A Longitudinal Twin Study on the Association Between Inattentive and Hyperactive-Impulsive ADHD Symptoms

  • Corina U. GrevenEmail author
  • Philip Asherson
  • Frühling V. Rijsdijk
  • Robert Plomin


DSM-IV distinguishes two symptom domains of attention deficit hyperactivity disorder (ADHD): inattentiveness and hyperactivity-impulsivity. The present study examines the aetiologies and developmental relations underlying the associations between inattentiveness and hyperactivity-impulsivity over time, based on a representative population sample from the United Kingdom of approximately 7,000 twin pairs. ADHD symptoms were assessed as continuous dimensions using the DSM-IV items from the Conners’ Parent Rating Scale at two ages: middle childhood (age 1) and early adolescence (age 2). Quantitative genetic cross-lagged analyses showed that the association of the ADHD dimensions over time is influenced by stable as well as newly developing genetic factors. Moreover the longitudinal relationship between the ADHD dimensions appears to be unidirectional, with hyperactivity-impulsivity in middle childhood predicting the presence of inattentiveness in early adolescence, but not vice versa. Thus, hyperactivity-impulsivity may serve to exacerbate inattentiveness over time. Findings are discussed in the context of developmental changes in ADHD symptoms.


ADHD Inattentiveness Hyperactivity-impulsivity Longitudinal Genetics 



Study supported by the United Kingdom Medical Research Council (G0500079). We are grateful to Twins Early Development Study families.

Conflict of Interest

Asherson has acted in an advisory capacity to Shire, Janssen-Cilag, Eli-Lilly and Flynn Pharma. He is the holder of an educational grant from Janssen-Cilag and a research grant from Shire. He has given talks at meetings or educational program sponsored by to Shire, Janssen-Cilag, Eli-Lilly and Flynn Pharma. The other authors have no competing interests to disclose.


