Skip to main content
SpringerLink
Log in

Trauma exposure in children with and without ADHD: prevalence and functional impairment in a community-based study of 6–8-year-old Australian children

European Child & Adolescent Psychiatry volume 27, pages 811–819 (2018)Cite this article

Abstract

Both ADHD and trauma exposure are common childhood problems, but there are few empirical data regarding the association between the two conditions. The aims of this study were to compare lifetime prevalence of trauma exposure in children with and without ADHD, and to explore the association between trauma exposure and outcomes in children with ADHD. Children aged 6–8 years with ADHD (n = 179) and controls (n = 212) recruited from 43 schools were assessed for ADHD, trauma exposure and comorbid mental health disorders using the Diagnostic Interview Schedule for Children IV. Outcome data were collected by direct child assessment, parent report and teacher-report, and included ADHD symptom severity, internalizing and externalizing problems, quality of life, and academic functioning. Logistic and linear regression models were used to examine differences adjusted for child and family socio-demographics. Children with ADHD were more likely than controls to have ever experienced a traumatic event (27 vs 16%; OR: 1.99; 95% CI 1.21, 3.27). This difference remained significant in the adjusted model (OR: 1.76, 95% CI 1.03, 3.01) accounting for child factors (age and gender) and family socio-demographic factors (parent age, parent high school completion and single parent status). Among those with ADHD, trauma-exposed children had higher parent-reported ADHD severity and more externalizing problems than non-exposed children, however, this effect attenuated in adjusted model. Children with ADHD were more likely to have experienced a traumatic event than controls. The high prevalence of trauma exposure in our sample suggests that clinicians should evaluate for trauma histories in children presenting with ADHD.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Alisic E, Zalta A, van Wesel F, Larsen S, Hafstad G, Hassanpour K, Smid G (2014) Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: meta-analysis. Br J Psychiat 204:1–6. doi:10.1192/bjp.bp.113.131227

    Article  Google Scholar 

  2. Polanczyk G, de Lima M, Horta B, Biederman J, Rohde L (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164(6):942–948

    Article  PubMed  Google Scholar 

  3. Spencer AE, Faraone SV, Bogucki OE, Pope AL, Uchida M, Milad MR, Spencer TJ, Woodworth KY, Biederman J (2015) Examining the association between posttraumatic stress disorder and attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. J Clin Psychiatry 77(1):72–83

    Google Scholar 

  4. Brassett-Harknett A, Butler N (2007) Attention-deficit/hyperactivity disorder: an overview of the etiology and a review of the literature relating to the correlates and lifecourse outcomes for men and women. Clin Psychol Rev 27(2):188–210

    Article  PubMed  Google Scholar 

  5. MTA Cooperative Group (1999) A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Arch Gen Psychiatry 56(12):1073

    Article  Google Scholar 

  6. Copeland WE, Keeler G, Angold A, Costello EJ (2007) Traumatic events and posttraumatic stress in childhood. Arch Gen Psychiatry 64(5):577–584. doi:10.1001/archpsyc.64.5.577

    Article  PubMed  Google Scholar 

  7. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. Am Psychiatr Publ, Arlington

    Book  Google Scholar 

  8. Cohen JA, Mannarino AP, Deblinger E (2006) Treating trauma and traumatic grief in children and adolescents. The Guilford Press, New York

    Google Scholar 

  9. Famularo R, Fenton T, Kinscherff R, Augustyn M (1996) Psychiatric comorbidity in childhood posttraumatic stress disorder. Child Abus Negl 20(10):953–961. doi:10.1016/0145-2134(96)00084-1

    Article  CAS  Google Scholar 

  10. Riggs PD, Baker S, Mikulich SK, Young SE, Crowley TJ (1995) Depression in substance-dependent delinquents. J Am Acad Child Adolesc Psychiatry 34(6):764–771

