Getting the Full Picture with ADHD

ADHD and adverse childhood experiences share similar symptoms

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) One of the challenges of identifying and treating children with mental health conditions is figuring out what symptoms are related to the condition. This is especially true with symptoms of attention deficit hyperactivity disorders.

In a recent study, the authors noted that many behaviors children with ADHD exhibited were also behaviors seen among children with traumatic childhood experiences.

Knowing whether a child's behavior results from ADHD or an adverse childhood experience would affect how the child is treated.

So the researchers set out to determine what the overlap was between children with ADHD and children with adverse childhood experiences.

"Tell your pediatrician about your child's history of stressful experiences."

The study, led by Nicole Brown, MD, of The Children's Hospital at Montefiore in New York City, looked at the possible overlap of symptoms between ADHD and adverse childhood experiences.

The researchers analyzed data involving children aged 2 to 17 years old from the 2011 National Survey of Children's Health.

They compared the symptoms and treatment of children with ADHD to those of children who experienced any of nine adverse childhood experiences. Those adverse childhood experiences included:

  • poverty
  • divorce
  • death of a parent/guardian
  • domestic violence
  • neighborhood violence
  • substance abuse
  • incarceration
  • familial mental illness
  • discrimination

Among a total of 85,637 children, the researchers identified 7.9 percent (6,758 kids) who were diagnosed with ADHD.

Among those with ADHD, 43 percent of the children had experienced at least two of the adverse childhood experiences, compared to 20 percent of children without ADHD.

The researchers found that children with ADHD were more likely to be on medication if they had been exposed to a greater number of adverse childhood experiences.

For example, children with ADHD who had been exposed to at least two adverse childhood experiences were 2.7 times more likely to be taking medication compared to children with ADHD but no exposure to adverse childhood experiences.

Children with ADHD and one past adverse childhood experience were 1.7 times more likely to be taking medication than those with no adverse childhood experiences.

In addition, children with at least two adverse childhood experiences were 2.6 times more likely to have their ADHD rated as "moderate to severe" by their parents, compared to kids without adverse childhood experiences.

"Children with ADHD have a higher prevalence of adverse childhood experiences compared to those without ADHD," the researchers concluded.

They also noted that an increase in adverse childhood experiences correlated an increase in severity of ADHD and in medication use among kids with ADHD.

“Clinicians who work regularly with children who have combined-type ADHD have long noted the increased risk these children have for experience traumatic, even life-threatening events because of impulsivity, high activity levels and often poor judgment," said Glen Elliott, MD, PhD, a clinical professor at the Stanford University Department of Psychiatry and Behavioral Sciences.

"It is useful to have a paper such as this document the extent to which such events occur the additional problems they can create for this population," he said. "The authors went further, though, and looked at other aspects of social environment, showing that individuals facing other stressors such as poverty and divorce or violence."

Dr. Elliott said it is not surprising that a patient dealing with multiple stresses in their lives is also more likely to be using medications.

"It is important to emphasize that this is a correlation, not causation, but, it is reasonable to speculate that increased stressors may worsen ADHD symptoms or at least that families whose children face such stressors are more willing to turn to medication to help reduce ADHD symptoms,” he said.

This study has not yet been published in a peer-reviewed journal, and its findings should be interpreted with caution.

The research was presented May 6 at the Pediatric Academic Societies annual meeting in Vancouver, Canada.

No outside funding was used for the study, and no information regarding disclosures or possible conflicts of interest was available.

Review Date: 
May 4, 2014
Last Updated:
May 26, 2014