Psychiatric disorders, including attention-deficit/hyperactivity disorder (ADHD), may serve as a risk factor for child abuse.
Methods:
This study aimed to evaluate the association between children and adolescents with ADHD diagnosis and the risk of child abuse. The effectiveness of a pharmacological intervention on reducing the risk of child abuse was also assessed. A nationwide, population-based, retrospective with a matched-cohort study design was used. Data were from the National Health Insurance Research Database of Taiwan over a 15-year period (2000–2015).
Results:
Increased risk of child abuse in the ADHD group was noticed and the adjusted hazard ratio (HR) was 1.797 (95% confidence interval [CI] = 1.245–2.388, p < 0.001). The Kaplan–Meier analysis showed a significantly higher cumulative incidence in the ADHD group over the 15-year period (Log-rank test p < 0.001). ADHD patients with other psychiatric comorbidities had a higher risk of child abuse. Pharmacological treatment of either methylphenidate or atomoxetine was associated with a reduced risk of child abuse. The total adjusted HR was 1.466 (95% CI = 1.077–1.883, p < 0.001) in medicine group compared with the controls.
Conclusions:
ADHD was associated with a subsequent risk of child abuse in Taiwan. Pharmacological treatment could reduce the risk of child abuse in ADHD patients.
Get full access to this article
View all access options for this article.
References
1.
AlexanderL, FarrellyN.Attending to adult ADHD: A review of the neurobiology behind adult ADHD. Ir J Psychol Med, 2018; 35(3):237–244; doi: 10.1017/ipm.2017.78
2.
AustinAE, LesakAM, ShanahanME. Risk and protective factors for child maltreatment: A review. Curr Epidemiol Rep, 2020; 7(4):334–342; doi: 10.1007/s40471-020-00252-3
3.
Briscoe-SmithAM, HinshawSP. Linkages between child abuse and attention-deficit/hyperactivity disorder in girls: behavioral and social correlates. Child Abuse Negl, 2006; 30(11):1239–1255.
4.
CabralMDI, LiuS, SoaresN.Attention-deficit/hyperactivity disorder: Diagnostic criteria, epidemiology, risk factors and evaluation in youth. Transl Pediatr, 2020;9(Suppl 1):S104–S113; doi: 10.2103/7/tp.2019.09.08
5.
CammackAL, HogueCJ. Retrospectively self-reported age of childhood abuse onset in a United States nationally representative sample. Inj Epidemiol, 2017; 4(1):7; doi: 10.1186/s40621-017-0103-1
6.
CapusanAJ, Kuja-HalkolaR, BendtsenP, et al.Childhood maltreatment and attention deficit hyperactivity disorder symptoms in adults: A large twin study. Psychol Med, 2016; 46(12):2637–2646 ; doi: 10.1017/S0033291716001021
7.
CorteseS, AdamoN, Del GiovaneC, et al.Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: A systematic review and network meta-analysis. Lancet Psychiatry, 2018; 5(9):727–738; doi: 10.1016/S2215-0366(18)30269-4
8.
Da FonsecaD, SeguierV, SantosA, et al.Emotion understanding in children with ADHD. Child Psychiatry Hum Dev, 2009; 40(1):111–121; doi: 10.1007/s10578-008-0114-9
9.
FangY, BoelensM, WindhorstDA, et al.Factors associated with parenting self-efficacy: A systematic review. J Adv Nurs, 2021; 77(6):2641–2661; doi: 10.1111/jan.14767
10.
FaraoneSV, PerlisRH, DoyleAE, et al.Molecular genetics of attention-deficit/hyperactivity disorder. Biol Psychiatry, 2005; 57(11):1313–1323; doi: 10.1016/j.biopsych.2004.11.024
11.
GhanizadehA, MohammadiMR, MoiniR.Comorbidity of psychiatric disorders and parental psychiatric disorders in a sample of Iranian children with ADHD. J Atten Disord, 2008; 12(2):149–155; doi: 10.1177/1087054708314601
12.
GnanavelS, SharmaP, KaushalP, et al.Attention deficit hyperactivity disorder and comorbidity: A review of literature. World J Clin Cases, 2019; 7(17):2420–2426; doi: 10.1299/8/wjcc.v7.i17.2420
13.
