Effect of Maternal Adverse Childhood Experiences on the Stress Level of Mothers of Children Diagnosed with Attention-Deficit/Hyperactivity Disorder: A Case-Control Study
DOI:
https://doi.org/10.6000/1929-4247.2025.14.01.07Keywords:
Attention deficit-hyperactivity disorder, Conners' Parent Rating Scale-revisedAbstract
Attention deficit-hyperactivity disorder (ADHD) is a psychiatric disorder that affects children’s ability to function and could be carried into adolescence and adulthood with a prevalence of approximately 66-85%. However, few studies have assessed the association between prenatal maternal stress and ADHD in children in Jeddah, Saudi Arabia. This study aimed to assess the impact of adverse childhood experiences on parents of children with ADHD. This was a case-control study with a sample size of 180 mothers of children with ADHD diagnosed in a child psychiatric clinic at King Abdulaziz University Hospital from 2015 to 2020. We recruited 94 mothers of non-ADHD children for the control group. We investigated stress with a validated questionnaire using the Perceived Stress Scale and Adverse Childhood Experience questionnaire and considered ADHD symptoms as determined using the Conners’ Parent Rating Scale–revised (CPRS-R). The one-way ANOVA revealed a significant association (p=0.002) between multiple early-life traumas and elevated adult stress. Mothers with ADHD children affected severely by past traumas displayed significantly higher stress (p<0.05), unlike the control group, which showed no notable link between PSS levels, ACE questionnaire scores, or the effect of past experiences on maternal health (p>0.05). Of note, mothers of children with ADHD had higher levels of stress than control participants. Boys had a higher prevalence (67.8%) of ADHD than girls.
References
Faraone SV, Sergeant J, Gillberg C, Biederman J. The worldwide prevalence of ADHD: Is it an American condition? World Psychiatry 2003; 2: 104.
Magnus W, Nazir S, Anilkumar AC, Shaban K. Attention Deficit Hyperactivity Disorder (ADHD). In: StatPearls; Treasure Island, FL, 2017.
Barbaresi WJ, Colligan RC, Weaver AL, Voigt RG, Killian JM, Katusic SK. Mortality, ADHD, and psychosocial adversity in adults with childhood ADHD: A prospective study. Pediatrics 2013; 131: 637-644. DOI: https://doi.org/10.1542/peds.2012-2354
Biederman J, Wilens T, Mick E, Milberger S, Spencer TJ, Faraone SV. Psychoactive substance use disorders in adults with attention deficit hyperactivity disorder (ADHD): Effects of ADHD and psychiatric comorbidity. Am J Psychiatry 1995; 152: 1652-1658. DOI: https://doi.org/10.1176/ajp.152.11.1652
Kollins SH, McClernon FJ, Fuemmeler BF. Association between smoking and attention-deficit/hyperactivity disorder symptoms in a population-based sample of young adults. Arch Gen Psychiatry 2005; 62: 1142-1147. DOI: https://doi.org/10.1001/archpsyc.62.10.1142
Qiu M-G, Ye Z, Li Q-Y, Liu G-J, Xie B, Wang J. Changes of brain structure and function in ADHD children. Brain Topogr 2011; 24: 243-252. DOI: https://doi.org/10.1007/s10548-010-0168-4
Fisk NM, Glover V. Association between maternal anxiety in pregnancy and increased uterine artery resistance index: Cohort-based study. BMJ 1999; 318: 153-157. DOI: https://doi.org/10.1136/bmj.318.7177.153
