Publications

2016
McLaughlin, K. A., Basu, A., Walsh, K., Slopen, N., Sumner, J. A., Koenen, K. C., & Keyes, K. M. (2016). Childhood Exposure to Violence and Chronic Physical Conditions in a National Sample of US Adolescents. Psychosomatic Medicine , 78 (9), 1072–1083.Abstract
OBJECTIVES: Exposure to violence is associated with chronic physical conditions in adults. Although violence exposure is common among youths, it is unknown whether violence is associated with chronic physical conditions in childhood and adolescence. We examined the associations of violence exposure with chronic physical conditions in a population-representative sample of US adolescents and determined whether associations were explained by co-occurring mental disorders. METHODS: Data were drawn from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A), a national cross-sectional survey of 6,483 adolescents (ages 13-17). Lifetime exposure to violence; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition mood, anxiety, and substance disorders; and self-reported arthritis, frequent headaches, back or neck problems, other chronic pain, asthma, and allergies were assessed. RESULTS: One in 4 (24.99%) adolescents reported exposure to violence. Violence exposure was associated with elevated odds of back/neck pain, headaches, chronic pain, allergies, and asthma (odds ratio [OR], 1.5-2.1; 95% confidence interval [CI], 1.1-3.5) after adjustment for sociodemographics, socioeconomic status, and lifetime mental disorders. Regarding new onsets, violence exposure was associated with greater hazard for subsequent first-onset only of back/neck pain (hazard ratio, 1.9; 95% CI, 1.2-3.0) and headaches (hazard ratio, 1.4; 95% CI, 1.1-1.8), and these associations were explained by early-onset mental disorders. CONCLUSIONS: Childhood violence exposure is associated with chronic physical conditions that emerge early in the life course, although associations are stronger for prevalent than incident conditions. Violence exposure predicts incident pain conditions only, and these associations are explained by mental disorders that begin after violence exposure. Interventions and policies aimed at preventing violence and detecting and treating early-onset mental disorders have the potential to reduce morbidity, mortality, and health disparities beginning early in development.
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Heleniak, C., Jenness, J. L., Stoep, A. V., McCauley, E., & McLaughlin, K. A. (2016). Childhood Maltreatment Exposure and Disruptions in Emotion Regulation: A Transdiagnostic Pathway to Adolescent Internalizing and Externalizing Psychopathology. Cognitive Therapy and Research , 40 (3), 394–415.Abstract
Child maltreatment is a robust risk factor for internalizing and externalizing psychopathology in children and adolescents. We examined the role of disruptions in emotion regulation processes as a developmental mechanism linking child maltreatment to the onset of multiple forms of psychopathology in adolescents. Specifically, we examined whether child maltreatment was associated with emotional reactivity and maladaptive cognitive and behavioral responses to distress, including rumination and impulsive behaviors, in two separate samples. We additionally investigated whether each of these components of emotion regulation were associated with internalizing and externalizing psychopathology and mediated the association between child maltreatment and psychopathology. Study 1 included a sample of 167 adolescents recruited based on exposure to physical, sexual, or emotional abuse. Study 2 included a sample of 439 adolescents in a community-based cohort study followed prospectively for 5 years. In both samples, child maltreatment was associated with higher levels of internalizing psychopathology, elevated emotional reactivity, and greater habitual engagement in rumination and impulsive responses to distress. In Study 2, emotional reactivity and maladaptive responses to distress mediated the association between child maltreatment and both internalizing and externalizing psychopathology. These findings provide converging evidence for the role of emotion regulation deficits as a transdiagnostic developmental pathway linking child maltreatment with multiple forms of psychopathology.
