December 19, 2021
Polycystic ovary syndrome (PCOS) is a disorder affecting women of reproductive age, characterized by elevated levels of male hormones (androgens). The name is derived from the presence of cysts surrounding the ovum, which cause enlargement of the ovaries. Its cause remains unknown. There is speculation that high androgen levels could affect brain development in the fetus.
A team of Iranian researchers (Maleki et al.) published a twofold meta-analysis earlier this year exploring the relationship between PCOS and offspring ADHD. A systematic search of the peer-reviewed medical literature came up with six studies, consisting of three cohort studies, and three case-control studies.
A meta-analysis of the three case-control studies with a combined total of 79,978 participants found that children of mothers with PCOS were 42 percent more likely to develop ADHD.
A separate meta-analysis of the three cohort studies with a combined total of 325,435 participants produced essentially identical outcomes: children of mothers with PCOS were 43 percent more likely to develop ADHD.
There was no indication of publication bias in either meta-analysis and virtually no heterogeneity. Except for one case-control study, all studies were considered to be of high quality.
The authors concluded, "Our study showed that maternal PCOS is a risk factor for ADHD. Therefore, Screening for ADHD among children of these women should be considered as part of the comprehensive clinical care for women with PCOS."
More recently, a second-team (Dubey et al.), based in Texas, published a meta-analysis on the same subject. Their systematic search produced the same studies, but classified one study described as case-control by Malekiet al. as a cohort study.
Their meta-analysis of four cohort studies with a combined total of over two million participants (they counted participants differently than Maleki et al.) found that children of mothers with PCOS were 43 percent more likely to develop ADHD. Adjusting for confounders made no difference.
Again, there was no indication of publication bias, and between-study heterogeneity was virtually nil.
Considering they relied on the same studies, the fact that both teams reported identical outcomes is unsurprising, confirming there's a clear association between maternal PCOS and ADHD in offspring.
Pallavi Dubey, Bhaskar Thakur, Sheryl Rodriguez, JessikaCox, Sheralyn Sanchez, Anacani Fonseca, Sireesha Reddy, Deborah Clegg, and Alok Kumar Dwivedi, "A systematic review and meta-analysis of the association between maternal polycystic ovary syndrome and neuropsychiatric disorders in children" TranslationalPsychiatry (2021), 11:569, published online,https://doi.org/10.1038/s41398-021-01699-8.
Given the persistence of ADHD and its adverse effects on children and adolescents, one might expect caregivers to face greater parenting challenges, with potential effects on their own mental health.
To what extent do parenting stress, depression, and – at the extreme – even suicidal ideation manifest themselves among caregivers of ADHD patients as opposed to caregivers of children and adolescents without ADHD?
A pair of Korean researchers made use of their country’s single-payer health insurance system, which maintains records on virtually the entire population, to perform a nationwide population study. They used data from the Korean National Health and Nutrition Examination Surveys (KNHANES) covering the decade from 2011 to 2020. KNHANES is an annual survey using a sophisticated sampling design conducted by the Korean Ministry of Health and Welfare to represent the entire population of South Korea.
The analysis included 14,428 individuals who had children younger than 19 at the time of participation. All were asked whether their child had ever been diagnosed with ADHD by a physician. The mental health problems of the parents were assessed in terms of perceived stress, depressive symptoms, and suicidality.
Of the 14,428 participants, 8,298 (57.5 %) were mothers and 6,130 (42.5 %) were fathers. Of the mothers, 116 (1.4 %) had a child with ADHD, and of the fathers, 86 (1.4 %) had a child with ADHD.
The researchers adjusted for the following confounders: age of caregiver, education level, household income, area of residence, employment status, alcohol consumption, smoking status, cohabitation status, number of children, and child’s age.
After adjustment, mothers of ADHD patients fared significantly worse than mothers of typically developing children on all three categories of mental health problems. They were 67% more likely to report higher stress, three times as likely to report symptoms of depression, and 2.5 times more likely to report suicidal ideation.
Yet that pattern did not carry over to fathers, where there was no significant difference in mental health indicators between fathers of children with ADHD and fathers of children without ADHD.
The authors concluded, “Parents of children with ADHD, especially mothers, need community support and public health attention to help alleviate their mental health problems.”
Background:
ADHD is commonly accompanied by psychiatric comorbidities that complicate its diagnosis and treatment. Roughly two out of three affected children and adolescents have one or more comorbid psychiatric disorder.
Because the peak age of ADHD onset is typically a decade or more earlier than those for schizophrenia, depressive disorder, or bipolar disorder, it is essential to explore these comorbidities over an extended period. Populations studies help researchers identify broader patterns and trends within an entire population and includes adults as well as children. This type of study provides unique insights into the population at large, rather than a sample group.
In earlier studies the maximum follow-up period was twelve years, insufficient in view of the roughly ten years between onset of ADHD and onset of major psychiatric disorders. Also, previous nationwide population studies have included less than 150,000 participants.
This study, relying on data from South Korea’s universal single-payer health insurance system, included over one and a half million individuals. Persons previously diagnosed with depression, bipolar disorder, tic disorder, or schizophrenia were excluded.
382,434 individuals had been diagnosed with ADHD, while 1,169,279 were without an ADHD diagnosis.
Propensity score matching ensured that potential confounders, both sociodemographic and clinical, were equalized for the ADHD and control groups. After matching, there were 353,898 individuals in each group.
After these adjustments, individuals in the ADHD group were at least an order of magnitude more likely to subsequently be diagnosed with psychiatric disorders than their peers without an ADHD diagnosis:
Conclusion:
The Korean study team concluded, “Overall, our findings suggest that upon prolonged examination, the risk of subsequent diagnoses of other psychiatric disorders in individuals with ADHD appears to be higher than that reported previously. … Therefore, patients with ADHD should be carefully screened for the presence of other psychiatric symptoms on a regular basis from an earlier age … It is advisable to have a follow-up period extending beyond 10 years to sufficiently identify the occurrence of comorbid disorders in patients with ADHD.”
Children with ADHD often face challenges in social interactions, leading to long-term consequences if not properly addressed. While various interventions exist, many fail to consider the broader social context in which these children interact. A recent study conducted in Bergen, Norway, explored how primary school teachers perceive their role in supporting children with ADHD who struggle socially and the strategies they use to assist them.
Researchers conducted semi-structured interviews with five focus groups of primary school teachers. Using reflexive thematic analysis, they identified two major themes:
Rather than relying on standardized interventions, teachers tailored their strategies to foster an inclusive and supportive social environment. Their methods included both active participation in social situations and behind-the-scenes efforts to encourage peer inclusion and understanding.
This study underscores the need to move beyond labels and recognize children with ADHD as individuals with distinct social needs. Teachers play a crucial role in shaping these children’s experiences, using flexible and personalized approaches to promote positive social interactions. By integrating social context and individualized support, educators can help children with ADHD build meaningful connections and navigate their social world more effectively.
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