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The impact and causal directions for the associations between diagnosis of ADHD, socioeconomic status, and intelligence by use of a bi-directional two-sample Mendelian randomization design
Dalarna University, School of Teacher Education, Educational Work.ORCID iD: 0000-0003-1657-9531
Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Sciences, Clinical Pharmacology, Uppsala University, Uppsala, Sweden.
Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University, Uppsala, Sweden.
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2022 (English)In: BMC Medicine, E-ISSN 1741-7015, Vol. 20, no 1, article id 106Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Previous studies have reported associations between attention-deficit/hyperactivity disorder (ADHD) and lower socioeconomic status and intelligence. We aimed to evaluate the causal directions and strengths for these associations by use of a bi-directional two-sample Mendelian randomization (MR) design.

METHODS: We used summary-level data from the largest available genome-wide association studies (GWAS) to identify genetic instruments for ADHD, intelligence, and markers of socioeconomic status including the Townsend deprivation index, household income, and educational attainment. Effect estimates from individual genetic variants were combined using inverse-variance weighted regression.

RESULTS: A genetically predicted one standard deviation (SD) increment in the Townsend deprivation index conferred an odds ratio (OR) of 5.29 (95% confidence interval (CI) 1.89-14.76) for an ADHD diagnosis (p<0.001). A genetically predicted one SD higher education level conferred an OR of 0.30 (95% CI 0.25-0.37) (p<0.001), and a genetically predicted one SD higher family income provided an OR of 0.35 (95% CI 0.25-0.49; p<0.001). The associations remained after adjustment for intelligence whereas the lower odds of an ADHD diagnosis with higher intelligence did not persist after adjustment for liability to greater educational attainment (adjusted OR 1.03, 95% CI 0.68-1.56; p=0.87). The MR analysis of the effect of ADHD on socioeconomic markers found that genetic liability to ADHD was statistically associated with each of them (p<0.001) but not intelligence. However, the average change in the socioeconomic markers per doubling of the prevalence of ADHD corresponded only to 0.05-0.06 SD changes.

CONCLUSIONS: Our results indicate that an ADHD diagnosis may be a direct and strong intelligence-independent consequence of socioeconomic related factors, whereas ADHD appears to lead only to modestly lowered socioeconomic status. Low intelligence seems not to be a major independent cause or consequence of ADHD.

Place, publisher, year, edition, pages
2022. Vol. 20, no 1, article id 106
Keywords [en]
ADHD, Attention-deficit/hyperactivity disorder, Education, GWAS, Gene, Income, Intelligence, Mendelian randomization, Socioeconomic status, Townsend deprivation index
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Health Sciences Learning
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URN: urn:nbn:se:du-41345DOI: 10.1186/s12916-022-02314-3ISI: 000779948300001PubMedID: 35399077Scopus ID: 2-s2.0-85127900658OAI: oai:DiVA.org:du-41345DiVA, id: diva2:1655477
Available from: 2022-05-02 Created: 2022-05-02 Last updated: 2023-03-17Bibliographically approved

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Michaëlsson, Madeleine

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