Low SES, maternal gestational diabetes may increase risk of ADHD in six year olds

In the first study of its kind, researchers at Queens College and Mount Sinai School of Medicine have found that low socioeconomic status (SES) and maternal gestational diabetes together may cause a 14-fold increased risk of attention deficit hyperactivity disorder (ADHD) in six year olds. The data are published in the January issue of the Archives of Pediatrics and Adolescent Medicine, one of the JAMA/Archives journals.

Led by Jeffrey M. Halperin, PhD, Distinguished Professor of Psychology at Queens College and Professorial Lecturer in Psychiatry at Mount Sinai, and Yoko Nomura, PhD, Assistant Professor of Psychology at Queens College and Assistant Clinical Professor of Psychiatry at Mount Sinai, the research team evaluated 212 children at age three or four and again at age six. They compared 115 children who had low SES, maternal gestational diabetes, or both, to 97 children who had neither, evaluating members of the control group at age three or four then again at age six. The team found that while maternal gestational diabetes and low SES increased the risk for the child to develop ADHD, the risk increased exponentially when the two factors were taken together.

"To our knowledge, this is the first study to evaluate how prenatal exposure to gestational diabetes and low socioeconomic status together contribute to the development of ADHD," said lead author Dr. Nomura. "The results show these children are at far greater risk for developing ADHD or showing signs of impaired neurocognitive and behavioral development."

At preschool age, children were assessed using a standard ADHD rating scale, a survey that was completed by their parents and teachers, and through one-on-one semi-structured interviews. Additional measurements included tests of neuropsychological functioning, IQ scores, and child temperament. The researchers determined history of gestational diabetes through one-on-one interviews with the mothers of the participants. Socioeconomic status was evaluated with a widely used measuring tool called the Socioeconomic Prestige Index.

At age six, the children were evaluated again using behavioral and emotional clinical scales, along with neuropsychological tests, to measure several functions, including hyperactivity, aggression, anxiety, and attention. Independently, gestational diabetes or low SES doubled the risk for ADHD. Collectively, the risk increased 14-fold.

Since ADHD is a disorder with high heritability, the authors conclude that clinicians should make stronger efforts to help families take steps to prevent the nongenetic factors that contribute to its development. Nutrition and psychosocial counseling may help modify the risk, during pregnancy and in early childhood.

"Physicians and health care professionals need to educate their patients who have a family history of diabetes and who come from lower income households on the risk for developing ADHD," said Dr. Halperin. "Even more important is the need for obstetricians, pediatricians, and internists to work together to identify these risks."