Seckl JR. Glucocorticoids, fetoplacental 11β-hydroxysteroid dehydrogenase type 2, and the early life origins of adult disease. Steroids 1997; 62: 89-94. DOI: https://doi.org/10.1016/S0039-128X(96)00165-1
Biederman J, Milberger S, Faraone SV, Kiely K, Guite J, Mick E, et al. Family-environment risk factors for attention-deficit hyperactivity disorder: A test of Rutter's indicators of adversity. Arch Gen Psychiatry 1995; 52: 464-470. DOI: https://doi.org/10.1001/archpsyc.1995.03950180050007
Lipińska E, Słopień A, Pytlińska N, Słopień R, Wolańczyk T, Bryńska A. The role of factors associated with the course of pregnancy and childbirth in attention deficit hyperactivity disorder (ADHD). Psychiatr Pol 2021; 55: 659-673. DOI: https://doi.org/10.12740/PP/OnlineFirst/110686
Parr J, Ward, A, Inman, S. Current practice in the management of attention deficit disorder with hyperactivity (ADHD). Child Care Health Dev 2003; 29: 215-218. DOI: https://doi.org/10.1046/j.1365-2214.2003.00333.x
Okano L, Ji Y, Riley AW, Wang X. Maternal psychosocial stress and children’s ADHD diagnosis: a prospective birth cohort study. J Psychosom Obstet Gynecol 2019; 40: 217-225. DOI: https://doi.org/10.1080/0167482X.2018.1468434
Tuovinen S, Lahti-Pulkkinen M, Rantalainen V, Kajantie E, Räikkönen K. Prenatal programming of child neurocognitive abilities and maternal mental health. Curr Opin Endocr Metab Res 2020; 13: 28-38. DOI: https://doi.org/10.1016/j.coemr.2020.09.001
Talge NM, Neal C, Glover V; Early Stress, Translational Research and Prevention Science Network: Fetal and Neonatal Experience on Child and Adolescent Mental Health. Antenatal maternal stress and long-term effects on child neurodevelopment: how and why? J Child Psychol Psychiatry 2007; 48: 245-261. DOI: https://doi.org/10.1111/j.1469-7610.2006.01714.x
DiPietro JA, Hilton SC, Hawkins M, Costigan KA, Pressman EK. Maternal stress and affect influence fetal neurobehavioral development. Dev Psychol 2002; 38: 659. DOI: https://doi.org/10.1037//0012-1649.38.5.659
Castejón OJ, Galindez P, Torres I, Leal J, Villasmil A, Grumbaum E, et al. Maternal stress, pregnancy diseases, and child hyperactivity and attention deficit (ADHD). Biomed J Sci Tech Res 2018; 12: 9118-9126. DOI: https://doi.org/10.26717/BJSTR.2018.12.002228
Cohen S, Kessler RC, Gordon LU. Measuring stress: A guide for health and social scientists; Oxford University Press, London UK 1997.
Petruccelli K, Davis J, Berman T. Adverse childhood experiences and associated health outcomes: A systematic review and meta-analysis. Child Abuse Negl 2019; 97: 104127. DOI: https://doi.org/10.1016/j.chiabu.2019.104127
Huhtala E. Prenatal maternal stress and child ADHD symptoms in early childhood. MSc Thesis, University of Helsinki, Helsinki, April 2015.
Chaaya M, Osman H, Naassan G, Mahfoud Z. Validation of the Arabic version of the Cohen Perceived Stress Scale (PSS-10) among pregnant and postpartum women. BMC Psychiatry 2010; 10: 1-7. DOI: https://doi.org/10.1186/1471-244X-10-111
ACES Aware Adverse Childhood Experience. Available online: https://www.acesaware.org/wp-content/uploads/2020/ 06/ACE-Questionnaire-for-Adults-De-Identified-Arabic.pdf (accessed on November 2020) [in Arabic].
Conners C. Conners’ Rating Scales-Revised (CRS-R): Technical Manual. Multi-Health Systems, North Tonawanda, NY 2001.
