Physical Abuse in Childhood Linked to ADHD in Adults

Megan Brooks

March 13, 2014

Roughly 30% of adults with attention-deficit disorder (ADD) or attention-deficit/hyperactivity disorder (ADHD) were physically abused as children, new research shows.

Investigators from the University of Toronto in Canada found that the likelihood of ADD/ADHD was about 7 times higher in those who reported a history of physical abuse before age 18 years.

"Only 7.2% of those without ADD/ADHD reported childhood physical abuse, in sharp contrast to 29.6% of those with ADD/ADHD," the researchers, led by Esme Fuller-Thomson, PhD, report.

"This strong association between abuse and ADD/ADHD was not explained by differences in demographic characteristics or other early adversities experienced by those who had been abused," Dr. Fuller-Thomson said in a statement.

The study was published online March 3 in the Journal of Aggression, Maltreatment and Trauma.

Strong Independent Link

The researchers analyzed data from the 2005 Canadian Community Health Survey on a representative sample of 13,054 adults aged 18 years and older. The group included 1020 who reported childhood physical abuse and 64 who reported being diagnosed by a health professional with either ADD or ADHD.

Adjusted analysis revealed that the odds of ADD/ADHD were more than 6 times higher for those reporting childhood physical abuse relative to their nonabused peers (odds ratio [OR], 6.56; 95% confidence interval [CI], 4.00 - 10.74).

When further adjusted for other adverse childhood experiences such as parental divorce, addictions, and long-term unemployment, the odds of ADD/ADHD were more than 7-fold higher for those reporting abuse (OR, 7.64; 95%, CI 4.38 - 13.33).

"This study underlines the importance of ADD/ADHD as a marker of abuse," coauthor Angela Valeo, PhD, from Ryerson University in Toronto, said in a statement. "With 30% of adults with ADD/ADHD reporting childhood abuse, it is important that health professionals working with children with these disorders screen them for physical abuse."

"Our data do not allow us to know the direction of the association," added coauthor Rukshan Mehta, a graduate of the University of Toronto's Masters of Social Work program.

"It is possible that the behaviors of children with ADD/ADHD increase parental stress and the likelihood of abuse. Alternatively, some new literature suggests early childhood abuse may result in and/or exacerbate the risk of ADD/ADHD."

Complex Relationship

Commenting on the study for Medscape Medical News, Julian D. Ford, PhD, director of the Center for Trauma Recovery and Juvenile Justice, University of Connecticut Health Center in Farmington, who was not involved in the study, said it is "an interesting extension of smaller clinical studies."

He cautioned, however, that it is hard to tell whether the real link is between childhood abuse and ADHD or a variety of related psychological and behavioral problems.

Dr. Ford noted that the "strongest link to date has been between childhood maltreatment and problems associated with ADHD but not ADHD itself ― so called oppositional-defiant disorder, problems with anger, frustration, and difficulties in relationships, which are common (but by no means universal) for people who have attentional and hyperactivity problems."

"It's important not to take the results as definite evidence that abuse leads to ADHD (or that ADHD leads to abuse)," Dr. Ford said. "There probably is a relationship, but it’s very complicated, and all of the risks that this study assessed may be involved in the adverse outcomes (which extend well beyond ADHD, unfortunately) of childhood abuse in very unique ways for each individual," he added.

The authors and Dr. Ford report no relevant financial relationships.

J Aggress Maltreat Trauma. 2014;23:188-198. Abstract

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