Childhood Neglect in Individuals with ADHD and Related Neurodevelopmental Conditions: A Scoping Review

Abstract

This scoping review investigates the relationship between childhood maltreatment, including physical, emotional, and sexual abuse, as well as neglect, and Attention-Deficit/Hyperactivity Disorder (ADHD) and Related Neurodevelopmental Outcomes. Following the PRISMA-ScR guidelines, a comprehensive literature search was conducted across five databases (PsycNET, Social Services Abstracts, ERIC, PubMed, and EBSCO) using a broad set of search terms related to ADHD, maltreatment, and childhood. The review included peer-reviewed articles published in English over the past 10 years, Studies published between January 2015 and February 2025 were included. The final database search was completed on March 1, 2025. The studies examined maltreatment in children with ADHD. Of the 854 initially identified studies, 12 met the inclusion criteria. Thematic analysis revealed three major findings: (1) various forms of maltreatment are strongly associated with increased risk and severity of ADHD symptoms; (2) mediating factors such as genetic predisposition, family dynamics, and emotional reactivity shape this relationship; and (3) maltreatment contributes to the persistence of ADHD symptoms and comorbid conditions into adulthood. These findings underscore the need for early trauma-informed interventions that address both biological and environmental influences on ADHD development.

Plain Language Summary

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common condition in children and young people. It can affect attention, self-control, activity levels, and emotional regulation. At the same time, some children grow up in difficult or harmful environments, including experiences of emotional, physical, or sexual abuse, or different forms of neglect. This review looked at research published in the past ten years to better understand how childhood maltreatment and ADHD are connected. Across many studies, there was a clear and consistent link between experiences of maltreatment and ADHD. Children who experienced abuse or neglect were more likely to show symptoms of ADHD, and their symptoms were often more severe or lasted longer over time. However, the relationship appears to be complex. Some studies suggest that children with ADHD may also be more vulnerable to negative or harsh responses from caregivers because of behaviors such as impulsivity, hyperactivity, or emotional outbursts. This means the relationship between ADHD and maltreatment may go in both directions. Recent research also highlights the role of family stress, emotional difficulties, and biological stress responses in shaping how these experiences affect children over time. These findings suggest that when professionals assess a child for ADHD, it is important to also consider whether the child has experienced trauma or significant stress.

Keywords

childhood maltreatment ADHD neglect scoping review early intervention

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by developmentally inappropriate levels of inattention and/or hyperactivity-impulsivity that interfere with daily functioning. In population-based work, ADHD is described as highly heritable, while also shaped by multiple environmental exposures, including adverse caregiving contexts and maltreatment experiences (Golm & Brandt, 2024). In recent years, the literature has increasingly emphasized that ADHD is not only an individual-level phenomenon but is embedded within family and ecological systems, where chronic stressors and adversities may contribute to symptom emergence, persistence, and functional impairment (Golm & Brandt, 2024). Within this broader ecological framing, childhood maltreatment has become a central variable of interest due to its robust association with later psychopathology and its potential overlap with ADHD-related developmental pathways.

Child maltreatment broadly refers to experiences of abuse and neglect that occur within caregiving contexts and may take multiple forms, including emotional and physical abuse, sexual abuse, and neglect. Studies focusing on disability and developmental vulnerability underscore that children with disabilities represent a particularly high-risk group for maltreatment and victimization. International evidence summarized by Joav Merrick (2017) suggests that children with disabilities report markedly elevated exposure to victimization and maltreatment, and that disability status can increase lifetime risk for physical maltreatment (e.g., elevated risk ratios reported across large school-aged samples). The same review highlights mechanisms that plausibly elevate vulnerability, including dependence on caregivers for intimate daily needs, communication barriers that limit disclosure, social isolation, institutional placement, and societal stigma that may reduce credibility and protection. Complementing this, a broader review of developmental disabilities emphasizes that abuse and neglect can have profound and enduring developmental consequences, including impacts on emotional, cognitive, and neurodevelopmental functioning, and that systemic neglect has historically been documented within institutional contexts for individuals with intellectual and developmental disabilities. Together, these works strengthen the rationale for examining maltreatment not only as a correlate of ADHD but also as part of a wider landscape of developmental risk in which neurodevelopmental vulnerabilities and adverse environments may co-occur and amplify one another.

Across empirical studies, associations between maltreatment exposure and ADHD symptoms have been documented from childhood through adulthood. In a nationally representative sample of Danish young adults, Sanderud et al. (2016) found significant relationships between maltreatment categories and probable ADHD in young adulthood; in adjusted analyses, “overall abuse” demonstrated the strongest association with probable ADHD, followed by emotional abuse and sexual abuse (Sanderud et al., 2016). These findings support the pattern that co-occurring or multi-type maltreatment may confer heightened risk relative to single-type exposure. Converging evidence emerges from longitudinal adolescent datasets: in a multiwave study examining early maltreatment and ADHD across childhood and adolescence, physical abuse showed prospective (lagged) associations with ADHD even after adjustment for key confounders and comorbidities, and increasing exposure across waves was associated with greater odds of ADHD and symptom persistence over time. Importantly, this work also reported differential patterns by sex, with emotional abuse showing stronger associations among boys and physical abuse showing stronger associations among girls, suggesting that developmental pathways and vulnerabilities may not be uniform across genders.

