Does ADHD cause childhood trauma or is it the other way around?

In this article, I provide my bi-weekly research summary on a topic I think may help others in some way. This week I focused on ADHD and childhood maltreatment. I read the research so you don't have to 😌

Childhood Maltreatment and Attention Deficit Hyperactivity Disorder (ADHD)

What is ADHD?

Attention Deficit Hyperactivity Disorder (ADHD) is a neuro-developmental disorder that is characterized by persistent difficulties in attention, hyperactivity, and/or impulsivity. ADHD is thought, like most mental health conditions, to be caused by a combination of genetic and environmental factors. ADHD can have a significant impact on a person's life, affecting their academic, social, and occupational functioning.

What is Childhood Maltreatment?

Childhood maltreatment is any act or omission by a parent or caregiver that results in harm to a child. It can include physical abuse and neglect (including malnutrition), sexual abuse, emotional abuse and neglect, and early deprivation. Childhood maltreatment can have a profound impact on a child's psychological development. It can lead to problems with self-esteem, trust, relationships, and behavior. In some cases, it can even lead to serious mental health problems, such as post-traumatic stress disorder (PTSD), depression, and anxiety.

Today I'm going to summarize for you the following article: 

Title: Is there evidence of a causal link between childhood maltreatment and attention deficit/hyperactivity disorder? A systematic review of prospective longitudinal studies using the Bradford-Hill criteria

Author/s: Paraskevi Bali, Edmund Sonuga‐Barke, Christina Mohr‐Jensen, Ditte Demontis, and Helen Minnis

Publication and Year: Journal of Child Psychology and Psychiatry Advances, May 2023

DOI: 10.1002/jcv2.12169

This article is for anyone who has ADHD or has experienced childhood maltreatment, or those who care for these individuals in some capacity. If you find this information helpful, please share this article with your community. 

The ADHD and Childhood Trauma (Maltreatment) Relationship

The relationship between childhood maltreatment (CM) and attention deficit hyperactivity disorder (ADHD) is well established. However, the exact nature of the relationship remains unclear. Overall, there are two main hypotheses about the relationship between CM and ADHD:

• Hypothesis A: CM can cause ADHD through biological programming. For example, CM can have long-term effects on brain development and functioning. This can lead to impairments in areas of the brain that are involved in ADHD, such as the prefrontal cortex.
• Hypothesis B: Symptoms of ADHD can lead to CM. For example, children with ADHD may be more likely to engage in behaviors that unintentionally annoy or frustrate their caregivers, which could lead to negative reactions and, in some cases, maltreatment.

Bradford-Hill Criteria used for ADHD and CM Association

This study indicated the use of Bradford-Hill criteria to complete the analysis. Bradford-Hill criteria are a set of criteria that can be used to assess the strength of the evidence for a causal relationship between two variables. Basically, they wanted to use something that could really assess for possible cause-and-effect between CM and ADHD.

These criteria include:

• Strength: The stronger the relationship is, the more likely the relationship is to be causal.
• Dose-response: The more frequent (or more severe) the exposure, the greater the risk of the outcome.
• Plausibility: The biological possibility of the relationship. Is it even possible?
• Temporality: The time-based relationship between variables. Which comes first?

What The Study Was

The study by Bali et al. was a review of studies published between 1985 and 2023 that included measurements of childhood maltreatment and/or ADHD during two different points of time, at minimum. 11 studies were included in the review and the review included 56,019 children and 14,770 adults with childhood CM and ADHD (including controls).

What The Results Showed

• Strength: The strength of the association between CM and ADHD is relatively moderate.
• Dose-response: There is some evidence for a dose-response relationship between CM and ADHD, meaning that the risk of ADHD increases with the severity of CM. None of the studies looked at whether more ADHD symptoms led to more CM.
• Plausibility: There is a biological plausibility for a causal relationship between CM and ADHD.
• Temporality: Studies showed a bidirectional, informal causality between ADHD and CM.

Quick Subjective Analysis of The Results

Out of the 11 studies reviewed, only two of them met all four of the Bradford-Hill criteria regarding causality and each of these studies suggested opposite directions of the relationship. One said childhood maltreatment may cause ADHD and the other said ADHD may cause childhood maltreatment. The most important thing to keep in mind is that if you have a child who is diagnosed with ADHD or shows ADHD-like behaviors, you should understand there is a link between childhood maltreatment and ADHD. Regardless of the direction, children with ADHD should not be exposed to any form of maltreatment. I've included tips below for those of you who are raising or supporting children with ADHD or ADHD children.

How To Apply What You Learned

This study suggests that there is a relationship between childhood maltreatment (CM) and attention deficit hyperactivity disorder (ADHD). ADHD and childhood maltreatment are both conditions and situations that can have a significant impact on a child's development and adult life functioning. Specific supports are required for ADHD children that not only prevent childhood maltreatment but that also provide the structure, motivation, and care children with ADHD need.

Prevention of Childhood Maltreatment on Children with ADHD

Here are some specific childhood maltreatment prevention strategies that can be helpful for people parents and caregivers of ADHD children:

• Get help and support. If you are struggling to cope with your child's ADHD, don't be afraid to ask for help. There are many resources available to you, such as support groups, therapy, and medication.
• Learn about ADHD. The more you know about ADHD, the better equipped you will be to manage your child's symptoms. There are many books, websites, and support groups that can provide you with information about ADHD.
• Talk to your child. It is important to talk to your child about their ADHD. Explain to them what ADHD is, and how it can affect them. Let them know that you love them and that you are there to help them.
• Avoid labeling your child. Avoid labeling your child as "bad" or "difficult." This can lead to low self-esteem and can make it more difficult for your child to change their behavior and/or for you to change their environment.
• Set realistic expectations. Children with ADHD and parenting children with ADHD can be challenging, but it is important to set realistic expectations for them and for you. Don't expect any of you to be perfect, and don't punish them or yourself for things that they can't control.
• Use positive reinforcement. Positive reinforcement is a powerful tool that can help to change behavior. When your child does something positive, be sure to praise them and give them a reward.
• Take care of yourself. It is important to take care of yourself, both physically and emotionally. If you are not taking care of yourself, you will not be able to take care of your child. Make sure to get enough sleep, eat healthy foods, and move your body regularly.
• Don't give up. Raising a child with ADHD can be challenging, but it is also rewarding. Don't give up on your child, and don't give up on yourself. With the right support, you can raise a happy, healthy child with ADHD.

Thanks for reading and see you in a couple of weeks! If you haven't checked out this week's other article titled "To Drink or Not To Drink?", check it out to see what your answer should be and why.

Remember: You're a human first, your unconscious is showing, and I'm so glad you exist.

Written by Dr. Courtney Tracy, LCSW, PsyD aka "The Truth Doctor"