    Article  PubMed  CAS  Google Scholar 

  11. Wozniak J, Crawford MH, Biederman J, Faraone SV, Spencer TJ, Taylor A, Blier HK (1999) Antecedents and complications of trauma in boys with ADHD: findings from a longitudinal study. J Am Acad Child Adolesc Psychiatry 38(1):48–56. doi:10.1097/00004583-199901000-00019

    Article  PubMed  CAS  Google Scholar 

  12. Lara C, Fayyad J, de Graaf R, Kessler RC, Aguilar-Gaxiola S, Angermeyer M, Demytteneare K, de Girolamo G, Haro JM, Jin R (2009) Childhood predictors of adult attention-deficit/hyperactivity disorder: results from the World Health Organization World Mental Health Survey Initiative. Biol Psychiatry 65(1):46–54

    Article  PubMed  Google Scholar 

  13. Bryant R (2004) In the aftermath of trauma: normative reactions and early intervention. In: Rosen G (ed) Posttraumatic stress disorder: issues and controversies. John Wiley & Sons, West Sussex, pp 187–211

    Chapter  Google Scholar 

  14. Bolton D, O’Ryan D, Udwin O, Boyle S, Yule W (2000) The long-term psychological effects of a disaster experienced in adolescence: II: general psychopathology. J Child Psychol Psychiatry 41(4):513–523

    Article  PubMed  CAS  Google Scholar 

  15. Pine DS, Ja Cohen (2002) Trauma in children and adolescents: risk and treatment of psychiatric sequelae. Biol Psychiatry 51(7):519–531

    Article  PubMed  Google Scholar 

  16. Daud A, Rydelius P-A (2009) Comorbidity/overlapping between ADHD and PTSD in relation to IQ among children of traumatized/non-traumatized parents. J Atten Disord 13(2):188–196. doi:10.1177/1087054708326271

    Article  PubMed  Google Scholar 

  17. Husain SA, Allwood MA, Bell DJ (2008) The relationship between PTSD symptoms and attention problems in children exposed to the Bosnian war. J Emot Behav Disord 16(1):52–62. doi:10.1177/1063426607310847

    Article  Google Scholar 

  18. Hoven CW, Duarte CS, Wu P, Erickson EA, Musa GJ, Mandell DJ (2004) Exposure to trauma and separation anxiety in children after the WTC attack exposure to trauma and separation anxiety in children after the WTC attack. Appl Dev Sci 8(4):37–41. doi:10.1207/s1532480xads0804

    Article  Google Scholar 

  19. Shaw JA, Applegate B, Schorr C (1996) Twenty-one-month follow-up study of school-age children exposed to Hurricane Andrew. J Am Acad Child Adolesc Psychiatry 35(3):359–364. doi:10.1097/00004583-199603000-00018

    Article  PubMed  CAS  Google Scholar 

  20. Kilpatrick DG, Ruggiero KJ, Acierno R, Saunders BE, Resnick HS, Best CL (2003) Violence and risk of PTSD, major depression, substance abuse/dependence, and comorbidity: results from the National Survey of Adolescents. J Consult Clin Psychol 71(4):692

    Article  PubMed  Google Scholar 

  21. Graham B (2005) Violence exposure and traumatic stress symptoms as additional predictors of health problems in high-risk children. J Pediatr 146(3):349–354

    Article  Google Scholar 

  22. Landolt MA, Buehlmann C, Maag T, Schiestl C (2009) Brief report: quality of life is impaired in pediatric burn survivors with posttraumatic stress disorder. J Pediatr Psychol 34(1):14–21. doi:10.1093/jpepsy/jsm088

    Article  PubMed  Google Scholar 

  23. Shonk SM, Cicchetti D (2001) Maltreatment, competency deficits, and risk for academic and behavioral maladjustment. Dev Psychol 37(1):3

    Article  PubMed  CAS  Google Scholar 

  24. Eckenrode J, Laird M, Doris J (1993) School performance and disciplinary problems among abused and neglected children. Dev Psychol 29(1):53

