Relations to mental health, academic, and social functioning. Journal of Attention Disorders.

  • Becker, S. P., Luebbe, A. M., Stoppelbein, L., Greening, L., & Fite, P. J. (2012). Aggression among children with ADHD, anxiety, or co-occurring symptoms: competing exacerbation and attenuation hypotheses. Journal of Abnormal Child Psychology, 40, 527–542.

    Article  PubMed  Google Scholar 

  • Becker, S. P., Luebbe, A. M., Fite, P. J., Stoppelbein, L.,. Greening, L. (2013). Sluggish Cognitive Tempo in Psychiatrically Hospitalized Children: Factor Structure and Relations to Internalizing Symptoms, Social Problems, and Observed Behavioral Dysregulation. Journal of Abnormal Child Psychology.

  • Boomsma, D. I. (2005). Sibling interaction effects. In B. Everitt & D. Howell (Eds.), Encyclopedia of statistics in behavioral science (pp. 1831–1832). Chisester: John Wiley & Sons.

    Google Scholar 

  • Carlson, C. L., & Mann, M. (2002). Sluggish cognitive tempo predicts a different pattern of impairment in the attention deficit hyperactivity disorder, predominantly inattentive type. Journal of Clinical Child and Adolescent Psychology : The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 3, 123–129.

  • Cox, A., Rutter, M., Yule, B., & Quinton, D. (1977). Bias resulting from missing information: some epidemiological findings. British Journal of Preventive & Social Medicine, 31, 131–136.

    Google Scholar 

  • Derks, E. M., Dolan, C. V., & Boomsma, D. I. (2004). Effects of censoring on parameter estimates and power in genetic modeling. Twin Research: The Official Journal of the International Society for Twin Studies, 7, 659–669.

    Google Scholar 

  • Derks, E. M., Hudziak, J. J., Boomsma, D. I. (2009). Genetics of ADHD, hyperactivity, and attention problems. Handbook Of Behavior Genetics (pp. 361–378).

  • Eaves, L. (1976). A model for sibling effects in man. Heredity, 36, 205–214.

    Article  PubMed  Google Scholar 

  • Eaves, L. J., Silberg, J. L., Meyer, J. M., Maes, H. H., Simonoff, E., Pickles, A., et al. (1997). Genetics and developmental psychopathology: 2. the main effects of genes and environment on behavioral problems in the Virginia twin study of adolescent behavioral development. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 38, 965–980.

    Article  PubMed  Google Scholar 

  • Faraone, S. V., Biederman, J., Keenan, K., & Tsuang, M. T. (1991). Separation of DSM-III attention deficit disorder and conduct disorder: evidence from a family-genetic study of American child psychiatric patients. Psychological Medicine, 21, 109–121.

    Article  PubMed  Google Scholar 

  • Faraone, S. V., Biederman, J., Spencer, T., Wilens, T., Seidman, L. J., Mick, E., et al. (2000). Attention-deficit/hyperactivity disorder in adults: an overview. Biological Psychiatry, 48, 9–20.

    Article  PubMed  Google Scholar 

  • Freitag, C. M., Rohde, L. A., Lempp, T., & Romanos, M. (2010). Phenotypic and measurement influences on heritability estimates in childhood ADHD. European Child & Adolescent Psychiatry, 19, 311–323.

    Article  Google Scholar 

  • Frick, P. J., Lahey, B. B., Applegate, B., Kerdyck, L., Ollendick, T., Hynd, G. W., et al. (1994). DSM-IV field trials for the disruptive behavior disorders: symptom utility estimates. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 529–539.

    Article  PubMed  Google Scholar 

  • Frigerio, A., Cattaneo, C., Cataldo, M. G., Schiatti, A., Molteni, M., & Battaglia, M. (2004). Behavioral and emotional problems among Italian children and adolescents aged 4 to 18 years as reported by parents and teachers. European Journal of Psychological Assessment, 20, 124–133.

    Article  Google Scholar 

  • Garner, A. A., Marceaux, J. C., Mrug, S., Patterson, C., & Hodgens, B. (2010). Dimensions and correlates of attention deficit/hyperactivity disorder and sluggish cognitive tempo. Journal of Abnormal Child Psychology, 38, 1097–1107.

    Article  PubMed Central  PubMed  Google Scholar 

  • Goldsmith, H. H. (1991). A zygosity questionnaire for young twins: a research note. Behavior Genetics, 21, 257–269.

