Associations Between Adverse Childhood Experiences and ADHD Diagnosis and Severity

Acad Pediatr. 2017 May-Jun;17(4):349-355. doi: 10.1016/j.acap.2016.08.013.


Objective: Although identifying adverse childhood experiences (ACEs) among children with behavioral disorders is an important step in providing targeted therapy and support, little is known about the burden of ACEs among children with attention deficit-hyperactivity disorder (ADHD). We described the prevalence of ACEs in children with and without ADHD, and examined associations between ACE type, ACE score, and ADHD diagnosis and severity.

Methods: Using the 2011 to 2012 National Survey of Children's Health, we identified children aged 4 to 17 years whose parents indicated presence and severity of ADHD, and their child's exposure to 9 ACEs. Multivariate logistic regression was used to estimate associations between ACEs, ACE score, and parent-reported ADHD and ADHD severity, adjusted for sociodemographic characteristics.

Results: In our sample (N = 76,227, representing 58,029,495 children), children with ADHD had a higher prevalence of each ACE compared with children without ADHD. Children who experienced socioeconomic hardship (adjusted odds ratio [aOR], 1.39; 95% confidence interval [CI], 1.21-1.59), divorce (aOR, 1.34; 95% CI, 1.16-1.55), familial mental illness (aOR, 1.55; 95% CI, 1.26-1.90), neighborhood violence (aOR, 1.47; 95% CI, 1.23-1.75), and incarceration (aOR, 1.39; 95% CI, 1.12-1.72) were more likely to have ADHD. A graded relationship was observed between ACE score and ADHD. Children with ACE scores of 2, 3, and ≥4 were significantly more likely to have moderate to severe ADHD.

Conclusions: Children with ADHD have higher ACE exposure compared with children without ADHD. There was a significant association between ACE score, ADHD, and moderate to severe ADHD. Efforts to improve ADHD assessment and management should consider routinely evaluating for ACEs.

Keywords: adverse childhood experiences; adverse childhood experiences score; attention deficit–hyperactivity disorder.

MeSH terms

  • Adolescent
  • Attention Deficit Disorder with Hyperactivity / epidemiology*
  • Attention Deficit Disorder with Hyperactivity / psychology
  • Case-Control Studies
  • Child
  • Child of Impaired Parents / psychology
  • Child of Impaired Parents / statistics & numerical data*
  • Child, Preschool
  • Cross-Sectional Studies
  • Divorce / statistics & numerical data*
  • Domestic Violence / statistics & numerical data*
  • Exposure to Violence / statistics & numerical data*
  • Female
  • Humans
  • Logistic Models
  • Male
  • Mental Disorders*
  • Multivariate Analysis
  • Odds Ratio
  • Prejudice / statistics & numerical data*
  • Prevalence
  • Prisons
  • Residence Characteristics
  • Severity of Illness Index
  • Socioeconomic Factors*
  • Surveys and Questionnaires
  • United States / epidemiology