Intimate partner violence (IPV) affects 1 in 4 women and 1 in 7 men. Children who experience this violence in the home are at increased risk for behavioral and mental health problems. According to a new study, a child's exposure to IPV and maternal depression before age 3 is associated with the development of attention-deficit/hyperactivity disorder (ADHD). Early exposure to parental depression is also associated with the child being prescribed psychotropic medications.
The study followed 2,422 children receiving care from 4 pediatric clinics. Each child had at least two documented visits. The first visit was between birth and age 36 months, while the second visit was between 37 and 72 months of age. During routine primary care encounters, their parents were screened for IPV and depression.
By the time their child turned 3 years old, 58 parents (2.4 percent) had reported IPV and depressive symptoms together. Another 69 parents (2.8 percent) reported IPV only. Finally, 704 parents (29.1 percent) reported depressive symptoms only. After 3 years of age, the prevalence of ADHD (4.5 percent) in children was significantly associated with depressive symptoms in their parents. This compares to 2.8 percent in children of parents without depressive symptoms. These children also had a higher likelihood of receiving psychotropic medications (2.9 percent vs. 1.6 percent). For exposure to IPV, the rates were 6.3 percent versus 3.1 percent, respectively. Children of parents with both IPV and depressive symptoms before age 3 were more likely to develop ADHD after age 3 years compared to non-exposed children.
The researchers recommend that pediatricians increase their efforts to screen these younger children for exposure to IPV and other risk factors when a parent or teacher is concerned about the child's behavior. If IPV or parental depressive symptoms are identified, there can be active surveillance at each visit for changes in behavior. In addition, parents with depression should be treated as part of the child's overall treatment plan. The study was supported in part by AHRQ (HS18453).
See "Associations of early exposure to intimate partner violence and parental depression with subsequent mental health outcomes," by Nerissa S. Bauer, M.D., M.P.H., Amy L. Gilbert, J.D., M.P.H., Aaron E. Carroll, M.D., M.S., and Stephen M. Downs, M.D., M.S., in the February 4, 2013, JAMA Pediatrics 167(4), pp. 341-347.