Examining the Relationship Between Adverse Childhood Experiences and ADHD Diagnosis and Severity

Published:March 18, 2021DOI:



      Although prior research has examined the prevalence of ACEs among children with attention deficit-hyperactivity disorder (ADHD), little is known about the household and family settings of children with ADHD. Our study utilizes a recent nationally representative dataset to examine the association between adverse childhood experiences (ACEs), child and household characteristics, and ADHD diagnosis and severity.


      Using the 2017–2018 National Survey of Children's Health (NSCH), our sample consisted of children three years of age or older, as this is the youngest age at which the NSCH begins to ask caregivers if a child has been diagnosed with ADHD (n = 42,068). Multivariable logistic regression was used to examine the association between ACE type, score, and ADHD and ADHD severity, controlling for child and household characteristics.


      Children exposed to four or more ACEs had higher odds of ADHD (aOR 2.16; 95% CI 1.72–2.71) and moderate to severe ADHD (aOR 1.89; 95% CI 1.31–2.72) than children exposed to fewer than four ACEs. Other child characteristics positively associated with ADHD included age and public insurance; other Non-Hispanic races compared to Non-Hispanic White had lower odds of ADHD. Of children reported with ADHD, public insurance was also associated with caregiver-reported moderate to severe ADHD.


      Children with ADHD have a higher prevalence of ACEs, making this study important for understanding the relationship between ACEs and ADHD at the population level.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Danielson ML
        • Bitsko RH
        • Ghandour RM
        • et al.
        Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents, 2016.
        J Clin Child Psychol. 2018; 47: 199-212
        • Danielson ML
        • Visser SN
        • Chronis-Tuscano A
        • et al.
        A national description of treatment among U.S. children and adolescents with ADHD.
        J Pediatr. 2018; 192: 240-246.e1
        • American Academy of Pediatrics, Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management
        ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents.
        Pediatrics. 2011; 128: 1007-1022
        • Felitti VJ
        • Anda RF
        • Nordenberg D
        • et al.
        Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) Study.
        Am J Prev Med. 1998; 14: 245-258
        • Shonkoff JP
        • Garner AS
        • Siegel BS
        • et al.
        The lifelong effects of early childhood adversity and toxic stress.
        Pediatrics. 2012; 129: e232-e246
        • Peterson C
        • Florence C
        • Klevens J.
        The economic burden of child maltreatment in the United States, 2015.
        Child Abuse Negl. 2018; 86: 178-183
        • Overmeyer S
        • Taylor E
        • Blanz B
        • Schmidt MH.
        Psychosocial adversities underestimated in hyperkinetic children.
        J Child Psychol Psychiatry. 1999; 40: 259-263
        • Epstein JN
        • Kelleher KJ
        • Baum R
        • et al.
        Variability in ADHD care in community-based pediatrics.
        Pediatrics. 2014; 134: 1136-1143
        • Bard DE
        • Wolraich ML
        • Neas B
        • et al.
        The psychometric properties of the Vanderbilt Attention-Deficit Hyperactivity Disorder Diagnostic Parent Rating Scale in a community population.
        J Dev Behav Pediatr. 2013; 34: 72-82
        • Chang LY
        • Wang MY
        • Tsai PS.
        Diagnostic accuracy of rating scales for attention-deficit/hyperactivity disorder: a meta-analysis.
        Pediatrics. 2016; 137e20152749
        • Moran A
        • Serban N
        • Danielson ML
        • et al.
        Adherence to recommended care guidelines in the treatment of preschool-age Medicaid-enrolled children with a diagnosis of ADHD.
        Psychiatr Serv. 2019; 70: 26-34
        • Kerker BD
        • Storfer-Isser A
        • Szilagyi M
        • et al.
        Do pediatricians ask about adverse childhood experiences in pediatric primary care?.
        Acad Pediatr. 2016; 16: 154-160
        • Wolraich ML
        • Hagan JF
        • Allan C
        • et al.
        Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents.
        Pediatrics. 2019; 144e20192528
        • Schickedanz A
        • Halfon N
        • Sastry N
        • et al.
        Parents’ adverse childhood experiences and their children's behavioral health problems.
        Pediatrics. 2018; 142e20180023
        • Brown NM
        • Brown SN
        • Briggs RD
        • et al.
        Associations between adverse childhood experiences and ADHD diagnosis and severity.
        Acad Pediatr. 2017; 17: 349-355
        • Jimenez ME
        • Wade Jr, R
        • Schwartz-Soicher O
        • et al.
        Adverse childhood experiences and ADHD diagnosis at age 9 years in a national urban sample.
        Acad Pediatr. 2017; 17: 356-361
        • Fuller-Thomson E
        • Lewis DA
        The relationship between early adversities and attention-deficit/hyperactivity disorder.
        Child Abuse Negl. 2015; 47: 94-101
        • Rowland AS
        • Lesesne CA
        • Abramowitz AJ.
        The epidemiology of attention-deficit/hyperactivity disorder (ADHD): a public health view.
        Ment Retard Dev Disabil Res Rev. 2002; 8: 162-170
        • Bethell CD
        • Newacheck P
        • Hawes E
        • Halfon N.
        Adverse childhood experiences: assessing the impact on health and school engagement and the mitigating role of resilience.
        Health Aff. 2014; 33: 2106-2115
        • Bethell C
        • Gombojav N
        • Solloway M
        • Wissow L.
        Adverse childhood experiences, resilience and mindfulness-based approaches: common denominator issues for children with emotional, mental, or behavioral problems.
        Child Adolesc Psychiatr Clin. 2016; 25: 139-156
        • Belsky J.
        Etiology of child maltreatment: A developmental-ecological analysis.
        Psychol Bull. 1993; 114: 413
        • Pathak P
        • Grimes K.
        Adverse Childhood Experiences (ACE) assessment in clinical practice: a pediatric integrated care model.
        Pediatrics. 2019; 144 (2; MeetingAbstract) 00
      1. Compassionate Schools Project 2020. Available at: Accessed October 13, 2020.

        • Perez Algorta G
        • Kragh CA
        • Arnold LE
        • et al.
        Maternal ADHD symptoms, personality, and parenting stress: Differences between mothers of children with ADHD and mothers of comparison children.
        J Atten Disord. 2018; 22 ( 1266-1277