    Article  Google Scholar 

  25. Kendall-Tackett KA, Eckenrode J (1996) The effects of neglect on academic achievement and disciplinary problems: a developmental perspective. Child Abus Negl 20(3):161–169

    Article  CAS  Google Scholar 

  26. El-Hage W, Gaillard P, Isingrini M, Belzung C (2006) Trauma-related deficits in working memory. Cogn Neuropsychiatry 11(1):33–46

    Article  PubMed  Google Scholar 

  27. DePrince AP, Weinzierl KM, Combs MD (2009) Executive function performance and trauma exposure in a community sample of children. Child Abus Negl 33(6):353–361

    Article  Google Scholar 

  28. Becker-Blease KA, Freyd JJ (2008) A preliminary study of ADHD symptoms and correlates: do abused children differ from nonabused children? J Aggress Maltreat 17(1):133–140. doi:10.1080/10926770802250736

    Article  Google Scholar 

  29. Sciberras E, Efron D, Schilpzand EJ, Anderson V, Jongeling B, Hazell P, Ukoumunne OC, Nicholson JM (2013) The Children’s Attention Project: a community-based longitudinal study of children with ADHD and non-ADHD controls. BMC Psychiatry 13:18

    Article  PubMed  PubMed Central  Google Scholar 

  30. Conners CK (2008) Conners, 3rd edn. Multi-Health Systems, Toronto

    Google Scholar 

  31. Shaffer D, Fisher P, Lucas CP, Dulcan MK, Schwab-Stone ME (2000) NIMH diagnostic interview schedule for children version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. J Am Acad Child Adolesc Psychiatry 39:28–38

    Article  PubMed  CAS  Google Scholar 

  32. Goodman R (2001) Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry 40:1337–1345

    Article  PubMed  CAS  Google Scholar 

  33. Varni J, Burwinkle TM, Seid M, Skarr D (2003) The PedsQL 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambul Pediatr 3:329–341

    Article  PubMed  Google Scholar 

  34. Wilkinson GS, Robertson GJ (2006) Wide Range Achievement Test 4 (WRAT 4). Psychological Assessment Resources, Lutz

    Google Scholar 

  35. Gresham FM, Elliott SN, Kettler RJ (2010) Base rates of social skills acquisition/performance deficits, strengths, and problem behaviors: an analysis of the social skills improvement system-rating scales. Psychol Assess 22:809–815

    Article  PubMed  Google Scholar 

  36. Australian Bureau of Statistics (2013) Census of population and housing: socio-economic indexes for areas (SEIFA), Australia—Data only Author. http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/2033.0.55.0012011?OpenDocument

  37. Alisic E, Van der Schoot T, van Ginkel JR, Kleber RJ (2008) Looking beyond posttraumatic stress disorder in children: posttraumatic stress reactions, posttraumatic growth, and quality of life in a general population sample. J Clin Psychol 69(9):1455–1461

    Google Scholar 

  38. Pasco Fearon R, Belsky J (2004) Attachment and attention: protection in relation to gender and cumulative social-contextual adversity. Child Dev 75(6):1677–1693

    Article  Google Scholar 

  39. Care NIoCHaHDEC, Network. R (2003) Do children’s attention processes mediate the link between family predictors and school readiness. Dev Psychol 39:581–593

    Article  Google Scholar 

  40. Kotchick BA, Forehand R (2002) Putting parenting in perspective: a discussion of the contextual factors that shape parenting practices. J Child Fam Stud 11(3):255–269

    Article  Google Scholar 

  41. Efron D, Sciberras E, Anderson V, Hazell P, Ukoumunne OC, Jongeling B, Schilpzand EJ, Bisset M, Nicholson JM (2014) Functional status in children with ADHD at age 6–8: a controlled community study. Pediatrics 134:1027

    Article  Google Scholar 

  42. Stover CS, Hahn H, Im JJ, Berkowitz S (2010) Agreement of parent and child reports of trauma exposure and symptoms in the early aftermath of a traumatic event. Psychol Trauma 2(3):159

