Longitudinal associations between physical health conditions in childhood and attention-deficit/hyperactivity disorder symptoms at age 17

Objective: Although evidence suggests significant cross-sectional relationships between attention-deficit/hyperactivity disorder (ADHD) and several physical health conditions, less is known about their longitudinal associations. We investigated the cumulative effect of childhood physical health conditions on ADHD symptoms at age 17 years, controlling for environmental factors, ADHD medication status, and ADHD symptoms at age 3 years. Method: Using Millennium Cohort Study data (weighted n = 8,059), we assessed whether 4 physical health clusters (sensory, neurological, atopic, and cardio-metabolic) were associated with scores on the ADHD subscale from the Strengths and Difficulties Questionnaire at age 17 years. Environmental factors were grouped into 5 cumulative risk indices: prenatal, perinatal, postnatal environment, postnatal maternal well-being, and sociodemographic factors. Regression analyses determined whether each physical health cluster was associated with ADHD score while controlling for environmental factors, ADHD medication, and earlier symptoms. Results: Sensory, neurological, and cardio-metabolic clusters were all significantly associated with ADHD symptoms (β range = 0.04-0.09, p < .001). The overall model explained 2% of the variance. This rose to 21% (ΔR ² = 0.06) after adjusting for confounders. The sensory (β = 0.06) and neurological (β = 0.06) clusters remained significant (R ² = 0.21, ΔR ² = 0.06), but the cardio-metabolic cluster was no longer a significant predictor. Conclusion: Sensory or neurological conditions in childhood were associated with higher ADHD symptoms aged 17 after adjustment of confounders. This was not the case for atopic or cardio-metabolic conditions. These findings have implications for the care of children with sensory/neurological conditions and future research examining ADHD etiopathophysiology.

ADHD, ADHD medication, environmental factors, physical health

10.1016/j.jaac.2023.06.016

1527-5418

245-254

Reed, Claire

465b9fe5-083a-41a3-81e4-c6b1f2efce7b

Cortese, Samuele

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Larsson, Henrik

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Galéra, Cédric

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Cotton, Joanne

5159795a-73cd-4783-8c78-f571de5277b7

Brandt, Valerie

e41f5832-70e4-407d-8a15-85b861761656

February 2024

Reed, Claire

465b9fe5-083a-41a3-81e4-c6b1f2efce7b

Cortese, Samuele

53d4bf2c-4e0e-4c77-9385-218350560fdb

Larsson, Henrik

b19ecc72-a223-44f9-adbc-f3825f4e211c

Galéra, Cédric

322be113-abce-4d3c-9ca6-644631837bed

Cotton, Joanne

5159795a-73cd-4783-8c78-f571de5277b7

Brandt, Valerie

e41f5832-70e4-407d-8a15-85b861761656

Reed, Claire, Cortese, Samuele, Larsson, Henrik, Galéra, Cédric, Cotton, Joanne and Brandt, Valerie (2024) Longitudinal associations between physical health conditions in childhood and attention-deficit/hyperactivity disorder symptoms at age 17. Journal of the American Academy of Child and Adolescent Psychiatry, 63 (2), 245-254. (doi:10.1016/j.jaac.2023.06.016).

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Accepted/In Press date: 23 June 2023

e-pub ahead of print date: 3 July 2023

Published date: February 2024

Additional Information: Funding Information: The authors are grateful to the Centre for Longitudinal Studies (CLS), UCL Social Research Institute, for the use of these data and to the UK Data Service for making them available. However, neither CLS nor the UK Data Service bear any responsibility for the analysis or interpretation of these data. The authors have reported no funding for this work. Disclosure: Prof. Cortese has declared honoraria and reimbursement for travel and accommodation expenses for lectures from the following non-profit associations: Association for Child and Adolescent Central Health (ACAMH), Canadian ADHD Alliance Resource (CADDRA), British Association of Pharmacology (BAP), and from Healthcare Convention for educational activity on ADHD. Prof. Larsson has acknowledged financial support from the European Union's Horizon 2020 research and innovation programme under grant agreement number 965381, the Swedish Research Council (2018-02599; 2022-01119) and the Swedish Brain Foundation (FO2021-0115). Prof. Larsson has reported receiving grants from Shire Pharmaceuticals; personal fees from and serving as a speaker for Medice, Shire/Takeda Pharmaceuticals and Evolan Pharma AB; and sponsorship for a conference on attention-deficit/hyperactivity disorder from Shire/Takeda Pharmaceuticals and Evolan Pharma AB, all outside the submitted work. Prof. Larsson is editor-in-chief of JCPP Advances. Dr. Cotton was funded by an ESRC/UKRI postdoctoral fellowship, Grant number: G108309 (October 2020 - August 2022). Dr. Brandt has acknowledged financial support from the Academy of Medical Sciences. Prof. Galéra and Mrs. Reed have reported no biomedical financial interests or potential conflicts of interest. Publisher Copyright: © 2023 American Academy of Child and Adolescent Psychiatry

Keywords: ADHD, ADHD medication, environmental factors, physical health

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