Claudia Lugo-Candelas Hello everyone. My name is  Claudia Lugo-Candelas and today I’m going to be   walking you through our paper called ADHD and risk  for subsequent to adverse childhood experiences,   understanding the cycle of adversity. So the  first childhood experiences are very common and   the compass three main categories, parental loss,  maltreatment and parental maladjustment. ACEs,   like I said, are very common, although they  are more commonly experienced by children,   individuals from disadvantaged populations. So, for example, ethnic and racial minorities.   The detrimental long-term impacts of ACEs are  well documented on both physical and mental health   wellbeing. However, particularly important for  the study at hand is the consistent finding that   children who experience ACEs are at an increased  risk of experiencing ADHD later on in life.   However, at the reverse association whether having  ADHD increases your risk for experiencing sequent   tolerant adversities is not well understood, and  a couple of studies that hindered disassociation,   however they’ve been limited in that a  lot of these studies are cross-sectional,   and what happens with the cross-sectional  study is that if you have concurrent ADHD   and ACEs assessments you have this bit of  a chicken and egg kind of situation when   you don’t know which one came first. The literature has also been limited in that it   hasn’t included the children at highest likelihood  for experiencing adversity. So again like I said   socio-economically disadvantaged children and  children from ethnic and racial minorities are at   increased risk for ACEs and ADHD as well.  This is particularly true for populations   in the US. They have higher ACEs then they’re  counterparts in ADHD diagnosis has sky rocketed   within these populations in the last decade. So the present study aims to address the gaps   in the literature and inform our prevention  strategies by examining if children with   ADHD are at an increased risk for ACEs in  a perspective longitudinal population based   study of Porto Rican children and adolescents in  the South Bronx in New York and in Porto Rico.   Here we’re going to leverage a prospectively  collected ADHD and ACE assessments and by   doing that we’re uniquely able to examine  whether ADHD at this one initial time point   predicts a sequent experiences of ACEs while  adjusting for pre-existing, what we’re going to   call baseline ACEs, in this under-privileged  population are at higher risk for ACEs. The participants in the study are the Boricua  Youth Study, BYS participants. This is a study   of two representative longitudinal probability  samples of Porto Rican children and their parents.   Families were included in the present study,  if they participated across all three data   collection waves. This yielded a sample of 2,132  children that were ages five to 15 at that first   assessment wave. So participants were interviewed  in their home, involved with three waves of data   collection, each were one year apart. The BYS has  a huge, excellent retention rate. So by wave two   there was 92%. By wave three it was 88%. ADHD was  assessed at all three waves via the diagnostic   interview schedule for children. So with the  DIS and ACEs were assessed using a number of   instruments. We have reported those separately in  our paper with a citation to the original paper   that details each of the assessments, but  briefly we assessed 11 adversities covering four   domains. So childhood mistreatment which included  neglect and physical, sexual and emotional abuse.   Parental maladjustment which included intimate  partner balance and types of personality and   parental arrest or jail, substance use problems  and emotional problems, and then exposure to   violence and lastly parental loss which included  parental death and divorce/separation. And for a child who were not able to address here,  very important which is experiences of   racism and discrimination and that has to do  with the fact that some of our children were   quite young and had original data collection  with, so we didn’t ask that from them. We   are analysis to examine whether wave one ADHD  increased with supportive sequent ACEs. We used   logistic regression using survey procedures  and SAS. Our outcome measure was having a   new, and that means a not previously  experienced ACE at either waves two or   three. So you could not have had experience at  ACE at wave one for that one to count as a new   incidence ACE. Adjusting models  controlled for side of recruitment, age,   disruptive behaviour disorders, use of public  assistance, wave one ACEs and child sex. So our analysis showed that wave one ADHD  was in fact associated with increased odds of   experiencing a new ACE at waves two or three. When  risk for ACEs was examined separately for each ACE   domain we found that parental maladjustment at  wave two or three was significantly predicted   by wave one ADHD. We also examined ADHD sub-type  effects and we found that the inattentive,   but not the hyperactive or the combined  presentation, sub-types at wave one were   predictive of wave two and wave three ACEs. So the findings document that ADHD predicts   increased likelihood of accruing subsequent  ACEs and that inattentive ADHD may be the   strongest predictor of future ACEs. Here because  of our longitudinal assessment we were able to   establish a clear temporal sequence that strongly  indicates that the ACEs that we considered as   outcome in our analysis accrued after the ADHD  symptoms were present. Given the whole documented   associations between ACEs and subsequent  risk for AHDH the study really points to the   cycle that perpetuates hardship and adversity  in the most under-assertive populations. We think that the finding about  inattentive ADHD is likely to be   about the nature of the very symptoms.  So inattentive symptoms are less likely   to be detected. Treatment for these starts  later and it lasts. It’s a shorter duration   and these symptoms also frequently persist into  adulthood. So the longer these symptoms hang out   in our present that might give more opportunity  for these snowballing, kind of, affects.   Our findings suggested ADHD may have a  role in perpetuating the cycle of adversity   and highlight the dire need for treatment,  because ADHD treatment is usually followed   by symptom reductions. ADHD treatment  may be a viable ACE prevention strategy.   However, our findings strongly under-score  the need for parents centred interventions.   Maybe in the form of mental health or  substance abuse services or parenting support.   The major finding of, the major point  of our findings highlight is that, I   call it the growing number of suggested  ACEs are a serious public health concern   and that we need public prevention efforts. Thank you so much for your attention.