Examining the Relationship Between Adverse Childhood Experiences (ACEs) and Attention-Deficit/Hyperactivity Disorder (ADHD) Symptom Presentation

Introduction ADHD is a multifactorial neurodevelopmental disorder with a symptom presentation that varies across individuals and the lifespan. Adverse childhood experiences (ACEs) have been linked to ADHD diagnosis and severity, though little research has examined whether ACE exposure is associated with specific symptom presentations. The cross-sectional study examined whether childhood ACE exposure predicts ADHD symptom presentations in adulthood. Methods Participants included 550 adults referred for neuropsychological evaluation at an academic medical center and diagnosed with ADHD and classified as low (0-3) or high (≥4) ACEs exposure with the 10-item ACE Questionnaire. Chi-square and logistic regression examined associations among ACE exposure, ADHD presentation, and co-occurring psychopathology. Results ACE exposure was significantly associated with symptom presentation type. Patients in the high exposure group were more likely to present with combined ADHD than those with low exposure. High ACE exposure was associated with 1.46 greater odds of a combined presentation (95% CI [1.03,2.06]). High ACE exposure also predicted 2.19 times greater odds of a co-occurring psychological disorder (95% CI [1.54,3.10]); however, co-occurring psychopathology did not independently predict presentation type. Conclusion Early adversity in childhood predicts ADHD symptom presentation in adulthood, with greater exposure associated with a more behaviorally dysregulated, combined inattentive/hyperactive-impulsive presentation.