. 2021 Jul 9;24(2):369–389. doi: 10.1177/15248380211030234

Table 1.

Review Results Organized by Child and Adult Samples.

Reference	Study Aims	Sample	Study Setting and Design	Measures	Main Findings
Child/adolescent samples
Boyd et al. (2019)	Examining how maltreatment influences attention problems	7,214 Mother and child dyads with information on child maltreatment	Australia Prospective longitudinal, birth cohort study	– ADHD: CBCL completed by caregivers; the YSR reported by children at 14 years; the YASR completed by participants at 21 years – CSA: official CPS records	14 years of age YSR: in bivariate analyses, but not in multiple regressions, sexual abuse associated with more attention problems: F test = 5.221, p = .022 YSR: unstandardized B = .484, SE = 0.266, β = .026, t = 1.82, p = .069 14 years of age CBCL: in bivariate analyses and multiple regressions, sexual abuse associated with more attention problems: F test = 6.755, p = .009 CBCL: unstandardized B = .896, SE = 0.316, β = .039, t = 2.838, p = .005 Confounding factors included for YSR and CBCL at 14 years of age: notification for physical, emotional abuse, or neglect; gender; indigenous Australian; relationship status; family income prior to birth; maternal education; chronic maternal depression; and birthweight 21 years of age YASR: sexual abuse not associated with attention problems in bivariate and multiple regressions: F test = 0.199, p = .655 Unstandardized B = .229, SE = 0.255, β = .015, t = 0.897, p = .370 Confounding factors included at 21 years of age YASR: same as in previous regression + youth income and relationships
Ford et al. (2000)	Investigate history of maltreatment in child psychiatry outpatients with ADHD	165 Children (mean age = 12, SD = 3.4; 57% female, 43% male) Study groups: for sexual abuse, 11% in ADHD only group, 18% in ODD only, 31% in ADHD/ODD group, and 0% adjustment disorder group	United States Retrospective case control	– ADHD: Multimodal Treatment Study of Children with ADHD – CSA: structured clinical interview with parent and child	Bivariate analysis: study groups differed significantly in sexual abuse χ²(3, N = 165) = 15.0, p < .001 Sexual abuse was greatest for the group with both ADHD and ODD
Ford et al. (2009)	Identify subgroups of children with psychiatric disorders in terms of maltreatment history	397 Psychiatric residents (mean age = 13.4 ± 2.6; 81% male) 126 had sexual abuse history	United States Cross-sectional, chart review study	– Attention: Devereux Scales of Mental Disorders – Impulsivity and hyperactivity: Conners’ Teacher Questionnaire – CSA: medical records	Sexual abuse was not a significant predictor of attention problems: (B = .30, SE = 1.30, β = .01, t = 0.23, p = .82) and did not predict Conners’ Teacher scores, B = .84, SE = 1.06, β = .05, t = 0.79, p = .43. Confounding factors included: female gender, non-White ethnicity, psychotic disorder, internalizing and externalizing disorder, developmental disorder, substance use disorder, complex trauma, parental impairment, nonfamily placement, placed before age 5, multiple placements, and physical abuse
Gokten et al. (2016)	To examine the risk of children diagnosed with ADHD to experience abuse or neglect	104 Children diagnosed with ADHD; 104 healthy control children were compared Children between 6 and 12 years old	Turkey Cross-sectional, case-controlled	– ADHD: the Turkish Schedule for Affective Disorders and Schizophrenia for School Age Children—Present and Lifetime (Kiddie Schedule for Affective Disorders and Schizophrenia; K-SADS-PL-T) – CSA: The Abuse Assessment Questionnaire in Children and Adolescents	Bivariate analysis: no statistically significant difference between children with and without ADHD in terms of sexual abuse (p = .149)
Gomes-Schwartz et al. (1985)	Evaluate children’s emotional responses following sexual abuse	112 Children ranging in age from 4 to 18	United States Cross-sectional	– ADHD: Louisville Behavior Checklist—Sexual abuse: evaluated by staff at the Family Crisis Program for Sexually Abused Children	Bivariate analysis (t tests): Among 7- to 13-year-olds, the mean score of hyperactivity was significantly higher than that of the general population as reported in the norm sample of the Louisville Behavior Checklist (M = 58.62, SD = 14.16, p < .05)
