Early childhood may hold critical clues to understanding, and potentially reducing, the risk of attention-deficit/hyperactivity disorder (ADHD).
Tracking risk from pregnancy to toddlerhood
In a new longitudinal study of 300 families in Portland, Oregon, Hanna Gustafsson, Ph.D., associate professor of psychiatry at Oregon Health & Science University, and Elinor Sullivan, Ph.D., professor of psychiatry and behavioral neuroscience, tracked parents from pregnancy through their children’s early years. The researchers explored how biological factors before birth and caregiving experiences in infancy shape later development. Their findings suggest that higher levels of inflammation during pregnancy are linked with greater ADHD symptoms at age three, but that “sensitive caregiving” in infancy can buffer children against this early biological risk.
Gustafsson and Sullivan recently discussed their findings in an interview with Managed Healthcare Executive. The study began in 2018, and researchers are now releasing data after the children turned three years old.
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Measuring biology and behavior
To understand the biological components, Sullivan explained that the team measured cortisol in hair samples. This method allows researchers to look at stress output across the three trimesters of pregnancy based on hair growth. They also assessed 30 inflammatory factors in maternal blood collected during the second and third trimesters.
For behavior, the researchers invited families to their laboratory. They provided age-appropriate toys and asked parents to interact with their children as they typically would. The interactions were videotaped and later coded by a team of observers who quantified behavioral exchanges. To supplement these observations, the team used surveys, questionnaires, and clinical interviews with parents to understand how a three-year-old behaves and regulates emotions.
The role of sensitive caregiving
Gustafsson defined sensitive caregiving as a caregiver who notices and responds to a child’s cues in a timely way. She described the behavior as attempting to understand what a child needs when they are upset and responding with warmth and consistency. This can be as simple as following a child’s lead during play or comforting them when they are upset.
Early in life, children are building the systems that help them pay attention, handle frustration, and regulate impulses. Gustafsson noted that caregivers who engage in sensitive and supportive behaviors can help to strengthen those developing skills.
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The study offers a detailed view of risk. Sullivan emphasized that parents should not interpret the findings as proof that parenting determines whether a child has ADHD. ADHD has a strong biological and genetic influence and is the result of many different interacting factors. The study suggests that relationships early in life can be a powerful source of resilience for children.
Future directions and interventions
Researchers are currently following up with the children as they grow older to understand the long-term effects of these early experiences. So far, they see very similar effects at year four. The team plans to follow the group through ages five, six, and seven, which is a critical period for assessing ADHD and other developmental outcomes.
Sullivan mentioned interest in interventions that could reduce inflammation during pregnancy, such as consuming a high level of omega-three fatty acids in the diet or engaging in exercise and mindfulness. She added that identifying risk early allows for interventions that are most effective in reducing symptoms and improving outcomes in other areas of a child’s life.
