New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, USA.
Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, PR, USA.
J Child Psychol Psychiatry. 2021 Aug;62(8):971-978. doi: 10.1111/jcpp.13352. Epub 2020 Dec 2.
Children with adverse childhood experiences (ACEs) are more likely to develop Attention-Deficit/Hyperactivity Disorder (ADHD). The reverse relationship - ADHD predicting subsequent ACEs - is vastly understudied, although it may be of great relevance to underserved populations highly exposed to ACEs.
Participants were 5- to 15-year-olds (48% females) with (9.9%) and without ADHD (DSM-IV criteria except age of onset) in a longitudinal population-based study of Puerto Rican youth. In each wave (3 yearly assessments, W1-3), ten ACEs (covering parental loss and maladjustment and child maltreatment) were examined, plus exposure to violence. Logistic regression models examined ADHD (including subtypes) and subsequent risk for ACEs. Also considered were interactions by age, sex, number of W1 ACEs, and recruitment site.
Children with W1 ADHD were more likely to experience subsequent adversity (OR: 1.63; 95% CI: 1.12-2.37) accounting for child age, sex, public assistance, maternal education, site, disruptive behavior disorders, and W1 ACEs. Inattentive (OR: 2.00; 95% CI: 1.09-3.66), but not hyperactive/impulsive or combined ADHD, predicted future ACEs.
ADHD predicts subsequent risk for ACEs, and the inattentive presentation may confer the most risk. Inattentive presentations could pose a bigger risk given differences in symptom persistence, latency to access to treatment, and treatment duration. The present study suggests a pathway for the perpetuation of adversity, where bidirectional relationships between ADHD and ACEs may ensnare children in developmental pathways predictive of poor outcomes. Understanding the mechanism underlying this association can help the development of interventions that interrupt the cycle of adversity exposure and improve the lives of children with ADHD.
经历过不良童年经历（ACEs）的儿童更有可能患上注意力缺陷多动障碍（ADHD）。而 ADHD 预测随后发生 ACEs 的反向关系则研究甚少，尽管这对于高度暴露于 ACEs 的服务不足的人群可能具有重要意义。
在一项针对波多黎各青少年的纵向基于人群的研究中，参与者为 5 至 15 岁（48%为女性）的 ADHD 儿童（DSM-IV 标准，除发病年龄外）和无 ADHD 儿童。在每一波（3 年评估，W1-3）中，检查了 10 项 ACE（涵盖父母丧失和失调以及儿童虐待），以及暴力暴露。逻辑回归模型检查了 ADHD（包括亚型）和随后发生 ACE 的风险。还考虑了年龄、性别、W1 ACE 数量和招募地点的交互作用。
患有 W1 ADHD 的儿童更有可能经历随后的逆境（OR：1.63；95%CI：1.12-2.37），考虑到儿童年龄、性别、公共援助、母亲教育、地点、破坏性行为障碍和 W1 ACE。注意力不集中（OR：2.00；95%CI：1.09-3.66），而不是多动/冲动或混合型 ADHD，预测未来 ACEs。
ADHD 预测随后发生 ACEs 的风险，而注意力不集中的表现可能带来更大的风险。鉴于症状持续时间、获得治疗的潜伏期和治疗持续时间的差异，注意力不集中的表现可能带来更大的风险。本研究提出了 ADHD 和 ACEs 之间可能存在的双向关系，这种关系可能使儿童陷入不良后果的发展轨迹，从而导致逆境的延续。了解这种关联的机制有助于制定干预措施，打破逆境暴露的循环，改善 ADHD 儿童的生活。