González et al. (2019)	Examine associations between maltreatment and ADHD and estimate associations between repetitive maltreatment and ADHD	2,480 Latino male and female children aged 5–13 years	United States Cross-sectional and longitudinal	– ADHD: DISC-IV (parent-report) – CSA: the sexual victimization measure from Finkelhor and Dziuba-Leatherman (child self-report)	Logistic regression: no significant association between sexual abuse and ADHD (OR = 1.44, p = .59) Confounding factors included: wave (time), study site (New York, Puerto Rico), age, gender (except for stratified analyses), household education and income band, any parental psychopathology, and having taken ADHD medication (time-varying)
Gul & Gurkan (2018)	Investigate child and parent factors contributing to maltreatment in children with ADHD	Children with ADHD (n = 100) and a comparison group without ADHD (N = 100) Children were between 6 and 11 years old (M = 8.4 years, SD = 0.88 years); 73% male	Turkey Case-control	– ADHD: K-SADS-PL; CRS (parent report) – CSA: Abuse and Neglect Assessment Questionnaire for Children developed by Irmak (2008; child self-report); two questions on sexual abuse	Bivariate analysis: no significant differences in sexual abuse between ADHD and control groups
Hébert et al. (2006)	Conduct a cluster analysis to identify profiles of children who had been sexually abused	123 Children (110 girls and 13 boys) 7 and 13 years old (M = 9.22, SD = 1.53)	Canada Cluster analysis, case-control study	– ADHD: CBCL – CSA: adaptation (Parent & Hébert, 1995) of the History of Victimization Form	Cluster analysis: results revealed four clusters of sexually abused children. Three of the four clusters of sexually abused children had higher scores of attention problem than non-abused children (p < .05)
Jaisoorya et al. (2016)	Study the prevalence of self-reported ADHD	7,150 Final sample; 3,631 (50.8%) were boys and 3,519 (49.2%) were girls with a mean age of 15.3 years (range = 12–19 years)	India Cross-sectional	– ADHD: The BAARS-IV–Childhood Symptoms self-report – CSA: four questions modified from the Child Abuse Screening Tool–Children’s Version	Logistic regression: students with ADHD combined type compared with the non-ADHD group had higher odds of reporting contact sexual abuse (OR = 3.63 [2.56, 5.15])
Kaplow et al. (2008)	Investigate attention problems in children who have experienced sexual abuse and the roles of gender, trauma, and disclosure	129 Girls and 27 boys (mean age = 10.7 years)	United States Longitudinal	– Demographic information and abuse were extracted from written reports completed at a Time 1 forensic interview – CSA: abuse characteristics were coded for severity scale (0 = exposure to 3 = oral, anal, or vaginal intercourse) and intra versus extrafamilial abuse – Parent report of attention problems using CBCL	Bivariate analysis: significantly higher mean attention score among children abused by someone within the family compared to those abused by someone outside of the family Path analysis revealed that intrafamilial abuse significantly predicted greater attention problems (β = .23) Confounding factors included: dissociation and time to follow-up from T1 to T2
McLeer et al. (1994)	Comparing the prevalence of psychiatric disorders among sexually abused and non-abused children	26 Sexually abused children (mean age = 9) referred to sexual abuse clinic for psychiatric evaluation 23 Nonsexually abused children (mean age = 10.4) recruited from an outpatient department	United States Cross-sectional	– ADHD: Psychiatric disorders assessed using K-SADS-E – CSA: sexually abused children were referred from rape and sexual crisis centers and from private practitioners	Bivariate analysis: ADHD was the most prevalent psychiatric disorder diagnosed in children who had been sexually abused, though the difference between sexually abused and nonsexually children was not statistically significant
