literature review on maternal Stress and ADHD in Children

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A literature review on maternal Stress and the Development of ADHD in Children

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Published: 28th JULY 2023

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Abstract

One of the most prevalent diagnoses among youngsters is attention deficit hyperactivity disorder (ADHD). Biological and environmental factors influence ADHD symptoms. Although inheritance is a key predictor of ADHD, various environmental variables have been linked to an increased risk of ADHD in children. Increased prenatal stress has been related to developing a mental disease, notably ADHD. Gender differences, the degree of mother stress, and socioeconomic disadvantages are all possible factors that may impact the association between maternal stress and ADHD diagnosis. In addition, genetic and environmental effects, as well as the combination of maternal stress and the DRD4 7/7 genotype in offspring, have been proposed as reasons for the causative link. As a result, this review investigated the link between prenatal stress and ADHD. Prenatal stress was conclusively discovered.

Introduction

One of the most prevalent behavioural diagnoses among young children is attention deficit hyperactivity disorder (ADHD). It is described as a neuro-developmental disease characterized by hyperactivity and inattention that lasts at least six months and occurs in several settings (Rodriguez & Bohlin, 2005). ADHD symptoms can interfere with a child's academic and social ability (Okano, Ji, Riley, & Wang, 2018). Although the frequency of ADHD declines with age, ADHD symptoms persist throughout adulthood (Rodriguez & Bohlin, 2005). ADHD symptoms can substantially impair a child's social and intellectual performance if left untreated (Grizenko, Shayan, Polotskaia, Ter-Stepanian, & Joober, 2008).

While the exact origins of ADHD are uncertain, environmental and genetic factors have been suggested. Despite several studies demonstrating that ADHD is a heritable illness, only 75-80% of ADHD symptoms are caused by hereditary factors. According to studies, prenatal, perinatal, and postnatal settings may have a role in ADHD (Grizenko et al., 2008). According to the findings, using intervention measures to lessen a woman's stress during pregnancy can reduce the likelihood that a child would acquire ADHD tendencies (Ronald, Pennell, & Whitehouse, 2011). Because prenatal stress is avoidable, studying the association between prenatal stress and ADHD symptoms in children is important for public health. As a result, this review focuses on prenatal stress as a controllable factor.

The diagnostic process of ADHD in children

ADHD diagnosis entails diagnostic testing, a patient history, and parent interviews. Clinical psychologists also utilize behaviour measures to assess the severity of children's symptoms. Clinical psychologists use the Diagnostic and Numerical Manual of Mental Disorders (DSM) when grading a child's conduct. Furthermore, behavioural measures can be used to analyze ADHD behaviour at school and home. Teachers' assessments of children are frequently more accurate when assessing externalizing behaviours, such as anger, because such behaviours generate apparent disruptions in the classroom, but internalizing behaviours, such as daydreaming, may not be noticed as frequently. Furthermore, moms are likelier than fathers to report inattentive rather than hyperactive behaviours (Mayfield et al., 2018). The following investigations make use of these diagnostic procedures.

Heritability of ADHD

Heritability is the proportion of a characteristic that may be attributed to genetic effects (Grimm, Kittel-Schneider, & Reif, 2018). ADHD has been demonstrated to be substantially heritable in several studies. According to Grimm et al. (2018), the heritability of ADHD is 76%. Furthermore, ADHD has been demonstrated to have higher heredity than other mental diseases (Grimm et al., 2018). ADHD has also been observed to be more common among first-degree relatives (Grimm et al., 2018). With heredity having a role in ADHD, it is critical to understand the interaction between environmental variables and the development of ADHD in children.