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Carliner, H., Keyes, K. M., McLaughlin, K. A., Meyers, J. L., Dunn, E. C., & Martins, S. S. (2016). Childhood Trauma and Illicit Drug Use in Adolescence: A Population-Based National Comorbidity Survey Replication-Adolescent Supplement Study. Journal of the American Academy of Child and Adolescent Psychiatry , 55 (8), 701–708.Abstract
OBJECTIVE: Although potentially traumatic events (PTEs) are established risk factors for substance use disorders among adults, little is known about associations with drug use during adolescence, an important developmental stage for drug use prevention. We examined whether childhood PTEs were associated with illicit drug use among a representative sample of US adolescents. METHOD: Data were drawn from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A), which included adolescents aged 13 to 18 years (N = 9,956). Weighted logistic regression models estimated risk ratios for lifetime use of marijuana, cocaine, nonmedical prescription drugs, other drugs, and multiple drugs. RESULTS: Exposure to any PTE before age 11 years was reported by 36% of the sample and was associated with higher risk for use of marijuana (risk ratio [RR] = 1.50), cocaine (RR = 2.78), prescription drugs (RR = 1.80), other drugs (RR = 1.90), and multiple drugs (RR = 1.74). A positive monotonic relationship was observed between number of PTEs and marijuana, other drug, and multiple drug use. Interpersonal violence was associated with all drug use outcomes. Accidents and unspecified events were associated with higher risk for marijuana, cocaine, and prescription drug use. CONCLUSION: Potentially traumatic events in childhood are associated with risk for illicit drug use among US adolescents. These findings add to the literature by illustrating a potentially modifiable health behavior that may be a target for intervention. The results also highlight that adolescents with a trauma history are a high-risk group for illicit drug use and may benefit from trauma-focused prevention efforts that specifically address traumatic memories and coping strategies for dealing with stressful life events.
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McLaughlin, K. A. (2016). Future Directions in Childhood Adversity and Youth Psychopathology. Journal of Clinical Child and Adolescent Psychology , 45 (3), 361–382.Abstract
Despite long-standing interest in the influence of adverse early experiences on mental health, systematic scientific inquiry into childhood adversity and developmental outcomes has emerged only recently. Existing research has amply demonstrated that exposure to childhood adversity is associated with elevated risk for multiple forms of youth psychopathology. In contrast, knowledge of developmental mechanisms linking childhood adversity to the onset of psychopathology-and whether those mechanisms are general or specific to particular kinds of adversity-remains cursory. Greater understanding of these pathways and identification of protective factors that buffer children from developmental disruptions following exposure to adversity is essential to guide the development of interventions to prevent the onset of psychopathology following adverse childhood experiences. This article provides recommendations for future research in this area. In particular, use of a consistent definition of childhood adversity, integration of studies of typical development with those focused on childhood adversity, and identification of distinct dimensions of environmental experience that differentially influence development are required to uncover mechanisms that explain how childhood adversity is associated with numerous psychopathology outcomes (i.e., multifinality) and identify moderators that shape divergent trajectories following adverse childhood experiences. A transdiagnostic model that highlights disruptions in emotional processing and poor executive functioning as key mechanisms linking childhood adversity with multiple forms of psychopathology is presented as a starting point in this endeavour. Distinguishing between general and specific mechanisms linking childhood adversity with psychopathology is needed to generate empirically informed interventions to prevent the long-term consequences of adverse early environments on children's development.
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Seeley, S. H., Mennin, D. S., Aldao, A., McLaughlin, K. A., Rottenberg, J., & Fresco, D. M. (2016). Impact of Comorbid Depressive Disorders on Subjective and Physiological Responses to Emotion in Generalized Anxiety Disorder. Cognitive Therapy and Research , 40 (30), 290–303.Abstract
Generalized anxiety disorder (GAD) and unipolar depressive disorders (UDD) have been shown to differ from each other in dimensions of affective functioning despite their high rates of comorbidity. We showed emotional film clips to a community sample (n = 170) with GAD, GAD with secondary UDD, or no diagnosis. Groups had comparable subjective responses to the clips, but the GAD group had significantly lower heart rate variability (HRV) during fear and after sadness, compared to controls. While HRV in the GAD and control groups rose in response to the sadness and happiness clips, it returned to baseline levels afterwards in the GAD group, potentially indicating lesser ability to sustain attention on emotional stimuli. HRV in the GAD + UDD group changed only in response to sadness, but was otherwise unvarying between timepoints. Though preliminary, these findings suggest comorbid UDD as a potential moderator of emotional responding in GAD.