Ohlsson et al. (2018)	To examine whether ADHD symptoms predict self-reported CSA at age 18	4,500 Children participated: 1,902 males, 2,598 females 18 males and 256 females reported sexual victimization	Sweden Prospective longitudinal, population-based - Child and Adolescent Twin Study	– ADHD (parent report; 9 or 12 years old): Autism–Tics, AD/HD and other Comorbidities inventory (A-TAC). – CSA (children report at age 18): two questions	Logistic regression: females with clinical ADHD had higher risk of experiencing sexual abuse (OR = 2.02, p < .05); same pattern for males, but not statistically significant Confounding factor included: overall neurodevelopmental disorder symptoms (autism spectrum and ADHD)
Ozbaran et al. (2009)	Evaluating the effects of sexual abuse on children	20 Parents and children followed for 2 years 9 Girls and 11 boys between the ages of 5 and 16 (M = 9.4)	Turkey Longitudinal	– ADHD: psychiatric evaluations according to DSM-IV; evaluation form for details of sexual abuse; demographic form – CBCL completed by mothers – CSA (2-year follow-up): evaluation form; interview with specialist of the child abuse team	Bivariate analysis: in comparison to Turkish norms, the sexually abused group of children had significantly higher attention problems both in the first year (p < .001) and third year assessment (p < .01)
Ruggiero et al. (2000)	Examine predictors of psychopathology in sexually abused children	Primarily African-American sample (84%) 65 Females and 15 males (mean age = 9.4 years)	United States Cross-sectional study part of a larger longitudinal study	– ADHD: CBCL – CSA: separate structured interviews for children and parents (frequency of abuse, victim–perpetrator relationship, disclosure of sexual abuse)	Descriptive analysis: higher scores in attention problems were associated with a higher frequency of sexual abuse (also included: gender, age at onset, severity, duration, and perpetrator type) Confounding factor included: physical abuse history
Sonnby et al. (2011)	Examine the prevalence of ADHD and depression in individuals with experiences of sexual abuse	All secondary school students (15–16 and 17–18 years old) n = 4,910 (2,473 boys and 2,437 girls)	Sweden Survey—Survey of Adolescent Life	– ADHD: Swedish translation of the short form of the World Health Organization ADHD self-report scale – CSA: assessed with three self-report questions	Logistic regression: ADHD boys, OR = 1.938, CI [1.184, 3.171] ADHD girls, OR = 2.577, CI [1.732, 3.835] Confounding factors included: separated parents, parental unemployment, type of housing, and non-Scandinavian ethnicity
Walrath et al. (2003)	Investigate behavior and functioning in children (aged 5–17.5 years) with histories of sexual abuse	759 Children with a history of sexual abuse; 2,722 children without sexual abuse history	United States Cross-sectional	– ADHD: behavior CBCL; diagnoses: made by clinical personnel according to DSM-IV – CSA: child or caregiver provided information in response to a dichotomous question (yes/no)	Logistic regression: child sexual abuse was associated with lower rates of ADHD compared to children with no history of sexual abuse (17.4% vs. 26.7%; OR = 0.58, SE = .06, p < .01 For child ratings on CBCL, there was no significant difference between those with and without sexual abuse histories in terms of attention problems (OR = 1.19, SE = .18). For caregiver ratings, there was a significant difference in attention problems for children with and without sexual abuse histories (OR = 1.22, SE = 10, p < .05) Confounding factors included: demographic (gender, age, and race); life challenges (psychiatric hospitalization, physical abuse, runaway attempts, suicide attempts, drug/alcohol use, and sibling in foster care)
Adult samples
Afifi et al. (2014)	Using a nationally representative sample, examine the relation between child abuse and mental health	Canadians aged 18 or older (n = 23,395)	Canada Cross-sectional	– ADHD: World Health Organization version of the Composite International Diagnostic Interview – CSA: 2012 Canadian Community Health Survey; self-reported; occurring before the age of 16	Logistic regression: CSA-ADD − OR1 (95% CI) = 2.9 [2.1, 4.0] CSA-ADD − OR2 (95% CI) = 1.7 [1.2, 2.4] OR1 confounding factors included: adjusted for age, sex, visible minority status, Canadian born status, education, income, marital status, and province OR2 Confounding factors included: adjusted for sociodemographic variables listed above, other types of child abuse and any diagnosed mental disorders