  1. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: Author.Google Scholar
  2. Barrett, P. (2007). Structural equation modelling: adjudging model fit. Personality and Individual Differences, 42, 815–824.CrossRefGoogle Scholar
  3. Biederman, J., Mick, E., & Faraone, S. V. (2000). Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. The American Journal of Psychiatry, 157, 816–818.PubMedCrossRefGoogle Scholar
  4. Burns, G. L., & Walsh, J. A. (2002). The influence of ADHD-hyperactivity/impulsivity symptoms on the development of oppositional defiant disorder symptoms in a 2-year longitudinal study. Journal of Abnormal Child Psychology, 30, 245–256.PubMedCrossRefGoogle Scholar
  5. Burns, G. L., Walsh, J. A., Patterson, D. R., Holte, C. S., Sommers-Flanagan, R., & Parker, C. M. (1997). Internal validity of the disruptive behavior disorder symptoms: implications from parent ratings for a dimensional approach to symptom validity. Journal of Abnormal Child Psychology, 25, 307–319.PubMedCrossRefGoogle Scholar
  6. Burt, S. A., McGue, M., Krueger, R. F., & Iacono, W. G. (2005). How are parent-child conflict and childhood externalizing symptoms related over time? Results from a genetically informative cross-lagged study. Development and Psychopathology, 17, 145–165.PubMedCrossRefGoogle Scholar
  7. Chen, W., Zhou, K., Sham, P., Franke, B., Kuntsi, J., Campbell, D., et al. (2008). DSM-IV combined type ADHD shows familial association with sibling trait scores: a sampling strategy for QTL linkage. American Journal of Medical Genetics. Part B: Neuropsychiatric Genetics, 147B, 1450–1460.CrossRefGoogle Scholar
  8. Conners, C. K., Sitarenios, G., Parker, J. D., & Epstein, J. N. (1998). The revised Conners’ Parent Rating Scale (CPRS-R): factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 257–268.PubMedCrossRefGoogle Scholar
  9. Donnelly, P. (2008). Progress and challenges in genome-wide association studies in humans. Nature, 456, 728–731.PubMedCrossRefGoogle Scholar
  10. DuPaul, G. J., Power, T. J., Anastopoulos, A. D., Reid, R., McGoey, K. E., & Ikeda, M. J. (1997). Teacher ratings of attention deficit hyperactivity disorder symptoms: factor structure and normative data. Psychological Assessment, 9, 436–444.CrossRefGoogle Scholar
  11. Ebejer, J. L., Coventry, W. L., Byrne, B., Willcutt, E. G., Olson, R. K., Corley, R., et al. (2010). Genetic and environmental influences on inattention, hyperactivity-impulsivity, and reading: kindergarten to grade 2. Scientific Studies of Reading, 14, 293–316.PubMedCrossRefGoogle Scholar
  12. Finkbeiner, C. (1979). Estimation for the multiple factor model when data are missing. Psychometrika, 44, 409–420.CrossRefGoogle Scholar
  13. Freeman, B., Powell, J., Ball, D. M., Hill, L., Craig, I. W., & Plomin, R. (1997). DNA by mail: an inexpensive and noninvasive method for collecting DNA samples from widely dispersed populations. Behavior Genetics, 27, 251–257.PubMedCrossRefGoogle Scholar
  14. Gregory, A. M., Rijsdijk, F. V., Lau, J. Y., Dahl, R. E., & Eley, T. C. (2009). The direction of longitudinal associations between sleep problems and depression symptoms: a study of twins aged 8 and 10 years. Sleep, 32, 189–199.PubMedGoogle Scholar
  15. 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.PubMedCrossRefGoogle Scholar
  16. Hallett, V., Ronald, A., Rijsdijk, F., & Happe, F. (2010). Association of autistic-like and internalizing traits during childhood: a longitudinal twin study. The American Journal of Psychiatry, 167, 809–817.PubMedCrossRefGoogle Scholar
  17. Halperin, J. M., & Schulz, K. P. (2006). Revisiting the role of the prefrontal cortex in the pathophysiology of attention-deficit/hyperactivity disorder. Psychological Bulletin, 132, 560–581.PubMedCrossRefGoogle Scholar
  18. Halperin, J. M., Trampush, J. W., Miller, C. J., Marks, D. J., & Newcorn, J. H. (2008). Neuropsychological outcome in adolescents/young adults with childhood ADHD: profiles of persisters, remitters and controls. Journal of Child Psycholology and Psychiatry, 49, 958–966.CrossRefGoogle Scholar
  19. Hart, E. L., Lahey, B. B., Loeber, R., Applegate, B., & Frick, P. J. (1995). Developmental change in attention-deficit hyperactivity disorder in boys: a four-year longitudinal study. Journal of Abnormal Child Psychology, 23, 729–749.PubMedCrossRefGoogle Scholar
  20. 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.CrossRefGoogle Scholar
  21. Kenny, D. A. (1975). Cross-lagged panel correlation: a test for spuriousness. Psychological Bulletin, 82, 887–903.CrossRefGoogle Scholar
  22. Kunsti, J., Wood, A. C., Rijsdijk, F., Johnson, K. A., Andreou, P., Albrecht, B., et al. (2010). Separation of cognitive impairments in attention deficit/hyperactivity disorder into 2 familial factors. Archives of General Psychiatry, 67, 1159–1167.CrossRefGoogle Scholar
  23. Kuntsi, J., Rijsdijk, F., Ronald, A., Asherson, P., & Plomin, R. (2005). Genetic influences on the stability of attention-deficit/hyperactivity disorder symptoms from early to middle childhood. Biological Psychiatry, 57, 647–654.PubMedCrossRefGoogle Scholar
  24. Lahey, B. B., Pelham, W. E., Loney, J., Lee, S. S., & Willcutt, E. (2005). Instability of the DSM-IV subtypes of ADHD from preschool through elementary school. Archives of General Psychiatry, 62, 869–902.CrossRefGoogle Scholar