At the same time, the literature cautions that temporal ordering and causality are complex, and bidirectionality remains a recurring theme. In a prospective twin cohort study, Stern et al. (2018) reported strong concurrent associations between abuse/neglect and ADHD in both childhood and young adulthood, while longitudinal analyses did not support childhood abuse/neglect predicting ADHD in young adulthood once key controls were applied. Instead, childhood ADHD predicted later exposure to abuse/neglect, particularly when ADHD was comorbid with conduct disorder, implying that disruptive behavior profiles may increase vulnerability to later victimization within adverse environments. These findings highlight that ADHD-related behaviors may evoke harsher or more punitive caregiving responses in some contexts, complicating straightforward “maltreatment → ADHD” causal narratives. Evidence from birth-cohort research similarly frames the relationship as bidirectional and emphasizes early shared risk factors: in a large longitudinal sample, infant negative emotionality was identified as an early factor that may contribute to later maltreatment risk and ADHD symptom development, underscoring the importance of early identification and family support in high-risk contexts (Golm & Brandt, 2024).

Recent genetically informed work further refines understanding of bidirectionality by directly testing gene-environment interplay. In a Brazilian population-based longitudinal cohort, Tovo-Rodrigues et al. (2024) found that both ADHD polygenic risk and childhood maltreatment exerted main effects on ADHD symptoms at age 18, and importantly, ADHD genetic liability also predicted maltreatment exposure, consistent with an evocative gene environment correlation (rGE) model. Mediation models indicated that a substantial portion of the association between ADHD polygenic scores and maltreatment was mediated by ADHD symptoms early in childhood (e.g., at age 6), suggesting that early ADHD-related behaviors may increase exposure to corporal punishment or psychological aggression via caregiving dynamics. Notably, the same study did not find evidence for gene × environment interaction (GxE) in predicting ADHD symptoms, reinforcing the interpretation that correlation/evocation pathways may be particularly salient in explaining the co-occurrence of ADHD risk and maltreatment exposure.

Beyond quantitative associations, qualitative evidence adds depth regarding how maltreatment becomes embedded in everyday parent-child interactions in families of children with ADHD. In a qualitative study among Chinese families in Hong Kong, Maet al. (2016) documented maltreatment disclosures within a clinical sample of families participating in multi-family group work. A substantial minority of children reported parental abuse, and a notable proportion of parents reported child-to-parent maltreatment; narratives described escalating parent-child conflict in contexts such as homework supervision, parental demands to stop play, misunderstanding of acting-out behaviors, and threats of removal from home. The authors framed these dynamics as culturally shaped and contextually dependent, and argued for complex, systemic intervention models that extend beyond narrow biomedical framings of ADHD. Such findings support conceptualizations of maltreatment not only as an “event exposure”, but also as a relational process that may develop under chronic stress, repeated conflict cycles, and insufficient psychosocial supports, conditions that are plausibly intensified by ADHD-related impairments in self-regulation and family functioning.

Finally, research examining downstream correlates suggests that maltreatment may intersect with emotion regulation and broader risk behaviors among individuals with elevated ADHD symptoms. In a sample of young adults at risk for ADHD, Bunford et al. (2017) reported high endorsement rates of multiple maltreatment types (particularly emotional neglect and emotional abuse), and found that emotional lability was associated with ADHD severity; additionally, emotional lability moderated associations between emotional neglect and alcohol problems, indicating heterogeneity in how maltreatment-linked vulnerabilities translate into later maladaptive outcomes. Complementary evidence from institutionalized child samples shows that maltreatment is associated with elevated ADHD symptom scores: in a large study of children under institutional care, maltreatment history was associated with higher hyperactive/impulsive and inattentive symptoms, with physical abuse showing particularly strong associations with hyperactive/impulsive symptoms. These findings are clinically meaningful because trauma-related presentations can resemble ADHD symptomatology, and institutional placement itself may shape behavioral expression, issues raised explicitly as interpretive cautions in institutionalized cohorts.

While Clayton et al. (2018) provided a comprehensive quantitative meta-analysis establishing the magnitude of the association between ADHD and childhood maltreatment in studies published up to 2013, the field has evolved considerably over the past decade. Since 2015, research has increasingly incorporated longitudinal and genetically informed designs, refined differentiation of ADHD presentations and comorbidities, expanded conceptualizations of maltreatment (including poly-victimization and psychological abuse), and trauma-informed as well as neurobiological frameworks (e.g., stress biomarkers and gene–environment correlation models). These methodological and conceptual developments suggest that recent empirical findings may reflect shifts in theoretical positioning and explanatory mechanisms that are not fully captured by earlier quantitative aggregation alone. Accordingly, a scoping review focusing on studies published between 2015 and 2025 is warranted to map how the scientific understanding of this relationship has developed in the past decade.

Taken together, the attached literature supports a nuanced synthesis: childhood maltreatment and ADHD are consistently associated across development, yet the direction of effects appears contingent on comorbidity, developmental timing, and family context, with increasing support for bidirectional pathways. Longitudinal and genetically informed studies suggest that ADHD-related behaviors and genetic liability may increase risk for adverse caregiving responses and maltreatment exposure, while maltreatment, particularly physical and emotional abuse, may contribute to ADHD persistence and symptom trajectories in some cohorts. Furthermore, cross-cultural qualitative evidence demonstrates that maltreatment in ADHD-affected families may be embedded within escalating conflict cycles in daily routines, emphasizing the need for family-based and system-level interventions.

