Neurodevelopmental disorders like Attention Deficit / Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are among the most frequent childhood-onset psychiatric disorders. These disorders have a strong recurrence from one generation to the next. Their early onset hinders achievement of typical developmental tasks such as social tasks with peers and cognitive tasks at school and their impact continues and often becomes worse throughout life.
There are important research gaps. Most knowledge on ADHD and ASD comes from the childhood years, when the onset has become clearly visible and impairments in daily life are encountered. At this point in in life, children with ADHD and ASD are typically referred to outpatient clinics and may enroll in scientific studies. However, this is only a small part of the lifespan. We strive to extend this knowledge to both the period before onset, starting even at preconception in multigenerational research and through pregnancy from birth on, as well as beyond childhood, through young- and mid-adulthood up to old age. By enhancing the knowledge base of understudied life phases, our ultimate aim is to improve the lifecourse of individuals ADHD or ASD.
Our approach is epidemiological and our focus can be biological, psychological, social or societal, including their transactions. Based on this bio-psycho-social-societal model, and through both large and broadly phenotyped, as well as smaller and deeply phenotyped, cohort and family data, we aim to identify (a) the complex mechanisms leading to an onset of ADHD or ASD as well as (b) the drivers of a comparatively mild in contrast to a more severe course of ADHD or ASD throughout life, this is comparison with individuals without ADHD or ASD. The more severe life course of persons with ADHD and ASD is characterized by onset of comorbid psychiatric (e.g., depression and anxiety disorders) and somatic conditions (e.g., obesity, type 2 diabetes). Comorbidity is thus an important focus in our work. Also, when studying intergenerational transmission, offspring psychopathology may take a whole different form than the type of psychiatric problems in the parents. As such, our research is strongly transdiagnostic. Often, we work in large multidisciplinary consortia: researchers with different expertise using different approaches complement our epidemiological work so that progress is maximized despite the complexity of the research questions.
Neurodevelopmental disorders are disabling and part of this could be averted. Although onset is in childhood, diagnosis and treatment are often much later, when comorbidity and impairments have already become more severe. Although the conditions occur more often in boys, females with ADHD or ASD are diagnosed much later if at all, since their problems are under-recognized. Although it is currently well-known that ADHD and ASD do not remit during childhood but are lifelong, many late-adolescents are ‘lost from care’ when they need to transition from childhood to adult services, which is when they are most at risk to develop adult psychiatric and somatic comorbid conditions. Although ADHD and ASD occur in all socioeconomic strata, the course throughout life is markedly poorer in the lower strata. All of these examples come from recent insights from research on the lifecourse of ADHD and ASD. All of these examples also show that the negative consequences of ASD and ADHD during the lifecourse can potentially be prevented. The question may even be raised if onset of ADHD or onset of ASD can be, if not be prevented, postponed or be milder, through early preventive measures.
The examples show how enhanced knowledge is an indispensable part of improving the lifes of individuals with ADHD and ASD. There is still a lót of room for research to establish how and under which conditions ADHD and ASD re-cur from one generation to the next and on how and why some individuals with ADHD and ASD are on a relatively mild trajectory throughout life whereas others are on a route of severe impairments and co-occurring conditions. Enhancing this knowledge and this kowledge is wat we do.
