A “cycle of stressors” can intensify ADHD symptoms, leading to more stressors, and worse symptoms, say researchers from University of Groningen and University of Nijmegen, the Netherlands. Citing earlier studies that have reported associations between exposure to stress (e.g., family conflict) and ADHD, they suggest a stress-psychopathology-stress cycle underlying ADHD, in which families and individuals are not only exposed to stress, but “create stress” through, for example, peer conflict or financial problems.
Importantly, the researchers note that stress is, at least in part, modifiable and may be a high leverage circumstance for potentially effective intervention.
They conducted their study by analyzing longitudinal data from the Tracking Adolescents’ Individual Lives Survey (TRAILS), a prospective study of Dutch adolescents with measurements at ages 11, 13, 16, and 19.
Stress exposure was consistently higher in the four ADHD subgroups, compared with the non-ADHD subgroups. The ADHD groups showed trajectories of symptoms that differed in severity and in the course of ADHD over time. The two non-remitting ADHD subgroups were associated with very high, curvilinear stress exposure with a peak in mid-adolescence, while the two remitting ADHD subgroups were related to lower as well as declining stress exposure.
“Of strong interest,” the researchers say, is the finding that high-stress exposure was associated with two persistent ADHD trajectories with diverging comorbid trajectories: one characterized by persistently elevated irritability, as well as elevated and increasing internalizing problems but without the more extreme reactivity and frustration; the other characterized by severe ongoing emotional regulation problems (irritability, extreme reactivity, frustration) but without the internalizing problems.
The researchers say their findings suggest that taking into account stressful environmental factors should be an inherent part of diagnosis, prognosis, and treatment of ADHD. “The clinical profile and level of stress exposure at the start of adolescence,” they say, “are strong markers for what comes next.”