Abstract
There is limited existing research on whether specific combinations of Adverse Childhood Experiences (ACEs) are associated with different psychiatric disorders among adolescents with ADHD. This study aimed to address this gap by identifying classes of ACEs and examining their association with behavioral problems, anxiety, and depression in adolescents with ADHD aged 11–17 (n = 1,806), using data from the 2018 National Survey of Children’s Health (NSCH). A latent class analysis revealed a four-class solution: (1) low-risk ACEs (61.6%), (2) moderate-risk ACEs (25.2%), (3) high discrimination and neighborhood violence exposure (7.6%), and (4) high-risk ACEs (5.6%). The “high-risk ACEs” and the “high discrimination and neighborhood violence exposure” class showed a higher likelihood of behavioral problems and depression, and anxiety and depression respectively. These findings provide some insight into the ACE patterns that are more likely to be associated with mental health problems among adolescents with ADHD.
Similar content being viewed by others
Data Availability
The data of this study are publicly available and accessible via the U.S. Census Bureau.
References
Barkley RA, Fischer M, Smallish L, Fletcher K (2006) Young adult outcome of hyperactive children: adaptive functioning in major life activities. J Am Acad Child Adolesc Psychiatry 45(2):192–202. https://doi.org/10.1097/01.chi.0000189134.97436.e2
Booster GD, DuPaul GJ, Eiraldi R, Power TJ (2012) Functional impairments in children with ADHD: unique effects of age and comorbid status. J Atten Disord 16(3):179–189. https://doi.org/10.1177/1087054710383239
Danielson ML, Bitsko RH, Ghandour RM, Holbrook JR, Kogan MD, Blumberg SJ (2018) Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents, 2016. J Clin Child Adolesc Psychol 47(2):199–212. https://doi.org/10.1080/15374416.2017.1417860
Danielson ML, Visser SN, Chronis-Tuscano A, DuPaul GJ (2018) A national description of treatment among United States children and adolescents with attention-deficit/hyperactivity disorder. J Pediatr 192:240-246.e1. https://doi.org/10.1016/J.JPEDS.2017.08.040
Faraone SV, Banaschewski T, Coghill D, Zheng Y, Biederman J, Bellgrove MA, Newcorn JH, Gignac M, Al Saud NM, Manor I, Rohde LA, Yang L, Cortese S, Almagor D, Stein MA, Albatti TH, Aljoudi HF, Alqahtani MMJ, Asherson P, Wang Y (2021) The World Federation of ADHD international consensus statement: 208 evidence-based conclusions about the disorder. Neurosci Biobehav Rev 128:789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022
Mrug S, Brooke BS, Hoza B, Gerdes AC, Hinshaw SP, Hechtman L, Arnold LE (2012) Peer rejection and friendships in children with attention-deficit/ hyperactivity disorder: contributions to long-term outcomes. J Abnorm Child Psychol 40(6):1013–1026. https://doi.org/10.1007/s10802-012-9610-2
Song J, Fogarty K, Suk R, Gillen M (2021) Behavioral and mental health problems in adolescents with ADHD: exploring the role of family resilience. J Affect Disord 294:450–458. https://doi.org/10.1016/J.JAD.2021.07.073
Visser SN, Danielson ML, Bitsko RH, Holbrook JR, Kogan MD, Ghandour RM, Perou R, Blumberg SJ (2014) Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003–2011. J Am Acad Child Adolesc Psychiatry 53(1):34-46.e2. https://doi.org/10.1016/J.JAAC.2013.09.001
Daviss WB (2008) A review of co-morbid depression in pediatric ADHD: etiology, phenomenology, and treatment. J Child Adolesc Psychopharmacol 18(6):565–571. https://doi.org/10.1089/cap.2008.032
