Adverse Childhood Experiences Linked to ADHD Symptoms

A new article in the Journal of Child and Adolescent Trauma finds that Adverse Childhood Experiences (ACE) are linked to ADHD symptoms in French college students. The current research, led by Ashlyn Schwartz from the University of Bordeaux, also finds that ADHD symptoms are more likely with exposure to multiple types of ACE. Sexual abuse, emotional neglect, physical neglect, and bullying were the ACEs most associated with ADHD symptoms.

“After controlling for potential confounders, every increase in ACE exposure heightened the risk of ADHD symptoms,” the authors write. “Findings suggest that ACEs heighten the risk for developing ADHD symptoms among college students and bear important implications for prevention and clinical practice.”

This research connecting ADHD symptoms to ACEs challenges the view of ADHD as a purely neurobiological disorder requiring pharmacological intervention. By demonstrating that ADHD symptoms can be significantly influenced by trauma, this study challenges the notion that these symptoms are purely biologically driven and unchangeable. Furthermore, the findings complicate some principles of the neurodiversity movement, which advocates for the acceptance of neurological differences without necessarily addressing the impact of environmental factors like trauma.

Instead, the research strengthens psychological perspectives that understand ADHD symptoms as neurodevelopmental, arising from a complex interplay between individual neurological predispositions and their relational and social environments. This perspective underscores the importance of addressing social determinants and trauma in the assessment and treatment, advocating for a more holistic approach and integrative approach.

The goal of the current research was to investigate the link between ACE and ADHD symptoms in college students. The authors also wanted to explore the association between exposure to multiple ACEs and ADHD symptoms, as well as associations between specific types of ACE and ADHD symptoms.

The current work used data from the Students Health Research Enterprise (i-Share), an online self-report survey available to French college students. I-Share collects data on ACE, mental health, substance use, risk behaviors, and demographic information. Students take a baseline assessment when registering for i-Share and are invited to complete annual follow-ups.

To be eligible for i-Share, students must be enrolled in a French college or higher education institution, be at least 18 years old, and be able to read French. The current study used baseline data collected between September 2018 and October 2021.

The authors created nine yes/no categories of ACE, including emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, parental divorce, parental substance use, parental mental illness, and bullying. They then separated participants into four groups: no ACE, 1 type of ACE, two types of ACE, and three or more types of ACE.

ADHD symptoms were measured using the World Health Organization’s Adult Self Report Scale (ASRS). This consists of 6 questions: 4 measuring how often the participant engages in inattentive behaviors and 2 measuring hyperactive/impulsive behaviors. Participants respond to each question on a 5-point scale, where 0 = never and 4 = often. A score between 18 and 24 represents a clinically relevant cut-off.

The researchers also examined data on variables other than ACE that could contribute to the development of ADHD symptoms. These variables included sex, how long they had attended a university, socioeconomic status during adolescence, whether they had ever consumed tobacco, whether they had ever used illicit drugs, whether they had ever used cannabis, and whether they had a history of depression or anxiety.

The authors used data from 1,062 participants in the current research. The majority of participants were female (81.4%). 30.6% reported no ACE, 29.6% reported 1 type of ACE, 19.2% reported two types of ACE, and 20.6% reported three or more kinds of ACE. 38.3% of participants reported parental mental illness, and 32.5% reported parental divorce.

All other types of ACE had significantly lower numbers reported as follows: bullying (18.5%), emotional neglect (14.6%), emotional abuse (12.8%), sexual abuse (11.6%), physical abuse (10.8%), parental substance use (9.1%), and physical neglect (6.7%). 5.13% reported ADHD symptoms. 12.4% reported a depressive disorder diagnosis, and 14.1% reported an anxiety disorder diagnosis.

ACEs were significantly associated with ADHD symptoms. After adjusting for sociodemographic, mental health, and substance use variables, participants who endorsed 1 ACE type were 2.1 times as likely as those who had no ACE to report ADHD symptoms. Those who endorsed 2 ACE types were 4.5 times more likely to report ADHD symptoms, and those who endorsed three or more ACE types were 5.2 times as likely to report ADHD symptoms.

Participants endorsing three or more ACE types were also significantly more likely to report a depression (4.9 times as likely) or anxiety (3.7) diagnosis. The individual ACEs most associated with ADHD symptoms were sexual abuse (2.3 times more likely), emotional neglect (2.5), physical neglect (2.5), and bullying (2.5).

The authors acknowledge several limitations to the current work. The participant sample was not representative of the population, and some groups most at risk for ADHD (males and those from low socioeconomic backgrounds) were underrepresented. The ASRS only measures ADHD symptoms and is not the same as an ADHD diagnosis. Several “overwhelmingly stressful” events that likely should be considered ACE were not examined in the current work, including severe economic hardship, parental intimate partner violence, parental incarceration, chronic disabilities, exposure to war/migration, and racial discrimination.

The self-report nature of the data also means the researchers were not able to determine if ADHD symptoms were present before the ACEs. The authors note that while the findings here could point to ACE causing ADHD symptoms, it is equally likely that children who exhibit ADHD symptoms are more likely to have ACE. For example, children lacking self-control may be more likely to experience bullying and harsh punishments from adults.

The authors conclude:

“Findings suggest that college students with ACE exposure have a heightened risk of ADHD symptoms and certain ACE types (sexual abuse, emotional neglect, physical neglect, and bullying) may contribute greater risk. More longitudinal research is needed to understand the temporality of the association between ACEs and ADHD symptoms to best identify factors to improve intervention and prevention efforts.”

Previous research has found that ACE can have lifelong health consequences. Exposure to ACE likely increases the risk of depression, psychosis, and suicide. ACE has been linked to poor sleep, lower academic achievement, and emotional/behavioral problems. Some research has found that childhood adversity can even change stress-related gene expression.

At present, no biomarkers can be reliably identified for ADHD, meaning researchers are unable to point to anything that can be objectively tested with biomedical measures. Previous research has found that ADHD is likely overdiagnosed, needlessly exposing service users to drugs that have been linked to cardiovascular disease. One piece of research found that children who exhibited identical symptoms had very different outcomes depending on whether they received an ADHD label, with those given a diagnosis having a worse quality of life and an increased risk of self-harm.

 

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Schwartz, A. et. al. (2023). Adverse Childhood Experiences and ADHD Symptoms Among French College Students. Journal of Child and Adolescent Trauma 16 1109-1117. (Link)