Although several included studies examined ADHD within broader neurodevelopmental contexts (e.g., specific learning disorders or autism spectrum conditions), the primary focus of the present review was ADHD. Other neurodevelopmental conditions were considered only insofar as ADHD-specific outcomes were explicitly analyzed.

The present scoping review addresses the following research question: How have empirical studies published between 2015 and 2025 conceptualized and examined the relationship between childhood maltreatment (including neglect) and ADHD in children and adolescents, and what are the clinical implications of these findings? Specifically, we sought to identify (a) patterns of association and directionality, (b) proposed mediating and moderating mechanisms, and (c) how recent research informs assessment and trauma-informed intervention in ADHD populations.

This scoping review therefore aims to map and integrate evidence on how maltreatment relates to ADHD across developmental stages, clarify heterogeneity by maltreatment type and sex, and identify mechanisms and contextual moderators (including disability-related vulnerabilities, caregiving ecology, and gene-environment correlation processes) to inform future research and clinical practice.

Methods

Search Strategy

This scoping review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines (Tricco et al., 2018) and was registered on the OSF website (Makhoul Khoury et al., 2025). Maltreatment of Children with ADHD: A Scoping Review. Retrieved from osf.io/495vf.

To identify relevant studies, five electronic databases were searched: PsycNET, Social Services Abstracts, ERIC, PubMed, and EBSCO. The search was designed to be comprehensive, using multiple keywords and Boolean operators for each of the main concepts, ADHD, maltreatment/neglect, and childhood, in order to capture the broadest possible range of empirical studies. Although search terms included broader neurodevelopmental terminology to enhance sensitivity, screening procedures ensured that only studies reporting ADHD-specific outcomes were retained.

The selection of these terms was guided by previous scoping reviews in this field.

For ADHD-related terms, we used: “learning disability” OR “attention deficit disorder” OR “attention deficit hyperactivity disorder” OR “ADHD” OR “learning disabilities”.

The term “learning disability” was included to enhance search sensitivity and capture studies in which ADHD may have been examined within broader neurodevelopmental or learning-related categories. We acknowledge that this term carries different meanings internationally, referring in North America primarily to specific learning disorders (e.g., dyslexia), while in the UK it may denote broader cognitive impairments (e.g., intellectual disability). Our intention was not to specifically target intellectual disability populations. Accordingly, studies focusing solely on intellectual disability without explicit examination of ADHD were excluded during the screening process.

For maltreatment-related terms, we used: “maltreatment” OR “mistreatment” OR “neglect” OR “emotional neglect” OR “medical neglect” OR “physical neglect” OR “educational neglect” OR “social neglect” OR “lack of supervision” OR “abuse” OR “sexual abuse” OR “physical abuse” OR “emotional abuse” OR “psychological abuse.”

For child-related terms, we used: “child” OR “children” OR “adolescent” OR “teen” OR “youth” OR “young person” OR “young people”.

Example of Full Search String (PsycNET Database)

To enhance transparency, the full Boolean search string for the PsycNET database is provided below. Similar structures were adapted for the other databases, with filters applied for publication year and language at the search stage.

(“attention deficit disorder” OR “attention deficit hyperactivity disorder” OR “ADHD” OR “learning disability” OR “learning disabilities”)

AND (“maltreatment” OR “mistreatment” OR “neglect” OR “emotional neglect” OR “physical neglect” OR “educational neglect” OR “medical neglect” OR “abuse” OR “physical abuse” OR “sexual abuse” OR “emotional abuse” OR “psychological abuse”)

AND (“child” OR “children” OR “adolescent” OR “teen” OR “youth” OR “young person” OR “young people”)

Filters: Publication year = 2015–2025; Language = English; Peer-reviewed = Yes.

The 10-year date range (January 2015–February 2025) was selected to build upon and extend previous quantitative syntheses, particularly the meta-analysis by Clayton et al. (2018), which covered studies published between 1987 and 2013. The earlier review established the strength of the association between ADHD and child maltreatment (odds ratio = 2.39, p < .001), whereas the current review aims to map how more recent empirical studies, emerging after the release of the DSM-5, have advanced theoretical, methodological, and clinical understandings of this relationship.

Although the review focused on English-language studies, the initial search identified three non-English articles (Portuguese, Spanish, and Danish). These were screened at the title and abstract stage but were excluded during the eligibility phase due to language restrictions. Their exclusion was recorded to acknowledge the presence of non-English research on this topic.

Eligibility Criteria

Studies were eligible for inclusion if they examined childhood maltreatment, particularly neglect, among individuals diagnosed with ADHD, or if neglect was assessed as part of broader maltreatment constructs that included ADHD populations. Studies focusing exclusively on other neurodevelopmental conditions without separate ADHD analysis were excluded. When ADHD was examined within broader neurodevelopmental samples, only ADHD-specific findings were extracted and synthesized.

A study was considered to focus on maltreatment in individuals with ADHD if it met at least one of the following conditions:

(a) ADHD was the primary or secondary diagnostic group examined;

(b) maltreatment or neglect was explicitly defined as an independent or dependent variable; or

Studies that only mentioned ADHD as part of a broader neurodevelopmental category without separate analysis were excluded.

For example, the study by Golm and Brandt (2024) was included because it examined the relationship between infant temperament and subsequent experiences of maltreatment and ADHD symptoms. Studies that included mixed samples (e.g., children with other developmental disabilities or at-risk groups) were retained if ADHD-related outcomes were explicitly analyzed or discussed.

