ARTICLES
Impact of Adversity on Functioning and Comorbidity in Children with Attention-Deficit Hyperactivity Disorder

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ABSTRACT

Objective

Prior research on risk factors for attention-deficit hyperactivity disorder (ADHD) has shown that familial risk factors play a role in the disorder's etiology. This study investigated whether features of the family environment were associated with ADHD.

Method

One hundred forty children with ADHD and 120 normal control probands were studied. Subjects were Caucasian, non-Hispanic males between the ages of 6 and 17 years. Exposure to parental psychopathology and exposure to parental conflict were used as indicators of adversity, and their impact on ADHD and ADHD-related psychopathology and dysfunction in children was assessed.

Results

Increased levels of environmental adversity were found among ADHD compared with control probands. The analyses showed significant associations between the index of parental conflict and several of the measures of psychopathology and psychosocial functioning in the children. In contrast, the index of exposure to parental psychopathology had a much narrower impact, affecting primarily the child's use of leisure time and externalizing symptoms.

Conclusion

A relationship appears to exist between adversity indicators and the risk for ADHD as well as for its associated impairments in multiple domains. These findings confirm previous work and stress the importance of adverse family-environment variables as risk factors for children who have ADHD.

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      The behavioral phenotype of ADHD is variable but characteristics fall broadly into two categories - inattention, and impulsivity plus hyperactivity (DSM-V, 2013); with the prevalence for the inattentive subtype potentially being as high as 5% (Wolraich et al., 1996) during childhood and 1.3% during adulthood (Murphy and Barkley, 1996). ADHD is a highly heritable disorder (Faraone and Doyle, 2000; Thapar et al., 2005) but a number of environmental factors have been proposed as contributors to the disorder, including early exposure to nicotine and alcohol (Biederman et al., 1995a; Biederman et al., 1995b). Developmental exposure to general anesthetic agents has been shown to trigger apoptotic neurodegeneration in animal models (Ikonomidou et al., 2000; Jevtovic-Todorovic et al., 2003), and this has been proposed as a mechanism for resulting behavioral impairments.

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    Preparation for this article was supported in part by grant R01 MH-41314-01A2 from the NIMH (USPHS) (Dr. Biederman).

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