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Child Psychiatrist /Adult Psychiatrist

Greater ADHD Symptoms Reported by Adults With Adverse Childhood Experiences



ADHD Childhood Diagram


Adults with greater adverse childhood experiences (ACEs) have higher attention deficit hyperactivity disorder (ADHD) symptom reporting than those with fewer ACEs, according to study findings published in the Journal of Attention Disorders. Yet, higher ACEs did not contribute to other psychological symptoms or worse neurocognitive performances.


Studies that examine the relationship between objective cognitive performance and ACEs (early life experiences that may influence mental health outcomes) report conflicting results, and few studies have explored the relationship between objective cognitive performance and ACEs among individuals with self-reported ADHD symptoms. Therefore, investigators sought to characterize ADHD symptom reporting, neurocognitive performance, and other psychological symptoms among adults who experienced ACEs.


The investigators conducted a cross-sectional study that began with 144 consecutive adults referred to an urban university academic medical center for neurological evaluation. Following the exclusion of 29 participants (primarily for invalid ADHD symptom reporting), a total of 115 individuals were included for analyses. On average, participants were aged 28.42 years (SD, 6.46), completed 16.47 years of education (SD, 1.99), and 65% (n=75) were women.

Participants completed the ACE Questionnaire in which they self-reported ACEs, including emotional, physical, and sexual abuse along with neglect, and witnessing violence.


Individuals were split into two groups based on these scores: the high ACEs group scored 4 or greater and the low ACEs group scored 3 or less. Participants also completed the Beck Depression Inventory-Second Edition (BDI-II), Beck Anxiety Inventory (BAI), and the Perceived Stress Scale (PSS). These measures were self-reports of depressive symptoms, anxiety, and perceived stress, respectively. In addition, all individuals completed a battery of standardized neuropsychological tests.



"[O]ur results and the growing body of literature demonstrating links between ADHD and ACEs highlight the need for clinicians to consider ACEs during ADHD diagnostic assessments and treatment planning."


Compared with the low ACEs group, the high ACEs group had higher ADHD symptom reporting for childhood impulsive (F =14.65; P <.001) and inattentive (F =11.31; P <.001) symptoms, and also reported significantly greater ADHD childhood symptom severity (F =11.31; P <.001). Similar results were found for the assessments of current/adulthood symptoms, with the high ACEs group reporting significantly higher levels of impulsive (F =7.24; P <.001) and hyperactive (F =4.62; P <.05) symptoms, along with greater symptom severity (F =5.51; P <.05) than the lower ACEs group.



However, despite these group differences in self-reported ADHD symptoms, psychological symptom reporting of depression, anxiety, and perceived stress did not differ between the high ACEs group and the low ACEs group. Further, neurocognitive functioning was similar across all tested domains between the groups.


These results demonstrate that a heavier burden of ACEs resulted in higher ADHD symptom reporting, but did not impact other psychological symptoms or neurocognitive performance. The investigators concluded, “[O]ur results and the growing body of literature demonstrating links between ADHD and ACEs highlight the need for clinicians to consider ACEs during ADHD diagnostic assessments and treatment planning.”



Study limitations include recall bias during childhood data reporting and the inability to investigate causative factors due to the cross-sectional study design.


References:

Alfonso D, Basurto K, Guilfoyle J, et al. The effect of adverse childhood experiences on ADHD symptom reporting, psychological symptoms, and cognitive performance among adult neuropsychological referrals.


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