1. NORTH AMERICAN REGIONAL CONFERENCE, IACE/AIEC MAY/MAI 3-5, 2002, UQAM Facteurs de risque chez les familles d'enfants présentant un trouble déficitaire de l'attention/hyperactivité (TDA/H): Données québécoises poissant.helene@uqam.ca Risk Factors in Families of Children with ADHD: Data from Quebec poissant.helene@uqam.ca H. Poissant, (1); C. Montgomery, (2) C. Sylvestre (3) S. Lecomte (1); J. Delisle (1) UQAM (1), University of Alberta (2), PANDA (3)

2. Most common psychiatric disorders encountered by pediatricians Attention Deficit and Hyperactivity Disorder (ADHD) Anxiety disorders (ANX) Depression (DEP) Substance-use Disorders (SD) Conduct Disorder (CD) Oppositional Defiant Disorder (ODD) Learning Disorders (LD) Comorbidity often occurs between disorders High rates of comordid disorders among ADHD

3. Statistics on ADHD - 1% - 3% American school-aged population - 5% - 10 % other problems/ psychiatric disorder :comorbidity - Boys are about 3X more likely than girls to develop ADHD - 30% - 50% still manifest symptoms in adulthood - 25 % fathers and 17 -25% mothers of ADHD children have this condition

4. Objectives Determine potential Risk Factors in Etiology of ADHD in French Canadian population Draw comparison with English Canadian population 2 Main types of Risk Factors: –Genetic –Environment

5. Etiology Twin studies First-degree relatives: siblings and parents Comorbidity Pre and Perinatal events Socioeconomic Family problems GeneticEnvironment Barkley, R. (1997)

6. Research Souza et al. (2001) Butler (1995) Breton (1994) Chang (2000) Cotugno (1995) Number/Age 34/6 -16 years 76/children- adolescent 235*/6-14 years 40/ high school 40/ children Comorbidity in Proband ODD (20,6%); CD (39,2%); MD & ANX (34,3%) MD (36%); BDP (22%) CD & ODD (30 %) ANX & DEP (46.7%) General psychopathology & DEP DEP vulnerability * estimated n. From Poissant, H. (submitted)

7. Positive Correlation: Adversity Factors & ADHD 6 Adversity Indicators (Rutter, et al. 1975; 1977) severe marital discord low social class large family size paternal criminality maternal mental disorder foster care placement & Associated Psychiatric Impairments: DEP, LD, etc. Biederman, J., Milberger, S., Faraone, S. V. et al. (1995) Pediatric Psychopharmacology Unit (PPU),Massachusetts General Hospital Family Environment & Developmental Disorders

8. Genetic studies Meta-analysis (% explained variance) Identical Twins (MZ) N-Ident. Twins (DZ) MZ + DZ 40-79% 30-32% 61-75% Lecomte, J., Poissant, H., Delisle, J. (2001)

9. Genetic studies Meta-analysis (% explained variance) Comorbidity in ADHD Proband –DEP –ANX –ODD –CD –BPD 4-25% 15-57% 23-47% 11-44% 5% Lecomte, S., Poissant, H., Delisle, J. (2001)

10. Genetic studies Meta-analysis (% explained variance) ADHD in Siblings & Parents Comorbidity in Siblings & Parents –DEP –ANX –ODD –CD –Mental Disorder 4-10% 1-4% 1% 0-1% 1% 0-11% Lecomte, S., Poissant, H., Delisle, J. (2001)

11. Environment studies Meta-analysis (% explained variance) Accident during Pregnancy Cigarettes Smoking Problems in Family Low Family Income Adversity Factors Surgery in Newborn 2% 4% 2% 1-7% 9% 2% Lecomte, S., Poissant, H., Delisle, J. (2001)

12. Method Questionnaire distributed to both Parents Age of Probands: 6-21; Mean = 10 N. of Probands: 60 - Control: no ADHD(N= 19: 8 M; 11 F) (Left hand = 5%;Right hand = 95%) - ADHD: ADD/ HY/ADHD(N= 41: 33 M; 8 F) (Left hand = 73%;Right hand = 17%; Ambi = 10%) School levels of Probands: 0-14 years

13. Relationship with Probands Mostly Biological Mothers (N= 52)

14. Gender of Probands (% Probands) 1 ADHD Girl : 4 ADHD Boys (*)

15. Hand dominance (Pct of probands) More Left and Ambidextrous in ADHD

16. School levels (n. of probands)

17. ADH/D (Attention Deficit Disorder with or without Hyperactivity) RISK FACTOR QUESTIONNAIRE Epidemiological Study - UQAM © Poissant, Lecomte, Sylvestre 2001 Proband current Health Status (Comorbidity) Diagnosis (Unique or Multi?) Attention Deficit Disorder and Hyperactivity / Impulsiveness (ADHD) Attention Deficit Disorder only (ADD) Hyperactivity and impulsiveness disorder only (HY) Conduct Disorder (CD) Etc. Treatment (Unique or Uulti?) Ritalin, etc. Questionnaire

18. Siblings Relationship with Proband Biological brother/sister Half brother/ half sister No biological relationship with Proband Diagnosis in Siblings (Comorbidity) Attention Deficit Disorder and Hyperactivity / Impulsiveness (AD/HD) Attention Deficit Disorder only (ADD) Hyperactivity and Impulsiveness Disorder only (HY) Conduct Disorder (CD) Etc. Pregnancy (Pre/ Perinatal, Baby at Birth) Substances consumed Etc. Questionnaire