Studies were required to be peer-reviewed journal articles published in English between January 2015 and February 2025. Both quantitative and qualitative studies were included.

Studies were excluded if they did not include participants with ADHD or if maltreatment/neglect was not examined in relation to ADHD. Articles were also excluded if they were not published in English, or if they were Ma, meta-analyses, or gray literature. For instance, the study by McDonnell et al. (2019) was excluded because, although it examined the effects of childhood maltreatment, it included only children with autism spectrum disorder (ASD). Similarly, the study by Hammad et al. (2024) was excluded because it focused exclusively on maltreatment among deaf and hard-of-hearing children, without reference to ADHD.

Although the search strategy focused on studies published in English, the initial database search identified three non-English articles (Portuguese, Spanish, and Danish). These records were screened at the title and abstract stage but were excluded during the eligibility phase due to language restrictions. This step allowed us to acknowledge the presence of non-English research on the topic while maintaining consistency in data extraction and analysis.

During the screening phase, studies published before 2015 were also excluded, in line with the predefined inclusion criteria specifying that only articles published between January 2015 and February 2025 were considered.

Selection of Studies

The database search yielded 854 articles, which reduced to 717 after duplicates were removed. The abstracts of the remaining articles were read by two authors who individually determined whether the articles met the criteria of inclusion. Differences in opinion were discussed, and consensus was reached. 27 articles met the inclusion criteria at this point. These articles were fully read by both authors individually, and 15 were excluded because they did not meet the criteria. In the end, 12 articles met the criteria and were included in the review.

Thematic Analysis

Articles were examined for content related to maltreatment, particularly neglect, among individuals with ADHD, including studies focusing on children, adolescents, and, in some cases, young adults. To analyze the study results, we employed a thematic analysis approach, which involved a three-step procedure in accordance with Braun and Clarke’s (2012) methodology. To begin with, a meticulous line-by-line coding of the papers is conducted. In the subsequent phase, descriptive themes are generated, maintaining a strong alignment with the studies that have been incorporated. The third stage involves the creation of overarching analytical themes, going beyond the confines of the study outcomes to establish innovative interpretations (Purssell & Gould, 2021). The researchers conducted separate data analysis procedures, during which they individually extracted data from the study results, organized the codes, and pinpointed potential themes. Following this, a collaborative review approach was utilized by the researchers to attain agreement on the identified themes, codes, and principal narratives evident within the data. Ultimately, the researchers classified the core themes to present the findings in a coherent and inclusive manner.

Reliability

All records were independently screened by two reviewers at both the title/abstract and full-text stages. Disagreements were discussed and resolved through consensus, with a third reviewer consulted when needed. During data extraction and thematic coding, both reviewers worked independently and then jointly reviewed and refined the codes and themes to ensure consistency. Although no formal inter-rater reliability coefficient was calculated, consensus-based agreement was achieved through iterative discussion, consistent with recommended practices for scoping reviews and qualitative synthesis (Braun & Clarke, 2012; Tricco et al., 2018).

Findings

Characteristics of Articles Included in the Review

Table 1 summarizes the main characteristics of the 12 reviewed articles. The sample sizes varied widely, ranging from small studies with 44 participants (Joyce et al., 2016) or 76 participants (Llorens et al., 2022) to a large-scale study with 56,816 participants (Karni-Visel et al., 2020). Most studies focused on children and adolescents up to 18 years old (Golm & Brandt, 2024; González et al., 2019; Gul & Gurkan, 2018; Imai et al., 2021; Joyce et al., 2016; Karni-Visel et al., 2020; Llorens et al., 2022; Stern et al., 2018; Tovo-Rodrigues et al., 2024; Uzun et al., 2024). However, two studies included young adults: one examined participants aged 19 (Bunford et al., 2017), and another focused on adults aged 24 (Sanderud et al., 2016).

Table 1.

