ADHD is the most common neurobehavioral disorder of childhood. There has been a significant increase in parent-reported ADHD prevalence over the last decade, and there has also been an associated rise in stimulant medication use. Current ADHD clinical practice guidelines recommend evaluating for other conditions that have similar symptoms to ADHD, such as disruptive behaviors, impulsivity, and issues with memory, organization and problem-solving, but few pediatricians routinely ask about psychosocial factors that could be effecting a child鈥檚 health during ADHD assessment.
Exposure to Adverse Childhood Experiences (ACEs), commonly referred to as family or environmental stressors, such as divorce and familial incarceration, is one way that behaviors similar to those exhibited by children with ADHD, can be triggered. Research has shown that this is because ACEs may increase a child鈥檚 risk for toxic levels of stress, which in turn may impair brain development, behavior, and overall physical and mental health.
鈥淚f clinicians aren鈥檛 routinely discussing exposure to traumatic experiences and identifying ACEs, particularly among children with behavioral concerns such as ADHD, there may be a heightened risk of missing an underlying trauma history or misattributing some of the symptoms of traumatic stress as solely those of ADHD,鈥� said lead author , M.D., M.P.H., M.H.S., attending pediatrician, Division of Academic General Pediatrics, CHAM, and assistant professor of Pediatrics, Albert Einstein College of Medicine. 鈥淲e sought to examine the link between ADHD and ACEs in an effort to improve ADHD assessment and management.鈥�
Dr. Brown and co-investigators at CHAM used a nationally representative sample of 76,227 children from the 2011-2012 National Survey of Children鈥檚 Health, to identify children 4 -17 years old whose parents reported both the presence and severity of ADHD and their child鈥檚 exposure to nine ACEs 鈥� socioeconomic hardship, divorce, death, domestic violence, neighborhood violence, substance abuse, incarceration, mental illness in the family, and discrimination.
The that children with parent-reported ADHD were more likely to have two or more ACEs exposures, compared to children without parent-reported ADHD. Most significantly, children with socioeconomic hardship, parent/guardian divorce, familial mental illness, neighborhood violence, and familial incarceration were more likely to have an ADHD diagnosis, and those with socioeconomic hardship and familial mental illness were more likely to have moderate to severe ADHD, according to parental reports.
Children with parent-reported ADHD represented 8.8 percent of the 76,227 children, and were more likely to be male, aged 12 鈥� 17 and non-Hispanic white.
鈥淥ur research shows there are significant associations between ACE exposures and having an ADHD diagnosis, and we encourage pediatric providers to more frequently evaluate for ACEs as part of ADHD assessments,鈥� said Dr. Brown. 鈥淯ltimately, this may lead to more trauma-informed approaches to care, particularly for children whose response to stimulant medications or targeted behavioral therapies are poor.鈥�
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About Montefiore Health SystemMontefiore Health System is one of New York鈥檚 premier academic health systems and is a recognized leader in providing exceptional quality and personalized, accountable care to approximately three million people in communities across the Bronx, Westchester and the Hudson Valley. It is comprised of 10 hospitals, including the Children鈥檚 Hospital at Montefiore, Burke Rehabilitation Hospital and close to 200 outpatient care sites. The advanced clinical and translational research at its medical school, Albert Einstein College of Medicine, directly informs patient care and improves outcomes. From the Montefiore-Einstein Centers of Excellence in cancer, cardiology and vascular care, pediatrics, and transplantation, to its preeminent school-based health program, Montefiore is a fully integrated healthcare delivery system providing coordinated, comprehensive care to patients and their families. For more information please visit www.montefiore.org. Follow us on and view us on and .
About Academic Pediatrics, the official journal of the Academic Pediatric Association, is a peer-reviewed publication whose purpose is to strengthen the research and educational base of academic general pediatrics. The journal provides leadership in pediatric education, research, patient care and advocacy. Content areas include pediatric education, emergency medicine, injury, abuse, behavioral pediatrics, holistic medicine, child health services and health policy, and the environment. The journal provides an active forum for the presentation of pediatric educational research in diverse settings, involving medical students, residents, fellows, and practicing professionals. The journal also emphasizes important research relating to the quality of child health care, health care policy, and the organization of child health services. It also includes systematic reviews of primary care interventions and important methodologic papers to aid research in child health and education.
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