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Association between adult attention-deficit hyperactivity disorder and generalised joint hypermobility: A cross-sectional case control comparison
Örebro University, School of Medical Sciences. University Health Care Research Centre.
Division of Psychiatry, Linköping University Hospital, Linköping, Sweden.
Örebro University, School of Medical Sciences. University Health Care Research Centre.ORCID iD: 0000-0001-6726-7787
Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Centre.
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2021 (English)In: Journal of Psychiatric Research, ISSN 0022-3956, E-ISSN 1879-1379, Vol. 143, p. 334-340Article in journal (Refereed) Published
Abstract [en]

Growing evidence suggests an unexpected association between generalised joint hypermobility (GJH) and several psychiatric conditions, and a shared pathophysiology has been proposed. No previous studies on adult attention-deficit/hyperactivity disorder (ADHD) are available. This study aimed to evaluate the association between adult ADHD and GJH. A total of 431 adults with ADHD and 417 non-ADHD controls were included in this cross-sectional comparative study. GJH was assessed by physical examination following the Beighton scoring system (BSS). Furthermore, musculoskeletal symptoms and skin abnormalities were queried to create a proxy for symptomatic GJH (e.g., Hypermobility spectrum disorders and Ehlers-Danlos syndrome) to differentiate this from non-specified GJH defined by BSS only. Logistic regression examined the influence of ADHD and candidate covariates (age, sex, ethnicity) on GJH and symptomatic GJH, respectively. ADHD was significantly associated with GJH, as defined by the BSS, with adjusted odds ratios of 4.7 (95% confidence interval [CI] 3.0-7.2, p < .005). Likewise, ADHD was significantly associated with symptomatic GJH, as defined by the BSS and additional symptoms, with adjusted odds ratios of 6.9 (CI 95% 4.1-11.9, p < .005). Our results suggest that GJH may represent a marker for an underlying systemic disorder involving both connective tissue and the central nervous system. GJH with additional musculoskeletal symptoms and/or skin abnormalities has a considerable stronger link to adult ADHD than non-specified GJH has, and may need awareness in ADHD management. Future studies should investigate the mechanisms behind this association and how comorbid GJH affects ADHD outcome.

Place, publisher, year, edition, pages
Elsevier, 2021. Vol. 143, p. 334-340
Keywords [en]
Attention deficit disorder with hyperactivity, Biomarkers, Comorbidity, Ehlers-Danlos syndrome, Hypermobility, Joint instability
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-94608DOI: 10.1016/j.jpsychires.2021.07.006ISI: 000701669500021PubMedID: 34560594Scopus ID: 2-s2.0-85115367374OAI: oai:DiVA.org:oru-94608DiVA, id: diva2:1597602
Funder
European CommissionSwedish Research Council, K2012-62X-22130-04-6
Note

Funding agencies:

Bror Gadelius minnesfond

Örebro University

Available from: 2021-09-27 Created: 2021-09-27 Last updated: 2022-08-29Bibliographically approved
In thesis
1. The relationship between generalised joint hypermobility and neurodevelopment disorders
Open this publication in new window or tab >>The relationship between generalised joint hypermobility and neurodevelopment disorders
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Knowledge about comorbidities is important since they often can affect the diagnoses, treatment and outcome of a patient. Moreover, it may provide an insight to biological underpinnings contributing to the association. Generalised joint hypermobility (GJH) has recently been suggested to be a common, yet unrecognized, comorbidity amongst individuals with NDDs. In the present thesis we aimed to evaluate the relationships between GJH and ADHD and GJH and ASD across the full clinical and non-clinical spectra. Moreover, we aimed to make available a simple screening tool for GJH for Swedish speakers.

In study I we translated the five-part questionnaire on hypermobility (5PQ) into Swedish and tested psychometric properties in a non-clinical adult population (n=315). The Swedish 5PQ showed good psychometric properties in the general adult population with a sensitivity of 91%, a specificity of 75%, and an AUC of 0.87. Thus, it is a promising measure for GJH screening in adults. 

In studies II and III we measured GJH in large cohorts of adults with ADHD (n=431), ASD (n=199) and general population controls (n=419). We evaluated the associations between GJH and ADHD and GJH and ASD by using logistic regression models, while adjusting for age, sex and ethnicity. GJH was associated with ADHD and ASD with adjusted odds ratios of 4.7 and 3.1, respectively.

In study IV a large cohort of adults from the general population (n=887) completed a survey form comprising the 5PQ and questions regarding symptoms and traits of ADHD, ASD and motor impairment. Responses were compared between GJH and non-GJH individuals. We found that sub-syndromal neurodevelopmental symptoms were not affected by GJH. Thus, the association between GJH and NDDs appears to be limited to clinical populations. However, the hypothesis needs to be tested with a physical assessment of GJH before any firm conclusions can be drawn.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2022. p. 96
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 260
Keywords
Attention Deficit Disorder with Hyperactivity (ADHD), Autism Spectrum Disorder (ASD), Adults, Biomarkers, Comorbidity, Joint Hypermobility, Joint Instability, Ehlers-Danlos Syndrome, Connective tissue
National Category
General Practice Psychiatry
Identifiers
urn:nbn:se:oru:diva-97615 (URN)9789175294346 (ISBN)
Public defence
2022-05-12, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2022-02-21 Created: 2022-02-21 Last updated: 2022-08-30Bibliographically approved

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Glans, MartinHumble, Mats B.Elwin, MarieBejerot, Susanne

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