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Family-Environment Risk Factors for Attention-Deficit Hyperactivity Disorder:  A Test of Rutter's Indicators of Adversity

Joseph Biederman, MD; Sharon Milberger, ScD; Stephen V. Faraone, PhD; Kathleen Kiely; Jessica Guite; Eric Mick; Stuart Ablon; Rebecca Warburton; Ellen Reed
Arch Gen Psychiatry. 1995;52(6):464-470. doi:10.1001/archpsyc.1995.03950180050007.
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Background:  This study investigated whether familyenvironment risk factors are associated with attentiondeficit hyperactivity disorder (ADHD). Compelling work by Rutter and coworkers revealed that it was the aggregate of adversity factors (severe marital discord, low social class, large family size, paternal criminality, maternal mental disorder, and foster care placement) rather than the presence of any single factor that led to impaired development. Based on the work of Rutter, we hypothesized a positive association between indicators of adversity and the diagnosis of ADHD and ADHD-associated impairments.

Methods:  We studied 140 ADHD and 120 normal control probands. Subjects were non-Hispanic white boys between the ages of 6 and 17 years. Rutter's indicators of adversity were used to predict ADHD-related psychopathology as well as impaired cognitive and psychosocial functioning.

Results:  The odds ratio for the diagnosis of ADHD increased as the number of Rutter's adversity indicators increased. Higher scores on Rutter's adversity index predicted ADHD-related psychopathology (depression, anxiety, and conduct disorder), learning disabilities, cognitive impairment, and psychosocial dysfunction.

Conclusions:  A positive association appears to exist between adversity indicators and the risk for ADHD as well as for its associated psychiatric, cognitive, and psychosocial impairments. These findings support the work of Rutter and stress the importance of adverse family-environment variables as risk factors for children with ADHD.

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