Characteristics of Articles Included in the Review

Authors	Year	Country	Participants	Child characteristics	Disability	Aim of the Study^a	Study design	Psychosocial outcomes	Recommendations and conclusions
Golm, D., & Brandt, V.	2024	USA	2860	Ages 5 and 9	ADHD	To assess the longi-tudinal relationship between infant temperament and subsequent experiences of maltreatment and ADHD symptoms.	Quantitative study	Infant negative emotionality positively predicted childhood maltreatment at ages 5 and 9, and ADHD symptoms at age 5. Maltreatment/ADHD symptoms predicted age 9. Both childhood maltreatment and ADHD symptoms at age 5 mediated the association between negative emotionality and childhood maltreatment/ADHD symptoms at age 9.	It is vital to identify early shared risk factors to prevent negative downstream effects and support families at risk.
González, R. A., Vélez-Pastrana, M. C., McCrory, E., Kallis, C., Aguila, J., Canino, G., & Bird, H.	2019	USA	2491	Latino male and female children ages 5–13 years and their caretakers	ADHD	To examine concurrent and prospective associations between maltreatment experiences and ADHD diagnosis and sex differences. To estimate the association between repetitive maltreatment exposure and ADHD through childhood and adolescence.	Qualitative study	Emotional abuse and foster placement had robust associations with ADHD diagnosis. For girls, physical abuse had a threefold increase in the odds of having ADHD diagnosis. For boys, associations were observed only for emotional abuse. Prospective models examining the risk of ADHD following maltreatment provided initial evidence for the effects of physical abuse on ADHD, and a linear trend for repetitive exposure suggested increased probability for disorder persistence.	Increased exposure to maltreatment may predict symptom persistence. Interventions addressing ADHD must consider the effects of both sex and family environment.
Gul, H., & Gurkan, C. K.	2018	Turkey	100	Aged 6 to 11 years	ADHD	To investigate the frequency of child maltreatment and its association with parental characteristics of children with ADHD.	Quantitative study	Maternal hyperactivity/impulsivity and male gender of the child increase the emotional abuse. whereas maternal history of emotional abuse and physical neglect and paternal attention deficit increase sexual abuse, and higher maternal hyperactivity/impulsivity increases emotional neglect of ADHD in children.	The study’s findings provide strong evidence that the maltreatment of children with ADHD is more associated with parental factors than with the symptoms of ADHD in children.
Imai, J., Sasayama, D., Kuge, R., Honda, H., & Washizuka, S.	2021	Japan	378 Children	Age 6 to 18 Under institutional care 45.2% girls, mean [SD] age = 12.6 [3.4] years	ADHD Autism-Spectrum	To investigate the severity of ADHD and ASD symptoms in institutionalized children. To examine the associations of each type of maltreatment with the severity of ADHD and ASD symptoms. To analyze the effect of hyperactivity/impulsivity symptoms and inattentive symptoms separately to determine how each symptom was related to being maltreated.	Quantitative study	ADHD and ASD symptoms are frequent in institutionalized children and that the symptoms of ADHD and ASD are associated with the experience of being maltreated. Maltreatment experience before being institutionalized was associated with hyperactive/impulsive symptoms and inattentive symptoms but not with autistic trait. Physical abuse was associated with hyperactive/impulsive symptoms and autistic trait but not with inattentive symptoms. Psychological abuse was associated with hyperactive/impulsive symptoms. Neglect was not associated with inattentive symptoms, hyperactive/impulsive symptoms, or autistic trait.	The prevalence of disabilities in the child protection system There is a need for awareness of the range of issues faced by children with ADHD and the necessity for interagency collaboration to ensure that their complex needs are addressed. Support is required for families with children with disabilities to assist in meeting the child’s health and developmental needs, as well as to support parents in managing the more complex parenting environment.
Joyce L. C. Ma, Kelly Lai, Erica S. F. Wan	2016	China	44	Thirty-one fathers, forty-two mothers, one maternal grandmother, forty-four children with ADHD (thirty-six boys and eight girls) and eighteen siblings (nine brothers and nine sisters)	Attention deficit hyperactivity disorder (ADHD)	To heighten the awareness among social workers and mental health professionals to detect and identify the problems. To provide timely assistance to these families, who may be reluctant, under a stigma of shame, to reveal their secret and suffering.	Qualitative study	The families’ narratives have revealed their pain and suffering and suggest that maltreatment is not uncommon. Child maltreatment was found in one-quarter of these families, Parent maltreatment was found in one-fifth of the families; in about 10% of the families, both occurred.	The findings underscore the need for developing a complex social work model to assess the service needs and to provide interventions.
Karni-Visel, Y., Hershkowitz, I., Hershkowitz, F., Flaisher, M., & Schertz, M.	2020	Israel	56816 children	Children without disabilities (53,739). With a developmental disability (3,077). 49.5 % boys, with a mean age of 6.7 years. The age range was composed of 41 % up to 5 years-old, 37 % between 6 and 10 years-old and 22% from 11 to 15 years-old. More than half were Arabs (57%), 34 % were from the general sector and 9% were Haredi (Ultra-Orthodox Jews).	Having a medical record with a developmental diagnosis (e.g., Autism, Intellectual Disability, ADHD; Developmental Language Disorder; Developmental Coordination Disorder). Received a series of developmental treatments (Occupational Therapy, Physiotherapy, Language therapy).	To explore primary care providers reporting rates of suspected child maltreatment among children with disabilities vs. children without disabilities attending community health clinics.	Quantitative study	Health professionals identified child maltreatment in those with disability at a higher rate than those without disability.	There is a need for greater awareness of the range of issues faced by children with disability. There is an importance of interagency collaboration to ensure their complex needs are met. Support is necessary for families with children with disabilities to help address the child’s health and developmental needs, but also to assist parents in managing the more complex parenting environment.
