Introduction
Methods
Study population
Diagnosis of ADHD, ASD, and their co-occurrence
Measures
Socio-economic indicators
Health-related factors
Psychosocial vulnerability
Risk-taking behaviours and perceptions of risks
Statistical analyses
Results
Socio-economic indicators
ADHDa (n = 182) | P value | ASDb (n = 78) | P value | Co-occurrencec (n = 51) | P value | Controls (n = 5860) | Case groups comparisons | |
---|---|---|---|---|---|---|---|---|
Participation 17–19 year follow-up | < .001 | .025 | .003 | a-b* | ||||
Yes | 182 (25.2%) | 78 (31.6%) | 51 (27.9%) | 5860 (38.6%) | ||||
No | 541 (74.8%) | 169 (68.4%) | 132 (72.1%) | 9340 (61.4%) | ||||
Sex | .093 | .002 | .013 | |||||
Male | 94 (51.6%) | 49 (62.8%) | 32 (62.7%) | 2657 (45.3%) | ||||
Female | 88 (48.4%) | 29 (37.2%) | 19 (37.3%) | 3202 (54.7%) | ||||
Occupation | .219 | .001 | < .001 | a-c** | ||||
Study/working | 150 (88.2%) | 61 (80.3%) | 36 (72.0%) | 5147 (91.0%) | ||||
Unemployed | 20 (11.8%) | 15 (19.7%) | 14 (28%) | 510 (9.0%) | ||||
Enough money compared with friends | < .001 | .001 | < .001 | |||||
Always/often | 120 (76.9%) | 62 (84.9%) | 36 (78.3%) | 5120 (94.0%) | ||||
Never/seldom | 36 (23.1%) | 11 (15.1%) | 10 (21.7%) | 325 (6.0%) |
Health-related outcomes
ADHDa (n = 182) | P value | ASDb (n = 78) | P value | Co-occurrencec (n = 51) | P value | Controls (n = 5860) | Case groups comparisons | |
---|---|---|---|---|---|---|---|---|
Health quality | < .001 | .005 | .003 | |||||
Excellent/very good/good | 109 (78.4%) | 53 (76.8%) | 29 (72.5%) | 4405 (87.9%) | ||||
Quite bad/bad | 30 (21.6%) | 16 (23.2%) | 11 (27.5%) | 608 (12.1%) | ||||
Severe illness | .739 | .008 | .004 | a-c* | ||||
Yes | 10 (5.5%) | 9 (11.5%) | 7 (13.7%) | 290 (4.9%) | ||||
No | 172 (94.5%) | 69 (88.5%) | 44 (86.3%) | 5570 (95.1%) | ||||
Autoimmune disease | .857 | .735 | .017 | |||||
Yes | 9 (4.9%) | 3 (3.8%) | 6 (11.8%) | 273 (4.7%) | ||||
No | 721 (95.5%) | 255 (93.8%) | 173 (92.0%) | 5587 (95.3%) | ||||
BMI | .501 | .002 | < .001 | a-c* | ||||
Underweight | 10 (6.8%) | 5 (8.1%) | 7 (15.9%) | 251 (4.9%) | ||||
Normal | 114 (77.6%) | 39 (62.9%) | 26 (59.1%) | 4146 (80.7%) | ||||
Overweight/obese | 23 (15.6%) | 18 (29.0%) | 11 (25.0%) | 742 (14.4%) | ||||
Allergies | .802 | .172 | .407 | |||||
Yes | 61 (44.9%) | 26 (37.7%) | 21 (52.5%) | 2290 (45.9%) | ||||
No | 75 (55.1%) | 43 (62.3%) | 19 (47.5%) | 2695 (54.1%) | ||||
Headache | .360 | .727 | .589 | |||||
Never/seldom | 51 (35.4%) | 26 (37.1%) | 19 (43.2%) | 2029 (39.2%) | ||||
Sometimes/regularly | 93 (64.6%) | 44 (62.9%) | 25 (56.8%) | 3148 (60.8%) | ||||
Stomach pain | .005 | .111 | .178 | a-b** a-c** | ||||
Never/seldom | 46 (31.7%) | 37 (52.9%) | 24 (53.3%) | 2238 (43.3%) | ||||
Sometimes/regularly | 99 (68.3%) | 33 (47.1%) | 21 (46.7%) | 2926 (56.7%) | ||||