  25. Larsson, J., Larsson, H., & Lichtenstein, P. (2004). Genetic and environmental contributions to stability and change of ADHD symptoms between 8 and 13 year of age: a longitudinal twin study. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 1267–1275.PubMedCrossRefGoogle Scholar
  26. Larsson, H., Lichtenstein, P., & Larsson, J. (2006). Genetic contributions to the development of ADHD subtypes from childhood to adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 973–981.PubMedCrossRefGoogle Scholar
  27. Larsson, H., Viding, E., Rijsdijk, F. V., & Plomin, R. (2008). Relationships between parental negativity and childhood antisocial behavior over time: a bidirectional effects model in a longitudinal genetically informative design. Journal of Abnormal Child Psycholology, 36, 633–645.CrossRefGoogle Scholar
  28. Larsson, H., Dilshad, R., Lichtenstein, P., & Barker, E. D. (in press). Developmental trajectories of DSM-IV symptoms of attention-deficit/hyperactivity disorder: genetic effects, family risk and associated psychopathology. Journal of Child Psychology and Psychiatry. doi: 10.1111/j.1469-7610.2011.02379.x
  29. Luo, Y. L., Haworth, C. M., & Plomin, R. (2010). A novel approach to genetic and environmental analysis of cross-lagged associations over time: the cross-lagged relationship between self-perceived abilities and school achievement is mediated by genes as well as the environment. Twin Research and Human Genetics, 13, 426–436.PubMedCrossRefGoogle Scholar
  30. McGue, M., & Bouchard, T. J. (1984). Adjustment of twin data for the effects of age and sex. Behavior Genetics, 14, 325–343.PubMedCrossRefGoogle Scholar
  31. McLoughlin, G., Ronald, A., Kuntsi, J., Asherson, P., & Plomin, R. (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.PubMedCrossRefGoogle Scholar
  32. Nadder, T. S., Rutter, M., Silberg, J. L., Maes, H. H., & Eaves, L. J. (2002). Genetic effects on the variation and covariation of attention deficit-hyperactivity disorder (ADHD) and oppositional-defiant disorder/conduct disorder (Odd/CD) symptomatologies across informant and occasion of measurement. Psychological Medicine, 32, 39–53.PubMedCrossRefGoogle Scholar
  33. Neale, M. C., Boker, S. M., Xie, G., & Maes, H. (2006). Mx: Statistical modeling (7th ed.). Richmond: Department of Psychiatry, Medical College of Virginia.Google Scholar
  34. 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.PubMedCrossRefGoogle Scholar
  35. Oliver, B., & Plomin, R. (2007). Twins Early Development Study (TEDS): a multivariate, longitudinal genetic investigation of language, cognition and behaviour problems from childhood through adolescence. Twin Research and Human Genetics, 10, 96–105.PubMedCrossRefGoogle Scholar
  36. Pennington, B. F. (2006). From single to multiple deficit models of developmental disorders. Cognition, 101, 385–413.PubMedCrossRefGoogle Scholar
  37. Plomin, R., DeFries, J. C., McClearn, G. E., & McGuffin, P. (2008). Behavioral genetics (5th ed.). New York: Worth Publishers.Google Scholar
  38. Plomin, R., Haworth, C. M., & Davis, O. S. (2009). Common disorders are quantitative traits. Nature Reviews. Genetics, 10, 872–878.PubMedCrossRefGoogle Scholar
  39. Polanczyk, G., de Lima, M. S., Horta, B. L., Biederman, J., & Rohde, L. A. (2007). The worldwide prevalence of ADHD: a systematic review and metaregression analysis. The American Journal of Psychiatry, 164, 942–948.PubMedCrossRefGoogle Scholar
  40. Price, T. S., Simonoff, E., Asherson, P., Curran, S., Kuntsi, J., Waldman, I., et al. (2005). Continuity and change in preschool ADHD symptoms: longitudinal genetic analysis with contrast effects. Behavior Genetics, 35, 121–132.PubMedCrossRefGoogle Scholar
  41. Ronald, A., Simonoff, E., Kunsti, J., Asherson, P., & Plomin, R. (2008). Evidence for overlapping genetic influences on autistic and ADHD behaviours in a community twin sample. Journal of Child Psychology and Psychiatry, 49, 535–542.PubMedCrossRefGoogle Scholar
  42. Todd, R. D., Huang, H., Todorov, A. A., Neuman, R. J., Reiersen, A. M., Henderson, C. A., et al. (2008). Predictors of stability of attention-deficit/hyperactivity disorder subtypes from childhood to young adulthood. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 76–85.PubMedCrossRefGoogle Scholar
  43. Turkheimer, E., & Waldron, M. (2000). Nonshared environment: a theoretical, methodological, and quantitative review. Psychological Bulletin, 126, 78–108.PubMedCrossRefGoogle Scholar
  44. Weyandt, L. L., Iwaszuk, W., Fulton, K., Ollerton, M., Beatty, N., Fouts, H., et al. (2003). The internal restlessness scale: performance of college students with and without ADHD. Journal of Learning Disabilities, 36, 382–389.PubMedCrossRefGoogle Scholar
  45. Wolraich, M. L., Lambert, E. W., Bickman, L., Simmons, T., Doffing, M. A., & Worley, K. A. (2004). Assessing the impact of parent and teacher agreement on diagnosing attention-deficit hyperactivity disorder. Journal of Developmental and Behavioral Pediatrics, 25, 41–47.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Corina U. Greven
    • 1
    • 2
    Email author
  • Philip Asherson
    • 1
  • Frühling V. Rijsdijk
    • 1
  • Robert Plomin
    • 1
  1. 1.King’s College London, MRC Social, Genetic and Developmental Psychiatry CentreInstitute of PsychiatryLondonUK
  2. 2.MRC Social Genetic and Developmental Psychiatry CentreInstitute of PsychiatryLondonUK

Personalised recommendations