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Adult smoking, depression linked to ADHD in children
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Children who lived in households with adults who smoked or were depressed demonstrated a significant increase in ADHD prevalence, according to findings recently published in Asia-Pacific Psychiatry.
“Recently, family environmental factors, including parental socioeconomic status, exposure to environmental smoking, and parents' psychological problems, have also been proposed as risk factors for ADHD. ... However, several studies also reported a non-significant association between them,” Youn Joo Cho, MPharm, of the College of Pharmacy and Research Institute of Pharmaceutical Sciences at Kyungpook National University in South Korea, and colleagues wrote.
“Furthermore, previous studies focused on effects due to the father and mother, which could overlook the effect of other adults in the household,” they added.
Researchers compiled ADHD status, age gap between parents and children, children’s BMI, classification of adults in the household, existence of adults with depression at home, exposure to environmental smoke in the household, and parental level of education among 23,561 children aged 18 years and younger living in Korea.
Cho and colleagues found that total smoking amounts and depression in adults in the household were significantly associated with ADHD in children.
In addition, the annual prevalence of physician-diagnosed ADHD showed a nearly fourfold increase from 0.35% (4,776 patients) in 2005 to 1.36% (14,478 patients) in 2014. The occurrence of physician-diagnosed ADHD was nearly three times higher in boys than girls.
“This study ... may provide insight and recommendations into public health care management demand, addressing the importance of parental involvement in the development of ADHD in children,” Cho and colleagues concluded. – by Janel Miller
Disclosure: The authors report no relevant financial disclosures.
Perspective
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Adiaha I.A. Spinks-Franklin, MD
This was a very interesting analysis of a national health database in South Korea. The authors concluded, based upon the analysis of their data, that there was a strong association between fathers with depression who smoked in the home and having a child with ADHD among this population. The worldwide prevalence of ADHD is estimated to be 5%. In the United States, approximately 4% of adults and 7% of children have ADHD. Evidence in the Unites States and around the world has shown a very high genetic predisposition to having ADHD. In children who are diagnosed with ADHD, they have a very high risk of having a first-degree relative (ie, parent, sibling) with ADHD. Individuals with ADHD are at higher risk of having co-existing conditions such as depression and anxiety. Individuals with ADHD are also more likely to use substances such as tobacco, alcohol and illicit drugs compared to peers without ADHD. Approximately 30% to 50% of children with ADHD will no longer show symptoms of ADHD in adulthood. However, even if they no longer have symptoms of ADHD in adulthood, they are more likely to struggle with life functioning such as substance use, unemployment, interpersonal problems, depression, anxiety, and the like.
This study did not examine ADHD symptoms in the parent. Rather, it examined behavioral characteristics of parents with and without children with ADHD. The study analysis suggested that fathers who had depression and smoked more than 15 cigarettes per day in the home were more likely to have a child diagnosed with ADHD. I caution readers to not confuse associations with causes. There is no data to suggest that parental cigarette smoking can cause ADHD in their children. However, evidence does suggest that children with ADHD are more likely to live in the households with a parent who has ADHD, a parent who uses substances (eg, alcohol, tobacco, illicit drugs), and to have their parents become divorced.
The findings of this study are similar to some studies in the U.S. examining family characteristics and environmental factors of children who have ADHD. This is not a causation study, but rather a correlation study finding associations between various household factors for children with and without ADHD. Primary care providers typically screen for smoking in the home. However, they may consider screening for other household factors in pediatric patients who have ADHD, such as depression in both mothers and fathers. We are less likely to screen for depression in fathers than we are in mothers. Although depression is more common in women, recent data from CDC and the American Psychological Association suggest that between 5% and 9% of men in the United States report symptoms of depression. Depression can put a parent at greater risk of using substances, such as tobacco, have difficulties with employment, and negatively influence how a parent manages a child's behaviors. PCPs can be the front line to refer parents of children with ADHD to appropriate mental health supports, such as behavior psychologists who can provide parent training and guidance in managing the challenging behavior of children with ADHD. PCPs can encourage parents to care for themselves, so they are better able to care for their children.
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