Children with both attention deficit hyperactivity disorder and histories of abuse require special consideration and might suffer from worse health outcomes than children with ADHD only or abuse histories only. ADHD, also referred to as attention deficit disorder, is a common disorder that begins in childhood and is characterized by trouble focusing, impulsiveness and hyperactivity. Child abuse is "any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse, or exploitation, or an act or failure to act which presents an imminent risk of serious harm," according to the Federal Child Abuse Prevention and Treatment Act.
Background
Inattention symptoms of ADHD include difficulty paying attention to details, being easily distracted, being unable to sustain attention on tasks that require mental effort, having difficulty finishing tasks, procastination and disorganization. Hyperactivity symptoms include fidgeting, getting up frequently, running or climbing excessively, making noise when they are not supposed to, talking excessively and always being on the go. Impulsiveness symptoms include impatience, blurting out answers, having difficulty waiting a turn, frequent interrupting or beginning conversations at inappropriate times. ADHD can be treated with medication and behavioral counseling.
Children who are emotionally abused might show symptoms that include anxiety, having no attachment to parents or acting inappropriately adult or inappropriately infantile. Children who are physically abused have frequent injuries, are always on alert or shying away from touch. Children who are neglected show signs such as bad hygiene, untreated illness or ill-fitting clothes. Children who are sexually abused might have trouble walking or sitting, have knowledge of sexual acts most children his age are unaware of or runs away from home.
Prevalence
In a study that compared girls with ADHD with girls without ADHD, higher rates of abuse were found in the ADHD population. Of the girls with ADHD, 14.3 percent had been abused. Of the girls without ADHD, 4.5 percent had been abused. The study was published by Allison M. Briscoe-Smith and Stephen P. Hinshaw in a 2006 edition of Child Abuse and Neglect.
Impact
In the 2006 study published by in Child Abuse and Neglect, girls with ADHD who had histories of abuse had higher rates of externalizing behaviors and peer rejection when compared with girls with ADHD without histories of abuse. Externalizing behaviors refers to impulsive, delinquent, aggressive and disruptive behaviors. Both ADHD and abuse are risk factors for externalizing behaviors.
Considerations
The higher rates of abuse found in the ADHD population can not yet be explained. Abuse might contribute to development of ADHD, although ADHD is likely mostly attributable to neurobiology, according to a 1998 study by R. Tannock in the Journal of Child Psychology and Psychiatry. Children who have been abused often have similar characteristics as children with ADHD, including impulsiveness and trouble managing anger, so ADHD might be misdiagnosed in those who are abused.
Treatment
The researchers of the 2006 study in Child Abuse and Neglect stressed the need for health care providers to determine history of trauma when making an ADHD diagnosis because both problems can result in similar outward signs. Individual treatment planning is needed if a child has both ADHD and a history of abuse resulting in post-traumatic stress disorder, according to a 2009 report published by Julian D. Ford and Daniel F. Connor in Current Attention Disorders Reports. The same report states that treatment of ADHD can help alleviate symptoms of PTSD, and treatment of PTSD can supplement treatment of ADHD by decreasing anxiety.
References
- "Child Abuse and Neglect"; Linkages Between Child Abuse and Attention-Deficit/Hyperactivity Disorder in Girls: Behavioral and Social Correlates; Allison M. Briscoe-Smith and Stephen P. Hinshaw; Nov. 2006
- "The Journal of Child Psychology and Psychiatry"; Attention Deficit Hyperactivity Disorder: Advances in Cognitive, Neurobiological and Genetic Research; Tannock R.; Jan. 1998
- "Current Attention Disorders Reports"; ADHD and Posttraumatic Stress Disorder; Julian D. Ford and Daniel F. Connor; 2009
- The Child Abuse Prevention and Treatment Act; U.S. Dept. of Health and Human Services; June 2003
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