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Children of Parents With ADHD Are at Substantial Risk of Developing ADHD and Associated Impairments

Key findings

  • This study compared the risk of attention-deficit/hyperactivity disorder (ADHD) and its correlates in 205 children from 74 families with parental ADHD and 105 from 55 families without parental ADHD, major depressive disorder, or anxiety disorder
  • Longitudinal data showed that compared with children who had no parent with ADHD, a significantly higher number of children ages 4 to 17 years old who had one or more parents with ADHD developed full or subthreshold ADHD
  • Children of parents with ADHD also had significantly higher levels of disruptive behavior disorders, mood disorders, and anxiety disorders compared with their counterparts, as well as more educational, social, and cognitive problems
  • Children of parents with ADHD could benefit from close observations for signs of ADHD and associated symptoms

Attention-deficit/hyperactivity disorder (ADHD) is thought to be heritable, but the evidence base comprises only four small studies with limited scopes of assessment.

Now, researchers at Massachusetts General Hospital have conducted a large, comprehensive analysis of this issue.

Joseph Biederman, MD, deceased, former chief of the Pediatric Psychopharmacology and Adult ADHD Program, Mai Uchida, MD, director of the Child Depression Program, and colleagues found that children of parents with ADHD are at significant risk of ADHD and ADHD-related impairments, as they report in the Journal of Attention Disorders.


The data sources for the retrospective study were two identically designed longitudinal case–control family studies focusing on youth 6 to 17 years old with and without ADHD (the Boys Study and the Girls Study) and a longitudinal case–control family study of parents with and without panic disorder or major depressive disorder (MDD) who had at least one child 2 to 6 years old.

In all three studies, psychiatrists interviewed adults with the Structured Clinical Interview for DSM-III-R. They interviewed children ages 5 to 18 with the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Epidemiologic Version. A parent of each child ages 4 to 18 completed the 1991 version of the Child Behavior Checklist (CBCL).

Children's social functioning was assessed using the clinician-rated Global Assessment of Functioning (GAF), the parent-rated Family Environment Scale (FES), and the parent-rated Social Adjustment Inventory for Children and Adolescents (SAICA). Neurocognitive ability was measured using the Wechsler Intelligence Scale for Children, Revised Version (WISC-R).

After restricting the sample to children who were 4 to 17 years old at the time of the original study and had parents with or without ADHD, the final pool for analysis consisted of 310 children: 205 from 74 families with parental ADHD (5% had both maternal and paternal ADHD) and 105 from 55 families without parental ADHD, MDD, or anxiety disorder.

Child Diagnoses

Compared to children without parental ADHD, children with parental ADHD:

  • Had significantly more full or subthreshold psychiatric disorders (including ADHD, average 1.5 vs. 0.8; P<0.001)
  • Were significantly more likely to have full or subthreshold ADHD
  • Had significantly higher rates of full or subthreshold MDD, anxiety disorders and conduct disorder

ADHD Correlates

Compared to children without parental ADHD, children with parental ADHD:

  • Had significantly higher proportions of impairment on all CBCL composite scales and individual scales
  • Were rated on the GAF as having significantly worse overall functioning, were rated significantly more poorly on the Interpersonal Relationship dimension of the FES and were rated on the SAICA as having significantly more problems with school, peers or family
  • Were significantly more likely to repeat a grade in school
  • Had significantly lower Digit Symbol and Arithmetic scores on the WISC-R and significantly lower Freedom from Distractibility IQ

The results were similar when the team adjusted for age, sex and study source.

The Potential for Early Intervention

This insight into the magnitude of the risk for ADHD and related conditions could aid in early identification of children at high risk and facilitate development of early interventions.

In a meta-analysis of the four previous small studies, also published in the Journal of Attention Disorders, Mass General researchers concluded more than 60% of children at high risk of ADHD do not develop ADHD. Still, close observation is advisable.

Learn more about the Pediatric Psychopharmacology and Adult ADHD Program

Learn more about the Child Depression Program

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