Disney ER, Elkins IJ, McGue M, Iacono WG (1999) Effects of ADHD, conduct disorder, and gender on substance use and abuse in adolescence. Am J Psychiatry 156(10):1515–1521. https://doi.org/10.1176/ajp.156.10.1515
Schatz DB, Rostain AL (2006) ADHD with comorbid anxiety. A review of the current literature. J Attention Disord 10(2):141–149. https://doi.org/10.1177/1087054706286698
Tung I, Li JJ, Meza JI, Jezior KL, Kianmahd JSV, Hentschel PG, O’Neil PM, Lee SS (2016) Patterns of comorbidity among girls with ADHD: a meta-analysis. Pediatrics. https://doi.org/10.1542/peds.2016-0430
Yoshimasu K, Barbaresi WJ, Colligan RC, Voigt RG, Killian JM, Weaver AL, Katusic SK (2012) Childhood ADHD is strongly associated with a broad range of psychiatric disorders during adolescence: a population-based birth cohort study. J Child Psychol Psychiatry 53(10):1036–1043. https://doi.org/10.1111/j.1469-7610.2012.02567.x
Center for Disease Control and Prevention (CDC) (2020) Adverse Childhood Experiences (ACEs). https://www.cdc.gov/vitalsigns/aces/index.html
Pervanidou P, Chrousos GP (2007) Post-traumatic stress disorder in children and adolescents: from Sigmund Freud’s “Trauma” to psychopathology and the (Dys)metabolic syndrome. Horm Metab Res 39(6):413–419. https://doi.org/10.1055/s-2007-981461
Trickett PK, Noll JG, Susman EJ, Shenk CE, Putnam FW (2010) Attenuation of cortisol across development for victims of sexual abuse. Dev Psychopathol 22(1):165–175. https://doi.org/10.1017/S0954579409990332
Center for Disease Control and Prevention (CDC) (2021) Preventing Adverse Childhood Experiences. https://www.cdc.gov/violenceprevention/aces/fastfact.html
Brown NM, Brown SN, Briggs RD, German M, Belamarich P, Oyeku SO (2017) Associations between adverse childhood experiences and ADHD diagnosis and severity. Acad Pediatr 17:349–355. https://doi.org/10.1016/j.acap.2016.08.013
Crouch E, Radcliff E, Bennett KJ, Brown MJ, Hung P (2021) Examining the relationship between adverse childhood experiences and ADHD diagnosis and severity. Acad Pediatr 21(8):1388–1394. https://doi.org/10.1016/J.ACAP.2021.03.009
Uddin J, Alharbi N, Uddin H, Hossain MB, Hatipoğlu SS, Long DL, Carson AP (2020) Parenting stress and family resilience affect the association of adverse childhood experiences with children’s mental health and attention-deficit/hyperactivity disorder. J Affect Disord 272:104–109. https://doi.org/10.1016/J.JAD.2020.03.132
Walker CS, Walker BH, Brown DC, Buttross S, Sarver DE (2021) Defining the role of exposure to ACEs in ADHD: examination in a national sample of US children. Child Abuse Negl 112:104884. https://doi.org/10.1016/J.CHIABU.2020.104884
Balistreri KS, Alvira-Hammond M (2016) Adverse childhood experiences, family functioning and adolescent health and emotional well-being. Public Health 132:72–78. https://doi.org/10.1016/j.puhe.2015.10.034
Bright MA, Knapp C, Hinojosa MS, Alford S, Bonner B (2016) The comorbidity of physical, mental, and developmental conditions associated with childhood adversity: a population based study. Matern Child Health J 20(4):843–853. https://doi.org/10.1007/s10995-015-1915-7
Scully C, McLaughlin J, Fitzgerald A (2020) The relationship between adverse childhood experiences, family functioning, and mental health problems among children and adolescents: a systematic review. J Fam Ther 42:291–316. https://doi.org/10.1111/1467-6427.12263
