Research In Action

Previous studies have found that youths with autism spectrum disorders (ASD) and attention deficit hyperactivity disorder (ADHD) have a higher prevalence of adverse childhood experiences (ACEs). But, a recent study is the first to examine ACEs among children with ASD, ADHD, and both ASD/ADHD and compare them to non ASD/ADHD youths. The researchers also examined differences in family resilience (categorized by diagnosis and number of ACEs) among these groups.

What they found was that families of youths with ADHD reported significantly higher rates of ACEs compared to families of youths with ASD as well as youths with both ASD and ADHD. Family resilience was rated as lowest in families of youths with both ASD and ADHD.

What They Did

Data from the over 50,000 surveys from the 2016 National Survey of Children's Health (conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics) were analyzed for this study. This cross-sectional nationally representative data was derived from a telephone and mail survey. Parents and caregivers reported that among their children:

• 8.2% had ADHD
• 1.3% had ASD
• 1.2% had ASD and ADHD
• 69.7% were male
• 79.6% were white

Parents who took the survey also completed items asking about ACEs and family resilience.

What They Found

Prevalence of ACEs

• Parents of youths diagnosed with ADHD only reported significantly higher amounts of ACEs than parents of youth with ASD, ASD and ADHD, and controls.
• There were no statistically significant differences in reported ACEs among those with ASD, ASD and ADHD, and controls.

Family Resilience

• Parents of youths with ASD and ADHD had significantly lower scores on family resilience (indicating less resilience) than parents of youths with ADHD and controls.
• Parents of youths with ASD had lower scores on family resilience than controls.
• There were no statistically significant differences in resilience scores between youths with ADHD and youths with ASD.

ACEs and Family Resilience

• Parents of youths with 1 ACE reported better family resilience than parents of youths who experienced more than 2 ACEs.
• Parents of youths with no ACEs had lower family resilience scores compared with parents who reported youths with 1 ACE. Their scores were similar to parents of youths who experienced more than 2 ACEs.
• Differences in family resilience based on the number of ACEs their youths experienced did not vary between the ASD, ADHD, and ASD and ADHD groups.

It should be noted that since this was a cross-sectional survey, we cannot infer any causal relationships between diagnosis and ACEs and family resilience, only associative relationships. It's  difficult to tease apart the primary impact of family resilience on ACEs, or the primary impact of ACEs on family resilience. Also, because this survey relied on parent report for diagnosis and ACEs exposure, there may be a degree of recall bias (though the prevalence of ADHD and ASD reported in this study aligns with the national prevalence of these conditions). This survey did not appear to ask or the analysis did not account for severity of diagnosis (impact on function, for instance), and the ACEs survey did not ask questions about child abuse. Finally, as nearly 80% of the respondents of the survey identified as white, these results may have limited generalizability in different areas of the country.

Key Takeaways

Given that, I thought two findings were notable:1) The prevalence of ACEs was highest in the ADHD population specifically, higher even among youths with ASD and ADHD. In my clinic, I know that there are times when behavioral services are more accessible (whether due to insurance issues or other reasons) for those with a diagnosis of ASD versus ADHD alone. I wonder if the increased access to behavioral support for children with ASD might help to protect them from ACEs. The other notable finding was that those with no ACEs had lower family resilience scores compared to those who reported 1 ACE. It would be interesting for future studies to explore whether the ACE itself helped to hone a degree of resilience.