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CATSS - The Child and Adolescent Twin Study in Sweden

This is an ongoing longitudinal twin study targeting all twins born in Sweden since July 1, 1992. Since 2004, parents of twins are interviewed regarding the children’s somatic and mental health as well as social environment in connection with their 9th or 12th birthdays (CATSS-9/12). By December 2012, >11 000 parental interviews concerning >22 000 twins has been completed, with an overall response rate of 80%.

Twin pairs in CATSS-9/12 with one or both twins screening positive for autism spectrum disorders, attention deficit/hyperactivity disorder, tic disorders, developmental coordination disorder, learning disorders, oppositional defiant disorder, conduct disorder, obsessive–compulsive disorder, and/or eating problems have been followed with in-depth questionnaires on family, social environment and personality, and subsequently by clinical assessments at age 15 together with randomly selected population controls, including 195 clinically assessed twin pairs from the first 2 year cohorts (CATSS15/DOGSS). DNA, via saliva, exists for more >12 000 twins.

At age 15 and 18, twins and parents complete questionnaires that, in addition to assessments of somatic and mental health, include measures of personality development and psychosocial adaptation. The 15 year phase of the study includes data on >7 000 twins and the 18 year follow up includes data on > 3 000 twins.

The article (link below) describes the cohorts and study groups, data collection, and measures used. Prevalence, distributions, heritability estimates, ages at onset, and sex differences of mental health problems in the CATSS-9/12, were analysed and found to be overall comparable to those of other clinical and epidemiological studies. The CATSS study has the potential of answering important questions about the aetiology of childhood mental health problems and their role in the development of later adjustment problems.

As of today the CATSS-study has generated more than 15 peer-reviewed articles and more more are currently submitted for evaluation. The CATSS is managed by The Swedish Twin registry at Karolinska Institutet. The prinicipal investigators of the different part of the study includes Henrik Anckarsäter (CATSS-9/12, DOGSS), Clara Gumpert (DOGSS), Niklas Långström (CATSS-15), Sebastian Lundström (CATSS-18), and Paul Lichtenstein (CATSS9/12-15-18 and DOGSS).

Principal Investigators:

Paul Lichtenstein, Karolinska Institutet
Henrik Anckarsäter, University of Gothenburg
Clara Gumpert, Karolinska Institutet
Niklas Långström, Karolinska Institutet
Sebastian Lundström, University of Gothenburg



