Adverse Childhood Experiences and ADHD Diagnosis at Age 9 Years in a National Urban Sample

Jimenez, Manuel E.; Wade, Roy; Schwartz-Soicher, Ofira; Lin, Yong; Reichman, Nancy E.

doi:10.1016/j.acap.2016.12.009

Cited by 104Child Abuse and TraumaAttention Deficit Hyperactivity DisorderChild and Adolescent Psychosocial and Emotional Development

Adverse Childhood Experiences and ADHD Diagnosis at Age 9 Years in a National Urban Sample

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Jimenez, Manuel E., Wade, Roy, Schwartz-Soicher, Ofira, Lin, Yong, Reichman, Nancy E.·2017·Academic Pediatrics

DOI 10.1016/j.acap.2016.12.009PMC PMC5555409

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Abstract

Objective To examine associations between adverse childhood experiences (ACEs) and attention-deficit/hyperactivity disorder (ADHD) at age 9 years using longitudinal data and assess the extent to which ACEs during middle childhood are independently associated with ADHD at age 9 years.Methods We conducted a secondary analysis of data from the Fragile Families urban birth cohort 5- and 9-year interviews. The sample was limited to children for whom mothers were the primary caregiver and mother-reported information on 8 ACEs and ADHD were available at age 5 and 9 years. We examined associations between ACEs and parent-reported ADHD at age 9 years using logistic regression and controlling for potential confounders.Results We included 1572 children; 48% were African American, 11% had parent-reported ADHD at age 9 years, 41% and 42% experienced ≥1 ACE by age 5 years and between the ages of 5 and 9 years, respectively. ACEs before age 5 years were associated with ADHD at age 9 years. One, 2, and ≥3 ACEs between age 5 and 9 years were associated with ADHD at age 9 years even after controlling for ACEs before age 5 years and ADHD at age 5 years (adjusted odds ratio [AOR], 1.9; 95% confidence interval [CI], 1.2-3; AOR, 2.1; 95% CI, 1.2-3.8; and AOR, 2.2; 95% CI, 1.1-4.3).Conclusions In this study of urban children, ACEs occurring before age 5 years as well as between the ages of 5 and 9 years were associated with ADHD at age 9 years. Even after controlling for early childhood ACEs and ADHD at age 5 years, the association between ADHD and ACEs in middle childhood remained significant, highlighting the importance of screening and intervention throughout childhood.