19. Parent(s) : Relationship with Proband: BiologicalNon-biological Mother Father Other (e.g. grand-parent) Family Socio-Economic Education completed Employment Family Income Etc. Questionnaire

20. Adversity Factors (Stress) in Family History of criminal activity (criminal record) Domestic violence Etc. Questionnaire Comorbidity in Parents (based on Diagnosis) Attention Deficit Disorder and Hyperactivity / Impulsiveness (AD/HD) Attention deficit disorder only (ADD) Hyperactivity and impulsiveness disorder only (HY) Conduct Disorder (CD) Bipolar disorder (manic-depression) (BPD) Etc. Medication in Parents SSRIs (e.g. Prozac)

21. Family Income Family Income = Lower in Control (*0.03)

22. Level of Education & Family Income min = 1; max = 4 * 0.03

23. Particular program (Pct of Probands)

24. School achievement (Pct of Probands)

25. Types of ADHD (pct of Probands)

26. Comorbidity in Proband (Pct of proband) * 0.05 ns

27. Comorbidity in Probands (Pct of probands) ** 0.01 ***0.001 ns

28. Comorbidity in Probands (Pct of Probands) ns

29. Medication in Probands (Pct of Probands) ***0.001

30. Length of Pregnancy (Pct of mothers) Mean = 39 weeks, ns

31. Difficulties during Pregnancy (Pct of Mothers)

32. Difficulties during Pregnancy (Pct of mothers)

33. **0.02

34. S. C. during Pregnancy: Alcohol

35. S. C. during Pregnancy: Cigarettes

36. S. C. during Pregnancy: Medication

37. S. C. during Pregnancy: Marijuana, hashish

38. S. C. during Pregnancy: LDS, mescaline, Extasy, PCP

39. Cumul S.C. during Pregnancy ns N.s in overall

40. Delivery n.s in overall

41. Delivery n.s n.s in overall

42. Baby at Birth n.s in overall

43. Baby at Birth n.s in overall

44. Baby at Birth n.s

45. Adversity Factors (Pct of Parents: mostly mothers) Chi-Squares: n.s. Learning Difficulties Undiagnosed Stress Factors N.s. N.s

46. Comorbidity in Parents (Cont = 17 Mothers; 2 Fathers; ADHD = 38 Mothers; 3 Fathers) 0.07 Dep. marginally significant

47. Comorbidity in Parents (Cont = 17 Mothers; 2 Fathers; ADHD = 38 Mothers; 3 Fathers) n.s in overall

48. Comorbidity in Parents (Cont = 17 Mothers; 2 Fathers; ADHD = 38 Mothers; 3 Fathers) n.s in overall

49. Medication in Parents (Cont = 17 Mothers; 2 Fathers; ADHD = 38 Mothers; 3 Fathers) *0.04

50. Medication in Parents (Cont = 17 Mothers; 2 Fathers; ADHD = 38 Mothers; 3 Fathers) Cumul Medication = 0.07

51. Main Findings Comorbidity in Probands Chi-Squares: Conduct Disorders (CD): 3.85; df=1; p= 0.05* Oppositional Defiant Disorder (ODD): 6.01, df=1; p= 0.01** Learning Disorder (LD): 15.15; df=1; p= 0.001*** Health Status (except CD, ODD, LD): 1.06; df=1; p= 0.3, ns Ritalin: 31.78; df= 1; p= 0.001*** Cumul Medication (except Ritalin); 0.70; df= 1; p= 0.41, ns

52. Main Findings Prenatal T-test Length of Pregnancy (ns) Control: Mean= 39.05 weeks ADHD: Mean= 39.00 weeks Chi- Squares: Difficulties during Pregnancy : Cumul (1 +), *0.02 Control:58% ADHD:85% Substances Consumed (S.C) during Pregnancy: Cumul (1 +), ns Control:68.4% ADHD:62.5%

53. Main Findings Perinatal Chi- Squares: Difficulty in Delivery: Cumul (1 +), ns Control: 37% ADHD:44% Difficulty Baby at Birth: Cumul (1 +), ns Control:47% ADHD:54% Weight at Birth (< or = 2.5 kg.), ns Control:17% ADHD:15%

54. Main Findings Perinatal T-Test: Length of labor:n.s Control: Mean= 12.6 hours ADHD: Mean= 12 hours Length of delivery: ns Control:2.4 hours ADHD:1.1 hour Weight at Birth: ns Control:6.5 pounds ADHD:6.8 pounds

55. Main Findings « Adversity & Socioeconomic » Chi-Squares: Learning Difficulties Undiagnosedn.s Stress Factors in Family: n.s Level of Educationn.s Family Income0.03 (in unexpected way)

56. Conclusion Etiology Comorbidity Proband: CD*, ODD*; LD* Comorbitiy Parents: DEP (Mothers) Fathers ? Comorbidity Siblings ? Pre and Perinatal: Cumul Difficulties Pregnancy* Socioeconomic (ns or unexpected) Adversity (ns) GeneticEnvironment

57. Future Research Comparison between Mothers and Fathers on Comorbidity and Medication Comparison between Mothers and Fathers on Adversity : Undiagnosed L.D (e.g. excessively agitated) and Stress Factors (e.g. Criminal activity, domestic violence)

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