title: Family-environment risk factors for attention-deficit hyperactivity disorder. A test of Rutter's indicators of adversity.
abstract: BACKGROUND
  This study investigated whether family-environment risk factors are associated with attention-deficit hyperactivity disorder (ADHD). Compelling work by Rutter and coworkers revealed that it was the aggregate of adversity factors (severe marital discord, low social class, large family size, paternal criminality, maternal mental disorder, and foster care placement) rather than the presence of any single factor that led to impaired development. Based on the work of Rutter, we hypothesized a positive association between indicators of adversity and the diagnosis of ADHD and ADHD-associated impairments.
  
  
  METHODS
  We studied 140 ADHD and 120 normal control probands. Subjects were non-Hispanic white boys between the ages of 6 and 17 years. Rutter's indicators of adversity were used to predict ADHD-related psychopathology as well as impaired cognitive and psychosocial functioning.
  
  
  RESULTS
  The odds ratio for the diagnosis of ADHD increased as the number of Rutter's adversity index predicted ADHD-related psychopathology (depression, anxiety, and conduct disorder), learning disabilities, cognitive impairment, and psychosocial dysfunction.
  
  
  CONCLUSIONS
  A positive association appears to exist between adversity indicators and the risk for ADHD as well as for its associated psychiatric, cognitive, and psychosocial impairments. These findings support the work of Rutter and stress the importance of adverse family-environment variables as risk factors for children with ADHD.
authors.affiliation: Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston, USA.
authors.forename: J
authors.initials: J
authors.lastname: Biederman
authors.forename: S
authors.initials: S
authors.lastname: Milberger
authors.forename: S V
authors.initials: SV
authors.lastname: Faraone
authors.forename: K
authors.initials: K
authors.lastname: Kiely
authors.forename: J
authors.initials: J
authors.lastname: Guite
authors.forename: E
authors.initials: E
authors.lastname: Mick
authors.forename: S
authors.initials: S
authors.lastname: Ablon
authors.forename: R
authors.initials: R
authors.lastname: Warburton
authors.forename: E
authors.initials: E
authors.lastname: Reed
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D005190:Family; D005191:Family Characteristics; D006801:Humans; D007398:Interpersonal Relations; D007859:Learning Disabilities / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008393:Marriage; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D016017:Odds Ratio; D011336:Probability; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012923:Social Class