  1. Lichtenstein P, Sullivan PF, Cnattingius S, et al. The Swedish Twin Registry in the third millennium: an update. Twin Res Hum Genet. Dec 2006;9(6):875-882.
  2. Ortqvist AK, Lundholm C, Carlstrom E, Lichtenstein P, Cnattingius S, Almqvist C. Familial factors do not confound the association between birth weight and childhood asthma. Pediatrics. Oct 2009;124(4):e737-743.
  3. Gustafsson PE, Anckarsater H, Lichtenstein P, Nelson N, Gustafsson PA. Does quantity have a quality all its own? Cumulative adversity and up- and down-regulation of circadian salivary cortisol levels in healthy children. Psychoneuroendocrinology. Oct 2010;35(9):1410-1415.
  4. Hallerod SL, Larson T, Stahlberg O, et al. The Autism--Tics, AD/HD and other Comorbidities (A-TAC) telephone interview: convergence with the Child Behavior Checklist (CBCL). Nord J Psychiatry. May 4 2010;64(3):218-224.
  5. Kerekes N, Brandstrom S, Stahlberg O, et al. The Swedish version of the parent-rated Junior Temperament and Character Inventory (J-TCI). Psychol Rep. Dec 2010;107(3):715-725.
  6. Larson T, Anckarsater H, Gillberg C, et al. The autism--tics, AD/HD and other comorbidities inventory (A-TAC): further validation of a telephone interview for epidemiological research. BMC Psychiatry. 2010;10:1.
  7. Lichtenstein P, Carlstrom E, Rastam M, Gillberg C, Anckarsater H. The genetics of autism spectrum disorders and related neuropsychiatric disorders in childhood. Am J Psychiatry. Nov 2010;167(11):1357-1363.
  8. Lundholm C, Ortqvist AK, Lichtenstein P, Cnattingius S, Almqvist C. Impaired fetal growth decreases the risk of childhood atopic eczema: a Swedish twin study. Clin Exp Allergy. Jul 2010;40(7):1044-1053.
  9. Lundstrom S, Haworth CM, Carlstrom E, et al. Trajectories leading to autism spectrum disorders are affected by paternal age: findings from two nationally representative twin studies. J Child Psychol Psychiatry. Jul 2010;51(7):850-856.
  10. Anckarsater H, Lundstrom S, Kollberg L, et al. The Child and Adolescent Twin Study in Sweden (CATSS). Twin Res
  11. Gustafsson PA, Gustafsson PE, Anckarsater H, et al. Heritability of cortisol regulation in children. Twin Res Hum Genet. Dec 2011;14(6):553-561.
  12. Lundstrom S, Chang Z, Kerekes N, et al. Autistic-like traits and their association with mental health problems in two nationwide twin cohorts of children and adults. Psychol Med. Nov 2011;41(11):2423-2433.
  13. Ronald A, Larsson H, Anckarsater H, Lichtenstein P. A twin study of autism symptoms in Sweden. Mol Psychiatry. Oct 2011;16(10):1039-1047.
  14. Larsson H, Anckarsater H, Rastam M, Chang Z, Lichtenstein P. Childhood attention-deficit hyperactivity disorder as an extreme of a continuous trait: a quantitative genetic study of 8,500 twin pairs. J Child Psychol
  15. Losh M, Esserman D, Anckarsater H, Sullivan PF, Lichtenstein P. Lower birth weight indicates higher risk of autistic traits in discordant twin pairs. Psychol Med. May 2012;42(5):1091-1102.
  16. Lundstrom S, Chang Z, Rastam M, et al. Autism spectrum disorders and autistic like traits: similar etiology in the extreme end and the normal variation. Arch Gen Psychiatry. Jan 2012;69(1):46-52.
  17. Walum H, Lichtenstein P, Neiderhiser JM, et al. Variation in the oxytocin receptor gene is associated with pair-bonding and social behavior. Biol Psychiatry. Mar 1 2012;71(5):419-426.
  18. Donahue KL, Lichtenstein P, Lundstrom S, et al. Childhood behavior problems and adolescent sexual risk behavior: familial confounding in the child and adolescent twin study in Sweden (CATSS). J Adolesc Health. May 2013;52(5):606-612.
  19. Garcia D, Anckarsater H, Lundstrom S. Self-directedness and cooperativeness, psychosocial dysfunction and suffering in ESSENCE. ScientificWorldJournal. 2013;2013:416981.
  20. Garcia D, Lundstrom S, Brandstrom S, et al. Temperament and character in the Child and Adolescent Twin Study in Sweden (CATSS): comparison to the general population, and genetic structure analysis. PLoS One. 2013;8(8):e70475.
  21. Ivanov VZ, Mataix-Cols D, Serlachius E, et al. Prevalence, comorbidity and heritability of hoarding symptoms in adolescence: a population based twin study in 15-year olds. PLoS One. 2013;8(7):e69140.
