Gestational diabetes and low socioeconomic status raise risk of ADHD in children

In the first study of its kind, researchers at Queens College and Mount Sinai School of Medicine have found that low socioeconomic status (SES) and maternal gestational diabetes together may cause a 14-fold increased risk of attention deficit hyperactivity disorder (ADHD) in six year olds. The data are published in the January issue of the Archives of Pediatrics and Adolescent Medicine, one of the JAMA/Archives journals.

Led by Jeffrey M. Halperin, PhD, Distinguished Professor of Psychology at Queens College and Professorial Lecturer in Psychiatry at Mount Sinai, and Yoko Nomura, PhD, Assistant Professor of Psychology at Queens College and Assistant Clinical Professor of Psychiatry at Mount Sinai, the research team evaluated 212 children at age three or four and again at age six. They compared 115 children who had low SES, maternal gestational diabetes, or both, to 97 children who had neither, evaluating members of the control group at age three or four then again at age six. The team found that while maternal gestational diabetes and low SES increased the risk for the child to develop ADHD, the risk increased exponentially when the two factors were taken together.

"To our knowledge, this is the first study to evaluate how prenatal exposure to gestational diabetes and low socioeconomic status together contribute to the development of ADHD," said lead author Dr. Nomura. "The results show these children are at far greater risk for developing ADHD or showing signs of impaired neurocognitive and behavioral development."

At preschool age, children were assessed using a standard ADHD rating scale, a survey that was completed by their parents and teachers, and through one-on-one semi-structured interviews. Additional measurements included tests of neuropsychological functioning, IQ scores, and child temperament. The researchers determined history of gestational diabetes through one-on-one interviews with the mothers of the participants. Socioeconomic status was evaluated with a widely used measuring tool called the Socioeconomic Prestige Index.

At age six, the children were evaluated again using behavioral and emotional clinical scales, along with neuropsychological tests, to measure several functions, including hyperactivity, aggression, anxiety, and attention. Independently, gestational diabetes or low SES doubled the risk for ADHD. Collectively, the risk increased 14-fold.

Since ADHD is a disorder with high heritability, the authors conclude that clinicians should make stronger efforts to help families take steps to prevent the nongenetic factors that contribute to its development. Nutrition and psychosocial counseling may help modify the risk, during pregnancy and in early childhood.

"Physicians and health care professionals need to educate their patients who have a family history of diabetes and who come from lower income households on the risk for developing ADHD," said Dr. Halperin. "Even more important is the need for obstetricians, pediatricians, and internists to work together to identify these risks."

The study was supported by a grant to Dr. Halperin through Queens College from the National Institute of Mental Health. Other collaborators include David Marks, PhD, Assistant Professor of Psychiatry at NYU Langone Medical Center; Holly Loudon, MD, Assistant Professor of Obstetrics, Gynecology, and Reproductive Sciences at Mount Sinai School of Medicine; Joanne Stone, MD, Professor of Obstetrics, Gynecology, and Reproductive Sciences at Mount Sinai School of Medicine; Michelle Yoon, a research coordinator at Mount Sinai School of Medicine; and Bella Grossman, a former Queens College undergraduate who is now a PhD student in clinical psychology at the New School for Social Research.

Queens College of the City University of New York (CUNY), founded in 1937, is dedicated to the idea that a first-rate education should be accessible to talented individuals of all backgrounds and financial means. Its more than 20,000 students come from over 150 nations and speak scores of languages, creating an extraordinarily diverse and welcoming environment. Located on a beautiful, 77-acre campus in Flushing, Queens College enjoys a national reputation for its liberal arts and sciences and pre-professional programs. Each year Queens College has been cited by The Princeton Review as one of the nation's 100 "Best Value" colleges, thanks to its outstanding academics, generous financial aid packages, and relatively low costs. The college opened its first residence hall in August 2009. More info on Queens College is available at www.qc.cuny.edu. Follow Queens College on Twitter and Facebook.

The Mount Sinai Medical Center encompasses both The Mount Sinai Hospital and Mount Sinai School of Medicine. Established in 1968, Mount Sinai School of Medicine is one of the leading medical schools in the United States. The Medical School is noted for innovation in education, biomedical research, clinical care delivery, and local and global community service. It has more than 3,400 faculty in 32 departments and 14 research institutes, and ranks among the top 20 medical schools both in National Institutes of Health (NIH) funding and by U.S. News & World Report.

The Mount Sinai Hospital, founded in 1852, is a 1,171-bed tertiary- and quaternary-care teaching facility and one of the nation's oldest, largest and most-respected voluntary hospitals. In 2011, U.S. News & World Report ranked The Mount Sinai Hospital 16th on its elite Honor Roll of the nation's top hospitals based on reputation, safety, and other patient-care factors. Of the top 20 hospitals in the United States, Mount Sinai is one of 12 integrated academic medical centers whose medical school ranks among the top 20 in NIH funding and US News & World Report and whose hospital is on the US News & World Report Honor Roll. Nearly 60,000 people were treated at Mount Sinai as inpatients last year, and approximately 560,000 outpatient visits took place.

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