Risk Of Attention-deficit/hyperactivity Disorder In Children Research Articles

Maternal asthma and asthma exacerbation during pregnancy and attention-deficit/hyperactivity disorder in offspring: a population-based cohort study.

The link between inflammatory disorders, such as asthma, and attention deficit hyperactivity disorder (ADHD) is attracting increasing attention but few studies have examined cross-generational associations. We sought to examine associations of maternal asthma and asthma exacerbation during pregnancy, as well as paternal asthma, with the risk of ADHD in children. This population-based cohort study used data from the Taiwan National Health Insurance Research Database from 2004 to 2017. Cox regression models compared the risk of ADHD in children of parents with and without asthma, adjusting for parental sociodemographic, physical, and mental health conditions, as well as the child's birth weight, and number of births. A sibling control approach was employed to compensate for unmeasured confounders of asthma exacerbation during pregnancy. In the fully adjusted models, maternal and paternal asthma were both significantly associated with an increased risk of ADHD in offspring, with hazard ratios (HRs) of 1.36 (1.31-1.40) and 1.10 (1.05-1.14), respectively. Acute asthma exacerbation during pregnancy was not associated with the risk of further offspring ADHD (adjusted HR 1.00, 95% CI: 0.75-1.34). Both maternal and paternal asthma are associated with an increased risk of ADHD in offspring. The risk was higher from maternal asthma. However, no such association was found with maternal asthma exacerbation during pregnancy of sibling comparison.

The Correlation Between Congenital Heart Disease and The Risk of ADHD in Children

Congenital Heart Disease (CHD) is the most common birth defect in the world, and patients are more prone to intellectual functioning deficits, developmental issues, and academic performance issues. Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder and is associated with coronary heart disease (CHD). While cardiac patients with ADHD symptoms are frequently misdiagnosed and, as a result, undertreated, this study examines the association between CHD and the risk of ADHD, including the effect of cardiac surgery on children. The data for this study was compiled by searching multiple databases using pertinent keywords. Through school age and adolescence, children with CHD have an elevated risk of neurodevelopmental impairment, specifically ADHD. In children with surgically corrected ADHD, inattention becomes the predominant subtype, and scores were significantly increased. However, the severity of the symptoms is reduced if cardiac surgery is performed at a young age. This association leads to alterations in behavior associated with hypoxic-ischemic mechanisms that occur in oxygen-sensitive regions. To improve the quality of life of children with CHD, surveillance, screening, evaluation, and management strategies for ADHD should be promoted regardless of their specific cardiac diagnosis.

Maternal Infection during Pregnancy and Attention-Deficit Hyperactivity Disorder in Children: A Systematic Review and Meta-Analysis.

We aimed to determine the association between maternal infections during pregnancy with risk of Attention-Deficit Hyperactivity Disorder (ADHD) in children. A systematic literature search was performed utilizing the online databases PubMed, Scopus, and Web of Sciences up to July 2020. Random-effects meta-analyses were applied to estimate pooled relative risk (RR). Heterogeneity, study quality and publication bias were assessed through I2 value, Newcastle-Ottawa scale (NOS) and Egger's test, respectively. Thirteen articles involving 1401904 mother-child pairs were included. The result of meta-analysis showed that the risk of ADHD increased by 30% among children whose mothers took any infections during pregnancy (pooled RR=1.30, 95% CI: 1.14-1.49; I2=85.5, P<0.001). Overall, the included studies were good in quality and no publication bias was found (P=0.23, Egger's test). Maternal infections during pregnancy might be associated with an increased risk of ADHD in children.

