P0228 - Emotional stressors in early childhood may have more influence on development of ADHD than trauma

Background: The correlation between Adverse Childhood Events (ACEs) and their effects on patients’ development of certain co-morbid conditions has been at the forefront of pediatrics since the late 1990’s when a study showed an increased prevalence of smoking, alcoholism, substance abuse, diabetes, depression, and attempted suicide among adults who had a higher number of ACEs. This study also showed an increased number behavioral and developmental disorders in childhood including Attention Deficit Hyperactivity Disorder (ADHD), thought to be due to the increased stress response from these events causing changes in brain development and leading to affect dysregulation (Felitti 1998). Discussions among the pediatric community on whether trauma in early childhood is a precursor to the development of ADHD or trauma being misdiagnosed as ADHD is ongoing (Szymanski 2001). Below we further study the association of childhood trauma and ADHD.

Methods: Our study explored the idea of an increased incidence of physical trauma in patients diagnosed with ADHD using the CYW Adverse Childhood Experiences Questionnaire (ACE-Q) (Burke 2015). with over 300 patients with an ADHD diagnosis included in the study. In this list of 17 questions asking about possible ACEs, 4 were related to physical trauma exposure including (1) A household member swore at, insulted, humiliated, or put down your child in a way that scared your child OR A household member acted in a way that made your child afraid that s/he might be physically hurt, (2) Someone touched your child’s private parts or asked your child to touch their private parts in a sexual way, (3) Someone pushed, grabbed, slapped or threw something at your child OR Your child was hit so hard that your child was injured or had marks, and (4) Your child experienced harassment or bullying at school. A checkmark next to the statement counted as a “yes” response.

Results: Although there was a correlation between an ADHD diagnosis and a higher number of total ACEs, there was no correlation between ADHD and answering “yes” to one of the 4 questions related to physical trauma. There was, however, a correlation between an ADHD diagnosis and answering “yes” to the question about neglect (i.e. More than once, your child went without food, clothing, a place to live, or had no one to protect her/him (p=0.0198)).

Conclusion: Exposure to emotional stressors as opposed to physical trauma in early childhood may be an early inclination toward the development of behavioral disorders such as ADHD. Screening for these stressors may guide pediatricians into early referrals to a behavioral and developmental pediatrician to help these patients develop coping mechanisms to these particular stressors.