Ebejer et al. (2012)	Identifying the prevalence of ADHD and exposure to childhood risk factors	1,369 Men and 2,426 women, recruited through the National Health and Medical Research Council Twin Registry	Australia Twin study, cross-sectional	– ADHD: The semistructured assessment for the Genetics of Alcoholism (include 34 items on ADHD diagnosis) – CSA: coded as a 0 or 1. Unclear how many questions assessed sexual abuse	Logistic regression: sexual abuse during childhood significantly predicted inattentive and hyperactivity-impulsive symptoms (p > .001 and p > .01, respectively) Confounding factors included: conduct problems included in the regression as a covariate. Other confounding factors included childhood SES, family structure, conflicts with parents, parental arguing, parental tension, parental drinking, and parental rules
Ferrer et al. (2017)	Compare maltreatment history among adults with ADHD, BPD, and comorbid ADHD with borderline	204 Patients with BPD clinical features 170 (83.3%) women (mean age = 31.17, SD = 9.61; clinical population)	Spain Cross-sectional	– ADHD: The Wender Utah Rating Scale (WURS) – CSA: CTQ-SF	Bivariate analysis: women with BPD and ADHD have higher scores of CSA than women without BPD and without ADHD: t(98) = 2.29, p = .02 No significant differences between women with ADHD only and women without BPD and without ADHD (p > .05) Logistic regression: emotional abuse (β = .18), physical abuse (β = −.22), and sexual abuse (β = .15) predicted combined BPD-ADHD diagnosis Confounding factor included: gender
Fuller-Thomson and Lewis (2015; same sample as Afifi et al., 2014)	Examine retrospectively reported abuse	10,496 Men and 12,877 women from the Canadian Community Health Survey-Mental Health	Canada Cross-sectional	– ADHD: self- reported to having a condition that has been diagnosed by a health professional – CSA: two questions on sexual abuse before the age of 16	Logistic regression: sexual abuse was significantly related to higher odds of having ADHD (men OR = 2.57, p < .001; women OR = 2.55, p < .001) Confounding factors included age and gender; logistic regression analysis adjusted for parental domestic abuse and physical abuse
Fuller-Thomson et al. (2016; same sample as Afifi et al., 2014)	Develop a profile of women with self-reported ADHD in comparison to those without ADHD	Women between the ages of 20 and 39 drawn from the 2012 Canadian Community Health Survey—Mental Health 107 Women self-reported diagnosis of ADHD; 3,801 not diagnose with ADHD	Canada Cross-sectional	– ADHD: self-reported to “do you have attention deficit disorder?” – CSA: two questions on sexual abuse before the age of 16	Descriptive analysis; prevalence of CSA: no ADHD: 10.9% p < .001 ADHD: 35.8%, p < .001 This difference was significant
Jaisoorya et al. (2019)	Document prevalence of retrospectively recalled symptoms of ADHD	5,145 College students, 1,750 (34.8%) were men and 3,395 (65.2%) were women (mean age = 19.4) -143 Participants with ADHD (67 male, 76 female); 5,002 non-ADHD participants (1,716 male; 3,286 female)	India Cross-sectional	– ADHD: Barkley Adult ADHD Rating Scale-IV (students rated their ADHD symptoms between 5 and 12 years) – CSA: lifetime exposure to sexual abuse was assessed using four questions from the Child Abuse Screening Tool Children’s Version 24	Logistic regression: participants with clinically significant ADHD symptoms had higher odds of contact (OR = 3.10) and non-contact sexual abuse (OR = 3.29) Confounding factors included: sex and residence
Matsumoto & Imamura (2007)	Examine associations between ADHD and dissociation in inmates	799 Male inmates (mean age = 23.7 years); 94 participants reported CSA	Japan Cross-sectional	– ADHD: Japanese version of the WURS—self-reported, retrospective account of ADHD symptoms – CSA: yes/no question	Bivariate analysis: ADHD symptoms were significantly higher in participants who reported CSA than those who did not (p < .001)
