Predictors of ADHD symptoms in childhood and adolescence over time: Results of the longitudinal BELLA study

Objectives: Attention-deficit/hyperactivity disorder (ADHD) is a common and impairing mental disorder in childhood and adolescence. So far, longitudinal studies on risk and protective factors for the development of ADHD symptoms are scarce. Therefore, the present study investigates the cross-sectional and longitudinal influences of individual, familial and social factors on the development of ADHD symptoms in children and adolescents.

Design and Methods: Within the population-based longitudinal BELLA study, data on n = 1,384 children and adolescents aged 11 to 17 years were collected at three measurement points covering a period of two years. We examined effects of parental mental health problems (risk factor) and self-efficacy, family climate and social support (protective factors) on symptoms of ADHD at baseline as well as over time using latent growth modelling and linear regression models. Sociodemographic factors, pre- and postnatal factors, and comorbid symptoms of internalizing and externalizing mental health problems were considered as covariates. In additional regression models, we explored potential interaction effects between risk and protective factors.

Results: Parental mental health problems, stronger aggressive behavior, younger age and male gender were negatively associated with ADHD symptoms in children and adolescents at baseline. Longitudinal analyses revealed that increasing parental mental health problems, increasing aggressive behaviour, increasing symptoms of generalized anxiety, migration status and female gender were related to stronger increase of ADHD symptoms over time. However, improving family climate was associated with decreasing ADHD symptoms over time. We further detected moderating effects of social support on the relationship between parental mental health problems and ADHD symptoms.

Conclusions: The findings of the present study demonstrate detrimental effects of parental mental health problems as well as beneficial effects of family climate and social support on ADHD in children and adolescents over time. The results may be integrated in future prevention and early intervention programs that target affected children and adolescents.