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Biological and psychosocial environmental risk factors influence symptom severity and psychiatric comorbidity in children with ADHD

  • Biological Child and Adolescent Psychiatry - Original Article
  • Published:
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Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a genetically as well as environmentally determined disorder with a high rate of psychiatric comorbidity. In this study, non-genetic biological and psychosocial risk factors for ADHD symptom severity and comorbid disorders were assessed in 275 children with ADHD, aged 5–13 years, mean age 9.7 (SD 1.9). Pre-/perinatal biological and lifetime psychosocial risk factors as well as data on parental ADHD were obtained. A different pattern of risk factors emerged for inattentive and hyperactive-impulsive ADHD symptoms. Inattentive symptoms were strongly influenced by psychosocial risk factors, whereas for hyperactive-impulsive symptoms, predominantly biological risk factors emerged. Hyperactive-impulsive symptoms also were a strong risk factor for comorbid oppositional defiant (ODD) and conduct disorder (CD). Smoking during pregnancy was a risk factor for comorbid CD but not ODD and further differential risk factors were observed for ODD and CD. Comorbid anxiety disorder (AnxD) was not related to ADHD symptoms and additional biological and psychosocial risk factors were observed. This study adds to the body of evidence that non-genetic biological and psychosocial risk factors have an impact on ADHD symptom severity and differentially influence comorbid disorders in ADHD. The findings are relevant to the prevention and treatment of ADHD with or without comorbid disorders.

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Abbreviations

ADHD:

Attention-deficit/hyperactivity disorder

ADHS-SB:

German self-rating instrument for ADHD symptoms in adulthood

AnxD:

Anxiety disorder

C:

Combined ADHD subtype

CD:

Conduct disorder

DCL-HKS:

German diagnosis checklist for hyperkinetic syndrome according to DSM-IV

DF:

Degrees of freedom

DSM-IV:

Diagnostic and Statistical Manual of Mental Disorders

HI:

Hyperactive-impulsive ADHD subtype

IA:

Inattentive ADHD subtype

ODD:

Oppositional defiant disorder

SD:

Standard deviation

SE:

Standard error of the mean

SES:

Socio-economic status

WURS-K:

Wender-Utah Rating Scale, short version, German

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Acknowledgments

We thank the children and their families for participation in the study. Bernd Janthur, MD, Child Psychiatrist, Dillingen, Germany, and Alexander Marcus, MD, Trier, Germany, closely cooperated with this project. This research was supported by the German Research Foundation (Deutsche Forschungsgemeinschaft DFG), by grants ME 1923/5-1, ME 1923/5-3 and GRK 1389/1.

Conflict of interest

No conflicts of interest have to be reported by any of the authors.

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Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, JW Goethe University, Deutschordenstraße 50, 60528, Frankfurt am Main, Germany

    Christine M. Freitag

  2. Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany

    Susann Hänig, Anna Schneider & Christiane Seitz

  3. Department of Neurobehavioural Genetics, University of Trier, Trier, Germany

    Haukur Palmason & Jobst Meyer

  4. Department of Forensic Psychiatry, Saarland University Hospital, Homburg, Germany

    Wolfgang Retz

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  1. Christine M. Freitag
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  2. Susann Hänig
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Correspondence to Christine M. Freitag.

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Freitag, C.M., Hänig, S., Schneider, A. et al. Biological and psychosocial environmental risk factors influence symptom severity and psychiatric comorbidity in children with ADHD. J Neural Transm 119, 81–94 (2012). https://doi.org/10.1007/s00702-011-0659-9

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  • DOI: https://doi.org/10.1007/s00702-011-0659-9

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