GonzálezRA, Vélez-PastranaMC, McCroryE, et al.Evidence of concurrent and prospective associations between early maltreatment and ADHD through childhood and adolescence. Soc Psychiatry Psychiatr Epidemiol, 2019; 54(6):671–682; doi: 10.1007/s00127-019-01659-0
14.
HanwellaR, SenanayakeM, de SilvaV.Comparative efficacy and acceptability of methylphenidate and atomoxetine in treatment of attention deficit hyperactivity disorder in children and adolescents: A meta-analysis. BMC Psychiatry, 2011;11:176; doi: 10.1186/1471-244X-11-176
15.
IbrahimK, DonyaiP.Drug holidays from ADHD medication: International experience over the past four decades. J Atten Disord, 2015; 19(7):551–568; doi: 10.1177/1087054714548035
16.
JaudesPK, Mackey-BilaverL.Do chronic conditions increase young children's risk of being maltreated?. Child Abuse Negl, 2008; 32(7):671–681; doi: 10.1016/j.chiabu.2007.08.007
17.
JensenPS, HinshawSP, SwansonJM, et al.Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): Implications and applications for primary care providers. J Dev Behav Pediatr, 2001; 22(1):60–73; doi: 10.1097/00004703-200102000-00008
18.
KaiserNM, McBurnettK, PfiffnerLJ. Child ADHD severity and positive and negative parenting as predictors of child social functioning: Evaluation of three theoretical models. J Atten Disord, 2011; 15(3):193–203; doi: 10.1177/1087054709356171
19.
KesslerRC, AmmingerGP, Aguilar-GaxiolaS, et al.Age of onset of mental disorders: A review of recent literature. Curr Opin Psychiatry, 2007; 20(4):359–364; doi: 10.1097/YCO.0b013e32816ebc8c
20.
KesslerRC, BerglundP, DemlerO, et al.Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry, 2005; 62(6):593–602; doi: 10.1001/archpsyc.62.6.593
21.
KielingC, KielingRR, RohdeLA, et al.The age at onset of attention deficit hyperactivity disorder. Am J Psychiatry, 2010; 167(1):14–16; doi: 10.1176/appi.ajp.2009.09060796
22.
LarsonK, RussSA, KahnRS, et al.Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007. Pediatrics, 2011; 127(3):462–470; doi: 10.1542/peds.2010-0165
23.
LeitnerY.The co-occurrence of autism and attention deficit hyperactivity disorder in children—What do we know?. Front Hum Neurosci, 2014;8:268; doi: 10.3389/fnhum.2014.00268
24.
LielC, UlrichSM, LorenzS, et al.Risk factors for child abuse, neglect and exposure to intimate partner violence in early childhood: Findings in a representative cross-sectional sample in Germany. Child Abuse Negl, 2020;106:104487; doi: 10.1016/j.chiabu.2020.104487
25.
LinLY, Warren-GashC, SmeethL, et al.Data resource profile: The National Health Insurance Research Database (NHIRD). Epidemiol Health, 2018;40:e2018062; doi: 10.4178/epih.e2018062
26.
Lugo-CandelasC, CorbeilT, WallM, et al.ADHD and risk for subsequent adverse childhood experiences: Understanding the cycle of adversity. J Child Psychol Psychiatry, 2021; 62(8):971–978; doi: 10.1111/jcpp.13352
27.
MortonWA, StocktonGG. Methylphenidate abuse and psychiatric side effects. Prim Care Companion J Clin Psychiatry, 2000; 2(5):159–164; doi: 10.4088/pcc.v02n0502
28.
MowlemFD, RosenqvistMA, MartinJ, et al.Sex differences in predicting ADHD clinical diagnosis and pharmacological treatment. Eur Child Adolesc Psychiatry, 2019; 28(4):481–489; doi: 10.1007/s00787-018-1211-3
29.
OzbaranB, KoseS, YuzugulduO, et al.Combined methylphenidate and atomoxetine pharmacotherapy in attention deficit hyperactivity disorder. World J Biol Psychiatry, 2015; 16(8):619–624; doi: 10.3109/15622975.2015.1051109
30.
SanderudK, MurphyS, ElklitA.Child maltreatment and ADHD symptoms in a sample of young adults. Eur J Psychotraumatol, 2016;7:32061; doi: 10.3402/ejpt.v7.32061
31.
ShangCY, ShihHH, PanYL, et al.Comparative efficacy of methylphenidate and atomoxetine on social adjustment in youths with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol, 2020; 30(3):148–158; doi: 10.1089/cap.2019.0139
32.
