Associations Between Participation in After-School Activities, Attention-Deficit/Hyperactivity Disorder Severity, and School Functioning.

OBJECTIVE: To examine the association between after-school activity (ASA) participation, attention-deficit/hyperactivity disorder (ADHD) severity, and school functioning among children with ADHD. METHODS: A cross-sectional study was conducted using data from the 2016 National Survey of Children's Health on ADHD severity, ASAs and 2 domains of school functioning among children with ADHD: missed days from school and calls home from school. RESULTS: Of 4,049 children with ADHD (weighted N = 5,010,662), 71.8% participated in at least 1 ASA. In multivariable regression analyses, ASA participation was associated with lower odds of moderate-to-severe ADHD [adjusted odds ratio (aOR): 0.62, 95% confidence interval (CI), 0.46-0.85] and lower odds of missed school days (aOR 0.55, 95% CI, 0.41-0.74). We did not find significant associations with calls home from school (aOR 0.79, 95% CI, 0.59-1.07). CONCLUSION: After-school activity participation is associated with decreased ADHD severity and reduced school absenteeism. Efforts to optimize ADHD outcomes should consider engaging children and adolescents in ASAs.

Associations Between Adverse Childhood Experiences and ADHD Diagnosis and Severity.

OBJECTIVE: Although identifying adverse childhood experiences (ACEs) among children with behavioral disorders is an important step in providing targeted therapy and support, little is known about the burden of ACEs among children with attention deficit-hyperactivity disorder (ADHD). We described the prevalence of ACEs in children with and without ADHD, and examined associations between ACE type, ACE score, and ADHD diagnosis and severity. METHODS: Using the 2011 to 2012 National Survey of Children's Health, we identified children aged 4 to 17 years whose parents indicated presence and severity of ADHD, and their child's exposure to 9 ACEs. Multivariate logistic regression was used to estimate associations between ACEs, ACE score, and parent-reported ADHD and ADHD severity, adjusted for sociodemographic characteristics. RESULTS: In our sample (N = 76,227, representing 58,029,495 children), children with ADHD had a higher prevalence of each ACE compared with children without ADHD. Children who experienced socioeconomic hardship (adjusted odds ratio [aOR], 1.39; 95% confidence interval [CI], 1.21-1.59), divorce (aOR, 1.34; 95% CI, 1.16-1.55), familial mental illness (aOR, 1.55; 95% CI, 1.26-1.90), neighborhood violence (aOR, 1.47; 95% CI, 1.23-1.75), and incarceration (aOR, 1.39; 95% CI, 1.12-1.72) were more likely to have ADHD. A graded relationship was observed between ACE score and ADHD. Children with ACE scores of 2, 3, and ≥4 were significantly more likely to have moderate to severe ADHD. CONCLUSIONS: Children with ADHD have higher ACE exposure compared with children without ADHD. There was a significant association between ACE score, ADHD, and moderate to severe ADHD. Efforts to improve ADHD assessment and management should consider routinely evaluating for ACEs.