Turner HA, Finkelhor D, Mitchell KJ, Jones LM, Henly M (2020) Strengthening the predictive power of screening for adverse childhood experiences (ACEs) in younger and older children. Child Abuse Negl 107:104522. https://doi.org/10.1016/j.chiabu.2020.104522
Turner HA, Finkelhor D, Ormrod R (2006) The effect of lifetime victimization on the mental health of children and adolescents. Soc Sci Med 62(1):13–27. https://doi.org/10.1016/j.socscimed.2005.05.030
Szymanski K, Sapanski L, Conway F (2011) Trauma and ADHD—association or diagnostic confusion? A clinical perspective. J Infant Child Adolesc Psychother 10(1):51–59. https://doi.org/10.1080/15289168.2011.575704
Jimenez ME, Roy W Jr, Schwartz-Soicher O, Lin Y, Reichman NE (2017) Adverse childhood experiences and ADHD diagnosis at age 9 years in a national urban sample. Acad Pediatr 17(4):356. https://doi.org/10.1016/J.ACAP.2016.12.009
Greeson JKP, Briggs EC, Layne CM, Belcher HME, Ostrowski SA, Kim S, Lee RC, Vivrette RL, Pynoos RS, Fairbank JA (2014) Traumatic childhood experiences in the 21st century: broadening and building on the ACE studies with data from the National Child Traumatic Stress Network. J Interpers Violence 29(3):536–556. https://doi.org/10.1177/0886260513505217
Soleimanpour S, Geierstanger S, Brindis CD (2017) Adverse childhood experiences and resilience: addressing the unique needs of adolescents. Acad Pediatr 17(7):S108–S114. https://doi.org/10.1016/j.acap.2017.01.008
Wolraich ML, Hagan JF, Allan C, Chan E, Davison D, Earls M, Evans SW, Flinn SK, Froehlich T, Frost J, Holbrook JR, Lehmann CU, Lessin HR, Okechukwu K, Pierce KL, Winner JD, Zurhellen W (2019) Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 144(4):2020. https://doi.org/10.1542/peds.2019-2528
Kerker BD, Storfer-Isser A, Szilagyi M, Stein REK, Garner A, O’Connor KG, Hoagwood KE, Horwitz SM (2016) Do pediatricians ask about adverse childhood experiences in pediatric primary care? Acad Pediatr 16(2):154. https://doi.org/10.1016/J.ACAP.2015.08.002
Lanier P, Maguire-Jack K, Lombardi B, Frey J, Rose RA (2018) Adverse childhood experiences and child health outcomes: comparing cumulative risk and latent class approaches. Matern Child Health J 22(3):288–297. https://doi.org/10.1007/s10995-017-2365-1
Bitsko RH, Claussen AH, Lichstein J, Black LI, Jones SE, Danielson ML, Hoenig JM, DavisJack SP, Brody DJ, Gyawali S, Maenner MJ, Warner M, Holland KM, Rerou R, Crosby AE, Blumbergm SJ, Avenevoli S, Kaminski JW, Ghandour RM (2022) Mental health surveillance among children—United States, 2005–2011. MMWR Suppl 71(2):1–42. https://doi.org/10.15585/mmwr.su7102a1
Dvorsky MR, Langberg JM (2016) A review of factors that promote resilience in youth with ADHD and ADHD symptoms. Clin Child Fam Psychol Rev 19(4):368–391. https://doi.org/10.1007/s10567-016-0216-z
Collins LM, Lanza ST (2010) Latent class and latent transition analysis : with applications in the social behavioral, and health sciences. Wiley, New York
Kim Y, Lee H, Park A (2021) Patterns of adverse childhood experiences and depressive symptoms: self-esteem as a mediating mechanism. Soc Psychiatry Psychiatr Epidemiol 1:1–11. https://doi.org/10.1007/S00127-021-02129-2
Lee HY, Kim I, Nam S, Jeong J (2020) Adverse childhood experiences and the associations with depression and anxiety in adolescents. Child Youth Serv Rev 111:104850. https://doi.org/10.1016/J.CHILDYOUTH.2020.104850
