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Evidence of concurrent and prospective associations between early maltreatment and ADHD through childhood and adolescence

  • González, Rafael A.1, 2
  • Vélez-Pastrana, María C.2, 3
  • McCrory, Eamon4
  • Kallis, Constantinos5
  • Aguila, Jivelisse3
  • Canino, Glorisa6
  • Bird, Hector7
  • 1 Imperial College London, Centre for Mental Health, Division of Brain Sciences, Department of Medicine, 7th floor Commonwealth Building, Du Cane Road, London, W12 0NN, UK , London (United Kingdom)
  • 2 University of Puerto Rico, Center for Evaluation and Sociomedical Research, Graduate School of Public Health, San Juan, PR, USA , San Juan (United States)
  • 3 Carlos Albizu University, Ph.D. Program in Clinical Psychology, San Juan, PR, USA , San Juan (United States)
  • 4 University College London, Division of Psychology and Language Sciences, London, UK , London (United Kingdom)
  • 5 University of Liverpool, Institute of Translational Medicine, Liverpool, UK , Liverpool (United Kingdom)
  • 6 University of Puerto Rico School of Medicine, Behavioral Sciences Research Institute, San Juan, PR, USA , San Juan (United States)
  • 7 Columbia University, New York, NY, USA , New York (United States)
Published Article
Social Psychiatry and Psychiatric Epidemiology
Springer Berlin Heidelberg
Publication Date
Mar 22, 2019
DOI: 10.1007/s00127-019-01659-0
Springer Nature


PurposeAn emerging body of work suggests a link between childhood maltreatment and attention-deficit hyperactivity disorder (ADHD). However, research examining the role of maltreatment in the early course of the disorder lacks robust evidence from longitudinal studies. Our aim was to examine concurrent and prospective associations between maltreatment experiences and ADHD diagnosis and sex differences, and to estimate the association between repetitive maltreatment exposure and ADHD through childhood and adolescence.MethodsData were obtained from the Boricua Youth Study, a longitudinal study of 2480 children and adolescents of Puerto Rican background. Neglect, physical, emotional and sexual abuse, and foster placement were regressed on ADHD diagnosis measured at each of three waves using the Diagnostic Interview Schedule for Children-IV. Multilevel regressions estimated the effects of exposure on ADHD, adjusted by age, sex, income, household education, parental psychopathology, comorbidity and ADHD medication status.ResultsEmotional abuse and foster placement had robust associations with ADHD diagnosis. For girls, physical abuse had a threefold increase in the odds of having ADHD diagnosis; for boys, associations were observed only for emotional abuse. Prospective models examining the risk of ADHD following maltreatment provided initial evidence for the effects of physical abuse on ADHD, and a linear trend for repetitive exposure suggested increased probability for disorder persistence.ConclusionsAssociations between early maltreatment and ADHD were robust. Different categories of maltreatment increase the likelihood of ADHD for girls and boys. Increased exposure to maltreatment may predict symptom persistence. Interventions addressing ADHD must consider the effects of both sex and family environment.

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