Maternal psychosocial stress and children’s ADHD diagnosis: a prospective birth cohort study

Abstract

Objective: Examine the association of mothers’ psychosocial stressors before and during pregnancy with their children’s diagnosis of attention deficit hyperactivity disorder (ADHD).

Methods: This study included 2140 mother–child pairs who had at least one postnatal pediatric visit at the Boston Medical Center between 2003 and 2015. Child ADHD was determined via International Classification of Diseases, Ninth Revision (ICD-9) codes documented in electronic medical records. Latent factors of maternal stress and social support and measures of the physical home environment and psychosocial adversities were constructed using exploratory factor analysis. The association between the latent factors and child ADHD diagnosis was examined using multiple logistic regression, controlling for known risk factors for ADHD.

Results: Children were 1.45 (95% CI: 1.06, 1.99) and 3.03 (95% CI: 2.19, 4.20) times more likely to receive an ADHD diagnosis if their mother experienced a major stressful event during pregnancy or reported a high level of perceived stress, respectively. The number of family adversities increases the risk of ADHD diagnosis [second quartile: OR = 1.90; CI (1.31, 2.77); third quartile: OR = 1.96 CI (1.34, 2.88); fourth quartile: OR = 2.89 CI (2.01, 4.16)] compared to first quartile.

Conclusions: In this prospective, predominantly urban, low-income, minority birth cohort, mothers’ psychosocial stress before and during pregnancy appears to be an independent risk factor for the development of ADHD in their children.

Keywords:

• Attention-deficit hyperactivity disorder
• maternal psychosocial stress
• prospective birth cohort study
• psychosomatic gynecology
• perinatal epidemiology

Acknowledgements

We gratefully acknowledge many individuals (including the Boston Birth Cohort field team and obstetrics and gynecology and pediatric clinical staff) who helped in the recruitment and follow-up of the Boston Birth Cohort, as well as all the women and children who participated in this study. Through their contributions this work has been possible.

Disclosure statement

No potential conflict of interest was reported by the authors.

Current knowledge on this subject.

• ADHD is among the most common childhood psychiatric disorders.

• Early life risk factors for ADHD such as smoking during pregnancy and preterm birth have been previously identified.

• Data are limited on the role of multidimensional maternal and family psychosocial stress before and during pregnancy in child development of ADHD.

What this study adds.

• This is the first prospective birth cohort study of low-income minority children to identify elevated risk for ADHD diagnosis among children born to mothers who reported psychosocial stress before and during pregnancy, over and above other well-established risks.

• This study accounts for several pre-, peri-, and postnatal factors previously associated with ADHD, as well as less commonly investigated factors such as maternal intrauterine infections.

• We identify a gradient in the effects of stressful adversities on the likelihood of ADHD diagnosis, suggesting the possibility for a prospective, perinatal equivalent to findings from the study of adverse childhood experiences study if further confirmed.

Additional information

Funding

This work was supported in part by the grants from the Maternal and Child Health Bureau of the Health Resources and Services Administration (HRSA) [R40MC27443 and UJ2MC31074] and the Boston Birth Cohort (the parent study) was supported in part by the grants from the National Institutes of Health (NIH) [2R01HD041702, R01HD086013, and R21HD085556].