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Patterns of Comorbidity in Probands and Relatives in Psychiatrically and Pediatrically Referred Samples

Joseph Biederman, MD; Stephen V. Faraone, PhD; Kate Keenan; Jonathan Benjamin, MD; Belinda Krifcher; Cindy Moore; Susan Sprich-Buckminster; Karen Ugaglia; Michael S. Jellinek, MD; Ronald Steingard, MD; Thomas Spencer, MD; Dennis Norman, EdD; Roselyn Kolodny, MD; Ilana Kraus, MD; James Perrin, MD; Martin B. Keller, MD; Ming T. Tsuang, MD, PhD, DSc

Arch Gen Psychiatry. 1992;49(9):728-738.

Abstract
• We examined 140 probands with attention deficit hyperactivity disorder, 120 normal controls, and their 822 firstdegree relatives using "blind" raters and structured diagnostic interviews. Compared with controls, probands with attention deficit hyperactivity disorder were more likely to have conduct, mood, and anxiety disorders. Compared with relatives of controls, relatives of probands with attention deficit hyperactivity disorder had a higher risk for attention deficit hyperactivity disorder, antisocial disorders, major depressive disorder, substance dependence, and anxiety disorders. Patterns of comorbidity indicate that attention deficit hyperactivity disorder and major depressive disorders may share common familial vulnerabilities, that attention deficit hyperactivity disorder plus conduct disorder may be a distinct subtype, and that attention deficit hyperactivity disorder and anxiety disorders are transmitted independently in families. These results extend previous findings indicating family-genetic influences in attention deficit hyperactivity disorder by using both pediatrically and psychiatrically referred proband samples. The distributions of comorbid illnesses in families provide further validation for subgrouping probands with attention deficit hyperactivity disorder by comorbidity.

Author Affiliations
From the Pediatric Psychopharmacology Unit, Psychiatry Service (Drs Biederman, Faraone, Jellinek, Steingard, Spencer, Norman, and Keller and Mss Keenan, Krifcher, Moore, Sprich-Buckminster, and Ugaglia) and Children's Service (Drs Jellinek and Perrin), Massachusetts General Hospital, the Department of Pediatrics, Harvard Community Health Plan (Drs Benjamin, Kolodny, and Kraus), Harvard Medical School (Drs Biederman, Benjamin, Faraone, Jellinek, Steingard, Spencer, Norman, Kolodny, Kraus, Perrin, Keller, and Tsuang), and Harvard School of Public Health (Dr Tsuang), Boston; and the Psychiatry Service, Brockton (Mass) Veterans Affairs Medical Center (Drs Faraone and Tsuang). Dr Keller is now with Brown University, Providence, RI.

Footnotes
Accepted for publication July 3, 1991.

Reprint requests to Pediatric Psychopharmacology Unit (ACC 725), Massachusetts General Hospital, Fruit Street, Boston, MA 02114 (Dr Biederman).

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