Prenatal stress as an environmental factor

Many studies have indicated that maternal stress has a major influence on a child's development. Despite the development of various ideas, the mechanisms by which maternal stress causes developmental difficulties in children remain unknown. Hypotheses that attempt to explain the onset of ADHD symptoms include but are not imperfect to sympathetic nervous system activation, which causes an increase in uterine artery resistance, resulting in a decrease in blood flow to the fetus; fetal cortisol amplification modifies the nervous system and dysregulates the hypothalamus-pituitary-adrenal (HPA) axis; and reduced inhibition of frontal activity caused by catecholamine in the Finally; it is physiologically possible that the evolution of ADHD is affected by prenatal stress.

Evidence of an Association

Three studies were chosen to investigate the link between prenatal stress and ADHD. The first research sought to ascertain whether there was a link between the degree of maternal stress and the level of ADHD symptomology in children. Participants were 203 youngsters between 6 and 12, with 32 females and 171 boys. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) was used to diagnose participants with ADHD. A range of clinical interviews and examinations were used to examine the youngsters. Parents also finished the Child Behavior Checklist (CBCL). The Kinney Medical and Gynecological Questionnaire was utilized in the study to measure the mother's stressful life events before, during, and after pregnancy.

Mothers were then placed into three groups: no stress, moderate stress, and high stress. CBCL scores were used to determine the severity of ADHD symptoms in youngsters. The study looked at the mother's stress levels during each trimester to see if stress at a specific phase affected the severity of ADHD symptoms in offspring. Grizenko et al. (2012) established a link between maternal stress and ADHD symptoms in children. Furthermore, the study discovered a link between third-trimester stress and high CBCL scores (Grizenko et al., 2012). If a woman experienced stress during the third trimester of her pregnancy, she was more likely to report ADHD symptoms. The following investigations revealed shortcomings that should be addressed in future studies, such as using the Kinney Medical and Gynecological Scale.

Another study, similar to the previous one, looked at the relationship between prenatal maternal stress (PNMS) and ADHD behaviours in 2-year-olds (Ronald, Pennell, & Whitehouse, 2011). The sample included 913 men and 833 women. The Child Behavior Checklist (CBCL) was used to assess child behaviour between the ages of one and five. Furthermore, ADHD was identified using the DSM-IV symptomology list. Maternal stress was assessed at 18 and 34 weeks of pregnancy by inquiring if 10 stressful life events had happened. Ronald et al. (2011) found a consistent link between prenatal maternal stress (PNMS) and ADHD behaviours in both men and females. Finally, PNMS has been linked to developing ADHD-like symptoms in youngsters. Mothers who reported higher levels of stress also reported higher levels of ADHD. However, the study could experience attrition bias as underprivileged mothers were less likely to participate.

The last study looked at whether there was a link between maternal psychosocial stress and the diagnosis of ADHD in children (Okano et al., 2018). The research included 2140 mother and child couples. The children who participated in the research were roughly 9.1 years old during the follow-up assessment. Maternal stress was assessed using the 4-item Perceived Stress Scale, daily stress experiences throughout pregnancy, and the absence or presence of five significant stressful events. Environmental variables, father engagement, social support, and whether or not the pregnancy was intended were also investigated. The International Classification of Diseases (ICD-9) was used to get the child's ADHD diagnosis. The study discovered that as the amount of a mother's psychosocial stress grew, so did the risk of an ADHD diagnosis. Single mothers, mothers who smoked during pregnancy, mothers who had not completed high school, and mothers who had intrauterine difficulties during pregnancy were more likely to have children diagnosed with ADHD. Furthermore, the study discovered that when the mother experienced stress during pregnancy, boys had a greater chance of getting ADHD. Although one disadvantage of this study was that the sample was not demographically varied, the findings could not be applied to the full population.

Explanations of the Causal Relationship

Maternal stress is linked to the development of ADHD in children. Much research has examined maternal stress's impact on a child's development. However, it is still debatable whether maternal stress is an environmental or hereditary risk factor. Although stressful events may be considered an environmental risk factor, several studies have revealed that genetic factors influence these "environmental" variables. Likely, genes that impact a mother's stress levels during pregnancy are also implicated in the chance of a kid having ADHD later in life (Ronald et al., 2011). As a result, if a woman is more likely to experience greater stress levels, it is more likely to have a detrimental influence.