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Bidirectional Relations between Adverse Childhood Experiences and Children’s Behavioral Problems
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Association of Adverse Childhood Experiences with Childhood Atopic Dermatitis in the United States
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“Composite scores in the top 10th percentile of the sample were deemed high risk for abuse and neglect as previously described.(27,28) At the 15-year follow-up interview, teenagers independently completed a youth survey that assessed abuse and neglect.”
Method
Troubled beginnings: the adverse childhood experiences and placement histories of a detained adolescent population with developmental disorders
Morris, D. J., Webb, E. L., Parmar, E., Trundle, G., & McLean, A. (2020) · Advances in Mental Health and Intellectual Disabilities · doi:10.1108/amhid-01-2020-0003 · Cited by 21 · see citing works
Associations between Adverse Childhood Experiences, Major Depressive Episode and Chronic Physical Health in Adolescents: Moderation of Race/Ethnicity
Elkins, J., Miller, K. M., Briggs, H. E., Kim, I., Mowbray, O. P., & Orellana, E. R. (2019) · Social Work in Public Health · doi:10.1080/19371918.2019.1617216 · Cited by 19 · see citing works
Biological Burden of Adverse Childhood Experiences in Children
de la Rosa, R., Zablotny, D., Ye, M., Bush, N. R., Hessler, D., Koita, K., Bucci, M., Long, D., & Thakur, N. (2023) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001167 · Cited by 18 · see citing works
“ACEs have been associated with proximal outcomes that occur during childhood, including behavioral challenges (49–51), mental health (attention-deficit/hyperactivity disorder) (50,52), and physical”
Background
Shared Reading at Age 1 Year and Later Vocabulary: A Gene–Environment Study
Jiménez, M. E., Reichman, N. E., Mitchell, C. M., Schneper, L. M., McLanahan, S., & Notterman, D. A. (2019) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2019.07.008 · Cited by 18 · see citing works
Self-citation
Adverse childhood experiences—household stressors and children’s mental health: a single centre retrospective review
Holmes, H., Darmanthé, N., Tee, K., & Goodchild, M. (2021) · BMJ Paediatrics Open · doi:10.1136/bmjpo-2021-001209 · Cited by 16 · see citing works
A Systematic Review of Longitudinal Studies Investigating the Association Between Early Life Maternal Depression and Offspring ADHD
Tucker, J. R. D., & Hobson, C. W. (2021) · Journal of Attention Disorders · doi:10.1177/10870547211063642 · Cited by 14 · see citing works
“Jimenez et al., (2017), reported a dose-response relationship, with greater number of ACEs associated with more severe ADHD symptomatology, controlling for early life ADHD symptoms.”
Adverse Childhood Experiences and Teen Behavior Outcomes: The Role of Disability
James, C. A., Jiménez, M. E., Wade, R., & Nepomnyaschy, L. (2021) · Academic Pediatrics · doi:10.1016/j.acap.2021.05.006 · Cited by 14 · see citing works
Self-citation
Risks of adverse childhood experiences on healthcare utilization and outcomes in early childhood
Lewis, K. N., McKelvey, L. M., Zhang, D., Moix, E., & Whiteside-Mansell, L. (2023) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2023.106396 · Cited by 12 · see citing works
The Effect and Mechanism of Adverse Childhood Experience on Suicide Ideation in Young Cancer Patients During Coronavirus Disease 2019 (COVID-19) Pandemic
Yang, G., Xiao, C., Li, S., & Yang, N. (2020) · Risk Management and Healthcare Policy · doi:10.2147/rmhp.s266269 · Cited by 12 · see citing works
Adverse Experiences and Special Health Care Needs Among Children
Kan, K., Gupta, R. S., Davis, M. M., Heard‐Garris, N., & Garfield, C. F. (2020) · Maternal and Child Health Journal · doi:10.1007/s10995-020-02874-x · Cited by 12 · see citing works
Childhood Environmental Unpredictability and Adolescent Mental Health and Behavioral Problems
Koss, K. J., Kronaizl, S. G., Brown, R., & Jeanne Brooks-gunn, B. (2025) · Child Development · doi:10.1111/cdev.14248 · Cited by 11 · see citing works
Exposure to Adverse Childhood Experiences (ACEs) and Stress among the Community-based Urban Pediatric Population in Korea
Lee, M., Kim, H. S., & Bhang, S. (2020) · Journal of Korean Medical Science · doi:10.3346/jkms.2020.35.e421 · Cited by 11 · see citing works
Association of adverse childhood experiences and depression among medical students: the role of family functioning and insomnia
Tao, H., Zeng, X., Hou, M., Chen, S., Shen, J., Liao, X., & Zou, C. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1134631 · Cited by 12 · see citing works
“As a chronic stressor, ACEs are more likely to predispose victims to future mental illness (Jimenez et al., 2017; Westermair et al., 2018).”