Llorens, M., Barba, M., Torralbas, J., Nadal, R., Armario, A., Gagliano, H., Betriu, M., Urraca, L., Pujol, S., Montalvo, I., Gracia, R., Giménez-Palop, O., Palao, D., Pàmias, M., & Labad, J.	2022	Spain	76	Adolescents	ADHD	To explore whether stress-related hormones (hypothalamic-pituitary-adrenal [HPA] axis hormones and prolactin) are associated with poorer cognitive functioning in adolescents with attention deficit and hyperactivity disorder (ADHD) and to test the potential moderating effect of childhood maltreatment.	Quantitative study	Female sex moderated the relationship between salivary cortisol levels and executive functioning, whereas childhood maltreatment moderated the relationship between salivary cortisol levels and inattention symptoms of patients with ADHD. lower cortisol levels at awakening were associated with poorer executive functioning.	HPA axis hormone levels are associated with the severity of cognitive and inattention symptoms of patients with ADHD and that childhood maltreatment and sex exert distinct moderating effects depending upon symptom type.
Bunford, N., Wymbs, B. T., Dawson, A. E., & Shorey, R. C.	2017	USA	122	Median age was 19, 37% were male.	Adults at risk for ADHD	To examine the association between childhood maltreatment and alcohol problems, whether emotional lability mediated or moderated this association, and whether either role of emotional lability differed between men and women.	Quantitative study	Emotional lability moderated the association between emotional neglect and alcohol problems; maltreatment increased risk for alcohol problems for those scoring high tovery high on emotional lability, but not for those with very low-moderate levels. The association between emotional abuse and alcohol problems depended both on emotional lability and sex; emotional abuse decreased the risk for alcohol problems among men very low/low on emotional lability, but not for men who were moderate to very high on emotional lability, or for women.	Targeting maltreatment and emotional lability may be incorporated into prevention and intervention programs to prevent alcohol problems among men and women at risk for ADHD.
Sanderud, K., Murphy, S., & Elklit, A.	2016	Denmark	4,718	24 years of age	ADHD	To examine the association between typologies of child maltreatment established from latent class analysis, as well as co-occurring maltreatment and ADHD symptoms in adult life.	Quantitative study	Significant relationships between child maltreatment groups and a probable diagnosis of ADHD using the Adult ADHD Self-Report Scale (ASRS) overall abuse class was more strongly associated with probable ADHD, followed by emotional abuse and sexual abuse.	Findings underscore the importance of exploring the role of childhood trauma in young adults with ADHD symptoms.
Stern, A., Agnew-Blais, J., Danese, A., Fisher, H. L., Jaffee, S. R., Matthews, T., Polanczyk, G. V., & Arseneault, L.	2018	United Kingdom	2232	Twins, adolescence, with ADHD up to age 12 and at age 18	ADHD diagnoses and symptoms	Examin the associations between abuse/neglect and ADHD diagnoses in childhood and in young adulthood separately. We tested the robustness of these associations by also analysing ADHD symptom scales and by controlling for potential confounders. We also explored the speci city of these associations by looking at bullying and domestic violence. We further examined whether the association was concentrated speci cally among ADHD par-ticipants with comorbid conduct disorder.	Quantitative study	Higher rates of children meeting diagnostic criteria for ADHD among those who were exposed to abuse/neglect compared to children who were not exposed to abuse/neglect. Strong associations between abuse/neglect and ADHD in childhood and also in young adulthood. In childhood, the association was concentrated among children with comorbid conduct disorder. Longitudinal analyses showed that childhood ADHD predicted abuse/neglect in later years.	The findings highlight the possibility of a long-term effect of disruptive behavior on the risk of experiencing violence victimization, rather than the other way around. Although our study does not support previous causal inferences regarding the relationship between child maltreatment leading to adult ADHD, it emphasises the complexity of establishing causality.
Tovo-Rodrigues, L., Camerini, L., Martins-Silva, T., Carpena, M. X., Bonilla, C., Oliveira, I. O., de Paula, C. S., Murray, J., Barros, A. J. D., Santos, I. S., Rohde, L. A., Hutz, M. H., Genro, J. P., & Matijasevich, A.	2024	Brazil	4231	6 and 11 years of age in predicting ADHD symptoms in Adulthood.	ADHD	To elucidate this relationship by examining the interplay between a polygenic score for ADHD and childhood maltreatment in predicting ADHD symptoms during young adulthood.	Quantitative study	The ADHD-PGS was associated with total mean maltreatment scores. Approximately 47% of the total effect of ADHD-PGS on maltreatment was mediated by ADHD symptoms at age 6.	There is a signicant roles of genetics and childhood maltreatment as predictors for ADHD symptoms in adulthood, while also indicating a potential evocative mechanism through gene-environment correlation.
Uzun, M. E., Koşan, Y., & Şirin, H.	2024	Türkiye	196 children 98 with SLD 98 control group	60 males, 38 females 9.16 average age of child with SLD, 9.52 average age of control group	Specific learning disorders (SLDs)	To compare the rates of neglect and abuse exposure between children diagnosed with SLDs and those with typical development.	Quantitative study	The study revealed significant sociodemographic differences and a higher vulnera- bility to abuse among children with SLDs compared to a control group. Children with SLDs more often came from families with lower parental education levels and were more likely to experience physical and emotional abuse, particularly from peers and family members. The presence of extended family was more common in the SLD group, and over half of these children also had ADHD. No significant difference between the groups in terms of neglect.	Both clinical and educational interventions from early childhood period would be beneficial for children and for raising awareness in children’s social circles about SLDs.