    Article  PubMed  PubMed Central  Google Scholar 

  43. Kassam-Adams N, García-España JF, Miller VA, Winston F (2006) Parent-child agreement regarding children’s acute stress: the role of parent acute stress reactions. J Am Acad Child Adolesc Psychiatry 45(12):1485–1493. doi:10.1097/01.chi.0000237703.97518.12

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was funded by the Australian National Health and Medical Research Council (NHMRC; project Grant No. 1008522), the Collier Foundation and the Murdoch Childrens Research Institute. Dr Sciberras’ position is funded by an NHMRC Early Career Fellowship in Population Health 1037159 (2012–2015) and an NHMRC Career Development Fellowship 1110688 (2016-2019). Dr Alisic’s position is funded by an NHMRC Early Career Fellowship 1090229 (2015-2019). Professor Anderson is funded by an NHMRC Senior Practitioner Fellowship 607333 (2010–2014). Professor Nicholson is supported by the Australian Communities Foundation through the Roberta Holmes Chair for the Transition to Contemporary Parenthood Program (Coronella sub-fund). This research was supported by the Victorian Government’s Operational Infrastructure Support Program to the MCRI. Dr Efron’s position is funded by a Murdoch Childrens Research Institute Clinician Scientist Fellowship. We would like to acknowledge all research assistants, students and interns who contributed to data collection for this study. We would also like to thank the many families, teachers, and schools for their participation in this study. Some study data were collected and managed using REDCap electronic data capture tools hosted at MCRI. REDCap (Research Electronic Data Capture) is a secure, web-based application designed to support data capture for research studies.

Author information

Authors and Affiliations

  1. Murdoch Childrens Research Institute, Royal Children’s Hospital, Flemington Road, Parkville, Melbourne, VIC, 3052, Australia

    Elizabeth J. Schilpzand, Emma Sciberras, Eva Alisic, Daryl Efron, Vicki Anderson & Jan M. Nicholson

  2. The Royal Children’s Hospital, Melbourne, VIC, Australia

    Emma Sciberras, Daryl Efron & Vicki Anderson

  3. The University of Melbourne, Melbourne, VIC, Australia

    Emma Sciberras, Daryl Efron & Vicki Anderson

  4. School of Psychology, Deakin University, Melbourne, VIC, Australia

    Emma Sciberras

  5. Monash University Accident Research Centre, Monash University, Melbourne, VIC, Australia

    Eva Alisic

  6. Department of Psychosomatics and Psychiatry, University Children’s Hospital Zürich, Zurich, Switzerland

    Eva Alisic

  7. Discipline of Psychiatry, Sydney Medical School, Sydney, NSW, Australia

    Philip Hazell

  8. Joondalup Child Development Centre, Perth, WA, Australia

    Brad Jongeling

  9. Department of Paediatrics, University of Western Australia, Perth, Australia

    Brad Jongeling

  10. Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia

    Jan M. Nicholson

Authors
  1. Elizabeth J. Schilpzand
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emma Sciberras
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eva Alisic
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daryl Efron
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Philip Hazell
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Brad Jongeling
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vicki Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jan M. Nicholson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elizabeth J. Schilpzand.

Ethics declarations

Conflict of interest

Dr. Hazell or his employer has received payment from Shire for participation in advisory boards; Eli Lilly and Shire for speaker’s bureau. Drs. Efron, Sciberras, Anderson, Alisic, Jongeling and Nicholson, and Ms Schilpzand report no biomedical financial interests or potential conflicts of interest.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schilpzand, E.J., Sciberras, E., Alisic, E. et al. Trauma exposure in children with and without ADHD: prevalence and functional impairment in a community-based study of 6–8-year-old Australian children. Eur Child Adolesc Psychiatry 27, 811–819 (2018). https://doi.org/10.1007/s00787-017-1067-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-017-1067-y

Keywords

search

Navigation