December 23, 2021
In the five years from 2006 through 2010, the child falls led to 11,535 head injuries in the United States, costing a billion dollars to treat. Previous studies have shown that persons with ADHD were more prone to accidental falls than normally developing individuals. Just how strong is that association among American youth?
A team of Stanford University researchers examined data for falls among youths under 18 years old from the Nationwide Emergency Department Sample (NEDS), covering 953 hospitals in 36 states between 2010 and 2015. These included falls from stairs, ladders, or scaffolding; falls from buildings or other structures; falls into holes; other falls from one level to another; falls on the same level from collisions, pushing, shoving, slipping, tripping, or stumbling.
Out of almost 49 million injuries involving youths recorded by hospital emergency departments in the NEDS from 2010 to 2015, there were 13,217,237 million falls, 139,642 of which involved youths 5-17 years old with ADHD only. These were compared with almost 7.8 million involving youths 5-17 years old with developmental disabilities.
The team adjusted for the following covariates to reduce confounding: age category, sex, income, payment source, developmental disability status, and mechanism of fall.
Youths with ADHD were found to be roughly 75% more likely than normally developing youths to be admitted for unintentional falls in hospital emergency departments. They were about 60% more likely to be admitted for hospital stays exceeding two days. They were almost twice as likely to require surgery. And they were four times as likely to require intubation through the mouth and into the airway to be placed on a ventilator to assist with breathing.
These outcomes are not surprising, given that a large proportion of youths with ADHD are prone to be more inattentive and/or impulsive on average than their normally developing peers. But they underscore the need for parents and physicians to take preventive action to reduce the chance of harm.
The authors "suggest that practitioners who provide care for children with ADHD spend extra time on educating parents regarding the increased risk of falls, especially among older children, to decrease the odds of worse outcomes from unintentional falls."
Quynh-Uyen P. Nguyen, Olga Saynina, Elizabeth A. Pirrotta, Lynne C. Huffman, Nancy Ewen Wang, "A retrospective observational cohort study: Epidemiology and outcomes of pediatric unintentional falls in US emergency departments," Injury(2021), published online,https://doi.org/10.1016/j.injury.2021.05.017.
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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