New research has identified several familial factors that are seemingly linked to symptom severity for pediatric patients with attention deficit/hyperactivity disorder (ADHD).

A team, led by Lea T. Jendreizik, University of Cologne, identified the association between familial factors and symptom severity in pediatric patients with ADHD.

Risk Factors

Genetic and environmental factors are known to contribute to the development of ADHD.

It is currently assumed that there is an interaction between polygenic and environmental risk factors in the development of ADHD, with environmental risk factors including exposure to toxins, pregnancy and birth complications, mild traumatic brain injuries, and psychosocial and familial disadvantages playing a role in the onset of the disease.

“There is evidence that children from families with low socioeconomic status (SES) are more than twice as likely to have ADHD than their peers from families with high SES,” the authors wrote.

However, the associations between the different risk factors and ADHD symptom severity in pediatric patients is not well understood.

The Studies

In the systematic review and meta-analysis, the investigators identified 43 studies involving 11,123 participants, as well as 5 additional studies involving 2643 for a supplemental review. The studies selected involved pediatric patients with a clinical diagnosis of ADHD and at least 20 participants that investigated the association between at least 1 familial factor and the severity of ADHD symptoms.

However, the investigators did not consider the maternal use of nicotine, alcohol or drug use during pregnancy, parental knowledge of ADHD, parental cognitions, parental attitudes toward ADHD or ADHD medication, or child sleep habits.The assessment also included studies that assessed ADHD symptom severity with a dimensional measure or with a rating scale that enabled ordinal ranking.

The investigators also assessed several familial factors, including SES, parental age, single-parent family, broken partnership, number of children, critical life events, parental ADHD, parental affective psychopathologies, parental mental health, parenting stress, parental quality of life, positive parenting practices, negative parenting practices.

The results show parenting stress (r = .25), negative parenting practices (r = .19), broken parental partnership (r = .19), critical life events (r = .17), parental psychopathologies (r = .14–.16), socioeconomic status (r = −.10), and single-parent family (r = .10) were all significantly associated with ADHD symptom severity.

“These results suggest that psychosocial familial factors show small but significant associations with symptom severity in children with ADHD. Implications are discussed,” the authors wrote. “Lower parental education, lower household income, and parental unemployment have each been found to be associated with an increased likelihood of having ADHD. In addition, family characteristics such as lower parental age at birth, lower interparental relationship quality, and growing up in a single-parent household have shown associations with an increased risk of developing ADHD.”

The results should be used to help guide the evidence-based selection and further development of interventions to manage and potentially prevent severe courses of childhood ADHD.

The study, “Familial Factors Associated With Symptom Severity in Children and Adolescents With ADHD: A Meta-Analysis and Supplemental Review,” was published online in the Journal of Attention Disorders.