ShawM, HodgkinsP, CaciH, et al.A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: Effects of treatment and non-treatment. BMC Med, 2012;10:99; doi: 10.1186/1741-7015-10-99
33.
ShresthaM, LautenschlegerJ, SoaresN.Non-pharmacologic management of attention-deficit/hyperactivity disorder in children and adolescents: A review. Transl Pediatr, 2020;9(Suppl 1):S114–S124; doi: 10.2103/7/tp.2019.10.01
34.
Statistics of child abuse in Taiwan, Department of Protective Services, Ministry of Health and Welfare. 2022. Available from: https://dep.mohw.gov.tw/DOPS/lp-1303-105-xCat-cat04.html [Last accessed: April 20, 2022].
35.
SternA, Agnew-BlaisJ, DaneseA, et al.Associations between abuse/neglect and ADHD from childhood to young adulthood: A prospective nationally-representative twin study. Child Abuse Negl, 2018;81:274–285; doi: 10.1016/j.chiabu.2018.04.025
36.
SugimotoA, SuzukiY, EndoT, et al.Efficacy of atomoxetine for symptoms of attention-deficit/hyperactivity disorder in children with a history of child abuse. J Child Adolesc Psychopharmacol, 2015; 25(3):269–271; doi: 10.1089/cap.2014.0119
37.
SvanborgP, ThernlundG, GustafssonPA, et al.Atomoxetine improves patient and family coping in attention deficit/hyperactivity disorder: A randomized, double-blind, placebo-controlled study in Swedish children and adolescents. Eur Child Adolesc Psychiatry, 2009; 18(12):725–735; doi: 10.1007/s00787-009-0031-x
38.
ThomasR, SandersS, DoustJ, et al.Prevalence of attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Pediatrics, 2015; 135(4):e994–e1001; doi: 10.1542/peds.2014-3482
39.
TorgersenT, GjervanB, NordahlHM, et al.Predictive factors for more than 3 years' duration of central stimulant treatment in adult attention-deficit/hyperactivity disorder: A retrospective, naturalistic study. J Clin Psychopharmacol, 2012; 32(5):645–652; doi: 10.1097/JCP.0b013e3182664dbc
40.
TreuerT, GauSS, MéndezL, et al.A systematic review of combination therapy with stimulants and atomoxetine for attention-deficit/hyperactivity disorder, including patient characteristics, treatment strategies, effectiveness, and tolerability. J Child Adolesc Psychopharmacol, 2013; 23(3):179–193; doi: 10.1089/cap.2012.0093
41.
TrickettPK, MennenFE, KimK, et al.Emotional abuse in a sample of multiply maltreated, urban young adolescents: Issues of definition and identification. Child Abuse Negl, 2009; 33(1):27–35; doi: 10.1016/j.chiabu.2008.12.003
42.
VaidyaCJ.Neurodevelopmental Abnormalities in ADHD. Curr Top Behav Neurosci, 2012;9:49–66; doi: 10.1007/7854_2011_138
43.
WangDS, ChungCH, ChangHA, et al.Association between child abuse exposure and the risk of psychiatric disorders: A nationwide cohort study in Taiwan. Child Abuse Negl, 2020;101:104362; doi: 10.1016/j.chiabu.2020.104362
44.
WangLJ, LeeSY, YuanSS, et al.Prevalence rates of youths diagnosed with and medicated for ADHD in a nationwide survey in Taiwan from 2000 to 2011. Epidemiol Psychiatr Sci, 2017; 26(6):624–634; doi: 10.1017/S2045796016000500
45.
WienerJ, BiondicD, GrimbosT, et al.Parenting stress of parents of adolescents with attention-deficit hyperactivity disorder. J Abnorm Child Psychol, 2016; 44(3):561–574; doi: 10.1007/s10802-015-0050-7
46.
WilliamsAN, GriffinNK. 100 Years of lost opportunity. Missed descriptions of child abuse in the 19th century and beyond. Child Abuse Negl, 2008; 32(10):920–924; doi: 10.1016/j.chiabu.2007.12.007
47.
WojciakAS, ButcherB, ConradA, et al.Trends, diagnoses, and hospitalization costs of child abuse and neglect in the United States of America. Int J Environ Res Public Health, 2021; 18(14):7585; doi: 10.3390/ijerph18147585
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