The effect of the DRD4 7/7 genotype is another possible explanation for the causal link between prenatal stress and subsequent development of ADHD (Grizenko et al., 2012). The DRD4 7/7 genotype of a kid can interact with the mother's stress levels during pregnancy. The interplay of the DRD4 7/7 genotype and maternal stress may raise the likelihood of the development and severity of ADHD symptoms in offspring (Grizenko et al., 2012).

The following studies have suggested probable reasons for the causal association between maternal stress and ADHD in children, although further study is needed. When looking at maternal stress and the development of ADHD, researchers discovered a gene-environment relationship. The environmental events that a woman faces throughout her pregnancy might alter her offspring's DNA, increasing the offspring's likelihood of having a psychiatric disease later in life. In contrast, stress experienced by the mother during pregnancy can interact with a child's genotype, influencing the duration and severity of ADHD symptoms. This interaction shows a link between maternal stress and the severity of ADHD symptoms in children. Although several possible explanations exist for the causal relationship between maternal stress and ADHD symptoms, including gene-environment interaction and a child's DRD4 7/7 genotype, more research is needed to explain the relationship further.

Maternal Stress and ADHD in Children: Factors Influencing the Relationship

Impact of Severity of Maternal Stress

Research shows a link between the degree of maternal stress and ADHD symptoms in children (Grizenko et al., 2008). Children of mothers who experienced moderate to severe stress during pregnancy had higher CBCL scores and more ADHD symptoms than children of moms who had mild stress (Grizenko et al., 2008). Furthermore, increasing stress during the third trimester appears to be connected with higher CBCL scores (Grizenko et al., 2008). Furthermore, when a mother suffers a stressful life event during the third trimester, it may linger after the kid is delivered, disrupting the bond between the mother and child (Grizenko et al., 2008).

Gender Differences in ADHD Children

Gender variations in the development of ADHD in children have been demonstrated. According to research, males are more prone than girls to acquire ADHD symptoms (Rodriguez & Bohlin, 2005). One probable reason for this phenomenon is that male fetuses are more vulnerable to disaster than female fetuses (Rodriguez & Bohlin, 2005). Another study has explained gender differences in the development of hyperactive behaviour in males due to dopamine receptor mass overproduction and later pruning (Rodriguez & Bohlin, 2005). Although there is a link between gender variations and the development of ADHD, it is rarely the primary focus of the study. As a result, future studies should focus on the impact of gender variations on the development of mental diseases.

Socioeconomic Status of Mothers

Research shows a link between ADHD behavioural symptoms and socioeconomic deprivation (Russell, Ford, Rosenberg, & Kelly, 2014). ADHD is more commonly diagnosed in people from low socioeconomic status (SES) backgrounds. Mothers in low-income communities face more stress and struggle. More study is needed to understand stress, adversity, and ADHD, although studies have shown that challenges and stressful settings, such as prejudice, poverty, crowded houses, and family dysfunction, might modify a person's stress response. Furthermore, exposing a woman to these stressful circumstances during pregnancy may alter the child's neurobehavioral development, influencing the development of ADHD symptoms. As a result, it is clear that poor socioeconomic position affects

Conclusions

All three studies identified a link between prenatal stress and ADHD symptoms in children, demonstrating consistent findings. Although the study has discovered a substantial association between the two factors, the mechanism and particular drivers remain unclear. This association might be explained by genetic impacts, postnatal environmental influences, and higher self-report data, but further study is needed.

Future Directions

Previous research has found a link between prenatal stress and ADHD symptoms, as previously indicated. To identify ADHD symptoms in children, most of this research employed the same metrics, such as the CBCL. Furthermore, when doing research, the studies encompassed a wide spectrum of ages. Overall, the findings indicated the existence of a link between maternal stress and ADHD symptoms in children.

