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September 26, 2024
Potentially traumatic experiences (PTEs) refer to events where someone is exposed to situations that involve threats to life, serious injury, or danger to themselves or others. These events can include things like accidents, violence, or the death of someone close. PTEs are significant because they can have lasting effects on a person's mental health.
A research team from Norway, working with a collaborator from the U.S., used their country’s universal health care system to study how PTEs affect the mental health of children and adolescents in Hordaland County, which includes the city of Bergen. They wanted to see how experiencing PTEs influenced the likelihood of these young people seeking help from child and adolescent mental health services (CAMHS) or being diagnosed with psychiatric disorders, including ADHD.
In 2012, the study invited all 19,439 teenagers born between 1993 and 1995 in Hordaland County to participate. These teens were 16 to 19 years old at the time. Out of this group, 9,555 teens agreed to let the researchers link their personal data with the National Patient Registry (NPR), which keeps track of health records. There was no significant difference in the types or number of PTEs between those who agreed to this data sharing and those who did not.
After removing participants with incomplete information, the researchers were left with 8,755 teens. These teens’ psychiatric diagnoses, including ADHD, were taken from the NPR. The researchers asked the participants if they had ever experienced specific traumatic events, such as:
If a participant reported experiencing the death of someone close, they were asked to specify who it was (a parent, sibling, grandparent, other family member, close friend, or romantic partner). One limitation of the study was that it did not ask about bullying, which could also be a traumatic experience.
The researchers divided the teens into three trauma groups based on their experiences:
Teens in the situational and interpersonal trauma groups were more likely to see their economic situation as worse than those in the low trauma group. For example, 11% of the situational trauma group and 17% of the interpersonal trauma group considered themselves economically worse off, compared to just 6.1% of the low trauma group. Also, fewer parents of teens in the two higher trauma groups had higher levels of education, which can impact family support and resources.
After adjusting for gender and parental education, the researchers found that:
The effect was even stronger when comparing the interpersonal trauma group to the low trauma group. Teens in the interpersonal trauma group were almost five times more likely to be diagnosed with ADHD than those in the low trauma group.
One limitation of the study is that while the researchers acknowledged that sex and socioeconomic status (SES) are important factors in the relationship between trauma and psychiatric disorders, they did not directly adjust for SES. However, they did indirectly account for it by considering the education levels of the parents, which is closely related to SES.
The study showed that adolescents who experience more interpersonal trauma (like violence or sexual abuse) are at a significantly higher risk of being diagnosed with ADHD. The findings suggest that it’s important to pay special attention to teens who experience both situational and interpersonal traumas, especially those exposed to interpersonal violence. Early intervention and support could be key to helping these adolescents manage their mental health.
Annika Skandsen, Sondre Aasen Nilsen, Mari Hysing, Martin H. Teicher, Liv Sand, and Tormod Bøe, “Associations Between Distinct Trauma Classes and Mental Health Care Utilization in Norwegian Adolescents: A National Registry Study,” Child Psychiatry & Human Development (2024), https://doi.org/10.1007/s10578-024-01671-9.
The Background:
Previous research has suggested that people with ADHD have higher rates of death than those without the condition. Until now, many of those studies lacked the detail needed to untangle why this might be the case. A recent meta-analysis of eight separate studies reported that ADHD roughly doubled the risk of death, and it hinted that factors like socioeconomic status and other mental illnesses might help explain the link.
The Study:
To explore this in more detail, researchers used the US National Health Interview Survey, a nationally representative prospective cohort of just over 52,000 adults. Survey records were linked with the National Death Index, and participants were followed from the date of interview until death or December 31, 2019, whichever came first. The main outcome was death from any cause. With a median follow-up of just under eight years, there were 6,024 deaths recorded.
When the team adjusted their analysis for age, sex, ethnicity, and the year of the survey, having ADHD was associated with a 58% higher risk of death. Controlling further for family income and educational level reduced that increased risk slightly, to 50%.
Controlling for health conditions (like high blood pressure, diabetes, stroke, heart disease, and cancer) and lifestyle factors (smoking, alcohol use, physical activity, and body weight) also reduced the association to about 46%.
By contrast, when the researchers adjusted for two psychiatric conditions (anxiety and depression) commonly found alongside ADHD, the link between ADHD and higher mortality disappeared statistically. In other words, once anxiety and depression were taken into account, ADHD itself was no longer associated with a clearly measurable increase in the risk of death.
What Does This Mean?