The association between dietary polyphenol intake and attention-deficit hyperactivity disorder: a case-control study

BackgroundPrevious research found that diets high in fruits and vegetables improved symptoms of attention deficit hyperactivity disorder (ADHD). Nevertheless, the relationship between dietary polyphenol intake and the risk of ADHD was not assessed.ObjectiveThe purpose of this study was to see if there was a relationship between dietary polyphenol intake and the risk of ADHD in children in preschool and elementary school.MethodsA total of 400 children aged 4 to 12 years old participated in this case-control research (200 children with diagnosed ADHD and 200 healthy controls). The presence of ADHD was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders-V criteria. To calculate dietary polyphenol intake, a 168-item food frequency questionnaire and the Phenol-Explorer database were used.ResultsA significant negative association was observed between one unit increase in dietary polyphenol intake and risk of ADHD (OR: 0.995, 95% CI = 0.994 to 0.996, P < 0.001) in the crude model. This finding was still significant even after adjusting for body mass index, energy intake, socioeconomic status, gender, and age (OR: 0.992, 95% CI = 0.989 to 0.995, P < 0.001).ConclusionWe found that the increased dietary intake of polyphenols is associated with a lower risk of ADHD in preschool and school children. Prospective studies are needed to corroborate these observations.

Association of maternal diabetes during pregnancy with attention deficit hyperactivity disorder in offspring in an Iranian population: A case-control study

Background and aims: Gestational diabetes has long-term adverse consequences for both the mother and child and seems to be a risk factor for attention deficit hyperactivity disorder (ADHD) in children. However, no research has been conducted in this regard in Iran. Methods: This was a case-control study. The sample consisted of 225 children who were referred to the general and psychiatric clinic of Besat Hospital in Sanandaj and were evaluated for a history of maternal diabetes in the fetal period. The diagnosis of ADHD in children was based on a structured clinical interview with Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL) by a psychiatrist and a short and revised form of Conners’ parent scale. The data were analyzed using Stata 14. Results: The results showed that 25.3% of the mothers of children with ADHD had gestational diabetes during pregnancy, and 17.3% were taking diabetes medication. However, the results revealed that there is no statistically significant relationship between the history of gestational diabetes and ADHD (P=0.427). Furthermore, the logistic regression results demonstrated that the place of residence (P&lt;0.027, OR=8.351) increases the probability of suffering from ADHD in children, while the age of the mother during pregnancy (P&lt;0.031, OR=0.907) decreases the probability of the child suffering from ADHD. Conclusion: Although cohort studies have associated gestational diabetes with an increased risk of ADHD in children, the results of this case-control study do not support this association.

Prenatal and early postnatal exposure to a natural disaster and Attention-Deficit/Hyperactivity Disorder symptoms in Indian children

The aim of this study was to assess the relation between early exposure to stressful events and symptoms of the Attention-Deficit/Hyperactivity Disorder (ADHD) in children, based on the outcomes from a natural experiment. It was hypothesized that children pre- and postnatally exposed to cyclone Aila have increased ADHD symptoms compared to the control group, and the effect depends on the timing of the exposure. Indian children (8–11 years) prenatally (N = 336) and early postnatally (N = 216) exposed to cyclone Aila were compared to a non-exposed control peer group (N = 285). ADHD symptoms were assessed using the Conner’s Teacher Rating Scale Revised. The main effect of exposure to the cyclone on the total ADHD symptoms’ score, ADHD index, Hyperactivity and Oppositional symptoms was significant and independent to covariates: age and sex of children, gestational age and birth weight, maternal stress during the year before the study and the socioeconomic status of a family. The timing of exposure and sex of the children were found to be a significant moderator of the relation between early exposure to the natural disaster and ADHD symptoms. The prenatal, but also early postnatal exposure to stressful experiences such as a natural disaster, may disturb the development of cognitive functions and behavioural control, thus increasing the risk of ADHD in children.

Preterm postnatal complications and risk of attention-deficit/hyperactivity disorder.