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McLaughlin, K. A., Lane, R. D., & Bush, N. R. (2016). Introduction to the Special Issue of Psychosomatic Medicine: Mechanisms Linking Early-Life Adversity to Physical Health. Psychosomatic Medicine , 78 (9), 976–978. PDF
McLaughlin, K. A., Sheridan, M. A., Gold, A. L., Duys, A., Lambert, H. K., Peverill, M., Heleniak, C., et al. (2016). Maltreatment Exposure, Brain Structure, and Fear Conditioning in Children and Adolescents. Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology , 41 (8), 1956–1964.Abstract
Alterations in learning processes and the neural circuitry that supports fear conditioning and extinction represent mechanisms through which trauma exposure might influence risk for psychopathology. Few studies examine how trauma or neural structure relates to fear conditioning in children. Children (n=94) aged 6-18 years, 40.4% (n=38) with exposure to maltreatment (physical abuse, sexual abuse, or domestic violence), completed a fear conditioning paradigm utilizing blue and yellow bells as conditioned stimuli (CS+/CS-) and an aversive alarm noise as the unconditioned stimulus. Skin conductance responses (SCR) and self-reported fear were acquired. Magnetic resonance imaging data were acquired from 60 children. Children without maltreatment exposure exhibited strong differential conditioning to the CS+ vs CS-, based on SCR and self-reported fear. In contrast, maltreated children exhibited blunted SCR to the CS+ and failed to exhibit differential SCR to the CS+ vs CS- during early conditioning. Amygdala and hippocampal volume were reduced among children with maltreatment exposure and were negatively associated with SCR to the CS+ during early conditioning in the total sample, although these associations were negative only among non-maltreated children and were positive among maltreated children. The association of maltreatment with externalizing psychopathology was mediated by this perturbed pattern of fear conditioning. Child maltreatment is associated with failure to discriminate between threat and safety cues during fear conditioning in children. Poor threat-safety discrimination might reflect either enhanced fear generalization or a deficit in associative learning, which may in turn represent a central mechanism underlying the development of maltreatment-related externalizing psychopathology in children.
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Bush, N. R., Lane, R. D., & McLaughlin, K. A. (2016). Mechanisms Underlying the Association Between Early-Life Adversity and Physical Health: Charting a Course for the Future. Psychosomatic Medicine , 78 (9), 1114–1119.Abstract
Early-life adversities (ELA) are associated with subsequent pervasive alterations across a wide range of neurobiological systems and psychosocial factors that contribute to accelerated onset of health problems and diseases. In this article, we provide an integrated perspective on recent developments in research on ELA, based on the articles published in this Special Issue of Psychosomatic Medicine. We focus on the following: 1) the distinction between specific versus general aspects of ELA with regard to the nature of exposure (e.g., physical and sexual abuse, emotional abuse or neglect, relative socioeconomic deprivation), biological and behavioral correlates of ELA, and differences across diseases; 2) the importance of timing in the critical phases of exposure to ELA; and 3) adaptive versus dysfunctional responses to ELA and their consequences for biological and behavioral risk factors for adverse health outcomes. This article concludes with outlining important new targets for research in this area, including the neurobiology of affect as a mechanism linking ELA to adverse health outcomes, and the need for large-scale longitudinal investigations of multisystem processes relevant to ELA in diverse samples, starting prenatally, continuing to late adolescence, and with long-term follow-up assessments that enable evaluation of incident disease outcomes.
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Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental Health of Transgender Children Who are Supported in Their Identities. Pediatrics , 138 (1). PDF
Dennison, M. J., Sheridan, M. A., Busso, D. S., Jenness, J. L., Peverill, M., Rosen, M. L., & McLaughlin, K. A. (2016). Neurobehavioral markers of resilience to depression amongst adolescents exposed to child abuse. Journal of Abnormal Psychology , 125 (8), 1201–1212.Abstract
{Childhood maltreatment is strongly associated with depression, which is characterized by reduced reactivity to reward. Identifying factors that mitigate risk for depression in maltreated children is important for understanding etiological links between maltreatment and depression as well as improving early intervention and prevention. We examine whether high reward reactivity at behavioral and neurobiological levels is a marker of resilience to depressive symptomology in adolescence following childhood maltreatment. A sample of 59 adolescents (21 with a history of maltreatment; Mean Age = 16.95 years
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Sheridan, M. A., & McLaughlin, K. A. (2016). Neurobiological Models of the Impact of Adversity on Education. Current Opinion in Behavioral Sciences , 10, 108–113.Abstract
Poverty and exposure to adversity have been linked with decreased educational success. Various environmental and neurobiological pathways have been proposed for these associations, however, existing models have several clear drawbacks. Here we outline existing models, and propose an alternate model linking exposure to adverse experiences in childhood to education success. Specifically, we propose that measured dimensions of experience (e.g., decreased cognitive enrichment or increased exposure to violence), instead of named exposures (e.g., poverty) impact neurobiology through neurodevelopmental processes of neuroplasticity. Our model results in testable hypotheses and clear intervention strategies. We predict that exposure to trauma will have a distinct neurobiological impact from exposure to a lack of cognitive stimulation and that these distinct exposures will benefit from different interventions. Specificity in this arena is thus likely to better support educational achievement for disadvantaged children.