    Article  PubMed  Google Scholar 

  • Greven, C. U., Rijsdijk, F. V., & Plomin, R. (2011). A twin study of ADHD symptoms in early adolescence: hyperactivity-impulsivity and inattentiveness show substantial genetic overlap but also genetic specificity. Journal of Abnormal Child Psychology, 39, 265–275.

    Article  PubMed  Google Scholar 

  • Greven, C. U., Rijsdijk, F. V., Asherson, P., & Plomin, R. (2011). A longitudinal twin study on the association between inattentive and hyperactive-impulsive ADHD symptoms. Journal of Abnormal Child Psychology, 53, 234–242.

    Google Scholar 

  • Haberstick, B. C. (2008). Genetic and environmental contributions to retrospectively reported DSM-IV childhood attention deficit hyperactivity disorder. Psychological Medicine, 38, 1057.

    Article  PubMed  Google Scholar 

  • Harrington, K. M., & Waldman, I. D. (2010). Evaluating the utility of sluggish cognitive tempo in discriminating among DSM-IV ADHD subtypes. Journal of Abnormal Child Psychology, 38, 173–184.

    Article  PubMed  Google Scholar 

  • Hartman, C. A., Willcutt, E. G., Rhee, S. H., & Pennington, B. F. (2004). The relation between sluggish cognitive tempo and DSM-IV ADHD. Journal of Abnormal Child Psychology, 32, 491–503.

    Article  PubMed  Google Scholar 

  • Hay, D. A., Bennett, K. S., Mcstephen, M., Rooney, R., & Levy, F. (2004). Attention deficit—hyperactivity disorder in twins: a developmental genetic analysis. Australian Journal of Psychology, 56, 99–107.

    Article  Google Scholar 

  • Heath, A. C., Neale, M. C., Hewitt, J. K., Eaves, L. J., & Fulker, D. W. (1989). Testing structural equation models for twin data using LISREL. Behavior Genetics, 19, 9–35.

    Article  PubMed  Google Scholar 

  • Hewitt, J. K. (1993). The new quantitative genetic epidemiology of behavior. In R. Plomin & G.E. McClearn (Eds), Nature, nurture & psychology, (401–415). Washington, DC, US.

  • Hinshaw, S. P., Carte, E. T., Sami, N., Treuting, J. J., & Zupan, B. A. (2002). Preadolescent girls with attention-deficit/hyperactivity disorder: II. neuropsychological performance in relation to subtypes and individual classification. Journal of Consulting and Clinical Psychology, 70, 1099–1111.

    Article  PubMed  Google Scholar 

  • Hofvander, B., Stahlberg, O., Nyden, A., Wentz, E., degl'Innocenti, A., Billstedt, E., et al. (2011). Life history of aggression scores are predicted by childhood hyperactivity, conduct disorder, adult substance abuse, and low cooperativeness in adult psychiatric patients. Psychiatry Research, 185, 280–285.

    Article  PubMed  Google Scholar 

  • Hudziak, J. J., Derks, E. M., Althoff, R. R., Rettew, D. C., & Boomsma, D. I. (2005). The genetic and environmental contributions to attention deficit hyperactivity disorder as measured by the Conners’ rating scales-revised. The American Journal of Psychiatry, 162, 1614–1620.

    Article  PubMed  Google Scholar 

  • ISTAT. (2003). Rapporto annuale 2002. Roma: Istituto Nazionale di statistica.

    Google Scholar 

  • Krol, N. P., De Bruyn, E. E., Coolen, J. C., van Aarle, E. J. (2006). From CBCL to DSM: A comparison of two methods to screen for DSM-IV diagnoses using CBCL data. Journal of Clinical Child and Adolescent Psychology : The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 35, 127–135.

    Google Scholar 

  • Lahey, B. B., Pelham, W. E., Schaughency, E. A., Atkins, M. S., Murphy, H. A., Hynd, G., et al. (1988). Dimensions and types of attention deficit disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 330–335.

    Article  PubMed  Google Scholar 

  • Lahey, B. B., Applegate, B., McBurnett, K., Biederman, J., Greenhill, L., Hynd, G. W., et al. (1994). DSM-IV field trials for attention deficit hyperactivity disorder in children and adolescents. The American Journal of Psychiatry, 151, 1673–1685.

    PubMed  Google Scholar 

  • Levy, F., Hay, D., & Bennett, K. (2006). Genetics of attention deficit hyperactivity disorder: a current review and future prospects. International Journal of Disability, Development and Education, 53, 5–20.

    Article  Google Scholar 

  • McBurnett, K., Pfiffner, L. J., & Frick, P. J. (2001). Symptom properties as a function of ADHD type: an argument for continued study of sluggish cognitive tempo. Journal of Abnormal Child Psychology, 29, 207–213.