To investigate the association between the risk of attention-deficit/hyperactivity disorder (ADHD) and preterm birth and determine how postnatal complications in children born preterm is associated with the risk of ADHD. This population-based cohort study used data from the Hong Kong electronic medical records. We followed 359 614 children (48% female; 6-17 years old, mean 11 years 7 months, SD 3 years 2 months) born in public hospitals in Hong Kong from 1st January 2004 to 31st December 2014 and collected medical records and demographic details for mothers and children until 11th November 2020. The risk of ADHD was 4.0% in children born at term and 5.1% in children born preterm. The odds ratio for ADHD was 2.08 (95% confidence interval [CI]1.64-2.64) for children born extremely preterm, 1.64 (95% CI 1.46-1.85) for children born very preterm, and 1.15 (95% CI 1.08-1.23) for children born late preterm. Among preterm postnatal complications, only early respiratory disease, retinopathy of prematurity (ROP), and intraventricular haemorrhage were significant predictors of ADHD after controlling for preterm birth, other risk factors, and sociodemographic variables. The excess risk of ADHD among children born very preterm or late preterm could be partly explained by respiratory disease. ROP partially mediated the risk of ADHD in children born very preterm. Children born preterm in all subcategories, from extremely preterm to late preterm, have increased risk of ADHD. Early respiratory infection partially mediates the risk of ADHD in children born preterm.

Relationship between Parenting Style and Risk of Attention Deficit Hyperactivity Disorder in Elementary School Children.

BackgroundAttention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder in a child with three symptoms, which include inattention, hyperactivity and impulsiveness that may persist into adulthood for some conditions. Parenting style is thought to be one part that determines the risk of ADHD in children. This study aims to analyse the relationship between parenting styles and the risk of ADHD in children.MethodsEmploying a cross-sectional design, this study was conducted in Surabaya from November 2020 to January 2021. The respondents of the study were parents who had children at risk of ADHD with a total of 55 samples recruited using the purposive sampling technique. The questionnaires used are the demographic questionnaire, Abbreviated Conners Rating Scale (ACRS), and the Parenting Style Questionnaire for Children and Adolescents (KPAA), which were filled out online by the respondents. The data were processed and analysed using the bivariate analysis test, Pearson’s chi-squared test, which has a significant value if the P-value < 0.05.ResultsThe majority of the parents used the authoritative style (94.5%). There was a significant relationship between parenting style and the risk of ADHD in children with P < 0.001 for authoritarian and permissive styles and P = 0.005 for an authoritative style.ConclusionThere is a significant relationship between parenting style and the risk of ADHD in children. This indicates the importance of early diagnosis of ADHD and treating the children with ADHD in the context of family environment, especially from parenting style.

A nationwide cohort study on the risk of ADHD in children with amblyopia mediated by fine motor skill impairment in East Asia

This national administrative investigation of Republic of Korea compared the risk of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders(ASD) in preschool amblyopic children and identified factors that possibly mediate this association. After propensity score (PS) matching, 7762 amblyopic children and 31,030 non-amblyopic children were included. Amblyopia was associated with ADHD (aOR:1.687; 95% CI 1.444, 1.970) but not with ASD (aOR: 0.591; 95% CI 0.341, 1.026). Fine motor skill impairment was a mediating factor in association of amblyopia with ADHD, accounting for 4.2% (95% CI 1.7, 8.0). In conclusion, amblyopic children have a greater risk of ADHD, and deficits in fine motor skills mediate this association. We suggest increased attention given to fine motor skill underdevelopment in amblyopic children to prevent the development of ADHD.

Association of Perinatal and Childhood Ischemic Stroke With Attention-Deficit/Hyperactivity Disorder

