When children struggle with focusing on tasks, staying organized, controlling their behavior and sitting still, they may be evaluated for attention-deficit/hyperactivity disorder (ADHD). Clinicians, however, shouldn't stop there, according to a study presented at the Pediatric Academic Societies (PAS) annual meeting in Vancouver, British Columbia, Canada.
Researchers found that many children with ADHD also face challenges such as poverty, divorce, neighborhood violence and substance abuse among family members.
"Our findings suggest that children with ADHD experience significantly higher rates of trauma than those without ADHD," said lead author Nicole M. Brown, MD, MPH, MHS, FAAP. "Providers may focus on ADHD as the primary diagnosis and overlook the possible presence of a trauma history, which may impact treatment."
Dr. Brown and her colleagues analyzed data from the 2011 National Survey of Children's Health. They identified 65,680 children ages 6-17 years whose parents answered questions regarding ADHD diagnosis, severity and medication use as well as nine adverse childhood experiences (ACEs): poverty, divorce, death of a parent/guardian, domestic violence, neighborhood violence, substance abuse, incarceration, familial mental illness and discrimination.
About 12 percent of the children were diagnosed with ADHD. Their parents reported a higher prevalence of all of the adverse events than parents of children without ADHD.
Parents of children with ADHD also reported a higher number of adverse childhood experiences compared to children without ADHD; 17 percent of children with ADHD had four or more ACEs compared to 6 percent of children without ADHD.
Children dealing with four or more adverse experiences were almost three times more likely to use ADHD medications compared to children with three or fewer adverse experiences. Children with four or more adverse experiences also were more likely to have a parent rate their ADHD as moderate to severe compared to children with three or fewer ACEs.
"Knowledge about the prevalence and types of adverse experiences among children diagnosed with ADHD may guide efforts to address trauma in this population and improve ADHD screening, diagnostic accuracy and management," said Dr. Brown, assistant professor of pediatrics, Division of General Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York.
"Pediatric providers should consider screening for adverse childhood experiences in children who they suspect may have ADHD and/or those who carry the diagnosis, and initiate evidence-based treatment/intervention plans for children who screen positive for ACEs," she concluded.