2026 ECNP Congress

PS01-1246

Two distinct pathways from childhood trauma to functional impairment in adults with attention-deficit/hyperactivity disorder

J. Antoni Ramos-Quiroga — J.J. Crespín Hombrao, M.F. Forte, A. Ruiz, M. Corrales, V. Richarte, M. Serra-Navarro, C. Torrent, D. Clougher, C. Fadeuilhe, S. Amoretti · Vall d’Hebron Research Institute VHIR, Group of Psychiatry- Mental Health and Addiction- Hospital Universitari Vall d’Hebron, Barcelona, Spain

2026 ECNP Congress

Background

Adverse childhood experiences (ACEs) affect nearly 44% of adults with attention-deficit/hyperactivity disorder (ADHD), significantly exacerbating clinical severity and functional impairment [1, 2]. Psychological sequelae—such as comorbid depression and post-traumatic stress disorder [3]—may act as primary drivers of functional disability, operating independently of core neurodevelopmental ADHD deficits. Despite this link, a critical gap remains in understanding the precise mechanisms through which specific adverse childhood experience subtypes translate into adult functional disability. Determining whether different adverse exposures impair functioning through shared mechanisms or distinct pathways—specifically investigating the interplay between ADHD symptoms and depressive states—is essential for guiding personalized therapeutic strategies and improving long-term outcomes in this population.

Aims

To determine whether distinct ACE subtypes exert their impact on daily functional impairment through differential serial mediation pathways—specifically via ADHD symptom severity and depressive symptomatology—in a large, specialised clinical cohort of adults with ADHD.

Methods

This cross-sectional study included 1,553 adults (aged 18–50 years, DSM-5-TR criteria) from a specialized ADHD programme. Five ACE subtypes were assessed and conceptually grouped into direct victimisation (sexual and physical abuse) and relational adversity (emotional abuse, family violence, neglect), evaluated alongside a cumulative Trauma Sum score. Serial mediation analyses (PROCESS Model 6) [4] tested the sequential chain: ACE subtype → ADHD symptom severity (ADHD-RS) → depressive symptoms (BDI-II) → daily functional impairment (FAST). Models were adjusted for chronological age and sex. We decomposed three indirect paths: Ind1 (via ADHD-RS), Ind2 (via BDI-II), and Ind3 (full serial chain), using bias-corrected bootstrapped 95% confidence intervals with 5,000 resamples.

Results

Analyses revealed two qualitatively distinct mediation pathways governing functional outcomes. For direct victimisation, impairment was primarily mediated via core ADHD symptom severity. Sexual abuse operated predominantly through this ADHD pathway (Ind1: B=2.00, 95% CI [0.54,3.65]). Conversely, relational adversity operated primarily through an affective pathway. For family violence and neglect, significant indirect effects were driven by depressive symptoms (Ind2: B=1.64, 95% CI [0.57,2.89] for family violence; Ind2: B=2.39, 95% CI [1.07,4.01] for neglect), with no significant mediation contribution from ADHD severity alone. The cumulative Trauma Sum yielded a significant adjusted total effect (B=1.15, p=0.039) and simultaneously activated all three indirect paths, engaging a full cascade from ADHD severity through depression to functional impairment. These combined indirect pathways accounted for 85.2% of the total functional effect (B=0.98, 95% CI [0.39,1.59]).

Conclusions

Childhood trauma subtypes operate through distinctly divergent routes to impair daily functioning in adults with ADHD [5]. Direct victimisation directly exacerbates core ADHD symptoms, whereas relational adversity operates via a secondary depressive mechanism, impacting functioning independently of ADHD severity [5]. Simultaneously, cumulative trauma burden engages the full serial pathway, linking ADHD symptoms and depressive vulnerability to poorer daily functioning. These findings suggest that clinical interventions should be tailored to trauma history: prioritizing ADHD-core symptom management for direct victimisation and incorporating targeted affective interventions for relational adversity to achieve meaningful functional recovery.

References

  1. Zou Z, Khambati H, Nguyen TTH, Danese A, Cortese S. Prevalence and neurobiological mechanisms underlying early life adversity and ADHD: A systematic review and meta-analysis. Neurosci Biobehav Rev. 2025;170:106436.
  2. Peleikis DE, Fredriksen M, Faraone SV. Childhood trauma in adults with ADHD is associated with comorbid anxiety disorders and functional impairment. Nord J Psychiatry. 2021;76(4):272-279.
  3. Weinstein D, Staffelbach D, Biaggio M. Attention-deficit hyperactivity disorder and posttraumatic stress disorder: differential diagnosis in childhood sexual abuse. Clin Psychol Rev. 2000;20(3):359-378.
  4. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. 2nd ed. Guilford Press; 2018.
  5. Soares ALG, Howe LD, Lacerda EM, Mesquita DN, Hallal PC, Fraser A. The mediating role of mental health in the association between adverse childhood experiences and adult health outcomes. Int J Epidemiol. 2022;51(3):920-932.