University of South Carolina, Columbia, USA.
J Atten Disord. 2025 Jan;29(1):42-52. doi: 10.1177/10870547241290673. Epub 2024 Oct 18.
Adverse childhood experiences (ACEs) have long been associated with attention-deficit/hyperactive disorder (ADHD) diagnoses in children; but the data used is now over 6 years old (from 2017 to 2018). Understanding the current landscape of their prevalence and association is needed to capture evolving social, environmental, and economic conditions, and ensure interventions remain relevant to addressing current childhood trauma.
This study provides an updated analysis of the association between ACEs and ADHD using post-acute-COVID-19 pandemic data.
This cross-sectional study of 10,518 children aged 5 to 17 years old derived data from the 2021 to 2022 National Health Interview Survey (NHIS).
Differences in the prevalence of number (0, 1-3, or 4+) and type of ACEs by ADHD diagnosis were evaluated using Rao-Scott chi-square tests and multivariable logistic regression. All analyses incorporate complex survey weights.
In 2021 to 2022, 2,457 (23.3%) of children experienced ACEs and 1,115 (9.9%) had an ADHD diagnosis. Children with ADHD were more likely to experience every type of ACE and were more likely to have 1 to 3 or 4+ ACEs than children without ADHD. Children with 4+ ACEs had higher odds of having an ADHD diagnosis (aOR: 3.44, 95% CI [2.64, 4.49]) than children without ACEs. Male children, children with fair or poor health, and children living in rural counties were more likely to have an ADHD diagnosis, while children of color and uninsured children were less likely. We found the odds ratio of ADHD diagnosis for children with four or more ACEs, compared to those without ACEs, slightly lower than found in Brown et al., 2017's estimate of 3.97 (CI [3.29, 4.80]). These results suggest a consistent association between ACEs and ADHD when comparing pre-COVID data to our post-acute-COVID results.
These findings highlight the need for clinicians to consider traumatic stress in ADHD screening. Policymakers and early childhood organizations should encourage early screening and intervention for ACEs to reduce the impacts of ADHD diagnoses.
不良童年经历（ACEs）长期以来一直与儿童注意缺陷/多动障碍（ADHD）的诊断相关；但现在使用的数据已经超过 6 年（2017 年至 2018 年）。为了捕捉不断变化的社会、环境和经济条件，了解 ACEs 的当前流行程度和关联非常重要，以确保干预措施仍然与解决当前儿童创伤相关。
本研究使用后 COVID-19 大流行数据提供了 ACEs 与 ADHD 之间关联的最新分析。
本横断面研究纳入了 10518 名 5 至 17 岁儿童的数据，这些数据来自 2021 年至 2022 年全国健康访谈调查（NHIS）。
使用 Rao-Scott 卡方检验和多变量逻辑回归评估 ADHD 诊断时 ACEs 数量（0、1-3 或 4+）和类型的差异。所有分析均包含复杂的调查权重。
在 2021 年至 2022 年，2457（23.3%）名儿童经历过 ACEs，1115（9.9%）名儿童被诊断为 ADHD。患有 ADHD 的儿童更有可能经历每一种 ACE，并且更有可能经历 1 到 3 次或 4 次以上 ACE，而没有 ADHD 的儿童则不然。经历过 4 次以上 ACE 的儿童患 ADHD 的可能性更高（比值比：3.44，95%置信区间 [2.64, 4.49]）比没有 ACE 的儿童。男童、健康状况一般或较差的儿童以及居住在农村县的儿童更有可能被诊断为 ADHD，而有色人种和没有保险的儿童则不太可能。我们发现，与没有 ACE 的儿童相比，有 4 次或以上 ACE 的儿童被诊断为 ADHD 的几率略低于 Brown 等人在 2017 年估计的 3.97（CI [3.29, 4.80]）。这些结果表明，当将 COVID 前的数据与我们的后 COVID 结果进行比较时，ACEs 与 ADHD 之间存在一致的关联。
这些发现强调了临床医生在 ADHD 筛查中考虑创伤性应激的必要性。政策制定者和儿童早期组织应鼓励对 ACEs 进行早期筛查和干预，以减轻 ADHD 诊断的影响。