The authors conclude that the apparent effect of ADHD on mortality seems to operate largely through accompanying mental illness, and to a lesser extent through lifestyle and physical health problems. They suggest that treating and managing these co-occurring issues (through medications, therapy, and behavioral interventions) might help reduce the risk of premature death in people with ADHD, although they note that further evidence is needed.
The Background:
Dementia is a rapidly growing public health problem affecting more than 50 million people worldwide. Nearly 10 million new cases are diagnosed each year, and that number is expected to almost triple by 2050. The most common form is Alzheimer’s disease, accounting for roughly 60–70% of cases, followed by vascular dementia at around 20%. Other types include dementia with Lewy bodies, Parkinson’s disease dementia, and frontotemporal dementia. While no cure exists, managing modifiable risk factors (such as high blood pressure, smoking, physical inactivity, and poorly controlled diabetes) can delay or slow both the onset and progression of the condition.
Several studies have reported an elevated dementia risk among people with ADHD, and a number of mechanisms may explain this association. These include shared genetic or neurobiological vulnerabilities, reduced cognitive reserve (leaving the brain less resilient to age-related damage), and greater lifetime exposure to other established dementia risk factors.
Earlier reviews explored the possible link between ADHD and dementia, but tended toward a broader scope (incorporating other neurodegenerative disorders or mixing study designs), which introduced substantial variability and precluded quantitative synthesis. The relevant research literature has also expanded considerably since those reviews appeared.
The Study:
This meta-analysis restricted inclusion to case-control and cohort studies, yielding five that met the criteria. One was a case-control study with 400 participants; the other four were cohort studies collectively covering 3.7 million individuals, two retrospective and two prospective.
The Results:
Pooling the four cohort studies, individuals with ADHD showed approximately two-and-a-half times the dementia risk of those without the diagnosis. There was no indication of publication bias.
The Take-Away:
The authors concluded that ADHD is associated with a significantly increased risk of all-cause dementia in later life, while noting that its relationship to specific dementia subtypes remains less clear and warrants attention in future research.
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The Background:
Women with polycystic ovary syndrome (PCOS) themselves show higher rates of ADHD. Because ADHD is partly heritable (meaning genes contribute to the condition), some of the increased ADHD seen in children of mothers with PCOS could come from shared genetic factors. In other words, a mother’s and her child’s increased risk might sometimes reflect common genes rather than an effect of the pregnancy itself.
Beyond genetics, growing evidence points to maternal metabolic problems during pregnancy as another important risk factor for neurodevelopmental outcomes. PCOS is one of these conditions and is considered both potentially modifiable (treatable or manageable) and biologically plausible as a contributor to risk. PCOS affects an estimated 5–10% of women of reproductive age worldwide and is characterized by signs such as hyperandrogenism (higher-than-normal levels of “male” hormones), insulin resistance (poorer ability to use the hormone insulin, which can affect blood sugar and metabolism), and chronic low-grade inflammation.
However, studies to date have not all reached the same conclusions. Some research suggests the association between maternal PCOS and offspring ADHD is stronger for girls, while other studies did not analyze results by child sex. Methodological differences make it harder to draw clear conclusions.
The Study:
It’s important to note that the studies included in this meta-analysis were observational (cohort studies and case-control studies). Observational studies can identify associations (that two things occur together) but cannot prove that one causes the other. A cohort study follows people over time, and a case-control study compares people with a condition to similar people without it.
The pooled results came from six studies that together included almost 1.4 million mother–child pairs and that adjusted for confounders (other factors that might influence the result, such as maternal age or socioeconomic status). After statistical adjustment, children of mothers with PCOS had about 40% greater odds of ADHD than children of mothers without PCOS. The analysis reported no evidence of publication bias (no clear sign that only positive studies were published) and zero heterogeneity (the results were consistent across the studies).
There was no meaningful difference in results between cohort and case-control studies, and the meta-analysis did not find a significant difference in the association when comparing male and female offspring.
The Take-Away:
The research team concluded that this large-scale synthesis found an association between maternal PCOS and higher odds of ADHD and other neuropsychiatric conditions in children. They suggested that children born to mothers with PCOS may benefit from developmental monitoring to identify and address problems early, while emphasizing that causal relationships have not been established. They called for further studies to confirm these findings and to investigate the biological and environmental mechanisms that might explain the association. Indeed, because women with PCOS show higher rates of ADHD than other women, we need genetically informed research designs to see if the reported association is confounded.
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