New research provides evidence of a bidirectional association between maltreatment in childhood and ADHD symptoms. Infants who are more easily upset and fussy are more likely to have ADHD symptoms when they get older. These babies are also more likely to experience mistreatment, like abuse or neglect. This mistreatment can make their ADHD symptoms worse.
The study, which has been published in Development and Psychopathology, provides new insights into how a child’s temperament, mistreatment, and ADHD symptoms are connected.
“Previous research has shown that there is a complex relationship between ADHD and maltreatment. We know that children who have higher symptoms of ADHD, or in other words, are inattentive, impulsive or hyperactive are at higher risk to experience maltreatment from caretakers,” explained study author Dennis Golm (@GolmDennis), a lecturer in psychology at the University of Southampton. “What we don’t quite know is why that’s the case. Our study adds one piece to this puzzle.”
“Infants who display negative emotionality, such as crying a lot, have a higher risk of developing ADHD. We wanted to know if these infants also were at a higher risk of being maltreated. I believe this topic is important to help parents cope with difficult situations. The first few months at home can be particularly challenging for parents. Even more so if they are experiencing mental health issues or their children display challenging behavior that these parents may not know how to respond to.”
“Support for new parents is still limited. We want to encourage parents to seek help. Going forward, we want to find out what type of help might be useful to support parents cope in difficult situations and to ultimately reduce the risk of childhood maltreatment.”
To conduct their new study, the researchers used data from the Fragile Families and Child Wellbeing Study (FFCWS), which followed a birth cohort of children born between 1998 and 2000. The study included a total of 4,898 children. Data from the 1-year, 5-year, and 9-year follow-ups were utilized for analysis.
The researchers assessed negative emotionality in infancy using three items from the Emotionality, Activity, and Sociability Temperament Survey. These items measured how often the child fussed, cried, got upset easily, and reacted intensely when upset. The mothers of children provided responses on a 5-point Likert scale.
Childhood maltreatment in middle childhood was assessed using selected items from the Conflict Tactics Scale, which measured psychological aggression, physical assault, and neglect. The items referred to the past year, and the mothers provided responses indicating the frequency of each type of maltreatment.
ADHD symptoms at ages 5 and 9 were assessed using the Attention Problems subscale of the Child Behavior Checklist. The checklist included items related to concentration difficulties and attention problems. The assessments were completed by the mothers and primary caregivers.
The researchers found that infant negative emotionality had an indirect effect on ADHD symptoms at age 9 through its influence on the extent of childhood maltreatment at age 5. Children with higher negative emotionality at 12 months were more likely to experience higher rates of maltreatment at age 5, which, in turn, increased the risk of ADHD symptoms at age 9. This highlights the importance of early temperament in predicting later maltreatment and ADHD symptoms.
There was also evidence of a bidirectional relationship. Having higher ADHD symptoms at age 5 increased the risk of experiencing maltreatment at age 9. This suggests a vicious cycle where the severity of ADHD symptoms is maintained through ongoing adverse experiences, such as maltreatment.
“We found that negative emotionality in infants, and ADHD symptoms in children put these children at higher risk of maltreatment. However, maltreatment also increased ADHD symptoms,” Golm told PsyPost.
“Several explanations are possible. It is possible that parents feel overwhelmed with infants who display more negative emotionality, such as crying, and with children who are impulsive and inattentive. Harsher parenting techniques are often used when parents feel helpless and overwhelmed and don’t know how to deal with the situation in a different way.”
“It is also possible that impulsive and hyperactive children have parents who tend to react impulsively,” Golm explained. “Those children may inherit the risk to develop ADHD and have parents who may react more impulsively in an overwhelming situation and use a harsher parenting technique. We need to figure out what the exact connections are, in order to help parents cope in challenging situations.”
The study emphasizes the reciprocal relationship between maltreatment and ADHD symptoms, suggesting the importance of interventions that target both areas. Early identification of ADHD and parenting support for maltreated children could be valuable in promoting their well-being and reducing the long-term mental health burden.
But Golm noted that “it is important to highlight that the findings of the study are not deterministic. What this means is that the presence of negative emotionality or ADHD symptoms in a child does not mean that they will be maltreated. It only increases the likelihood to experience maltreatment. Secondly, the effects of the study are small, highlighting the fact that our findings are just one piece of a much larger puzzle.”
The researchers included several covariates in their analysis, such as sex, low birth weight, physical disabilities, maternal age, child age, maternal depression, and family income. These variables were controlled to account for their potential influence on the outcomes. But the study, like all research, had some limitations.
“Our study was not able to take into account if parents had ADHD. Given the high heritability of ADHD, it is likely that parents also have higher levels of ADHD symptoms and because of that a higher likelihood of having experienced maltreatment themselves. Future studies need to examine how these factors could interact with different child temperaments.”
The study, “The longitudinal association between infant negative emotionality, childhood maltreatment, and ADHD symptoms: A secondary analysis of data from the Fragile Families and Child Wellbeing Study“, was authored by Dennis Golm and Valerie Brandt.