Abstract
OBJECTIVE: Children with higher adverse childhood experiences (ACEs) experience more severe parent-reported attention-deficit/hyperactivity disorder (ADHD). Positive childhood experiences (PCEs) help to build resilience and mitigate the impact of ACEs on ADHD. Prior studies have measured the 2 constructs as independent factors, but no research has examined their combined influence on children with ADHD. The first aim was to categorize children with different levels of parent-reported ADHD severity into classes based on shared characteristics of ACE and PCE promoters. The second aim was to examine the relationship between the classes and ADHD severity. METHODS: Participants included children 6 to 17 years with data on the 2019 National Survey of Children's Health ADHD severity questionnaire (n = 19,715; weighted n = 49,149,269). Latent class analysis (LCA) identified subgroups of children experiencing patterns among PCE promoters and ACEs, which were measured as independent variables in an adjusted ordinal regression model to estimate their composite effects on ADHD severity. RESULTS: Using LCA, one class belonging to children with low ACEs and high PCE promoters (class 1) and another belonging to children with high ACEs and low PCE promoters (class 2) were identified. Class 2 was 2.2 times more likely to have more severe ADHD (aOR 2.2; 95% confidence interval, 1.8-2.6). CONCLUSION: Findings suggest ACEs and PCE promoters do not operate independently; children with high ACEs had low PCE promoters and had more severe parent-reported ADHD. Clinicians should consider actively screening for the presence of ACEs and PCEs in all children, especially those with high ADHD severity, and build strong alliances with families.