Kids who are diagnosed with ADHD already have enough on their little minds just dealing with those issues. But are they more likely to have trouble at home, too?
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When a child is diagnosed with ADHD, it's likely that teachers and therapists will chalk all of his difficulties up to the ADHD alone. But it might be a good time to dig a little bit deeper with these kids. A study revealed that children who are diagnosed with ADHD are more likely to also be dealing with difficulties or trauma in their home life, such as divorce, poverty, loss of a parent, violent living situations or family substance abuse in the home.

Not a clear picture

Focusing all of the efforts on the diagnosis and treatment of ADHD won't help children who are also grappling with adverse childhood experiences (ACEs) such as those mentioned above. The course of treatment when ACEs are co-existent with ADHD may need to be altered for results to truly help. Researchers wanted to determine if there was often a correlation between the two. "Knowledge about the prevalence and types of adverse experiences among children diagnosed with ADHD may guide efforts to address trauma in this population and improve ADHD screening, diagnostic accuracy and management," says lead author Nicole M. Brown, M.D., MPH, MHS, FAAP.

What researchers studied

Dr. Brown and her team were able to use data from the 2011 National Survey of Children's Health for their analysis. They were able to identify 65,680 children between the ages of 6 and 17 whose parents not only answered the questions pertaining to ADHD, but who also had one or more of nine identified ACEs. For purposes of this study, the ACEs were poverty, domestic violence, divorce, death of a parent or guardian, familial mental illness, incarceration of a family member, neighborhood violence, substance abuse and discrimination. Approximately 12 percent of these children had a diagnosis of ADHD, and those children were reported to have a higher number of adverse events in their lives than were reported by parents of children who did not have ADHD. Additionally, 17 percent of the children with a diagnosis of ADHD had not just one but four or more ACEs. Only six percent of the children without ADHD reported as many ACEs.

ADHD treatment compromised?

Providers may focus on ADHD as the primary diagnosis and overlook the possible presence of a trauma history, which may impact treatment.

Children in the study who had four or more ACEs in their lives were almost three times more likely to be using prescriptions for treatment of their ADHD symptoms than the children dealing with only three or fewer adversities — and were more likely to have had their ADHD rated by their parents as in the moderate to severe range. Is it possible that treatment of the underlying adverse situations through talk therapy, play therapy, family counseling or other avenues of assistance might help the treatment of ADHD overall? "Our findings suggest that children with ADHD experience significantly higher rates of trauma than those without ADHD," says Dr. Brown. "Providers may focus on ADHD as the primary diagnosis and overlook the possible presence of a trauma history, which may impact treatment."

"Pediatric providers should consider screening for adverse childhood experiences in children who they suspect may have ADHD and/or those who carry the diagnosis, and initiate evidence-based treatment/intervention plans for children who screen positive for ACEs," she concludes. Maybe a more well-rounded approach to children's health and well-being will result in better care overall for our kids.

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