Diagnosis of attention-deficit/hyperactivity disorder (ADHD) at age 9 years is associated with adverse childhood experiences (ACEs), according to an analysis of data for 1572 children who are part of the Fragile Families and Child Wellbeing Study (FFCWS) birth cohort.
The database for FFCWS includes information about child maltreatment collected at 5-year and 9-year follow-up interviews at which mothers provided information about ACEs as measured by any contact with Child Protective Services regarding physical abuse, sexual abuse, or neglect, and an instrument to assess if the child was exposed to psychological aggression, physical assault, or neglect. The FFCWS interviewers also assessed maternal depressive symptoms, substance use, paternal incarceration, and violence against the mother, using a variety of diagnostic scales and questionnaires.
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Forty-one percent of the children experienced at least 1 ACE before age 5 years, and 42% experienced at least 1 ACE between ages 5 and 9 years. The most common ACEs were neglect, maternal depressive symptoms, and substance abuse, which was more commonly reported at the 9-year follow-up than at the 5-year follow-up.
Investigators found that experiencing ACEs both before age 5 years and between ages 5 and 9 years was associated with parent-reported ADHD diagnosis at age 9 years. Even after controlling for ACEs that occurred before the age of 5 years and other potential confounders, including ADHD diagnosis at age 5 years, ACEs occurring during middle childhood were significantly associated with parent-reported ADHD at age 9 years (Jimenez ME, et al. Acad Pediatr. 2017;17:356-361).
Thoughts from Dr Burke
This goes to show that the brain of a child is a work in progress. Early negative experiences are associated with ADHD, but so are late ones, even when the child was spared ACEs in the first 5 years of life. This is another reason that longitudinal care provided by known physicians and others in the patient’s medical home is a great asset for children.