Lew D, Xian H (2019) Identifying distinct latent classes of adverse childhood experiences among US children and their relationship with childhood internalizing disorders. Child Psychiatry Hum Dev 50(4):668–680. https://doi.org/10.1007/s10578-019-00871-y
Census Bureau (2019) 2018 National Survey of Children’s Health. https://www2.census.gov/programs-surveys/nsch/technical-documentation/methodology/2018-NSCH-Methodology-Report.pdf
Bethell CD, Gombojav N, Whitaker RC (2019) Family resilience and connection promote flourishing among US children, even amid adversity. Health Aff 38(5):729–737. https://doi.org/10.1377/hlthaff.2018.05425
Nylund KL, Asparouhov T, Muthén BO (2007) Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Struct Equ Modeling 14(4):535–569
Weller BE, Bowen NK, Faubert SJ (2020) Latent class analysis: a guide to best practice. J Black Psychol 46(4):287–311. https://doi.org/10.1177/0095798420930932
Lanza ST, Collins LM, Lemmon DR, Schafer JL (2007) PROC LCA: a SAS procedure for latent class analysis. Struct Equ Model 14(4):671–694. https://doi.org/10.1080/10705510701575602
Clark SL, Muthén B (2009) Relating LCA results relating latent class analysis results to variables not included in the analysis. https://www.statmodel.com/download/relatinglca.pdf
Nylund-Gibson K, Choi AY (2018) Ten frequently asked questions about latent class analysis. Transl Issues Psychol Sci 4(4):440–461. https://doi.org/10.1037/tps0000176
Nylund-Gibson K, Grimm RP, Masyn KE (2019) Prediction from latent classes: a demonstration of different approaches to include distal outcomes in mixture models. Struct Equ Modeling 26(6):967–985. https://doi.org/10.1080/10705511.2019.1590146
Huynh VW, Fuligni AJ (2010) Discrimination hurts: the academic, psychological, and physical well-being of adolescents. J Res Adolesc 20(4):916–941. https://doi.org/10.1111/J.1532-7795.2010.00670.X
Seaton EK, Caldwell CH, Sellers RM, Jackson JS (2008) The prevalence of perceived discrimination among African American and Caribbean Black Youth. Dev Psychol 44(5):1288–1297. https://doi.org/10.1037/A0020026
Umaña-Taylor AJ (2016) A post-racial society in which ethnic-racial discrimination still exists and has significant consequences for youths’ adjustment. Curr Directions Psychol Sci 25(2):111–118. https://doi.org/10.1177/0963721415627858
Benner AD, Wang Y, Shen Y, Boyle AE, Polk R, Cheng Y-P (2018) Racial/ethnic discrimination and well-being during adolescence: a meta-analytic review. Am Psychol 73(7):855–883. https://doi.org/10.1037/amp0000204
Carter RT, Lau MY, Johnson V, Kirkinis K (2017) Racial discrimination and health outcomes among racial/ethnic minorities: a meta-analytic review. J Multicult Couns Dev 45(4):232–259. https://doi.org/10.1002/jmcd.12076
Clark R, Anderson NB, Clark VR, Williams DR (1999) Racism as a stressor for African Americans. Am Psychol 54(10):805–816
Estrada-Martínez LM, Caldwell CH, Schulz AJ, Diez-Roux AV, Pedraza S (2013) Families, neighborhood socio-demographic factors, and violent behaviors among Latino, white, and black adolescents. Youth Soc 45(2):221–242. https://doi.org/10.1177/0044118X11411933
Crouch JL, Hanson RF, Saunders BE, Kilpatrick DG, Resnick HS (2000) Income, race/ethnicity, and exposure to violence in youth: results from the national survey of adolescents. J Community Psychol 28(6):625–641. https://doi.org/10.1002/1520-6629(200011)28:6%3c625::AID-JCOP6%3e3.0.CO;2-R
Meza JI, Bondoc C, Keshav N, Bosco J, Barnert E (2022) Exploring the link between neighborhood violence and health among African-American and Latinx youth returning home after incarceration. Child Youth Care Forum. https://doi.org/10.1007/s10566-022-09696-8