Ouyang et al. (2008)	Examine the associations between ADHD during childhood and child maltreatment	14,322 Youths interviewed twice During Wave 3, participants ranged in age from 18 to 28 years (mean age = 21.8 years)	United States Longitudinal, population-based—National Longitudinal Study of Adolescent Health	– ADHD (Wave 3): 18 retrospective questions – CSA (Wave 3): computer-assisted self-interview completed at T2	Logistic regression: ADHD (all types together): OR = 2.31, p < .001) Inattentive type: OR = 2.61, p < .001 Combined type: OR = 2.90, p < .001 All three ADHD categories were associated with contact sexual abuse Confounding factors included: race, sex, age cohort, family structure, whether the mother was a teenager when the child was born, whether the biological father was ever jailed, parent education level, and family size adjusted poverty status
Rucklidge et al. (2006)	Investigate the prevalence of child abuse in individuals who were identified with ADHD in adulthood, and the impact of ADHD and abuse on psychosocial functioning	-Only participants who believed they had problems with attention when they were children not diagnosed with ADHD until adulthood -114 Participants: 17 men and 40 women with ADHD; 40 men and 17 women without ADHD	Canada Cross-sectional	– ADHD: The Conners’ Adult ADHD Rating Scale–Self-Report: Short Version – CSA: Childhood Trauma Questionnaire	Bivariate analysis: -23.1% of women with ADHD and 12.5% of men with ADHD reported experiencing moderate to severe sexual abuse -Females who experienced sexual abuse had higher ADHD scores compared to the three other groups (female controls, male controls, and males with ADHD) Confounding variables included: SES
Sanderud et al. (2016)	Investigate the relationship between child maltreatment and ADHD in adulthood	Sample of 4,718 young adults (24 years of age). Interviews conducted with 2,980 participants	Denmark Cross-sectional, national study	– ADHD: Adult ADHD Self-Report Scale – CSA: Structured interviews of 20 questions covering child maltreatment	Logistic regression: sexual abuse predicted probable ADHD (OR = 2.07, p < .05)
White & Buehler (2012)	Examine the association between ADHD symptoms experienced before age 12 and sexual victimization during adolescence	Subsample of 374 participants (mean age = 18.9 years, SD = 2.90) who did not experience sexual abuse before age 13; 43 participants had experienced child sexual abuse	United States Cross-sectional	– ADHD (before 12): DuPaul et al. (1998) modification of Barkley and Murphy’s (1998) rating scale – CSA: modified version of the Koss et al.’s (1987) Sexual Experiences Survey	Mediation analyses: ADHD symptoms were associated with greater sexual victimization experiences (Sobel t = 2.67, p = .007) and were linked to sexual victimization through risky sexual behaviors Moderators included: SES, primary caregiver employment status, race, and family structure. Association between ADHD and sexual victimization was stronger for Black women
White et al. (2014; same sample as White & Buehler, 2012)	To investigate the mediating effects of risky behaviors in the association between child ADHD and adolescent sexual victimization	417 Women recruited through university psychology classes (mean age = 18.90 years, SD = 2.90)	United States Cross-sectional	– ADHD: The DuPaul et al. (1998) modification of Barkley and Murphy’s (1998) rating scale – CSA: female adolescent sexual victimization: the Kosson et al. (1997) revision of the Sexual Experiences Survey	There was a significant direct association between childhood ADHD symptoms and adolescent sexual victimization (β = .15) Risky sexual behavior explained the association between ADHD symptoms and adolescent sexual victimization Moderation analysis showed consensual sexual activity and staying out all night interacted with ADHD to increase risky behavior and sexual risk-taking Confounding factors included: early onset of alcohol or marijuana use, consensual sexual activity, and staying out all night interacted with childhood ADHD symptoms to increase general risky behavior and sexual risk-taking

Note. OR = odds ratio; ADHD = attention deficit hyperactivity disorder; CSA = child sexual abuse; CTQ-SF: Conflict Tactics Scale-Short Form; ODD = oppositional defiant disorder; CBCL = Child Behavior Checklist; YSR = Youth Self Report; YASR = Young Adult Self Report; K-SADS-PL-T = Kiddie Schedule for Affective Disorders and Schizophrenia; DISC-IV = Diagnostic Interview Schedule for Children IV; CRS = Conners’ Rating Scales; BAARS-IV = The Barkley Adult ADHD Rating Scale–IV; BPD = borderline personality disorder; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; SES = socioeconomic status.