A recent study compared the medications preschoolers had been prescribed to the existence of violence or depression in the home.
The researchers found that kids were four times more likely to have ADHD if a parent was depressed and involved in an abusive relationship.
Kids were also more likely to be prescribed mental health medications if one of their parents was depressed.
"Get help for domestic abuse and/or depression."
The study, led by Nerissa S. Bauer, MD, MPH, of Indiana University's School of Medicine, involved 2,422 children receiving treatment at four pediatric clinics between November 2004 and June 2012.
The researchers first looked in the children's files for any report of intimate partner violence (domestic abuse between romantic partners) or symptoms of depression in a child's parent while the children were newborns up through age 3.
Then the researchers looked for children who were prescribed mental health medications between ages 3 and 6.
From the whole group, 58 parents reported symptoms of both depression and domestic violence in the home (2.4 percent of the total group) before their children turned 3 years old.
There was an additional 69 parents or guardians who reported only domestic violence in the home between partners and 704 (29 percent) who reported only symptoms of depression.
The rest of the children's caregivers, a total of 1,591 adults, did not report domestic violence or depression symptoms.
When the researchers analyzed the data, they found that children of the parents who reported both depression and partner violence were about four times more likely to be diagnosed with attention deficit hyperactivity disorder (ADHD).
Children of parents who reported depression symptoms were almost twice as likely to be prescribed psychotropic (mental health) medications than children of parents who did not report depression.
These findings remained after the researchers adjusted for the children's gender, race/ethnicity and type of insurance.
The researchers concluded that children are more likely to be diagnosed with ADHD if one of their parents experiences depression and is involved in intimate partner violence in the home.
LuAnn Pierce, a licensed clinical social worker in Colorado and a dailyRx expert, said she found this study disturbing.
"ADHD is a neurological disorder, commonly believed to be the result of brain dysfunction that impacts the frontal lobes and impairs executive functioning," Pierce said. "Usually this is present from birth, but in a minority of cases, head injury or other environmental causes are responsible."
She noted that this study brings up a number of questions to consider: "Does this study indicate that children who come from homes where they experience secondary violence (child witnesses) are experiencing brain changes as a result of trauma? Could it mean that women who are involved in violent relationships have a higher incidence of ADHD (possibly undiagnosed and untreated) and their children have a genetic predisposition?" she said.
"Or, that the fathers of these kids, if he is indeed the abusive partner, has ADHD which results in a propensity toward impulsivity and abusive behavior? Perhaps it is simply that these children are anxious and afraid, and these behaviors are mislabeled as ADHD," Pierce said. "I suspect it may be some of all of the above."
Pierce also noted that it is rare for a psychiatrist to medicate a child for ADHD before school age, which is appropriate, she said. "Over-prescribing medication and misdiagnosing psychiatric problems is a major problem with doctors and nurse practitioners who do not specialize in psychiatric medicine," she said.
Pierce offered a list of possible indicators that could help parents and adults with ADHD identify early warning symptoms of the condition in children:
- Activation - organizing tasks and materials, estimating time and getting started
- Focus - focusing, sustaining focus and shifting focus between tasks
- Effort - regulating alertness, sustaining effort and processing speed
- Emotion - managing frustration and regulation emotions
- Memory - using working memory and accessing recall
- Action - monitoring and regulation action
"If you notice that your child (or you) have problems in two or more of these areas, seek professional help to find out if you have ADHD," Pierce said. "However, if your child is experiencing significant levels of stress or trauma, that needs to be disclosed to the professional who is evaluating the child, as many mental health problems mimic ADHD symptoms."
The study was published February 4 in the journal JAMA Pediatrics. The research was funded by the Agency for Healthcare Research and Quality and the National Library of Medicine. The authors declared no conflicts of interest.