Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder affecting millions of children worldwide. While the exact causes of ADHD are not fully understood, recent research suggests that pre- and perinatal factors may play a role in its development. A new study published in Development and Psychopathology explores this possibility using data from the Adolescent Brain Cognitive Development (ABCD) cohort, a large-scale study of children aged 9-10 from the United States.
The study analyzed pre- and perinatal data from over 9,900 children and their caregivers to identify potential predictors of ADHD symptoms. The data included information on maternal substance-use, obstetric complications, child demographics, and the Child Behavior Checklist reported by the parent.
Using elastic net regression with 5-fold validation, the researchers identified 17 pre/perinatal variables that were robust predictors of ADHD symptoms in this cohort. However, the model explained just 8.13% of the variance in ADHD symptoms on average, indicating that other factors not measured in this study also contribute to ADHD risk.
Interestingly, the model’s predictive accuracy varied significantly by subgroup, particularly across income groups, and several pre/perinatal factors appeared to be sex-specific. Pre/perinatal variables were more predictive of attention problems in low-income households than high- or middle-income households, more predictive in families with a stronger parental psychiatric history, and more reliable for White children than Black or Hispanic children. However, the predictive capacity did not differ significantly between males and females, though several male-specific risk factors were identified, including maternal medication use in pregnancy and a total number of delivery complications.
The findings of this study suggest that we may be able to predict childhood ADHD symptoms with modest accuracy from birth, using information that is generally known by birth, such as sex, parental age, and prenatal exposures. Furthermore, almost half of the robust predictors identified were potentially preventable, such as maternal substance-use, anemia, UTI, and young parental age at birth.
However, this study needs to be replicated using prospectively measured pre/perinatal data to confirm the results and improve prediction accuracy by comparing other, more complex, prediction techniques. Additionally, the study did not examine the impact of postnatal factors, such as parenting practices, environmental exposures, or educational interventions, which may also influence ADHD outcomes.
Despite these limitations, the findings of this study may inform interventions to prevent and minimize childhood ADHD symptoms, particularly in the United States, where ADHD prevalence rates are among the highest in the world. By identifying modifiable risk factors, such as maternal substance-use and prenatal complications, this study highlights the potential for early intervention and prevention strategies that could benefit a large number of children and families.
