Duke 2008 | ASHE | Equity and Efficiency in Health and Healthcare

Rationale: Child maltreatment is prevalent in the United States. Based on a nationally representative survey of children 2 through 17 years of age, more than one in eight children were estimated to have been physically or sexually abused or neglected in one year spanning 2002–2003. Given the public health importance of child maltreatment, it is important to identify risk factors for the purposes of surveillance and prevention.

Objective: The objective of this study is to determine whether attention-deficit/hyperactivity disorder (ADHD) symptoms during childhood were associated with child maltreatment.

Methodology: The study sample consisted of 14,322 eligible participants in the National Longitudinal Study of Adolescent Health (Add Health), a U.S. nationally representative sample of adolescents followed from 1995. Based on retrospectively self-reported ADHD symptoms during childhood, we constructed ADHD subtypes (hyperactivity/impulsivity, inattention, and combined) according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV). We also constructed types of child maltreatment (supervision neglect, physical neglect, physical abuse, and contact sexual abuse) according to self-reported frequencies of past child maltreatment by parents or other adult care givers. We used logistic regressions to examine the relationship between different types of child maltreatment and subtypes of ADHD during childhood, controlling for demographic and familial risk factors for child maltreatment. We also used sibling fixed- effect regression to control for family level unobserved factors.

Results: Controlling for other risk factors, having six or more inattention symptoms was significantly associated with the likelihood of supervision neglect (odds ratio [OR]: 1.69; 95% confidence interval [CI]: 1.27–2.26; p < 0.001), physical neglect (OR: 2.18; 95% CI: 1.46–3.26; p < 0.001), physical abuse (OR: 1.66; 95% CI: 1.18–2.32; p < 0.05), and being sexually abused (OR:2.70; 95% CI:1.57–4.64; p < 0.001). To a lesser extent, having six or more hyperactivity/impulsivity symptoms was associated with the likelihood of supervision neglect (OR: 1.49; 95% CI: 1.13–1.97; p < 0.05) and physical abuse (OR: 1.28; 95% CI: 1.01–1.64; p < 0.05). The results for the association between inattentive subtype and child maltreatment from the sibling fixed-effect models were similar in magnitude to the full sample logistic regression models.

Conclusions: The likelihood of being maltreated by adult caregivers was associated with inattentive symptoms during childhood. The association was significant in the full sample and was consistent across study designs, which was suggestive of a causal relationship. The association between hyperactive symptoms and child maltreatment was less likely to have been causal, because the results from different models were not consistent. The findings suggest pediatricians need to maintain a heightened awareness of the potential for child maltreatment for children with inattentive symptoms.