Background
Child-Centered Play Therapy and Adverse Childhood Experiences: A Single-Case Research Design
Schoonover, T., & Perryman, K. L. (2022) · Journal of Child and Adolescent Counseling · doi:10.1080/23727810.2022.2138045 · Cited by 11 · see citing works
“In addition to the studies that focused on the prevalence of ACEs in children, there are studies that explored the impact that the exposure has on children (Clarkson Freeman, 2014; Fox et al., 2015; Gruhn & Compas, 2020; Jimenez et al., 2017; Ray et al., 2020).”
BackgroundInfluential
The combined effects of adverse childhood experiences and neighborhood quality on child health and well-being
Jones, M. S., Everett, H. D., & Hoffmann, J. P. (2024) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2024.106913 · Cited by 9 · see citing works
Unseen Costs: The Direct and Indirect Impact of U.S. Immigration Policies on Child and Adolescent Health and Well‐Being
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“The political debate over access to living conditions has garnered considerable media attention and has raised the pressing health-related question: What are the direct and indirect health-related costs of these shifting immigration policies given the risk for traumatic separation and loss among children? Children exp…”
Background
Adverse Childhood Experiences and ADHD Symptoms Among French College Students
Schwartz, A. N., Galéra, C., Kerbage, H., Montagni, I., & Tzourio, C. (2023) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-023-00543-z · Cited by 9 · see citing works
“…relationship between the number of accumulated ACEs and ADHD symptoms and severity (Briscoe-Smith & Hinshaw, 2006; Crouch et al., 2021; Ford et al., 2000; Fuller-Thomson & Lewis, 2015; Fuller-Thomson et al., 2014; Hunt et al., 2017; Jimenez et al., 2017; Ouyang et al., 2008; Zarei et al., 2021).”
Background
Examining adverse childhood experiences and attention deficit/hyperactivity disorder: A systematic review
Wojtara, M. S., Syeda, Y., Singh, H., Rana, E., & Sabeer, S. (2023) · Mental Health Science · doi:10.1002/mhs2.26 · Cited by 9 · see citing works
Longitudinal Patterns of Multidimensional Violence Exposure and Adolescent Early Sexual Initiation
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“We then summed up the frequencies of those five items and identified participants whose scores of frequencies were high in top 10 percentile of the entire study sample, consistent with coding in prior work (e.g., Jimenez et al., 2017; Wang et al., 2020).”
Result
Patterns of Adverse Childhood Experiences and Psychiatric Disorders Among Adolescents with ADHD: A Latent Class Analysis
Song, J. (2023) · Child Psychiatry & Human Development · doi:10.1007/s10578-023-01645-3 · Cited by 9 · see citing works
“The effect of ACEs amplifies symptoms of inattention, impulsivity, and hyperactivity and leads to ADHD diagnosis due to the brain in early childhood being vulnerable to the influence of toxic stress [28].”
Effect of Daily Stress on School Adjustment among Children at Community Child Centers: Mediating Roles of Inattention and Social Withdrawal
Lee, R. (2024) · Korean Journal of Stress Research · doi:10.17547/kjsr.2024.32.1.1 · Cited by 6 · see citing works
Adverse Childhood Experiences in Latinx Families: A Comparison between Intraracial and Interracial Families
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Academic failure and the role of early life course economic deprivation
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Assessing Disproportional Calls Home for Problems at School: A Critical Race Framing and Analysis of Race, Ethnicity, Gender, and Childhood Adversities
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“Children who experience ACEs often face a greater psychiatric toll, evident in high rates of stress, depression, substance abuse, post-traumatic stress disorder, and attention de ﬁ cit hyperactivity disorder (Cisler et al., 2012; Costello et al., 2002; Horn et al., 2019; Jimenez et al., 2017).”
Paternal Depression at Kindergarten Entry and Teacher-Reported Behavior at Age 9 Years
Schmitz, K., Noonan, K., Corman, H., Nguyen, J. M., Jiménez, M. E., & Reichman, N. E. (2025) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2025.01.017 · Cited by 4 · see citing works
Self-citation
Αντίξοες εμπειρίες κατά την παιδική ηλικία: προεκτάσεις για ένα ευαισθητοποιημένο σχολείο στις ψυχοκοινωνικές και μαθησιακές ανάγκες των μαθητών
Touloumakos, A. Κ., Adamopoulou, E., & Evangelou-Tsitiridou, M. (2023) · Psychology the Journal of the Hellenic Psychological Society · doi:10.12681/psy_hps.26786 · Cited by 6 · see citing works
The School Counselors Role in Supporting Teachers Working with Children who Have Experienced Trauma: Lessons Learned