Early detection of attention-deficit/hyperactivity disorder (ADHD) plays a crucial role in reducing negative effects on everyday life, including academic failure and poor social functioning. Children who survive ischemic strokes risk major disabilities, but their risk of ADHD has not been studied in nationwide cohorts. To assess the risk of ADHD in children after pediatric ischemic stroke. Participants in this Swedish nationwide cohort study included 1320 children diagnosed with ischemic stroke recorded in linked Swedish national registers from January 1, 1969, to December 31, 2016, without prior ADHD diagnosis. Ten matched controls were identified for each index case, and first-degree relatives were identified for index individuals and controls. Analyses were stratified by perinatal and childhood strokes and presence of comorbid adverse motor outcomes and/or epilepsy. End of follow-up was the date of ADHD diagnosis, death, or December 31, 2016, whichever occurred first. Data analyses were performed August 1 to 28, 2021. Pediatric ischemic stroke. Attention-deficit/hyperactivity disorder identified using codes from the International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, and/or prescribed ADHD medication recorded in the Medical Birth Register, National Patient Register, or Prescribed Drug Register after stroke. Cox proportional hazards regression was used to assess adjusted hazard ratios (aHRs) for ADHD after pediatric stroke, adjusting for parental age and ADHD in first-degree relatives. Of 1320 children with stroke included in the analysis (701 boys [53.1%]), 75 (45 boys [60.0%]) were diagnosed with ADHD after stroke compared with 376 (252 boys [67.0%]) among the controls (aHR, 2.00 [95% CI, 1.54-2.60]). The risk was increased after both perinatal (aHR, 2.75 [95% CI ,1.65-4.60]) and childhood (aHR, 1.82 [95% CI, 1.34-2.48]) strokes and were similar if children born preterm or small for gestational age were excluded. Compared with controls, risks of ADHD were higher among children with perinatal stroke and adverse motor outcomes and/or epilepsy (aHR, 6.17 [95% CI, 2.80-13.62]) than among those without these comorbidities (aHR, 1.65 [95% CI, 0.80-3.42]). However, findings were similar in childhood stroke for children with adverse motor outcomes and/or epilepsy (aHR, 1.80 [95% CI, 1.12-2.89]) and among those without these comorbidities (aHR, 1.92 [95% CI, 1.28-2.90]). This cohort study of 1320 children with pediatric ischemic stroke suggests that there is an increased risk of ADHD, particularly in children with adverse motor outcomes and/or epilepsy, compared with controls. The risk increases after childhood strokes regardless of comorbidities.

Two meta-analyses of the association between atopic diseases and core symptoms of attention deficit hyperactivity disorder

Studies in the field of neuroscience and psychology have hypothesized that a causal association exists between atopic diseases and attention-deficit/hyperactivity disorder (ADHD). Previous systematic reviews and meta-analyses have reported a higher risk of ADHD in children with atopic diseases; however, the relationship between ADHD symptoms and atopic diseases remains unclear. We systematically reviewed observational cross-sectional and longitudinal studies to investigate the relationship between atopic diseases and ADHD symptom severity (hyperactivity/impulsivity and inattention). The majority of studies showed a statistically significant association between atopic diseases and both ADHD symptoms, with substantial heterogeneity in the outcome of hyperactivity/impulsivity. Remarkably decreased heterogeneity and statistical significance were observed in the second meta-analysis of ADHD-related behavior symptoms in atopic patients without ADHD. Our study indicated that atopic diseases not only associated with ADHD but also ADHD symptoms severity. This association was even observed in children with subthreshold ADHD, indicating that atopic diseases may play a role in the spectrum of ADHD symptom severity. Trial registration: This study was registered on PROSPERO (registration ID: CRD42020213219).

Relationship between Parenting Stress and Risk of Attention Deficit Hyperactivity Disorder (ADHD) in Elementary School Children

Background: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorderduring child development with three symptoms which are comprised of inattention, hyperactivity, andimpulsiveness that may persist into adulthood. This condition can be a stressor for parents in performingparenting and may lead into a state of parenting stress. Objective: To analyze the relationship betweenparenting stress and the risk of developing Attention Deficit Hyperactivity Disorder (ADHD) inelementary school children. Methods: This research was conducted in Surabaya from November 2020to January 2021 with respondents consisting of parents of elementary school children who have ADHDrisk and agreed to participate in this study with a total of 55 samples selected using a purposive samplingtechnique. The research design was cross-sectional using demographic questionnaire, AbbreviatedConners Rating Scale (ACRS), and Parenting Stress Index-Short Form (PSI-SF) which were filledout by respondents through an online form. The data were processed and analyzed using One-SampleChi-Square analysis test program with a p-value &lt;0.05, considered statistically significant. Results:The majority of parents experienced moderate parenting stress levels (58.2%). There was a significantrelationship between each level of parenting stress and the risk of ADHD in children (p &lt; 0.001).Conclusions: There is a significant relationship between parenting stress and the risk of ADHD inchildren.

Dietary phytochemical index and attention-deficit/hyperactivity disorder in Iranian children: a case control study.