Joint pain | .001 | .171 | .172 | |||||
Never/seldom | 98 (67.6%) | 49 (72.1%) | 31 (70.5%) | 4067 (78.9%) | ||||
Sometimes/regularly | 47 (32.4%) | 19 (27.9%) | 13 (29.5%) | 1088 (21.1%) | ||||
Exercise until get sweaty | .008 | .028 | .152 | |||||
Yes | 111 (71.6%) | 51 (69.9%) | 33 (71.7%) | 4351 (80.2%) | ||||
No | 44 (28.4%) | 22 (30.1%) | 13 (28.3%) | 1074 (19.8%) | ||||
Sleep quality | < .001 | .863 | < .001 | a-b* b-c* | ||||
Excellent/very good/good | 100 (66.2%) | 58 (82.9%) | 30 (65.2%) | 4382 (83.6%) | ||||
Quite bad/bad | 51 (33.8%) | 12 (17.1%) | 16 (34.8%) | 858 (16.4%) | ||||
Screen exposure (weekdays) | .286 | .122 | .782 | |||||
0-4h | 51 (33.3%) | 20 (28.6%) | 16 (35.6%) | 2021 (37.6%) | ||||
> 4h | 102 (66.7%) | 50 (71.4%) | 29 (64.4%) | 3359 (62.4%) | ||||
Screen exposure (weekends) | .190 | .001 | .087 | a-b* | ||||
0-4h | 61 (39.9%) | 19 (26.0%) | 15 (32.6%) | 2430 (45.2%) | ||||
> 4h | 92 (60.1%) | 54 (74.0%) | 31 (67.4%) | 2944 (54.8%) |
Psychosocial vulnerability
ADHDa (n = 182) | P value | ASDb (n = 78) | P value | Co-occurrencec (n = 51) | P value | Controls (n = 5860) | Case groups comparisons | |
---|---|---|---|---|---|---|---|---|
Serious life event index | < .001 | .262 | < .001 | |||||
None | 100 (54.9%) | 42 (53.8%) | 22 (43.1%) | 3364 (57.4%) | ||||
1–2 | 65 (35.7%) | 31 (39.7%) | 20 (39.2%) | 2310 (39.4%) | ||||
> 3 | 17 (9.3%) | 5 (6.4%) | 9 (17.6%) | 186 (3.2%) | ||||
Death/illness family | .691 | .934 | .015 | |||||
Yes | 53 (29.1%) | 22 (28.2%) | 22 (43.1%) | 1628 (27.8%) | ||||
No | 129 (70.9%) | 56 (71.8%) | 29 (56.9%) | 4232 (72.2%) | ||||
Unstable family situation | .113 | .240 | .013 | |||||
Yes | 41 (22.5%) | 18 (23.1%) | 16 (31.4%) | 1051 (17.9%) | ||||
No | 141 (77.5%) | 60 (76.9%) | 35 (68.6%) | 4809 (82.1%) | ||||
Sexually abused | .079 | .766 | .756 | |||||
Yes | 10 (5.5%) | 2 (2.6%) | 2 (3.9%) | 185 (3.2%) | ||||
No | 172 (94.5%) | 76 (97.4%) | 49 (96.1%) | 5675 (96.8%) | ||||
Physically abuse | < .001 | .794 | .380 | |||||
Yes | 14 (7.7%) | 2 (2.6%) | 2 (3.9%) | 125 (2.1%) | ||||
No | 168 (92.3%) | 76 (97.4%) | 49 (96.1%) | 5735 (97.9%) | ||||
Robbery victim | < .001 | .740 | .972 | |||||
Yes | 12 (6.6%) | 2 (2.6%) | 1 (2.0%) | 119 (2.0%) | ||||
No | 170 (93.4%) | 76 (97.4%) | 50 (98.0%) | 5741 (98.0%) | ||||
Social authorities support | .003 | .003 | < .001 | a-c* | ||||
Yes | 7 (3.8%) | 4 (5.1%) | 6 (11.8%) | 75 (1.3%) | ||||
No | 175 (96.2%) | 74 (94.9%) | 45 (88.2%) | 5785 (98.7%) | ||||
Performance at school/work | < .001 | .440 | .023 | |||||
Bad | 13 (9.2%) | 3 (5.6%) | 4 (11.8%) | 181 (3.7%) | ||||
Good | 55 (38.7%) | 13 (24.1%) | 13 (38.2%) | 1534 (31.4%) | ||||
Very good | 74 (52.1%) | 38 (70.4%) | 17 (50.0%) | 3176 (64.9%) | ||||
Faith in the future | .004 | < .001 | < .001 | |||||
Hopeless | 13 (8.1%) | 10 (14.1%) | 5 (10.9%) | 204 (3.7%) | ||||