  22. Kerekes N, Brandstrom S, Lundstrom S, Rastam M, Nilsson T, Anckarsater H. ADHD, autism spectrum disorder, temperament, and character: phenotypical associations and etiology in a Swedish childhood twin study. Compr Psychiatry. Nov 2013;54(8):1140-1147.
  23. Larson T, Lundstrom S, Nilsson T, et al. Predictive properties of the A-TAC inventory when screening for childhood-onset neurodevelopmental problems in a population-based sample. BMC Psychiatry. 2013;13:233.
  24. Magnusson PK, Almqvist C, Rahman I, et al. The Swedish Twin Registry: establishment of a biobank and other recent developments. Twin Res Hum Genet. Feb 2013;16(1):317-329.
  25. Molero Y, Gumpert C, Serlachius E, et al. A study of the possible association between adenosine A2A receptor gene polymorphisms and attention-deficit hyperactivity disorder traits. Genes Brain Behav. Apr 2013;12(3):305-310.
  26. Pettersson E, Anckarsater H, Gillberg C, Lichtenstein P. Different neurodevelopmental symptoms have a common genetic etiology. J Child Psychol Psychiatry. Dec 2013;54(12):1356-1365.
  27. Rastam M, Taljemark J, Tajnia A, et al. Eating problems and overlap with ADHD and autism spectrum disorders in a nationwide twin study of 9- and 12-year-old children. ScientificWorldJournal. 2013;2013:315429.
  28. Robinson EB, Lichtenstein P, Anckarsater H, Happe F, Ronald A. Examining and interpreting the female protective effect against autistic behavior. Proc Natl Acad Sci U S A. Mar 26 2013;110(13):5258-5262.
  29. Zettergren A, Jonsson L, Johansson D, et al. Associations between polymorphisms in sex steroid related genes and autistic-like traits. Psychoneuroendocrinology. Nov 2013;38(11):2575-2584.
  30. Bolte S, Willfors C, Berggren S, et al. The Roots of Autism and ADHD Twin Study in Sweden (RATSS). Twin Res Hum Genet. Jun 2014;17(3):164-176.
  31. Cederlof M, Ostberg P, Pettersson E, et al. Language and mathematical problems as precursors of psychotic-like experiences and juvenile mania symptoms. Psychol Med. Apr 2014;44(6):1293-1302.
  32. Garcia D, Strage A, Lundstrom S, et al. Responsibility and cooperativeness are constrained, not determined. Front Psychol. 2014;5:308.
  33. Gustafsson P, Kerekes N, Anckarsater H, Lichtenstein P, Gillberg C, Rastam M. Motor function and perception in children with neuropsychiatric and conduct problems: results from a population based twin study. J Neurodev Disord. 2014;6(1):11.
  34. Halldner L, Tillander A, Lundholm C, et al. Relative immaturity and ADHD: findings from nationwide registers, parent- and self-reports. J Child Psychol Psychiatry. Aug
  35. Hovey D, Zettergren A, Jonsson L, et al. Associations between oxytocin-related genes and autistic-like traits. Soc Neurosci. 2014;9(4):378-386.
  36. Jonsson L, Anckarsater H, Zettergren A, et al. Association between ASMT and autistic-like traits in children from a Swedish nationwide cohort. Psychiatr Genet. Feb 2014;24(1):21-27.
  37. Kerekes N, Lundstrom S, Chang Z, et al. Oppositional defiant- and conduct disorder-like problems: neurodevelopmental predictors and genetic background in boys and girls, in a nationwide twin study. PeerJ. 2014;2:e359.
  38. Larson T, Kerekes N, Selinus EN, et al. Reliability of Autism-Tics, AD/HD, and other Comorbidities (A-TAC) inventory in a test-retest design. Psychol Rep. Feb 2014;114(1):93-103.
  39. Pettersson E, Sjolander A, Almqvist C, et al. Birth weight as an independent predictor of ADHD symptoms: a within-
  40. Ronald A, Larsson H, Anckarsater H, Lichtenstein P. Symptoms of autism and ADHD: a Swedish twin study examining their overlap. J Abnorm Psychol. May 2014;123(2):440-451.
  41. Lundström S, Reichenberg A, Melke J, et al. Autism Spectrum Disorders and Coexisting Disorders in a Nationwide Swedish Twin Study. J Child Psychol Psychiatry. In press .
  42. Willfors C, Poltrago L, Berggren S, et al. On the role of non-shared environment for executive functioning in ADHD: a twin-differences design study. Int J Dev Disabil. Jul 2014;60(3):163-173.
  43. Tong G, Almqvist C, Bölte S, et al. Exposure to air pollution from traffic and neurodevelopmental disorders in Swedish Twins. In Press

Contact Information

Henrik Anckarsäter

Contact Information

Sebastian Lundström

Page Manager: Stefan Axelsson|Last update: 9/23/2014

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