Attention Deficit/Hyperactivity Disorder (ADHD) is a common behavioral disorder among children. Based on literature, it has been hypothesized that the higher intake of rich sources of phytochemicals may be inversely related to the risk of ADHD. We investigated the association of dietary phytochemical index (DPI) with odds of ADHD. This case-control study was conducted on 360 children and adolescents 7-13 years old in Yazd, Iran. Subjects were categorized into the case (n = 120) and control groups (n = 240) based on matching age and sex. To diagnose ADHD, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSMIV-TR) was used. Food frequency questionnaire was used to measure food intake. DPI was calculated by percent of daily energy intake from phytochemical-rich foods. The association of DPI with the odds ratio of ADHD was examined by logistic regression. Subjects in the highest quartile of DPI have higher intake of macronutrient, eicosatetraenoic acid, docosahexaenoic acid, calcium, zinc, iron, vitamins B12, B6, and folic acid compared to lowest quartile. After adjusting for potential confounders, subjects in the highest quartile of DPI compared with subjects in the lowest quartile showed a lower risk of ADHD (OR: 0.44; 95% CI: 0.18-0.90). There was a significant decreasing trend in the odds of ADHD across increasing quartile of DPI (P for trend: 0.02). We found that higher DPI score is associated with lower risk of ADHD in children. Cohort and clinical studies are necessary to approve our results.

Early-Life Exposure to Polycyclic Aromatic Hydrocarbons and ADHD Behavior Problems

Background: Polyfluoroalkyl chemicals (PFCs) have been widely used in consumer products. Exposures in the United States and in world populations are widespread. PFC exposures have been linked to various health impacts, and data in animals suggest that PFCs may be potential developmental neurotoxicants. Little is known about the effect of PFCs on Attention Deficit/Hyperactivity Disorder (ADHD). This study investigated the associations (i) between postnatal PFCs exposure and ADHD in children; and (ii) between PFCs and IgE levels for the possible disease pathogenesis. Methods: A total of 453 children from Childhood Environment and Allergic Diseases Study cohort with urine samples were recruited in Taiwan. Urinary (PFCs) levels were measured by UPLC-MS/MS. The associations between BPAG levels and IgE levels and the risk of ADHD were evaluated by multivariate linear regression and logistic regression. Results: The geometric mean (SD) of PFCS concentrations was 8.84(2.57) ng/ml at age 6. Urinary PFCS levels were positively associated with the risk of ADHD at age 6 (β=3.21 KU/l per ln-unit increase PFCS level; 95% CI, 0.99-10.51 KU/l), after adjusting for potential confounders. There was no significant gender difference. The FPCS levels were positively associated with IgE levels at age 6 (β=64.85 KU/l per ln-unit increase BPAG level; 95% CI, 14.59-115.11 KU/l).Conclusions: PFCS exposures were positively associated with the risk of ADHD in children.

Early-Life Exposure to Polyfluoroalkyl chemicals and ADHD Behavior Problems

Background: Polyfluoroalkyl chemicals (PFCs) have been widely used in consumer products. Exposures in the United States and in world populations are widespread. PFC exposures have been linked to various health impacts, and data in animals suggest that PFCs may be potential developmental neurotoxicants. Little is known about the effect of PFCs on Attention Deficit/Hyperactivity Disorder (ADHD). This study investigated the associations (i) between postnatal PFCs exposure and ADHD in children; and (ii) between PFCs and IgE levels for the possible disease pathogenesis. Methods: A total of 453 children from Childhood Environment and Allergic Diseases Study cohort with urine samples were recruited in Taiwan. Urinary (PFCs) levels were measured by UPLC-MS/MS. The associations between BPAG levels and IgE levels and the risk of ADHD were evaluated by multivariate linear regression and logistic regression. Results: The geometric mean (SD) of PFCS concentrations was 8.84(2.57) ng/ml at age 6. Urinary PFCS levels were positively associated with the risk of ADHD at age 6 (β=3.21 KU/l per ln-unit increase PFCS level; 95% CI, 0.99-10.51 KU/l), after adjusting for potential confounders . There was no significant gender difference. The FPCS levels were positively associated with IgE levels at age 6 (β=64.85 KU/l per ln-unit increase BPAG level; 95% CI, 14.59-115.11 KU/l). Conclusions: PFCS exposures were positively associated with the risk of ADHD in children

