November 19, 2021

How social disadvantages affect risk of ADHD

Danish health care is universal and free. That means there is very complete data available that covers the entire population. The health registers are linked to other national registers that provide access to socioeconomic information. That offers unusual opportunities to research correlations across an entire national population.

Moreover, the health care system requires a high standard for diagnosis of ADHD - evaluation by specialist doctors or psychiatrists rather than a general practitioner. An exception is when parents seek a diagnosis from a private practicing child psychiatrist, in which case diagnostic registration is not mandatory and data is therefore incomplete.

A trio of Danish researchers used the country' national registers to conduct a nationwide population cohort study to explore the cumulative effects of social disadvantages as risk factors for being diagnosed with ADHD.

They looked at all 632,725 children born in Denmark during the 1990s, of which 23,287 (3.7 percent) either had a registered diagnosis in the Patient Registry or else were undergoing ADHD treatment before age 18. Of these, 12,610 children had a registered ADHD diagnosis and entered medical treatment, 4,049 children had a registered diagnosis with no medical treatment, and 6,628 children entered medical treatment with no registered diagnosis. The latter were presumably diagnosed by private practicing psychiatrists. Adjustments were made for gender, immigrant status, birth characteristics (weight, gestational age), single-parenthood, parent ADHD diagnosis, and the number of children in the household.

The study determined that parental educational attainment had the largest effect on the risk of ADHD. Having parents who completed no more than the minimum compulsory education was associated with a 3.5 percentage point higher risk of getting an ADHD diagnosis. Completing no more than upper secondary education was associated with a 1.3 percent higher risk. But there was a sharp bifurcation in the two alternative components of upper secondary education. Children of parents who completed a vocational track faced a 1.7 percent increase in risk, whereas those whose parents completed a college preparatory track faced a negligible 0.17 percent increase.

Parental unemployment also had a significant effect. Youths whose parents were unemployed most of the year faced a 2.1 percent higher risk of ADHD, whereas those whose parents were unemployed less than half the year faced a 1.3 percent higher risk.

Relative income poverty had a comparable impact. Children of parents in the lowest income quintile faced a 2.3 percent higher risk of ADHD than those of parents in the uppermost income quintile. Those in the second-lowest quintile faced a 1.9 percent higher risk than those in the uppermost quintile; those in the middle quintile a 1.3 percent higher risk, and those in the second-highest quintile a 0.8 percent higher risk.

All three cases showed a dose-response relationship, in which higher gradations of social disadvantage were associated with higher levels of risk.

Since these social disadvantages often overlap, the researchers looked at combinations as well and found them to be roughly additive in effect. Parental unemployment plus relative income poverty was associated with a 1.9 percent higher risk of offspring ADHD. Parental unemployment plus completion of no more than compulsory education was associated with a 3.2 percent higher risk. Parental relative income poverty plus completion of no more than compulsory education produced a 4.2 percent higher risk. Finally, Parental relative income poverty plus completion of no more than compulsory education plus unemployment was associated with a 4.9 percent higher risk.

The authors concluded, "This study shows that specific and well-measured parental social disadvantages in terms of unemployment, relative income poverty, and low educational attainment independently affect the risk of ADHD."

Maria Kellow, Chunsen Wu, Carsten Obel, "Cumulative social disadvantage and risk of attention deficit hyperactivity disorder: Results from a nationwide cohort study," SSM - Population Health (2020) 10, 100548,

Related posts

No items found.

News Tuesday: Fidgeting and ADHD

A recent study delved into the connection between fidgeting and cognitive performance in adults with Attention-Deficit/Hyperactivity Disorder. Recognizing that hyperactivity often manifests as fidgeting, the researchers sought to understand its role in attention and performance during cognitively demanding tasks. They designed a framework to quantify meaningful fidgeting variables using actigraphy devices.

(Note: Actigraphy is a non-invasive method of monitoring human rest/activity cycles. It involves the use of a small, wearable device called an actigraph or actimetry sensor, typically worn on the wrist, similar to a watch. The actigraph records movement data over extended periods, often days to weeks, to track sleep patterns, activity levels, and circadian rhythms. In this study, actigraphy devices were used to measure fidgeting by recording the participants' movements continuously during the cognitive task. This data provided objective, quantitative measures of fidgeting, allowing the researchers to analyze its relationship with attention and task performance.)