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Tibu, F., Sheridan, M. A., McLaughlin, K. A., Nelson, C. A., Fox, N. A., & Zeanah, C. H. (2016). Reduced Working Memory Mediates the Link between Early Institutional Rearing and Symptoms of ADHD at 12 Years. Frontiers in Psychology , 7 1850.Abstract
Children who are raised in institutions show severe delays across multiple domains of development and high levels of psychopathology, including attention deficit/hyperactivity disorder (ADHD). Low performance in executive functions (EFs) are also common in institutionally reared children and often do not remediate following improvements in the caregiving environment. ADHD symptomatology also remains elevated even after children are removed from institutional care and placed in families. We investigate whether poor EF is a mechanism explaining elevated rates of ADHD in children reared in institutional settings in the Bucharest Early Intervention Project (BEIP). In the current study, we examine the potentially mediating role of poor EF in the association between institutionalization and symptoms of ADHD at age 12 years. A total of 107 children were assessed with the Cambridge Neuropsychological Test Automated Battery (CANTAB) on working memory, set-shifting and planning. We also obtained concurrent teacher reports on their levels of ADHD symptoms (inattention and impulsivity separately). Institutionalization strongly predicted elevations in symptoms of inattention and impulsivity at age 12 years (ps \textless 0.01). Indices of working memory and planning were also associated with ADHD after controlling for potential confounders (ps \textless 0.03). Mediation analyses revealed that poor working memory performance mediated the link between exposure to early institutionalization and higher scores of both inattention and impulsivity. These results replicate and extend the findings that we reported in the BEIP sample at age 8 years. Together, they suggest that compromised working memory is a key mechanism that continues to explain the strikingly high levels of ADHD in late childhood among children institutionalized in early life. Interventions targeting working memory may help to prevent ADHD among children exposed to institutional care.
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Austin, S. B., Rosario, M., McLaughlin, K. A., Roberts, A. L., Gordon, A. R., Sarda, V., Missmer, S., et al. (2016). Sexual orientation and diurnal cortisol patterns in a cohort of U.S. young adults. Psychoneuroendocrinology , 69, 197–208.Abstract
Sexual minorities in the United States are at elevated risk of bullying, discrimination, and violence victimization, all stressors that have been linked to psychological and behavioral stress responses including depressive and anxious symptoms and substance use. Acute and chronic stressors may also elicit physiologic stress responses, including changes in the regulation of the hypothalamic-pituitary-adrenocortical (HPA) axis. Few studies, however, have examined the relationship between minority sexual orientation and diurnal cortisol patterns. The present study included 1670 young adults ages 18-32 years (69% female, 31% male) from the Growing Up Today Study, a prospective cohort of U.S. youth. Participants provided five saliva samples over one day to estimate diurnal cortisol patterns. Sexual orientation groups included: completely heterosexual with no same-sex partners (referent), completely heterosexual with same-sex partners/mostly heterosexual, and gay/lesbian/bisexual. Covariates included perceived stress and stressful life events in the past month. Sex-stratified multilevel models of log-transformed cortisol values were used to model diurnal cortisol patterns, and generalized estimating equations were used to model area under the curve (AUC), both with respect to ground (AUCg) and increase (AUCi). Among females, sexual minorities reported significantly more stressful life events in the past month than their heterosexual counterparts. In adjusted multilevel models, sexual orientation was not significantly associated with diurnal cortisol patterns or with AUCg or AUCi in either females or males. There were no significant interactions between sexual orientation and stressful life events. Time-varying negative mood was significantly associated with higher cortisol levels across the day for both female and male participants, after adjusting for all covariates. This study from a large cohort of U.S. young adults did not detect a relationship between sexual orientation and diurnal cortisol patterns. Despite consistent evidence indicating that, compared to heterosexuals, sexual minorities experience elevated exposure to multiple forms of stressors and adversity across the life course, we did not find differences in diurnal cortisol rhythms by sexual orientation. One possible explanation is that sexual minority participants in the study exhibited physiologic resilience.