^aIf the study had a number of aims, only the aims related to spirituality are listed.

Several studies included participants with comorbid neurodevelopmental conditions; however, the synthesis focused exclusively on findings related to ADHD. Some included Autism Spectrum Disorder (Imai et al., 2021; Karni-Visel et al., 2020) and Specific Learning Disorders (Uzun et al., 2024). One study examined children with and without developmental disabilities (Karni-Visel et al., 2020). The participants included not only children with ADHD but also family members in some cases, such as parents and siblings (Joyce et al., 2016).

The studies were conducted in diverse geographic locations. In Europe, two were conducted in Turkey (Gul & Gurkan, 2018; Uzun et al., 2024), one in Spain (Llorens et al., 2022), one in Denmark (Sanderud et al., 2016), and one in the United Kingdom (Stern et al., 2018). Three studies were conducted in the United States (Bunford et al., 2017; Golm & Brandt, 2024; González et al., 2019). Other locations included Brazil (Tovo-Rodrigues et al., 2024), Israel (Karni-Visel et al., 2020), Japan (Imai et al., 2021), and China (Joyce et al., 2016).

The methodological approaches varied, including qualitative (e.g., Joyce et al., 2016; González et al., 2019), quantitative (e.g., Gul & Gurkan, 2018; Imai et al., 2021; Karni-Visel et al., 2020; Stern et al., 2018; Tovo-Rodrigues et al., 2024).

Emergent Themes Across the Reviewed Studies

The review of the selected studies highlights the complex interplay between childhood maltreatment and ADHD, revealing three key themes. First, a strong association emerges between various forms of childhood abuse, physical, emotional, sexual, and neglect, and the development and severity of ADHD symptoms. These findings suggest that exposure to maltreatment not only increases the risk of ADHD but also influences symptom presentation and comorbid conditions. Second, several mediating factors shape this relationship, including genetic predisposition, family dynamics, and early emotional reactivity, highlighting the intricate gene-environment interactions at play. Finally, the long-term effects of childhood maltreatment extend into adulthood, contributing to the persistence of ADHD symptoms and the development of additional mental health challenges. These themes underscore the importance of early intervention strategies considering biological and environmental factors influencing ADHD trajectories.

The Link Between Childhood Maltreatment, Types of Abuse, and ADHD

A growing body of research indicates a significant association between childhood maltreatment, including physical, emotional, and sexual abuse, as well as neglect, and the development and severity of ADHD symptoms. Children exposed to maltreatment appear to be 2 to 3 times more likely to receive an ADHD diagnosis compared to those without such experiences (Stern et al., 2018). Furthermore, exposure to multiple forms of maltreatment (poly-victimization) has been linked to heightened ADHD symptom severity and increased rates of comorbid conditions such as emotional dysregulation, conduct problems, and substance misuse (Bunford et al., 2017; Imai et al., 2021).

Preliminary findings suggest that different forms of maltreatment may be associated with distinct patterns of ADHD-related behaviors, although further research is needed to clarify these relationships. Emotional abuse consistently emerges as one of the strongest predictors of ADHD symptoms, particularly among boys (González et al., 2019), and has been associated with inattention, emotional dysregulation, and externalizing behaviors. Physical abuse shows a similar association with ADHD symptomatology, particularly in girls (Tovo-Rodrigues et al., 2024), potentially reflecting heightened physiological stress responses that exacerbate impulsivity and hyperactivity. Emotional neglect has also been linked to increased vulnerability to emotional dysregulation and substance use in adulthood, particularly among young adults at risk for ADHD (Bunford et al., 2017).

Poly-victimization appears to increase the likelihood of persistent ADHD symptoms and comorbid conditions such as anxiety and conduct difficulties (Imai et al., 2021). More than half of children who experienced physical abuse also reported other forms of maltreatment, underscoring the cumulative impact of multiple adversities on ADHD-related outcomes. The mechanisms connecting maltreatment and ADHD are multifactorial, involving biological, psychological, and social pathways. Maltreatment-related stress may influence the hypothalamic–pituitary–adrenal (HPA) axis, leading to dysregulated stress responses that contribute to ADHD-like behaviors (Llorens et al., 2022). In addition, maltreatment may affect executive functioning, particularly attention regulation and impulse control, thereby sustaining or intensifying ADHD symptom expression over time (Golm & Brandt, 2024).

Risk and Mediating Factors

Emerging evidence highlights a complex interplay between biological, environmental, and psychological mechanisms that mediate the relationship between childhood maltreatment and ADHD. Rather than operating in isolation, these factors interact dynamically to influence both the onset and persistence of ADHD symptoms.

Children with a genetic predisposition to ADHD may be more vulnerable to experiencing maltreatment, creating a bidirectional process in which ADHD-related traits such as impulsivity or emotional dysregulation increase the likelihood of harsh or inconsistent parenting, while maltreatment further exacerbates these symptoms (Tovo-Rodrigues et al., 2024). Within this context, family-level stressors, particularly parental psychopathology and poor mental health, serve as major risk factors, as they compromise parental capacity for consistent caregiving and heighten the risk of neglect and abuse (Ma et al., 2011).

At the same time, early temperamental and emotional characteristics, such as high emotional reactivity in infancy, have been identified as early indicators of ADHD vulnerability and later exposure to maltreatment. These early traits not only elicit more negative parental responses but also increase the child’s susceptibility to stress, compounding the developmental impact of maltreatment (Golm & Brandt, 2024).

Collectively, these findings underscore that the pathway between maltreatment and ADHD is best understood as transactional, shaped by the mutual reinforcement of genetic predispositions, early emotional regulation difficulties, and adverse family environments, highlighting the need for early identification and family-focused interventions (Figure 1).

Figure 1.

Review process of articles for inclusion in systematic review (PRISMA flowchart)

Discussion

The present scoping review aimed to synthesize the existing literature on the relationship between childhood maltreatment and ADHD. The findings reveal a complex and bidirectional relationship between childhood maltreatment and ADHD, understanding the significant role of adverse childhood experiences in the development, severity and persistence of ADHD symptoms.

Three main themes emerged from the review: the association between maltreatment and ADHD, the mediating factors influencing this relationship and the long-term implications of childhood maltreatment on individuals with ADHD. The findings consistently demonstrate that childhood maltreatment, including physical, emotional, and sexual abuse, as well as neglect, is a significant risk factor for the onset, severity, and persistence of ADHD symptoms (González et al., 2019; Stern et al., 2018). Maltreatment has been shown to impair emotional regulation, intensify inattention, and contribute to impulsivity, further complicating the diagnosis and treatment of ADHD (Bunford et al., 2017; González et al., 2019; Stern et al., 2018).