Moderate | 52 (32.3%) | 27 (38.0%) | 21 (45.7%) | 1515 (27.6%) | ||||
Hopeful | 96 (59.6%) | 34 (47.9%) | 20 (43.5%) | 3765 (68.7%) | ||||
Perceived stress | .002 | .248 | .836 | a-b* | ||||
Low | 34 (24.6%) | 21 (31.3%) | 9 (20.5%) | 1195 (24.3%) | ||||
Moderate | 47 (34.1%) | 32 (47.8%) | 22 (50.0%) | 2312 (47.0%) | ||||
High | 57 (41.3%) | 14 (20.9%) | 13 (29.5%) | 1416 (28.8%) | ||||
Control over life | .007 | < .001 | .071 | |||||
No control | 21 (15.0%) | 15 (22.1%) | 7 (16.7%) | 380 (7.7%) | ||||
Moderate | 57 (40.7%) | 30 (44.1%) | 19 (45.2%) | 2136 (43.4%) | ||||
Full control | 62 (44.3%) | 23 (33.8%) | 16 (38.1%) | 2404 (48.9%) | ||||
Bully victim | .060 | .660 | < .001 | b-c* | ||||
Never/seldom | 131 (90.3%) | 65 (92.9%) | 36 (80.0%) | 4885 (94.1%) | ||||
Sometimes/often/always | 14 (9.7%) | 5 (7.1%) | 9 (20.0%) | 306 (5.9%) | ||||
Social support | .019 | .042 | .005 | |||||
Yes | 130 (89.7%) | 62 (88.6%) | 38 (84.4%) | 4890 (94.3%) | ||||
No | 15 (10.3%) | 8 (11.4%) | 7 (15.6%) | 296 (5.7%) | ||||
Feeling depressed | .001 | .142 | .029 | |||||
Never/seldom/sometimes | 91 (65.5%) | 48 (69.6%) | 25 (62.5%) | 3868 (77.1%) | ||||
Regularly | 48 (34.5%) | 21 (30.4%) | 15 (37.5%) | 1151 (22.9%) | ||||
Feeling worried/anxious | .003 | .255 | .011 | |||||
Never/seldom/sometimes | 79 (56.8%) | 43 (62.3%) | 20 (50.0%) | 3441 (68.7%) | ||||
Regularly | 60 (43.2%) | 26 (37.7%) | 20 (50.0%) | 1566 (31.3%) | ||||
Concentration difficulties | < .001 | < .001 | .022 | |||||
Never/seldom/sometimes | 59 (42.4%) | 35 (50.7%) | 22 (55.0%) | 3583 (71.5%) | ||||
Regularly | 80 (57.6%) | 34 (49.3%) | 18 (45.0%) | 1429 (28.5%) |
Risk-taking behaviours and perceptions of risks
ADHDa (n = 182) | P value | ASDb (n = 78) | P value | Co-occurrencec (n = 51) | P value | Controls (n = 5860) | Case-groups comparisons | |
---|---|---|---|---|---|---|---|---|
Smoking | < .001 | .150 | .129 | a-b*** b-c* | ||||
Yes | 36 (24.3%) | 2 (2.9%) | 6 (13.3%) | 385 (7.4%) | ||||
No | 112 (75.7%) | 68 (97.1%) | 39 (86.7%) | 4839 (92.6%) | ||||
e-cigarette smoking | < .001 | .012 | .765 | a-b*** a-c* | ||||
Yes | 67 (48.6%) | 10 (15.6%) | 10 (27.8%) | 1438 (30.1%) | ||||
No | 71 (51.4%) | 54 (84.4%) | 26 (72.2%) | 3344 (69.9%) | ||||
Hashish/marijuana smoking | .012 | .038 | .470 | a-b** b-c* | ||||
Yes | 32 (22.2%) | 4 (5.8%) | 8 (18.6%) | 757 (14.7%) | ||||
No | 112 (77.8%) | 65 (94.2%) | 35 (81.4%) | 4399 (85.3%) | ||||
Snuff use | < .001 | .392 | .500 | a-b* | ||||
Yes | 29 (19.6%) | 5 (7.1%) | 6 (13.3%) | 536 (10.3%) | ||||
No | 119 (80.4%) | 65 (92.9%) | 39 (86.7%) | 4687 (89.7%) | ||||
Alcohol consumption | .797 | < .001 | < .001 | a-b** a-c*** | ||||
Yes | 126 (86.9%) | 48 (69.6%) | 27 (62.8%) | 4526 (87.6%) | ||||
No | 19 (13.1%) | 21 (30.4%) | 16 (37.2%) | 640 (12.4%) | ||||