The study involved 70 adult participants aged 18-50, all diagnosed with ADHD. Participants underwent a thorough screening process, including clinical interviews and ADHD symptom ratings. The analysis revealed that fidgeting increased during correct trials, particularly in participants with consistent reaction times, suggesting that fidgeting helps sustain attention. Interestingly, fidgeting patterns varied between early and later trials, further highlighting its role in maintaining focus over time.

Additionally, a correlation analysis validated the relevance of the newly defined fidget variables with ADHD symptom severity. This finding suggests that fidgeting may act as a compensatory mechanism for individuals with ADHD, aiding in their ability to maintain attention during tasks requiring cognitive control.

This study provides valuable insights into the role of fidgeting in adults with ADHD, suggesting that it may help sustain attention during challenging cognitive tasks. By introducing and validating new fidget variables, the researchers hope to standardize future quantitative research in this area. Understanding the compensatory role of fidgeting can lead to better management strategies for ADHD, emphasizing the potential benefits of movement for maintaining focus.

July 16, 2024

Identifying Autistic-Like Symptoms in Children with ADHD

NEWS TUESDAY: Identifying Autistic-Like Symptoms in Children with ADHD

A recent study investigated the presence of autistic-like symptoms in children diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD). Given the overlapping social difficulties in both ADHD and Autism Spectrum Disorder (ASD), distinguishing between the two disorders can be challenging. This study aims to pinpoint specific patterns of autistic symptoms in children with ADHD, comparing them to those with ASD using the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2).

The research involved 43 school-age children divided into two groups:

  • ADHD Group (25 children): Initially referred for ASD symptoms but later diagnosed with ADHD.
  • ASD Group (18 children): Children diagnosed with ASD.

Researchers used ADOS-2 to evaluate differences in communication deficits, social interaction challenges, and repetitive behaviors between the two groups. The study also compared IQ, age, ADOS-2 domain scores, and externalizing/internalizing problems.

Key Findings:

  • Significant differences were found between the ADHD and ASD groups in ADOS-2 domain scores, including Social Affect, Restricted and Repetitive Behavior, and Total Score.
  • On an individual item level, children with ADHD displayed similar atypical behaviors as those with ASD in social-communication areas such as "Pointing" and "Gestures".
  • Both groups showed comparable frequencies in behaviors like "Stereotyped/idiosyncratic words or phrases", "Mannerisms", and "Repetitive interests and behaviors".

The study highlights the importance of identifying transdiagnostic domains that overlap between ADHD and ASD. The transdiagnostic domain refers to a set of symptoms or behaviors that are common across multiple diagnostic categories rather than being specific to just one. Identifying these domains in mental health practice and in psychological research is crucial to understanding, properly diagnosing, and treating conditions with overlapping features. This understanding could pave the way for tailored treatments addressing the specific needs of children with ADHD, particularly those exhibiting autistic-like symptoms.

July 9, 2024

Non-stimulant Medications for Adults with ADHD: An Overview

NEW STUDY: Non-stimulant Medications for Adults with ADHD: An Overview

Attention-Deficit/Hyperactivity Disorder (ADHD) in adults is commonly treated with stimulant medications such as methylphenidate and amphetamines. However, not all patients respond well to these stimulants or tolerate them effectively. For such cases, non-stimulant medications provide an alternative treatment approach.

Recent research by Brancati et al. reviews the efficacy and safety of non-stimulant medications for adult ADHD. Atomoxetine, a well-studied non-stimulant, has shown significant effectiveness in treating ADHD symptoms in adults. The review highlights the importance of considering dosage, treatment duration, safety, and the presence of psychiatric comorbidities when prescribing atomoxetine.

Additionally, certain antidepressants, including tricyclic compounds, bupropion, and viloxazine, which possess noradrenergic or dopaminergic properties, have demonstrated efficacy in managing adult ADHD. Antihypertensive medications, especially guanfacine, have also been found effective. Other medications like memantine, metadoxine, and mood stabilizers show promise, whereas treatments like galantamine, antipsychotics, and cannabinoids have not yielded positive results.

The expert opinion section of the review emphasizes that while clinical guidelines primarily recommend atomoxetine as a second-line treatment, several other non-stimulant options can be utilized to tailor treatments based on individual patient needs and comorbid conditions. Despite these advancements, the authors call for further research to develop and refine more personalized treatment strategies for adults with ADHD.

This review underscores the growing landscape of non-stimulant treatment options, offering hope for more personalized and effective management of ADHD in adults.

June 25, 2024