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Associations Between Attention Deficit Hyperactivity Disorder Symptom Dimensions and Disordered Eating Symptoms in Adolescence: A Population-Based Twin Study

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Abstract

Although bivariate associations between attention-deficit/hyperactivity disorder (ADHD) and eating disorders in adolescent girls and boys have been previously identified, the mechanistic link underlying the symptom-level associations remains unclear. We evaluated shared genetic and environmental influences on ADHD symptoms and disordered eating in 819 female and 756 male twins from the Swedish TCHAD cohort using bivariate models. Common additive genetic and unique environmental effects accounted for majority of ADHD and disordered eating associations in a differential manner. For girls, the strongest genetic correlation was observed for cognitive/inattention problems-bulimia (0.54), with genetic factors accounting for 67% of the phenotypic correlation. For boys, the strongest genetic correlations were observed for conduct problems-bulimia and hyperactivity-bulimia (~ 0.54), accounting for 83% and 95% of the phenotypic correlation, respectively. As per our findings, the risk of comorbidity and shared genetics highlights the need for preventative measures and specialized treatment for ADHD and disordered eating in both sexes.

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Data Availability

The datasets generated during and/or analysed during the current study are available from the corresponding author upon reasonable request.

Code Availability

The code used for data analysis as a part of the current study are available from the corresponding author upon reasonable request.

Notes

  1. An E model, which estimates only unique environmental variance and covariance, was not fit as—based on numerous published studies—there is substantial empirical evidence that this is a poor fitting model for both disordered eating and ADHD.

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Funding

TCHAD study was supported by the Swedish Research Council for Health, Working Life and Welfare (2004-0383) and the Swedish Research Council (2004-1415). ZY acknowledges support from the National Institute of Mental Health (NIMH; T32MH076694, K01MH109782, R01MH120170) and Brain and Behavior Research Foundation NARSAD Young Investigator Award (Grant # 28799). MJQ was supported by the National Institute of General Medical Sciences (T32GM081740). CMB acknowledges grant support from the Swedish Research Council (Vetenskapsrådet, award: 538-2013-8864) and the Lundbeck Foundation (Grant # R276-2018-4581). KNJ was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (K23DK120517). JHB received grant funding from the NIMH (K01MH106675).

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Authors and Affiliations

  1. National Centre for Register-Based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark

    Zeynep Yilmaz

  2. Department of Biomedicine, Aarhus University, Aarhus, Denmark

    Zeynep Yilmaz

  3. Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Zeynep Yilmaz, Laura M. Thornton, Cynthia M. Bulik & Jessica H. Baker

  4. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Zeynep Yilmaz, Laura M. Thornton, Cynthia M. Bulik, Shuyang Yao, Paul Lichtenstein & Henrik Larsson

  5. Department of Psychology, University of South Carolina, Columbia, SC, USA

    Mary J. Quattlebaum

  6. Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, India

    Pratiksha S. Pawar

  7. Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Cynthia M. Bulik

  8. Department of Psychiatry, Harvard Medical School, Boston, MA, USA

    Kristin N. Javaras

  9. Division of Women’s Mental Health, McLean Hospital, Belmont, MA, USA

    Kristin N. Javaras

  10. School of Medical Sciences, Örebro University, Örebro, Sweden

    Henrik Larsson

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  1. Zeynep Yilmaz
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  2. Mary J. Quattlebaum
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  10. Jessica H. Baker
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Contributions

ZY was responsible for developing the research question, study conceptualization and design, critical review of the literature, interpretation of data, and manuscript preparation. MJQ and PSP assisted with literature search, interpretation of data, and manuscript preparation. LMT, CMB, KNJ, SY, and PL contributed to the development of the research question, study design, interpretation of data, and critical review of the manuscript. HL was involved in study design, data preparation and interpretation, and critical review of the manuscript. JHB was responsible for study design, data acquision and analysis, interpretation of data, and manuscript preparation. All authors have read and approved the current version of the manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Jessica H. Baker.

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Conflict of interest

KNJ owns equity shares in Sanofi and Centene Corporation. CMB is a Scientific Advisory Board member for Shire, serves as a consultant for Idorsia (consultant), is an author with and royalty recipient from Pearson, and is on the Clinical Advisory Board of Equip Health Inc. HL reports receiving grants from Shire Pharmaceuticals, personal fees from and serving as a speaker for Medice, Shire/Takeda Pharmaceuticals and Evolan Pharma AB, and sponsorship for a conference on attention-deficit/hyperactivity disorder from Shire/Takeda Pharmaceuticals and Evolan Pharma AB. All other authors report no financial interests or potential conflicts of interest.

Ethical Approval

The Swedish Twin study of CHild and Adolescent Development (TCHAD) was approved by the Ethics Committee of Karolinska Institutet, Stockholm, Sweden. This study was also approved by the Institutional Review Board of the University of North Carolina at Chapel Hill, where the data were analyzed.

Informed Consent

All parents and twins who participated provided informed consent.

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Yilmaz, Z., Quattlebaum, M.J., Pawar, P.S. et al. Associations Between Attention Deficit Hyperactivity Disorder Symptom Dimensions and Disordered Eating Symptoms in Adolescence: A Population-Based Twin Study. Behav Genet 53, 143–153 (2023). https://doi.org/10.1007/s10519-022-10128-5

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