Serviço de Psiquiatria da Infância e Adolescência, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul 90035-003, Brazil.
Eur Child Adolesc Psychiatry. 2011 Mar;20(3):137-45. doi: 10.1007/s00787-011-0158-4. Epub 2011 Feb 3.
Attention-deficit/hyperactivity disorder (ADHD) seems to be associated with significant psychosocial adversity. However, few studies assessed the role of environmental, social and interpersonal factors specifically in ADHD, inattentive type (ADHD-I). Thus, this study aims to investigate whether family environment risk factors are associated with ADHD-I. In a case-control study, we assessed a non-referred sample of 100 children and adolescents with ADHD-I and 100 non-ADHD controls (6-18 years old). They were systematically evaluated through structured diagnostic interviews. The following family adversity measures were used: Rutter's family adversity index (marital discord, low social class, large family size, paternal criminality, maternal mental disorder), Family Environment Scale (FES) (subscores of cohesion, expressiveness and conflict) and Family Relationship Index (FRI) (based on the subscores above). After adjusting for confounding factors (social phobia and maternal history of ADHD), the odds ratio (OR) for ADHD-I increased as the number of Rutter's indicators increased. Families of children with lower FES cohesion subscores presented higher OR for ADHD-I (OR 1.24; 95% confidence interval 1.05-1.45). Lower levels of FRI, a general index of family relationship, were also related to higher risk of ADHD-I (OR 1.11; 95% confidence interval 1.03-1.21). Our findings suggest that family adversity (in general), low family cohesion and low FRI (in particular) are associated with an increase in the risk for ADHD-I. However, the cross-sectional nature of the study limits our ability to infer causality.
注意缺陷多动障碍（ADHD）似乎与重大的心理社会逆境有关。然而，很少有研究专门评估环境、社会和人际关系因素在注意力不集中型多动症（ADHD-I）中的作用。因此，本研究旨在探讨家庭环境危险因素是否与 ADHD-I 相关。在一项病例对照研究中，我们评估了 100 名 ADHD-I 患儿和青少年以及 100 名非 ADHD 对照组（6-18 岁）的非转介样本。他们通过结构化诊断访谈进行了系统评估。使用了以下家庭逆境措施：Rutter 的家庭逆境指数（婚姻不和、社会阶层低、家庭规模大、父亲犯罪、母亲精神障碍）、家庭环境量表（FES）（凝聚力、表达力和冲突的子分数）和家庭关系指数（FRI）（基于上述子分数）。在调整混杂因素（社交恐惧症和母亲 ADHD 病史）后，随着 Rutter 指标数量的增加，ADHD-I 的优势比（OR）增加。FES 凝聚力子分数较低的家庭，其 ADHD-I 的 OR 更高（OR 1.24；95%置信区间 1.05-1.45）。一般家庭关系指标 FRI 水平较低也与 ADHD-I 的风险增加相关（OR 1.11；95%置信区间 1.03-1.21）。我们的研究结果表明，家庭逆境（总体而言）、低家庭凝聚力和低 FRI（特别是）与 ADHD-I 的风险增加有关。然而，研究的横断面性质限制了我们推断因果关系的能力。