Association between postnatal second-hand smoke exposure and ADHD in children: a systematic review and meta-analysis.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder which is caused by the interplay of genetic and environmental risk factors such as second-hand smoke (SHS). The association between postnatal exposure to SHS and ADHD risk in children was still inconclusive. We performed a systematic review and meta-analysis to explore the definite association. We searched for relevant studies from PubMed, Embase, Ovid, and Web of Science databases up to January 2020. We used random effect models to calculate pooled odds ratio (OR) with 95% confidence interval (CI). Subgroup analyses and sensitive analyses were also performed to solve the heterogeneity. According to our inclusion criteria, 9 studies including 6 cross-sectional studies, 2 cohort studies, and 1 case-control study were included in the final analysis. Postnatal exposure to SHS increased the risk of ADHD in children (OR: 1.60; 95% CI: 1.37-1.87). Children who exposed to SHS were found a slight risk for conduct problems (OR: 1.33, 95% CI: 1.00-1.77). Among the studies which used cotinine as a biomarker for SHS exposure, a lower pooled OR (OR = 1.16, 95%CI = 1.01, 1.33) was observed between cotinine and ADHD in children. Our meta-analysis results suggested that SHS exposure may be a risk factor for ADHD. We also found that SHS exposure may be associated with some adverse behavioral outcomes. More prospective studies should be conducted to confirm the relationship between SHS exposure and ADHD in children.

Prenatal antibiotic exposure and risk of attention-deficit/hyperactivity disorder: a population-based cohort study.

Abnormal microbiota composition induced by prenatal exposure to antibiotics has been proposed as a potential contributor to the development of attention-deficit/hyperactivity disorder (ADHD). We examined the association between prenatal antibiotic exposure and risk of ADHD. We conducted a population-based retrospective cohort study of children born in Manitoba, Canada, between 1998 and 2017 and their mothers. We defined exposure as the mother having filled 1 or more antibiotic prescriptions during pregnancy. The outcome was diagnosis of ADHD in the offspring, as identified in administrative databases. We estimated hazard ratios (HRs) using Cox proportional hazards regression in the overall cohort, in a separate cohort matched on high-dimensional propensity scores and in a sibling cohort. In the overall cohort, consisting of 187 605 children, prenatal antibiotic dispensation was associated with increased risk of ADHD (HR 1.22, 95% confidence interval [CI] 1.18-1.26). Similar results were observed in the matched cohort of 129 674 children (HR 1.20, 95% CI 1.15-1.24) but not in the sibling cohort (HR 1.06, 95% CI 0.99-1.13). Two negative-control analyses indicated a positive association with ADHD despite the lack of a reasonable biological mechanism, which suggested that the observed association between prenatal antibiotic dispensation and risk of ADHD was likely due to confounding. In our study, prenatal antibiotic exposure was not associated with increased risk of ADHD in children. Although the risk was higher in the overall and matched cohorts, it was likely overestimated because of unmeasured confounding. Future studies are warranted to examine other factors affecting microbiota composition in association with risk of ADHD.

Alcohol Intake in Early Pregnancy and Risk of Attention-Deficit/Hyperactivity Disorder in Children Up to 19 Years of Age: A Cohort Study.