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Peverill, M., McLaughlin, K. A., Finn, A. S., & Sheridan, M. A. (2016). Working memory filtering continues to develop into late adolescence. Developmental Cognitive Neuroscience , 18, 78–88.Abstract
While most measures of working memory (WM) performance have been shown to plateau by mid-adolescence and developmental changes in fronto-parietal regions supporting WM encoding and maintenance have been well characterized, little is known about developmental variation in WM filtering. We investigated the possibility that the neural underpinnings of filtering in WM reach maturity later in life than WM function without filtering. Using a cued WM filtering task (McNab and Klingberg, 2008), we investigated neural activity during WM filtering in a sample of 64 adults and adolescents. Regardless of age, increases in WM activity with load were concentrated in the expected fronto-parietal network. For adults, but not adolescents, recruitment of the basal ganglia during presentation of a filtering cue was associated with neural and behavioral indices of successful filtering, suggesting that WM filtering and related basal ganglia function may still be maturing throughout adolescence and into adulthood.
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Jenness, J. L., Jager-Hyman, S., Heleniak, C., Beck, A. T., Sheridan, M. A., & McLaughlin, K. A. (2016). Catastrophizing, rumination, and reappraisal prospectively predict adolescent PTSD symptom onset following a terrorist attack. Depression and Anxiety , 33 (11), 1039–1047. Publisher's VersionAbstract
Disruptions in emotion regulation are a transdiagnostic risk factor for psychopathology. However, scant research has examined whether emotion regulation strategies are related to the onset of posttraumatic stress disorder (PTSD) symptoms among youths exposed to trauma. We investigated whether pretrauma emotion regulation strategies prospectively predicted PTSD symptom onset after the 2013 Boston Marathon terrorist attack among adolescents and whether these associations were moderated by the degree of exposure to media coverage of the attack. A sample of 78 Boston-area adolescents (mean age = 16.72 years, 65% female) who previously participated in studies assessing emotion regulation and psychopathology were recruited following the terrorist attack. Within 4 weeks of the attack, we assessed self-reported PTSD symptoms and attack-related media exposure via an online survey. We examined the association of pretrauma emotion regulation strategies with PTSD symptom onset after adjustment for pretrauma internalizing symptoms and violence exposure. Greater pretrauma engagement in rumination predicted onset of PTSD symptoms following the attack. Adolescents who engaged in catastrophizing also had greater PTSD symptoms postattack, but only when exposed to high levels of media coverage of the attacks; the same pattern was observed for adolescents who engaged in low levels of cognitive reappraisal. Engagement in specific emotion regulation strategies prior to a traumatic event predicts the onset of PTSD symptoms among youths exposed to trauma, extending transdiagnostic models of emotion regulation to encompass trauma-related psychopathology in children and adolescents.
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2015
Gilman, S. E., Ni, M. Y., Dunn, E. C., Breslau, J., McLaughlin, K. A., Smoller, J. W., & Perlis, R. H. (2015). Contributions of the social environment to first-onset and recurrent mania. Molecular psychiatry , 20 (3), 329–336. Publisher's VersionAbstract
{In treated cohorts, individuals with bipolar disorder are more likely to report childhood adversities and recent stressors than individuals without bipolar disorder; similarly, in registry-based studies, childhood adversities are more common among individuals who later become hospitalized for bipolar disorder. Because these types of studies rely on treatment-seeking samples or hospital diagnoses, they leave unresolved the question of whether or not social experiences are involved in the etiology of bipolar disorder. We investigated the role of childhood adversities and adulthood stressors in liability for bipolar disorder using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC
Gilman, S. E., Ni, M. Y., Dunn, E. C., Breslau, J., McLaughlin, K. A., Smoller, J. W., & Perlis, R. H. (2015). Contributions of the social environment to first-onset and recurrent mania. Molecular psychiatry , 20 (3), 329–336. Publisher's VersionAbstract
{In treated cohorts, individuals with bipolar disorder are more likely to report childhood adversities and recent stressors than individuals without bipolar disorder; similarly, in registry-based studies, childhood adversities are more common among individuals who later become hospitalized for bipolar disorder. Because these types of studies rely on treatment-seeking samples or hospital diagnoses, they leave unresolved the question of whether or not social experiences are involved in the etiology of bipolar disorder. We investigated the role of childhood adversities and adulthood stressors in liability for bipolar disorder using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC
