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Poster #49 - ADHD and Risk for Subsequent Adverse Childhood Experiences Among Puerto Rican Youth

Sat, March 23, 2:30 to 3:45pm, Baltimore Convention Center, Floor: Level 1, Exhibit Hall B

Integrative Statement

Children with adverse childhood experiences (ACEs) are more likely to subsequently develop Attention-Deficit/Hyperactivity Disorder (ADHD). However, the relationship between ADHD and subsequent ACEs has received far less attention. A handful of studies support the hypothesis that children with ADHD are at an increased likelihood of experiencing trauma (Schilpzand, 2017; Konstenius, 2017; Koyuncu,2016). However, not all studies find this association (Ford,1999; Wozniak,1999). The existing body of literature is mostly comprised of Caucasian samples and cross-sectional retrospective self-reports. The present study examined the relationship between ADHD and subsequent risk for ACEs in the Boricua Youth Study, a longitudinal population-based study of Puerto Rican children and adolescents (3 assessment waves from 2000 to 2004). We examined the ten typically studied ACEs (covering three domains: parental loss, maltreatment, and parental maladjustment) as well as exposure to violence (Ramos-Olazagasti, Bird, Canino, & Duarte). Participants were children (males: n=1280; females: n=1202) aged 5–15 years with (n=237) and without (n=2245) ADHD (defined as fulfilling DSM-IV ADHD criteria except for age of onset) and their parents. Parental interviews inquired about the presence of ACEs and mental health disorders using the Diagnostic Interview Schedule for Children-IV (Shaffer et al., 2000). Analyses showed that children with ADHD at wave 1 were more likely to experience ACEs in the second and third assessment waves (OR:1.92; 95% CI:1.14, 3.25) compared to children without ADHD. This difference remained significant in the adjusted model (57 vs 43%; OR:1.80; 95% CI:1.11, 2.93) accounting for child age and gender, reception of public assistance, recruitment site, and ACEs at wave 1. Children with ADHD, compared to those without, had more incidences of parental substance use and emotional problems, child physical and emotional abuse, and exposure to violence. ADHD subtype analyses demonstrated that inattentive (OR:1.90; 95% CI:1.10, 3.28) but not hyperactive (OR:1.60; 95% CI:.91, 2.82) ADHD type predicted future ACEs. This is the first longitudinal population-based prospective study to document that ADHD places children at risk for ACEs, even when controlling for prior ACEs. Previous studies using retrospective self-reports have hypothesized that the impulsive behaviors and lack of self-regulation that often characterize ADHD may increase risk for ACEs. However, our findings suggest that inattentive symptoms may ultimately have a greater impact on risk for future ACEs. There is evidence that inattentiveness may be more closely tied to the social deficits (poor interpretation of emotional and nonverbal cues, immaturity; Sciberras, 2012; Semrud-Clikeman, 2010) often seen in the disorder. Lack of self-awareness and awareness about surroundings may be responsible for increasing risk for witnessing violence and suffering victimization. This study is also the first to examine this relationship in a Latino subgroup, which given a dramatic increase in ADHD diagnoses among Latino populations in the US in the last decade (Collins, 2016), is of great importance. Further study is needed to understand the mechanism though which inattention creates risk for future ACEs, as it may help elucidate avenues for prevention and intervention.

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