Little is known about maternal alcohol intake in early pregnancy and the risk of attention-deficit/hyperactivity disorder (ADHD) in children beyond 5years of age. We examined the association between alcohol binge drinking and weekly alcohol intake in early pregnancy and the risk of ADHD in children followed from birth to 19years of age. We included 48,072 children born between 1998 and 2012, whose mothers participated in the Aarhus Birth Cohort. Maternal alcohol intake was obtained from a self-administered questionnaire completed in early pregnancy. ADHD diagnoses were retrieved from the Danish Psychiatric Central Research Register and the Danish National Patient Register. Crude hazard ratio and adjusted hazard ratio (aHR) of ADHD according to alcohol binge drinking or weekly intake of alcohol were calculated using the Cox regression. Compared to children of women with no binge drinking episodes, we observed an aHR for ADHD of 0.91 (95% CI 0.76 to 1.08), 0.73 (95% CI 0.56 to 0.96), and 0.77 (95% CI 0.57 to 1.06) among children of women reporting 1, 2, and 3 or more binge drinking episodes, respectively. Among children of women drinking <1 drink per week, 1 drink per week, 2 drinks per week, and 3 or more drinks per week, we observed an aHR for ADHD of 0.87 (95% CI 0.74 to 1.03), 0.63 (95% CI 0.40 to 0.98), 1.30 (95% CI 0.89 to 1.92), and 0.78 (95% CI 0.38 to 1.59), respectively, when compared to children of women not drinking on a weekly basis. We found no evidence that binge drinking or low alcohol intake in early pregnancy was associated with the risk of ADHD in children.

Brain structure mediates the association between socioeconomic status and attention-deficit/hyperactivity disorder.

Low socioeconomic status (SES) is associated with greater risk for symptoms of attention-deficit/hyperactivity disorder (ADHD). One mechanism through which SES may confer risk for ADHD is by influencing brain structure. Alterations to cortical thickness, surface area and subcortical volume have been associated with low SES and with the presence of ADHD across multiple studies. The current study examined whether cortical thickness, surface area or subcortical volume mediate the associations between SES and ADHD in youth 3-21years old (N=874) from the Pediatric Imaging, Neurocognition and Genetics Study. Freesurfer was used to estimate cortical thickness, surface area and subcortical volume from structural magnetic resonance imaging. Parents reported on demographics, family SES, ADHD diagnoses and the presence of child attention problems. Statistical mediation was assessed using a bootstrap resampling procedure. Controlling for parental ADHD, child age, gender, birth weight and scanner, children in low SES families were more likely to be in the ADHD group. Consistent with previous reports in this sample, low SES was associated with reduced surface area across the frontal lobe and reduced subcortical volume in the amygdala, cerebellum, hippocampus and basal ganglia. Of these regions, a significant indirect effect of SES on ADHD status through subcortical volume was observed for the left cerebellum (95% confidence interval: 0.004, 0.022), the right cerebellum (95% confidence interval: 0.006, 0.025), and the right caudate (95% confidence interval: 0.002, 0.022). Environmentally mediated changes in the cerebellum and the caudate may be neurodevelopmental mechanisms explaining elevated risk of ADHD in children in low SES families.

Ecological model of school engagement and attention-deficit/hyperactivity disorder in school-aged children.

School engagement protects against negative mental health outcomes; however, few studies examined the relationship between school engagement and attention-deficit hyperactivity disorder (ADHD) using an ecological framework. The aims were to examine: (1) whether school engagement has an independent protective association against the risk of ADHD in children, and (2) whether environmental factors have an association with ADHD either directly or indirectly via their association with school engagement. This cross-sectional study used data from the 2011-2012 National Survey of Children's Health, which collected information about children's mental health, family life, school, and community. The sample contained 65,680 children aged 6-17years. Structural equation modeling was used to estimate the direct association of school engagement and ADHD and indirect associations of latent environmental variables (e.g., family socioeconomic status (SES), adverse childhood experiences (ACEs), environmental safety, and neighborhood amenities) and ADHD. School engagement had a direct and inverse relationship with ADHD (β = - 0.35, p < 0.001) such that an increase in school engagement corresponds with a decrease in ADHD diagnosis. In addition, family SES (β = - 0.03, p = 0.002), ACEs (β = 0.10, p < 0.001), environment safety (β = - 0.10, p < 0.001), and neighborhood amenities (β = - 0.01, p = 0.025) all had an indirect association with ADHD via school engagement. In conclusion,schoolengagement had a direct association with ADHD. Furthermore, environmental correlates showed indirect associations with ADHD via school engagement. School programs targeted at reducing ADHD should consider family and community factors in their interventions.