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Sumner, J. A., McLaughlin, K. A., Walsh, K., Sheridan, M. A., & Koenen, K. C. (2015). Caregiving and 5-HTTLPR Genotype Predict Adolescent Physiological Stress Reactivity: Confirmatory Tests of Gene × Environment Interactions. Child Development , 86 (4), 985–994.Abstract
A theory-driven confirmatory approach comparing diathesis-stress and differential susceptibility models of Gene × Environment (G × E) interactions was applied to examine whether 5-HTTLPR genotype moderated the effect of early maternal caregiving on autonomic nervous system (ANS) stress reactivity in 113 adolescents aged 13-17 years. Findings supported a differential susceptibility, rather than diathesis-stress, framework. Carriers of one or more 5-HTTLPR short alleles (SS/SL carriers) reporting higher quality caregiving exhibited approach ANS responses to a speech task, whereas those reporting lower quality caregiving exhibited withdrawal ANS responses. Carriers of two 5-HTTLPR long alleles (LL carriers) were unaffected by caregiving. Findings suggest that 5-HTTLPR genotype and early caregiving in interaction are associated with ANS stress reactivity in adolescents in a "for better and for worse" fashion, and they demonstrate the promise of confirmatory methods for testing G × E interactions.
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McLaughlin, K. A., Sheridan, M. A., Tibu, F., Fox, N. A., Zeanah, C. H., & Nelson, C. A. (2015). Causal effects of the early caregiving environment on development of stress response systems in children. Proceedings of the National Academy of Sciences of the United States of America , 112 (18), 5637–5642.Abstract
Disruptions in stress response system functioning are thought to be a central mechanism by which exposure to adverse early-life environments influences human development. Although early-life adversity results in hyperreactivity of the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis in rodents, evidence from human studies is inconsistent. We present results from the Bucharest Early Intervention Project examining whether randomized placement into a family caregiving environment alters development of the autonomic nervous system and HPA axis in children exposed to early-life deprivation associated with institutional rearing. Electrocardiogram, impedance cardiograph, and neuroendocrine data were collected during laboratory-based challenge tasks from children (mean age = 12.9 y) raised in deprived institutional settings in Romania randomized to a high-quality foster care intervention (n = 48) or to remain in care as usual (n = 43) and a sample of typically developing Romanian children (n = 47). Children who remained in institutional care exhibited significantly blunted SNS and HPA axis responses to psychosocial stress compared with children randomized to foster care, whose stress responses approximated those of typically developing children. Intervention effects were evident for cortisol and parasympathetic nervous system reactivity only among children placed in foster care before age 24 and 18 months, respectively, providing experimental evidence of a sensitive period in humans during which the environment is particularly likely to alter stress response system development. We provide evidence for a causal link between the early caregiving environment and stress response system reactivity in humans with effects that differ markedly from those observed in rodent models.
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Lewis, T., Schwebel, D. C., Elliott, M. N., Visser, S. N., Toomey, S. L., McLaughlin, K. A., Cuccaro, P., et al. (2015). The association between youth violence exposure and attention-deficit/hyperactivity disorder (ADHD) symptoms in a sample of fifth-graders. The American Journal of Orthopsychiatry , 85 (5), 504–513.Abstract
The purpose of the current study was to examine the association between violence exposures (no exposure, witness or victim only, and both witness and victim) and attention-deficit/hyperactivity disorder (ADHD) symptoms, as well as the potential moderating role of gender. Data from 4,745 5th graders and their primary caregivers were drawn from the Healthy Passages study of adolescent health. Parent respondents completed the DISC Predictive Scales for ADHD, and youth provided information about exposure to violence. Results indicated that youth who reported both witnessing and victimization had more parent-reported ADHD symptoms and were more likely to meet predictive criteria for ADHD. Among those with both exposures, girls exhibited a steeper increase in ADHD symptoms and higher probability of meeting predictive criteria than did boys. Findings indicate that being both victim-of and witness-to violence is significantly associated with ADHD symptoms particularly among girls.
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