Clark C, Ryan L, Kawachi I, Canner MJ, Berkman L, Wright RJ (2008) Witnessing community violence in residential neighborhoods: a mental health hazard for urban women. J Urban Health 85(1):22–38. https://doi.org/10.1007/s11524-007-9229-8
Griggs S, Ratner HH, Hannigan JH, Delaney-Black V, Chiodo LM (2019) Violence exposure, conflict, and health outcomes in inner-city African American adolescents. Nurs Forum 54(4):513–525. https://doi.org/10.1111/nuf.12365
Theall KP, Shirtcliff EA, Dismukes AR, Wallace M, Drury SS (2017) Association between neighborhood violence and biological stress in children. JAMA Pediatr 171(1):53–60. https://doi.org/10.1001/jamapediatrics.2016.2321
Wright AW, Austin M, Booth C, Kliewer W (2017) Systematic review: exposure to community violence and physical health outcomes in youth. J Pediatr Psychol 42(4):364–378. https://doi.org/10.1093/jpepsy/jsw088
Fowler PJ, Tompsett CJ, Braciszewski JM, Jacques-Tiura AJ, Baltes BB (2009) Community violence: a meta-analysis on the effect of exposure and mental health outcomes of children and adolescents. Dev Psychopathol 21(1):227–259. https://doi.org/10.1017/S0954579409000145
Miliauskas CR, Faus DP, da Cruz VL, do NascimentoVallaperde JGR, Junger W, Lopes CS (2022) Community violence and internalizing mental health symptoms in adolescents: a systematic review. BMC Psychiatry 22(1):1–23. https://doi.org/10.1186/s12888-022-03873-8
Björkenstam E, Björkenstam C, Jablonska B, Kosidou K (2018) Cumulative exposure to childhood adversity, and treated attention deficit/hyperactivity disorder: a cohort study of 543 650 adolescents and young adults in Sweden. Psychol Med 48(3):498–507. https://doi.org/10.1017/S0033291717001933
La Greca AM, Silverman WK (1993) Parent reports of child behavior problems: bias in participation. J Abnorm Child Psychol 21(1):89–101. https://doi.org/10.1007/BF00910491
Rigles B (2017) The relationship between adverse childhood events, resiliency and health among children with autism. J Autism Dev Disord 47(1):187–202. https://doi.org/10.1007/s10803-016-2905-3
Visser SN, Danielson ML, Bitsko RH, Perou R, Blumberg SJ (2013) Convergent validity of parent-reported attention-deficit/hyperactivity disorder diagnosis: a cross-study comparison. JAMA Pediatr 167(7):674–675. https://doi.org/10.1001/JAMAPEDIATRICS.2013.2364
Connor DF, Ford JD (2012) Comorbid symptom severity in attention-deficit/hyperactivity disorder: a clinical study. J Clin Psychiatry 73(5):711–717. https://doi.org/10.4088/JCP.11m07099
Amato PR (2000) The consequences of divorce for adults and children. J Marriage Fam 62(4):1269–1287. https://doi.org/10.1111/j.1741-3737.2000.01269.x
Funding
No funding was received for conducting this study.
Author information
Authors and Affiliations
Contributions
JS contributed to drafting and revising the manuscript critically, including the study’s conception, analysis, and revision.
Corresponding author
Ethics declarations
Competing interests
The author declares no competing interests.
Ethical Approval
Not applicable.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Song, J. Patterns of Adverse Childhood Experiences and Psychiatric Disorders Among Adolescents with ADHD: A Latent Class Analysis. Child Psychiatry Hum Dev (2023). https://doi.org/10.1007/s10578-023-01645-3
Accepted:
Published:
DOI: https://doi.org/10.1007/s10578-023-01645-3