To ensure consistency, future studies should employ the same measures for evaluating prenatal stress and criteria for identifying children with ADHD, and an experienced child psychiatrist should supervise all children. Furthermore, rather than relying on recollections to recall the stress they experienced, studies should collect data on the mother's stress levels before, throughout, and after pregnancy. In addition, different developmental stages should be evaluated, and participants should be tracked for extended periods to understand the link better. All the studies looked at did not follow up with children more than once. Future studies should use a longitudinal research design to overcome these limitations. Researchers should enrol pregnant women and track the mother's stress levels throughout the pregnancy to avoid recollection bias. Furthermore, a longitudinal research design would enable researchers to follow up with children more than once so that the children could be evaluated during different developmental periods.

Other environmental factors may implicate the following studies, and therefore, further research should analyze the impact of other possible factors, in addition to prenatal stress, on ADHD. Previous studies have found environmental factors, such as maternal smoking, drug or alcohol consumption during pregnancy, low socioeconomic status, and family discord associated with developmental cases (Freitag et al., 2012). These account for possible environmental explanations for the development of ADHD, and therefore, additional research is necessary.

Overall, current research has discovered a small but substantial link between prenatal stress and ADHD outcomes in children. Prenatal stress was a significant risk factor that can impact ADHD cases in all studies; however, other environmental factors may also contribute to the development of ADHD in children and should be examined in future studies. To summarize, prenatal stress should be managed to reduce the incidence of ADHD diagnoses in children.

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References

Freitag, C. M., Hänig, S., Schneider, A., Seitz, C., Palmason, H., Retz, W., & Meyer, J. (2012). Biological and psychosocial environmental risk factors influence symptom severity and psychiatric comorbidity in children with ADHD. Journal of Neural Transmission (Vienna, Austria : 1996), 119(1), 81–94. https://doi.org/10.1007/s00702-011-0659-9
Grimm, O., Kittel-Schneider, S., & Reif, A. (2018). Recent developments in the genetics of attention-deficit hyperactivity disorder. Psychiatry and Clinical Neurosciences, 72(9), 654–672. https://doi.org/10.1111/pcn.12673
Grizenko, N., Fortier, M. E., Zadorozny, C., Thakur, G., Schmitz, N., Duval, R., & Joober, R. (2012). Maternal stress during pregnancy, ADHD symptomatology in children and genotype: Gene-environment interaction. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 21(1), 9–15.
Mayfield, A. R., Parke, E. M., Barchard, K. A., Zenisek, R. P., Thaler, N. S., Etcoff, L. M., & Allen, D. N. (2018). Equivalence of mother and father ratings of ADHD in children. Child Neuropsychology : A Journal on Normal and Abnormal Development in Childhood and Adolescence, 24(2), 166–183.
Okano, L., Ji, Y., Riley, A. W., & Wang, X. (2018). Maternal psychosocial stress and children's ADHD diagnosis: a prospective birth cohort study. Journal of Psychosomatic Obstetrics and Gynecology, 0(0), 1–9. https://doi.org/10.1080/0167482X.2018.1468434
Rodriguez, A., & Bohlin, G. (2005). Are maternal smoking and stress during pregnancy related to ADHD symptoms in children? Journal of Child Psychology and Psychiatry and Allied Disciplines, 46(3), 246–254. https://doi.org/10.1111/j.1469-7610.2004.00359.x
Ronald, A., Pennell, C. E., & Whitehouse, A. J. O. (2011). Prenatal maternal stress associated with ADHD and autistic traits in early childhood. Frontiers in Psychology, 1(JAN), 1–8. https://doi.org/10.3389/fpsyg.2010.00223
Russell, G., Ford, T., Rosenberg, R., & Kelly, S. (2014). The association of attention deficit hyperactivity disorder with socioeconomic disadvantage: alternative explanations and evidence. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 55(5), 436–445. https://doi.org/10.1111/jcpp.12170

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