Smoking everyday | < .001 | .210 | .631 | |||||
Extremely/quite harmful | 117 (79.6%) | 58 (84.1%) | 41 (91.1%) | 4638 (88.9%) | ||||
Not/slightly/moderately harmful | 30 (20.4%) | 11 (15.9%) | 4 (8.9%) | 582 (11.1%) | ||||
Smoking (e-cigarette) every day | < .001 | .411 | .862 | |||||
Extremely/quite harmful | 42 (30.4%) | 26 (40.6%) | 17 (47.2%) | 2190 (45.8%) | ||||
Not/slightly/moderately harmful | 96 (69.6%) | 38 (59.4%) | 19 (52.8%) | 2594 (54.2%) | ||||
Smoking (hashish/marijuana) every week | .034 | .931 | .205 | a-c* | ||||
Extremely/quite harmful | 86 (59.3%) | 45 (68.2%) | 33 (76.7%) | 3491 (67.7%) | ||||
Not/slightly/moderately harmful | 59 (40.7%) | 21 (31.8%) | 10 (23.3%) | 1667 (32.3%) | ||||
Snuff use every week | .002 | .277 | .875 | |||||
Extremely/quite harmful | 61 (41.5%) | 33 (47.8%) | 25 (55.6%) | 2841 (54.4%) | ||||
Not/slightly/moderately harmful | 86 (58.5%) | 36 (52.2%) | 20 (44.4%) | 2383 (45.6%) | ||||
Alcohol consumption every week | .693 | .227 | .063 | b-c* | ||||
Extremely/quite harmful | 55 (37.9%) | 22 (32.4%) | 23 (53.5%) | 2042 (39.6%) | ||||
Not/slightly/moderately harmful | 90 (62.1%) | 46 (67.6%) | 20 (46.5%) | 3120 (60.4%) |
Case-group comparisons
Statistically independent effects
Unadjusted modela | Adjusted modelb | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
ADHD (n = 182) OR (95% CI) | P value | ASD (n = 78) OR (95% CI) | P value | Co-occurrence (n = 51) OR (95% CI) | P value | ADHD (n = 182) OR (95% CI) | P value | ASD (n = 78) OR (95% CI) | P value | Co-occurrence (n = 51) OR (95% CI) | P value | |
Socio-economic indicators | ||||||||||||
Unemployed | 1.36 (.84–2.20) | .208 | 2.45 (1.38–4.35) | .002 | 3.83 (2.06–7.13) | < .001 | 1.02 (.60–1.74) | .928 | 1.32 (.69–2.52) | .407 | 2.64 (1.31–5.32) | .007 |
Less money than friends | 4.11 (2.80–6.02) | < .001 | 2.75 (1.45–5.21) | .002 | 4.14 (2.01–8.53) | < .001 | 2.86 (1.82–4.51) | < .001 | 1.85 (.90–3.84) | .096 | 1.88 (.80–4.41) | .147 |
Health-related outcomes | ||||||||||||
Bad health quality | 1.89 (1.28–2.79) | .002 | 2.13 (1.23–3.69) | .007 | 2.69 (1.45–5.01) | .002 | 1.02 (.63–1.67) | .927 | 1.18 (.58–2.39) | .644 | 1.21 (.53–2.78) | .649 |
Autoimmune disease | 1.06 (.54–2.10) | .857 | .82 (.26–2.61) | .735 | 2.73 (1.15–6.45) | .022 | .88 (.44–1.78) | .724 | .79 (.24–2.55) | .689 | 2.41 (.99–5.83) | .051 |
BMI | 1.05 (.74–1.49) | .783 | 1.72 (1.02–2.90) | .040 | 1.12 (.56–2.22) | .749 | .93 (.66–1.31) | .688 | 1.43 (.89–2.32) | .142 | .98 (.52–1.84) | .951 |
Allergies | .98 (.69–1.40) | .920 | .75 (.46–1.21) | .236 | 1.28 (.68–2.39) | .437 | ||||||
Headache | 1.17 (.80–1.70) | .410 | 1.08 (.65–1.80) | .762 | .88 (.49–1.58) | .680 | ||||||
Stomach pain | 1.49 (1.05–2.11) | .027 | .70 (.41–1.18) | .178 | .70 (.40–1.23) | .220 | 1.20 (.83–1.76) | .331 | .65 (.35–1.22) | .175 | .49 (.25-.93) | .030 |
