Maternal Depression, Violence at Home May Raise Child's ADHD Risk

THURSDAY Feb. 7, 2013 -- Preschoolers whose parents report depression and intimate partner violence may be more likely to develop attention-deficit/hyperactivity disorder (ADHD) by the age of 6, new research suggests.

And young children with depressed moms may be more likely to receive prescription drugs to treat behavioral and mental health issues down the road.

"Our study indicates that preschoolers who are diagnosed with ADHD are more likely to have been exposed to both intimate partner violence and parental depression within the first three years of life than their peers not exposed to either risk factor," said study author Dr. Nerissa Bauer, an assistant professor of pediatrics at Indiana University School of Medicine, in Indianapolis.

"There has been increasing awareness that certain psychosocial risk factors can impact the behavioral presentation of children at very young ages," she said. Still, not all children who are exposed to maternal depression and intimate partner violence will develop ADHD, she noted.

"There are other factors that can be associated with a child's higher likelihood of being diagnosed with ADHD, including a family history of ADHD," Bauer explained.

ADHD symptoms can include impulsiveness, hyperactivity and difficulty focusing. Kids with ADHD may have difficulty in school, holding down jobs and sustaining relationships. They are also at greater risk for alcohol or substance abuse, depression and anxiety disorders. Treatment typically involves medication and behavioral modifications.

"Pediatricians and family practitioners know to routinely screen for the presence of these psychosocial risk factors because of the potential negative effects on the child," Bauer said. "Families who experience intimate partner violence will need help, not only to make sure the victims stay safe from physical harm, but there [are] also psychological effects."

The study, which appeared online Feb. 4 in the journal JAMA Pediatrics, included more than 2,400 children who were 3 years old. Parents who brought them to four different pediatric community clinics filled out questionnaires regarding their personal history of depression and domestic violence while in the pediatricians' waiting room.

Fifty-eight caregivers reported a history of intimate partner violence and depression before their child turned 3. In addition, 69 reported a history of intimate partner violence and 704 had symptoms of depression during this time frame. Close to 66 percent of the parents reported neither depression nor intimate partner violence. Children who were exposed to intimate partner violence and/or parental depression were four times more likely to be diagnosed with ADHD by the age of 6.

What's more, 2.9 percent of kids whose parents reported depression received prescription drugs to treat behavioral and mental health issues, compared with 1.6 percent of children whose parents did not report a history of depression. Medications included those that treat anxiety, depression and sleep problems.

While the study showed an association, it did not prove a cause-and-effect link between intimate partner violence and/or maternal depression and likelihood of an ADHD diagnosis.

Experts said the findings make sense, but more study is needed.

"This study adds to the already robust literature revealing that early life experiences can have profound effects on brain development," said Dr. Michael Duchowny, a pediatric neurologist at Miami Children's Hospital. "While heredity is known to play a strong role in the expression of ADHD symptoms, the study further suggests that additional environmental factors operating during the formative years of brain maturation are also significant."

New York City-based child psychoanalyst Dr. Leon Hoffman said the new findings make sense. "Unquestionably, intimate partner violence and maternal depression have a profound effect on children," he said.

Exactly how to deal with this is another story, said Hoffman, who is the co-director of the New York Psychoanalytic Society's Pacella Parent Child Center. "This is a public health problem that needs a lot of funds if reasonably effective programs are to be developed," he noted.

Dr. Rachel Klein, professor of child and adolescent psychiatry at NYU Langone Medical Center in New York City, said the study shows an association based on how parents answered certain questions, but it can't say how, or even if, maternal depression and intimate partner violence predict a child's risk of ADHD.

"If parents are worried, ask the pediatrician to evaluate your child for possible ADHD or refer the child to a mental health professional," she added.

More information

Learn more about ADHD and its treatments at the U.S. Centers for Disease Control and Prevention.

Posted: February 2013


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