Elsevier

Academic Pediatrics

Volume 17, Issue 4, May–June 2017, Pages 356-361
Academic Pediatrics

ACEs and ADHD
Adverse Childhood Experiences and ADHD Diagnosis at Age 9 Years in a National Urban Sample

https://doi.org/10.1016/j.acap.2016.12.009Get rights and content

Abstract

Objective

To examine associations between adverse childhood experiences (ACEs) and attention-deficit/hyperactivity disorder (ADHD) at age 9 years using longitudinal data and assess the extent to which ACEs during middle childhood are independently associated with ADHD at age 9 years.

Methods

We conducted a secondary analysis of data from the Fragile Families urban birth cohort 5- and 9-year interviews. The sample was limited to children for whom mothers were the primary caregiver and mother-reported information on 8 ACEs and ADHD were available at age 5 and 9 years. We examined associations between ACEs and parent-reported ADHD at age 9 years using logistic regression and controlling for potential confounders.

Results

We included 1572 children; 48% were African American, 11% had parent-reported ADHD at age 9 years, 41% and 42% experienced ≥1 ACE by age 5 years and between the ages of 5 and 9 years, respectively. ACEs before age 5 years were associated with ADHD at age 9 years. One, 2, and ≥3 ACEs between age 5 and 9 years were associated with ADHD at age 9 years even after controlling for ACEs before age 5 years and ADHD at age 5 years (adjusted odds ratio [AOR], 1.9; 95% confidence interval [CI], 1.2–3; AOR, 2.1; 95% CI, 1.2–3.8; and AOR, 2.2; 95% CI, 1.1–4.3).

Conclusions

In this study of urban children, ACEs occurring before age 5 years as well as between the ages of 5 and 9 years were associated with ADHD at age 9 years. Even after controlling for early childhood ACEs and ADHD at age 5 years, the association between ADHD and ACEs in middle childhood remained significant, highlighting the importance of screening and intervention throughout childhood.

Section snippets

Study Design and Data Source

We conducted a secondary analysis of data from the Fragile Families and Child Wellbeing Study (FFCWS) birth cohort. The FFCWS cohort consists of nearly 5000 children born between 1998 and 2000 in 20 large US cities.21 Most children in the study were born to unmarried parents by design. This longitudinal data set includes postpartum (baseline) and follow-up interviews with mothers with children at ages 1, 3, 5, and 9 years. A more detailed description of the study design and methods, including

Study Sample

The study sample included 1572 children. Baseline demographic and socioeconomic characteristics of the study sample are summarized in Table 1 along with corresponding measures for respondents who participated in the FFCWS but were not included in the study sample. There were no statistically significant differences between these groups. Nearly half of the children included in the study sample were African American, one-quarter were Latino, and 69% were born to unmarried parents. Only 4% of the

Discussion

In a national US urban sample, we found that experiencing ACEs before age 5 years and experiencing ACEs between age 5 and 9 years were both associated with parent-reported ADHD diagnosis at age 9 years. Even after controlling for ACEs occurring before age 5 years and other potential confounders, including ADHD diagnosis at age 5 years, we found that ACEs occurring during middle childhood were significantly associated with parent-reported ADHD at age 9 years. These findings add to the growing

Acknowledgments

Financial disclosure: Dr Jimenez is supported by the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program. The project described was supported in part by Award Numbers R25HD074544, P2CHD058486, and 5R01HD036916 awarded by the Eunice Kennedy Shriver National Institute of Child Health & Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child

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    The authors have no conflicts of interest to disclose.

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