Joint pain | 1.64 (1.17–2.30) | .004 | 1.37 (.80–2.33) | .250 | 1.46 (.77–2.76) | .245 | 1.14 (.78–1.66) | .503 | 1.35 (.74–2.49) | .326 | 1.12 (.54–2.34) | .755 |
No exercise | 1.48 (1.03–2.13) | .036 | 1.73 (1.04–2.88) | .035 | 1.45 (.75–2.79) | .267 | 1.06 (.71–1.58) | .772 | 1.19 (.67–2.14) | .548 | .92 (.43–1.96) | .820 |
Bad sleep quality | 2.36 (1.71–3.26) | < .001 | 1.13 (.60–2.14) | .704 | 2.59 (1.39–4.82) | .003 | 1.50 (1.01–2.22) | .043 | .67 (.32–1.40) | .283 | 1.58 (.70–3.53) | .265 |
Screen exposure weekdays (> 4h) | 1.18 (.86–1.63) | .296 | 1.52 (.91–2.54) | .112 | 1.25 (.68–2.31) | .474 | ||||||
Screen exposure weekends (> 4h) | 1.26 (.92–1.72) | .148 | 2.21 (1.29–3.79) | .004 | 1.80 (.96–3.38) | .065 | 1.08 (.78–1.50) | .629 | 1.59 (.90–2.84) | .111 | 1.43 (.76–2.72) | .269 |
Psychosocial vulnerability | ||||||||||||
Performance at work/school | .66 (.49-.88) | .006 | 1.09 (.68–1.74) | .721 | .60 (.35–1.01) | .056 | .79 (.58–1.08) | .133 | 1.36 (.81–2.28) | .242 | .71 (.40–1.24) | .223 |
Faith in the future | .71 (.55-.91) | .007 | .48 (.34-.67) | < .001 | .46 (.30-.69) | < .001 | 1.08 (.76–1.54) | .650 | .63 (.40–1.01) | .055 | .72 (.41–1.26) | .257 |
Perceived stress | 1.21 (.98–1.49) | .069 | .83 (.59–1.15) | .260 | 1.08 (.72–1.62) | .698 | .92 (.71–1.19) | .527 | .70 (.46–1.07) | .099 | .79 (.49–1.28) | .334 |
Control over life | .78 (.61-.99) | .048 | .55 (.38-.79) | .001 | .63 (.42-.96) | .031 | 1.13 (.81–1.59) | .461 | .76 (.46–1.25) | .282 | 1.19 (.65–2.20) | .571 |
Being bullied | 1.55 (.83–2.87) | .162 | 1.13 (.45–2.85) | .790 | 3.91 (1.93–7.94) | < .001 | .92 (.47–1.81) | .817 | .69 (.26–1.85) | .457 | 1.96 (.85–4.52) | .116 |
Lack of social support | 1.83 (1.09–3.07) | .021 | 2.10 (1.01–4.35) | .046 | 3.08 (1.33–7.17) | .009 | 1.00 (.55–1.82) | .995 | 1.26 (.54–2.92) | .596 | 1.20 (.43–3.35) | .724 |
Feeling depressed | 1.63 (1.15–2.31) | .006 | 1.45 (.87–2.41) | .151 | 2.09 (1.12–3.92) | .021 | .92 (.55–1.55) | .764 | .87 (.40–1.89) | .726 | .95 (.33–2.68) | .919 |
Feeling anxious | 1.53 (1.07–2.20) | .021 | 1.28 (.77–2.11) | .336 | 2.01 (1.13–3.59) | .017 | .94 (.54–1.64) | .820 | 1.01 (.47–2.19) | .981 | 1.39 (.58–3.32) | .463 |
Concentration difficulties | 2.53 (1.83–3.51) | < .001 | 2.34 (1.48–3.67) | < .001 | 1.95 (1.06–3.60) | .031 | 1.96 (1.32–2.91) | < .001 | 2.35 (1.38–3.99) | .002 | 1.42 (.67–3.00) | .358 |
Risk-taking behaviours and perceptions of risks | ||||||||||||
Risk-taking behaviours | 1.74 (1.24–2.46) | .002 | .41 (.24-.68) | < .001 | .68 (.37–1.24) | .208 | 1.24 (.86–1.79) | .233 | .40 (.24-.67) | < .001 | .71 (.38–1.32) | .274 |
Perceptions of risks | 1.44 (1.15–1.81) | .002 | 1.22 (.87–1.70) | .253 | .79 (.50–1.24) | .299 | 1.25 (.98–1.59) | .068 | 1.19 (.82–1.71) | .357 | .70 (.42–1.19) | .181 |