Low Apgar scores and risk of childhood attention deficit hyperactivity disorder

J Pediatr. 2011 May;158(5):775-9. doi: 10.1016/j.jpeds.2010.10.041. Epub 2011 Jan 15.


Objective: To examine whether low Apgar scores at 5 minutes are associated with increased risks of attention deficit hyperactivity disorder (ADHD).

Study design: We conducted a nationwide population-based cohort study of all 980 902 singletons born in Denmark from 1988 to 2001. All children were monitored from 3 years of age until a first International Classification of Diseases diagnosis of hyperkinetic disorder, a first medication for ADHD, migration, death, or the end of 2006, whichever came first. We used Cox regression models to examine the association between Apgar scores at 5 minutes and ADHD.

Results: Apgar scores were inversely associated with risk of ADHD (hazard ratio 0.92; 95% CI: 0.88-0.96, P trend < .001). Compared with children with Apgar scores of 9 or 10 at 5 minutes, the risk for ADHD was 75% higher in children with Apgar scores of 1 to 4 (hazard ratio 1.75; 95% CI: 1.15 to 2.11) and 63% higher for those with Apgar scores of 5 to 6 (95% CI: 1.25 to 2.11).

Conclusions: A low Apgar score was associated with an increased risk of ADHD in childhood. Low Apgar scores and ADHD may share common causes or a low Apgar score reflects at least one causal pathway leading to ADHD.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Apgar Score*
  • Attention Deficit Disorder with Hyperactivity / diagnosis
  • Attention Deficit Disorder with Hyperactivity / epidemiology*
  • Attention Deficit Disorder with Hyperactivity / rehabilitation
  • Denmark / epidemiology
  • Developmental Disabilities / diagnosis
  • Developmental Disabilities / epidemiology*
  • Follow-Up Studies
  • Humans
  • Incidence
  • Infant, Newborn
  • Population Surveillance / methods*
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Time Factors