    Article  PubMed  Google Scholar 

  • McLoughlin, G. G. (2007). Genetic support for the dual nature of attention deficit hyperactivity disorder: substantial genetic overlap between the inattentive and hyperactive-impulsive components. Journal of Abnormal Child Psychology, 35, 999–1008.

    Article  PubMed Central  PubMed  Google Scholar 

  • Moruzzi, S., Ogliari, A., Ronald, A., Happe, F., & Battaglia, M. (2011). The nature of covariation between autistic traits and clumsiness: a twin study in a general population sample. Journal of Autism and Developmental Disorders, 41, 665–674.

    Article  Google Scholar 

  • Nadder, T. S., Silberg, J. L., Rutter, M., Maes, H. H., & Eaves, L. J. (2001). Comparison of multiple measures of ADHD symptomatology: a multivariate genetic analysis. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 42, 475–486.

    Article  PubMed  Google Scholar 

  • Nakamura, B. J., Ebesutani, C., Bernstein, A., & Chorpita, B. F. (2009). A psychometric analysis of the child behavior checklist DSM-oriented scales. Journal of Psychopathology and Behavioral Assessment, 31, 178189.

    Article  Google Scholar 

  • Neale, M. C., & Cardon, L. R. (1992). Methodology for genetic studies of twins and families. Dordrecht, The Netherlands: Kluwer.

  • Neale, M. C., Boker, S. M., Xie, G., & Maes, H. (2003). Mx: Statistical modeling (6th ed.). Richmond, VA: Department of Psychiatry. Virginia Institute for Psychiatric and Behavior Genetics, Virginia Commonwealth University.

  • Nikolas, M. A., & Burt, S. A. (2010). Genetic and environmental influences on ADHD symptom dimensions of inattention and hyperactivity: a meta-analysis. Journal of Abnormal Psychology, 119, 1–17.

    Article  PubMed  Google Scholar 

  • Ogliari, A., Citterio, A., Zanoni, A., Fagnani, C., Patriarca, V., Cirrincione, R., et al. (2006). Genetic and environmental influences on anxiety dimensions in italian twins evaluated with the SCARED questionnaire. Journal of Anxiety Disorders, 20, 760–777.

    Article  PubMed  Google Scholar 

  • Penny, A. M., Waschbusch, D. A., Klein, R. M., Corkum, P., & Eskes, G. (2009). Developing a measure of sluggish cognitive tempo for children: content validity, factor structure, and reliability. Psychological Assessment, 21, 380–389.

    Article  PubMed  Google Scholar 

  • Plomin, R., Emde, R. N., Braungart, J. M., Campos, J., Corley, R., Fulker, D. W., et al. (1993). Genetic change and continuity from fourteen to twenty months: the MacArthur longitudinal twin study. Child Development, 64, 1354–1376.

    Article  PubMed  Google Scholar 

  • Price, T. S., Simonoff, E., Waldman, I., Asherson, P., & Plomin, R. (2001). Hyperactivity in preschool children is highly heritable. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1362–1364.

    Article  PubMed  Google Scholar 

  • Ramtekkar, U. P., Reiersen, A. M., Todorov, A. A., & Todd, R. D. (2010). Sex and age differences in attention-deficit/hyperactivity disorder symptoms and diagnoses: implications for DSM-V and ICD-11. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 217–228.

    PubMed Central  PubMed  Google Scholar 

  • Rietveld, M. J., Hudziak, J. J., Bartels, M., van Beijsterveldt, C. E., & Boomsma, D. I. (2003a). Heritability of attention problems in children: I. cross-sectional results from a study of twins, age 3–12 years. American Journal of Medical Genetics. Part B Neuropsychiatric, 117B, 102–113.

  • Rietveld, M. J., Posthuma, D., Dolan, C. V., & Boomsma, D. I. (2003b). ADHD: sibling interaction or dominance: an evaluation of statistical power. Behavior Genetics, 33, 247–255.

    Google Scholar 

  • Silberg, J., Rutter, M., Meyer, J., Maes, H., Hewitt, J., Simonoff, E., et al. (1996). Genetic and environmental influences on the covariation between hyperactivity and conduct disturbance in juvenile twins. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 37, 803–816.

    Article  PubMed  Google Scholar 

  • Simonoff, E., Pickles, A., Hervas, A., Silberg, J. L., Rutter, M., & Eaves, L. (1998). Genetic influences on childhood hyperactivity: contrast effects imply parental rating bias, not sibling interaction. Psychological Medicine, 28, 825–837.