An important insight from the reviewed literature is the recognition of the bidirectional nature of the relationship between childhood maltreatment and ADHD. While childhood maltreatment can heighten the vulnerability to ADHD, children with ADHD are also at increased risk of experiencing maltreatment due to behavioral characteristics such as impulsivity, hyperactivity, and emotional dysregulation (Gul & Gurkan, 2018). This cyclical relationship suggests that addressing the psychosocial environment of children with ADHD is crucial to mitigating negative outcomes.

The role of mediating factors, such as genetic predispositions, family dynamics, and emotional reactivity, further complicates the link between childhood maltreatment and ADHD. Research indicates that children with a genetic predisposition for ADHD may be more likely to experience maltreatment, while the experience of maltreatment itself can worsen ADHD symptoms (Tovo-Rodrigues et al., 2024). Additionally, adverse family environments characterized by parental psychopathology and inconsistent caregiving practices exacerbate the effects of maltreatment on ADHD symptom persistence (Ma et al., 2011).

When situating the present findings in relation to the quantitative meta-analysis conducted by Clayton et al. (2018), several points of convergence and extension become apparent. Consistent with Clayton et al. (2018), who reported a significant overall association between childhood maltreatment and ADHD (OR = 2.39, p < .001) and a moderate correlation between maltreatment and ADHD symptomatology (r = .28), the studies included in the current review confirm a robust and developmentally persistent relationship between maltreatment exposure and ADHD severity. Both syntheses underscore the importance of multiple maltreatment subtypes and cumulative adversity.

However, the present scoping review extends beyond the estimation of effect sizes. Compared to the earlier meta-analysis, more recent research increasingly conceptualizes the ADHD–maltreatment relationship as bidirectional, drawing on longitudinal, genetically informed, and trauma-informed frameworks. Post-2015 studies place greater emphasis on mediating mechanisms such as gene–environment correlation processes, emotional dysregulation pathways, and stress-related biological markers. These developments suggest that while the magnitude of association identified by Clayton et al. (2018) remains supported, contemporary research has moved toward greater mechanistic specificity and clinical contextualization.

Practical Implications and Recommendations

These findings have significant implications for clinical practice, policy, and intervention strategies. While trauma-informed care frameworks are increasingly implemented in child and adolescent mental health services, their systematic integration into ADHD assessment and treatment pathways remains inconsistent. Current diagnostic protocols for ADHD do not uniformly include structured screening for maltreatment exposure, despite accumulating evidence supporting their strong association.

Routine assessment of adverse childhood experiences within ADHD evaluations may enhance diagnostic accuracy, particularly in cases where trauma-related symptoms overlap with inattention or emotional dysregulation. Incorporating standardized trauma screening tools into ADHD assessment procedures, alongside collaboration with child protection and family services, may reduce misdiagnosis and support more tailored intervention planning.

Family-based interventions should extend beyond symptom management to address parental mental health, caregiving stress, and relational conflict patterns that may perpetuate risk cycles. Cross-sector collaboration between schools, pediatric services, and mental health providers is particularly important given that many children with ADHD are first identified in educational settings.

At the policy level, efforts should focus not only on raising awareness but also on strengthening structural integration between neurodevelopmental services and child welfare systems. Training initiatives for educators, pediatricians, and mental health clinicians should explicitly address the bidirectional relationship between ADHD and maltreatment, the potential for diagnostic overlap, and the importance of trauma-informed adaptations in behavioral and pharmacological treatment planning.

Limitations and Future Studies

While this review provides valuable insights into the relationship between childhood maltreatment and ADHD, several limitations should be acknowledged. First, as most studies assess maltreatment and ADHD symptoms at a single point in time it limits the ability to draw causal inferences. Longitudinal studies are needed to extensive understand the dynamics between maltreatment and ADHD development.

Second, cultural and contextual factors were not sufficiently examined, as most of the reviewed studies were conducted in Western contexts. Future research should explore the intersection of culture, maltreatment, and ADHD to provide a more comprehensive understanding.

Third, While some included studies involved broader neurodevelopmental samples, the present review synthesized only ADHD-related findings. Future research may benefit from comparative analyses across neurodevelopmental conditions.

Finally, the potential impact of publication bias should be considered, as studies reporting significant associations are more likely to be published, which may bias the conclusions of the review.

Conclusion

Overall, this review underscores the critical need for a holistic approach that considers both the biological and environmental contributors to ADHD. Future research should focus on longitudinal designs to further clarify causal mechanisms and evaluate the efficacy of trauma-informed interventions in addressing the adverse effects of childhood maltreatment. Addressing childhood maltreatment may not directly, mitigate ADHD symptoms, but it can help reduce secondary emotional and behavioral difficulties, foster resilience, and promote healthier developmental trajectories and overall well-being.

Footnotes

Siwar Makhoul Khoury

Ayelet Gur

Ayala Cohen

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Author Biographies

Dr. Siwar Makhoul Khoury, Lecturer in the Department of Social Work, Tel-Hai College, and Postdoctoral Researcher, Paul Baerwald School of Social Work and Social Welfare, Hebrew University of Jerusalem.

Prof. Ayelet Gur, Professor of Social Work and Head of the Department of Social Work, Tel-Hai College.

Prof. Ayala Cohen, Professor of Social Work and former Head of the Department of Social Work, Tel-Hai College.

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