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“…externalized symptoms like those of Attention-Deficit/ Hyperactivity-Disorder (ADHD) and other aggressive and disruptive behaviors (Clarkson Freeman, 2014; Fox et al., 2015; Fuller-Thomson & Lewis, 2015; Jimenez et al., 2017; Ray et al., 2020; Ray et al., 2022; Schoonover & Perryman, 2023).”
Comparing the relationship between three resilience frameworks and mental health outcomes among children who experienced multiple adverse childhood experiences
Keane, K. J., Evans, R. R., Wilkinson, L. L., King, D. M., Leban, L., & Macrina, D. M. (2025) · Children and Youth Services Review · doi:10.1016/j.childyouth.2025.108237 · Cited by 3 · see citing works
Eye Movement Desensitization and Reprocessing (EMDR) as a Possible Evidence-Based Rehabilitation Treatment Option for a Patient with ADHD and History of Adverse Childhood Experiences: A Case Report Study
Guidetti, C., Brogna, P., Chieffo, D. R. P., Turrini, I., Arcangeli, V., Rausa, A., Bianchetti, M., Rolleri, E., Santomassimo, C., Cesare, G. D., et al. (2023) · Journal of Personalized Medicine · doi:10.3390/jpm13020200 · Cited by 3 · see citing works
“Interestingly, a longitudinal study found that experiencing ACEs before age 5 years was associated with ADHD at age 9 years [9].”
Background
Adverse Childhood Experiences Are Associated With Seizures in Children
Anto, M. M., Shipley, S. C., Massey, S. L., & Szperka, C. L. (2023) · Neurology Clinical Practice · doi:10.1212/cpj.0000000000200136 · Cited by 3 · see citing works
Screening for Adverse Childhood Experiences (ACEs) before age 3: Evidence for the Family Map Inventory
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“These range from concurrent disruptions in development in early childhood to early adolescent behavior concerns to serious illness in adulthood such as cancer, diseases of the heart, lungs, and liver (American Academy of Pediatrics, 2014; Chanlongbutra, Singh, & Mueller, 2018; Gilgoff, Singh, Koita, Gentile, & Marques…”
Background
Psychophysiological Insights into Child-Centered Play Therapy for Trauma: A Case Study
Perryman, K. L., Robinson, S., Schoonover, T., & Conroy, J. (2024) · Trauma Care · doi:10.3390/traumacare4030019 · Cited by 3 · see citing works
Exploring Interrelatedness of Adverse Childhood Experiences in Infancy and Toddlerhood: Using Latent Class Approaches to Examine Developmental Outcomes
McKelvey, L. M., Zhang, D., Whiteside-Mansell, L., & Selig, J. P. (2022) · Adversity and Resilience Science · doi:10.1007/s42844-022-00066-w · Cited by 3 · see citing works
Child Centered Play Therapy and Adverse Childhood Experiences: Effectiveness on Impulsivity and Inattention
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Interplay Between Adverse Childhood Experiences and Neurodevelopmental Disorders: A Systematic Review of Recent Evidence
Jangid, R., Seema, N., Arun, G., Prasad, B. V., Walia, D., & Rana, S. (2025) · Annals of Neurosciences · doi:10.1177/09727531251359413 · Cited by 2 · see citing works
“29 Supporting these findings, further research indicated a strong cumulative relationship showing that children who experienced more than four ACEs had approximately four times increased odds of ADHD compared to those having no exposure to ACEs.”
When Trauma Mimics ADHD
McDonald, A. C., & Ingram, K. (2025) · Springer eBooks · doi:10.1007/978-3-031-96950-8_16 · Cited by 2 · see citing works
Predictors of Attention Deficit/Hyperactivity Disorder Behaviors in Chinese Adoptees: A 10-Year Longitudinal Study
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“Contextual factors such as early life adverse experiences may account for prevalence and severity of symptoms of ADHD (Jimenez et al., 2017).”
BackgroundInfluential
Psychological intimate partner violence, child witnessing of parental arguments, and emotional-behavioral outcomes in five-years old: The French ELFE cohort
Bailhache, M., El-Khoury, F., Leproux, O., Chazelas, E., Gomajee, R., van der Waerden, J. E. B., Galéra, C., Charles, M.-A. A., & Melchior, M. (2024) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2024.107185 · Cited by 2 · see citing works
The Coexistence of Adverse Childhood Experiences, Positive Childhood Experiences, and Parent-reported Attention-deficit/Hyperactivity Disorder Severity: National Survey of Children's Health
Hong, S.-J., Vu, M. H., Vanderbilt, D., Yin, L., Imagawa, K. K., & Deavenport-Saman, A. (2025) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000001395 · Cited by 1 · see citing works
Factors associated with the occurrence and persistence of subthreshold and full attention-deficit hyperactivity disorder in women: A population-based epidemiological study