Abou-Khadra MK, Amin OR, Shaker OG, Rabah TM. Parent-reported sleep problems, symptom ratings, and serum ferritin levels in children with attention-deficit/hyperactivity disorder: a case-control study. BMC Pediatr 2013; 13: 1-6. DOI: https://doi.org/10.1186/1471-2431-13-217
Conners CK, Sitarenios G, Parker JD, Epstein JN. The revised Conners' Parent Rating Scale (CPRS-R): Factor structure, reliability, and criterion validity. J Abnorm Child Psychol 1998; 26: 257-268. DOI: https://doi.org/10.1023/A:1022602400621
Li J, Olsen J, Vestergaard M, Obel C. Attention-deficit/hyperactivity disorder in the offspring following prenatal maternal bereavement: A nationwide follow-up study in Denmark. Eur Child Adolesc Psychiatry 2010; 19: 747-753. DOI: https://doi.org/10.1007/s00787-010-0113-9
Gershon J, Gershon J. A meta-analytic review of gender differences in ADHD. J Atten Disord 2002; 5: 143-154. DOI: https://doi.org/10.1177/108705470200500302
Davis EP, Sandman CA. The timing of prenatal exposure to maternal cortisol and psychosocial stress is associated with human infant cognitive development. Child Dev 2010; 81: 131-148. DOI: https://doi.org/10.1111/j.1467-8624.2009.01385.x
Spann MN, Monk C, Scheinost D, Peterson BS. Maternal immune activation during the third trimester is associated with neonatal functional connectivity of the salience network and fetal to toddler behavior. J Neurosci 2018; 38: 2877-2886. DOI: https://doi.org/10.1523/JNEUROSCI.2272-17.2018
Van Steijn DJ, Oerlemans AM, Van Aken MA, Buitelaar JK, Rommelse NN. The reciprocal relationship of ASD, ADHD, depressive symptoms, and stress in parents of children with ASD and/or ADHD. J Autism Dev Disord 2014; 44: 1064-1076. DOI: https://doi.org/10.1007/s10803-013-1958-9
Craig L. Does father care mean fathers share? A comparison of how mothers and fathers in intact families spend time with children. Gender Soc 2006; 20: 259-281. DOI: https://doi.org/10.1177/0891243205285212
Wiener J, Biondic D, Grimbos T, Herbert M. Parenting stress of parents of adolescents with attention-deficit hyperactivity disorder. J Abnorm Child Psychol 2016; 44: 561-574. DOI: https://doi.org/10.1007/s10802-015-0050-7
Breen MJ, Barkley RA. Child psychopathology and parenting stress in girls and boys having attention deficit disorder with hyperactivity. J Pediatr Psychol 1988; 13: 265-280. DOI: https://doi.org/10.1093/jpepsy/13.2.265
Podolski C-L, Nigg JT. Parent stress and coping in relation to child ADHD severity and associated child disruptive behavior problems. J Clin Child Psychol 2001; 30: 503-513. DOI: https://doi.org/10.1207/S15374424JCCP3004_07
Von Cheong E, Sinnott C, Dahly D, Kearney PM. Adverse childhood experiences (ACEs) and later-life depression: Perceived social support as a potential protective factor. BMJ Open 2017; 7: e013228. DOI: https://doi.org/10.1136/bmjopen-2016-013228
Pechtel P, Pizzagalli DA. Effects of early life stress on cognitive and affective function: an integrated review of human literature. Psychopharmacology 2011; 214: 55-70. DOI: https://doi.org/10.1007/s00213-010-2009-2
Anda RF, Felitti VJ, Bremner JD, Walker JD, Whitfield C, Perry BD, et al. The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatry Clin Neurosci 2006; 256: 174-186. DOI: https://doi.org/10.1007/s00406-005-0624-4
Haber MG, Cohen JL, Lucas T, Baltes BB. The relationship between self-reported received and perceived social support: A meta-analytic review. Am J Community Psychol 2007; 39: 133-144. DOI: https://doi.org/10.1007/s10464-007-9100-9
Downloads
Published
How to Cite
Issue
Section
License
Policy for Journals/Articles with Open Access
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work
Policy for Journals / Manuscript with Paid Access
Authors who publish with this journal agree to the following terms:
- Publisher retain copyright .
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work .