    Article  PubMed  Google Scholar 

  • Spatola, C. A., Fagnani, C., Pesenti-Gritti, P., Ogliari, A., Stazi, M. A., & Battaglia, M. (2007). A general population twin study of the CBCL/6–18 DSM-oriented scales. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 619–627.

    Article  PubMed  Google Scholar 

  • Sprich-Buckminster, S., Biederman, J., Milberger, S., Faraone, S. V., & Krifcher Lehman, B. (1993). Are perinatal complications relevant to the manifestation of ADD? Issues of comorbidity and familiality. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 1032–1037.

    Article  PubMed  Google Scholar 

  • Stazi, M. A., Cotichini, R., Patriarca, V., Brescianini, S., Fagnani, C., D'Ippolito, C., et al. (2002). The italian twin project: from the personal identification number to a national twin registry. Twin Research: The Official Journal of the International Society for Twin Studies, 5, 382–386.

    Google Scholar 

  • Steiger, J. H. (1980). Tests for comparing elements of a correlation matrix. Psychological Bulletin, 87, 245–251.

    Article  Google Scholar 

  • Thapar, A., & Stergiakouli, E. (2008). An overview on the genetics of ADHD. Xin Li Xue Bao. Acta Psychologica Sinica, 40, 1088–1098.

    PubMed Central  PubMed  Google Scholar 

  • Todd, R. D., Rasmussen, E. R., Wood, C., Levy, F., & Hay, D. A. (2004). Should sluggish cognitive tempo symptoms be included in the diagnosis of attention-deficit/hyperactivity disorder? Journal of the American Academy of Child and Adolescent Psychiatry, 43, 588–597.

    Article  PubMed  Google Scholar 

  • van Beijsterveldt, C. E., Verhulst, F. C., Molenaar, P. C., & Boomsma, D. I. (2004). The genetic basis of problem behavior in 5-year-old dutch twin pairs. Behavior Genetics, 34, 229–242.

    Article  PubMed  Google Scholar 

  • van den Oord, E. J., Pickles, A., & Waldman, I. D. (2003). Normal variation and abnormality: an empirical study of the liability distributions underlying depression and delinquency. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 44, 180–192.

    Article  PubMed  Google Scholar 

  • Wåhlstedt, C., & Bohlin, G. (2010). DSM-IV-defined inattention and sluggish cognitive tempo: independent and interactive relations to neuropsychological factors and comorbidity. Child Neuropsychology: A Journal on Normal and Abnormal Development in Childhood and Adolescence, 16, 350–365.

    Article  Google Scholar 

  • Willcutt, E. G., Nigg, J. T., Pennington, B. F., Solanto, M. V., Rohde, L. A., Tannock, R., et al. (2012). Validity of DSM-IV attention deficit/hyperactivity disorder symptom dimensions and subtypes. Journal of Abnormal Psychology, 121, 991–1010.

    Article  PubMed Central  PubMed  Google Scholar 

  • Wood, A. C. (2009). Hyperactive-impulsive symptom scores and oppositional behaviours reflect alternate manifestations of a single liability. Behavior Genetics, 39, 447–460.

    Article  PubMed Central  PubMed  Google Scholar 

  • Zou, G. Y. (2007). Toward using confidence intervals to compare correlations. Psychological Methods, 12, 399–413.

    Article  PubMed  Google Scholar 

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Acknowledgements

The coordinating work of M. Antonietta Stazi (from Istituto Superiore di Sanita’, Rome, Italy) at the Italian Twin Registry is gratefully acknowledged; Dr Paola Pesenti Gritti and Giuseppina Ferrer (from the Academic Centre for the Study of Behavioural Plasticity, Vita-Salute San Raffaele University, Milan, Italy) provided assistance with data analyses; we also thank all children and parents for their participation to this study.

Financial Support

This study was supported in part by COFIN 2001 and PRIN 2006061953 grants, and Italian Ministry of Health 2002 and 2009 Strategic Research grants to M. Battaglia. The first author of this paper is in the San Raffaele University Developmental Psychopathology Ph D Program, supported in part by the CARIPLO Foundation ‘Human Talents’ Grant for Academic Centres of Excellence in Post-Graduate Teaching (Dr Battaglia recipient).

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Moruzzi, S., Rijsdijk, F. & Battaglia, M. A Twin Study of the Relationships among Inattention, Hyperactivity/Impulsivity and Sluggish Cognitive Tempo Problems. J Abnorm Child Psychol 42, 63–75 (2014). https://doi.org/10.1007/s10802-013-9725-0

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