Buadze, A., Ajdacic-Gross, V., Müller, M., Xu, Y., Seifritz, E., Wagner, E.-Y. N., von Känel, R., Glaus, J., Ranjbar, S., Castelao, E., et al. (2026) · PLOS One · doi:10.1371/journal.pone.0340179 · Cited by 1 · see citing works
Considerations on Resilience in At-Risk Youth
Vinson, S. (2018) · Springer eBooks · doi:10.1007/978-3-319-90350-7_1
Gender, Race, Ethnicity, and Adverse Childhood Experiences: Predictors of an Attention-Deficit Hyperactivity Disorder Diagnosis
Schoonover, T., Robinson, S., & Perryman, K. L. (2026) · Journal of Child and Adolescent Counseling · doi:10.1080/23727810.2026.2615613 · Cited by 1 · see citing works
“Researchers have found a connection between ACE exposure and symptoms that are similar to an ADHD diagnosis (Fuller-Thomson & Lewis, 2015; Hunt et al., 2017; Jimenez et al., 2017; Van der Kolk, 2014).”
Influential
Cumulative Adverse Childhood Experiences and Multiple Neurodevelopmental Disorders in Children and Adolescents: A Population‐Based Study
Lin, J., Scott, J. G., Eapen, V., Kallapiran, K., O’Shea, P., Haslam, D. M., Edirippulige, S., & Davidson, P. M. (2026) · Stress and Health · doi:10.1002/smi.70202 · Cited by 1 · see citing works
“After disaggregating multiple NDDs, the number of ACEs was significantly associated with six specific combinations of NDDs in the fully adjusted models (Table 2, Figure 3), including for children with concurrent LD and ID (i.e., LD + ID) (aOR = 1.20, 95% CI: 1.04–1.40), LD + ASD (aOR = 1.19, 95% CI: 1.03–1.38), LD + S…”
Influential
Race, Ethnicity, Socioeconomic Factors, and Attention-Deficit Hyperactivity Disorder
Zuckerman, K. E., & Pachter, L. M. (2019) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000000645 · Cited by 1 · see citing works
“The relationship between behavioral symptoms and childhood trauma (i.e., adverse childhood events [ACEs]) in particular may make parents more reluctant to raise behavioral symptoms with providers, despite the fact that ACEs are widespread and are risk factors for ADHD.18,19 Many low-income and/or racial/ ethnic minori…”
BackgroundInfluential
School Counselors' Perceptions of Trauma-Informed Approaches in Schools
Burkhardt, E. A. (2020) · Digital Commons (Liberty University) · Cited by 1 · see citing works
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Specific Adverse Childhood Experiences and Homelessness are Associated with Increased Risk for Attention Deficit Hyperactivity Disorder in a Nationally Representative Sample
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Bhoyroo, R., Chivers, P., Morandini, H., Milroy, H., Barbaro, P., Boutrus, M., Woolard, A., & Rao, P. (2026) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2026.108138
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“With so many positive aspects to the book, one of the few cons is the authors’ failure to associate the findings with the latest theory of Adverse Childhood Environments, or ACEs (Jimenez et al., 2017).”
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Kawasaki Disease in Children
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Authors: Jimenez, M. E., Wade, R., Schwartz-Soicher, O., Lin, Y., & Reichman, N. E.
Affiliations: Children's Hospital of Philadelphia (US)
Rutgers, The State University of New Jersey (US)
ORCID: Lin, Yong
Reichman, Nancy E.
Venue: Academic Pediatrics
Publisher: Elsevier BV
Published: 2017-05
Volume: 17
Issue: 4
Pages: 356-361
ISSN: 1876-2859 (ISSN-L)
DOI: 10.1016/j.acap.2016.12.009
PMC: PMC5555409
OpenAlex: W2566635941
Cited by: 104
References: 37
Citations by year: 2026: 10 · 2025: 9 · 2024: 8 · 2023: 18 · 2022: 7 · 2021: 15 · 2020: 18 · 2019: 13 · 2018: 4 · 2017: 1
FWCI: 8.02
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Academic Pediatrics (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: Eunice Kennedy Shriver National Institute of Child Health and Human Development (R25HD074544, K12HD085848, R24HD058486, P2CHD058486, R01HD036916)
Topics: Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords: adverse childhood experiences, attention deficit hyperactivity disorder, middle childhood, early childhood adversity, urban children, ADHD screening, maternal care, child mental health
MeSH terms: Exposure to Violence, Attention Deficit Disorder with Hyperactivity, Black or African American, Child, Child Abuse, Depression, Female, Humans, Longitudinal Studies, Male, Prisons, United States, Urban Population, Cohort Studies, Odds Ratio, Child of Impaired Parents, Domestic Violence, Substance-Related Disorders, White People

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Adverse Childhood Experiences and ADHD Diagnosis at Age 9 Years in a National Urban Sample

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