Birth weight as an independent predictor of ADHD symptoms: a within-twin pair analysis
Corresponding Author
Erik Pettersson
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Correspondence
Eric Pettersson, Karolinska Institute – Department of Medical Epidemiology and Biostatistics, Nobels väg 12A Box 281, Stockholm 17177, Sweden; Email: [email protected]
Search for more papers by this authorArvid Sjölander
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Search for more papers by this authorCatarina Almqvist
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
Search for more papers by this authorHenrik Anckarsäter
Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
Search for more papers by this authorBrian M. D'Onofrio
Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
Search for more papers by this authorPaul Lichtenstein
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Search for more papers by this authorHenrik Larsson
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Search for more papers by this authorCorresponding Author
Erik Pettersson
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Correspondence
Eric Pettersson, Karolinska Institute – Department of Medical Epidemiology and Biostatistics, Nobels väg 12A Box 281, Stockholm 17177, Sweden; Email: [email protected]
Search for more papers by this authorArvid Sjölander
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Search for more papers by this authorCatarina Almqvist
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
Search for more papers by this authorHenrik Anckarsäter
Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
Search for more papers by this authorBrian M. D'Onofrio
Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
Search for more papers by this authorPaul Lichtenstein
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Search for more papers by this authorHenrik Larsson
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Search for more papers by this authorConflict of interest statement: No conflicts declared.
Abstract
Background
Studies have found an association between low birth weight and ADHD, but the nature of this relation is unclear. First, it is uncertain whether birth weight is associated with both of the ADHD dimensions, inattentiveness and hyperactivity-impulsivity. Second, it remains uncertain whether the association between birth weight and ADHD symptom severity is confounded by familial factors.
Method
Parents of all Swedish 9- and 12-year-old twins born between 1992 and 2000 were interviewed for DSM-IV inattentive and hyperactive-impulsive ADHD symptoms by the Autism – Tics, AD/HD and other Comorbidities (A-TAC) inventory (N = 21,775 twins). Birth weight was collected prospectively through the Medical Birth Registry. We used a within-twin pair design to control for genetic and shared environmental factors.
Results
Reduced birth weight was significantly associated with a mean increase in total ADHD (β = −.42; 95% CI: −.53, −.30), inattentive (β = −.26; 95% CI: −.33, −.19), and hyperactive-impulsive (β = −.16; 95% CI: −.22, −.10) symptom severity. These results imply that a change of one kilogram of birth weight corresponded to parents rating their child nearly one unit higher (going from “no” to “yes, to some extent” on a given symptom) on the total ADHD scale. These associations remained within pairs of MZ and DZ twins, and were also present when restricting the analyses to full term births.
Conclusions
There is an independent association between low birth weight and all forms of ADHD symptoms, even after controlling for all environmental and genetic confounds shared within twin pairs. These results indicate that fetal growth restriction (as reflected in birth weight differences within twin pairs) and/or the environmental factors which influence it is in the casual pathway leading to ADHD.
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