Predicting Flourishing in ADHD Youth: Positive Childhood Experiences and Mood Disturbances in Context of Adversity

In response to the increasing prevalence of ADHD, efforts have focused on understanding methods to optimize psychosocial, emotional, and behavioral well-being, defined as flourishing. Mood disturbances, environmental vulnerabilities, and Adverse Childhood Experiences (ACEs) are risk factors for not flourishing. There is limited research on protective relational factors, as measured by Positive Childhood Experiences (PCEs), as facilitators of flourishing in children with ADHD and comorbid mood disturbances.

Using a nationally representative sample of 4,847 children, aged 6 to 17 years-old, currently diagnosed with ADHD, hierarchical binary logistic regression examined whether the number of PCEs present for children with and without mood disturbances could significantly predict who was flourishing or not. The initial model included demographics, ADHD treatment-related variables, and the number of ACEs encountered.

After controlling for covariates, the odds of flourishing measured by the Child Flourishing Index (CFI) for children with ADHD were 7.31 [4.51, 11.86] times greater for those with 6 to 7 PCEs compared to peers with 0 to 2 PCEs, and 3.37 [2.24, 5.06] times greater for those with 3 to 5 PCEs relative to peers with 0 to 2 PCEs. Furthermore, parents who reported their children had neither current anxiety nor depression were 2.92 [1.87, 4.55] times more likely to flourish than children currently reported to have both anxiety and depression. These associations were consistent regardless of the level of ACEs.

Our findings suggest that more PCEs and the absence of mood disturbance may attenuate the influence of ACEs on healthy adjustment for children with ADHD. Encouraging resilience in families, connecting with caregivers, and community volunteering were the most predictive positive childhood experiences of flourishing in this national sample of youth with ADHD and comorbid mood disturbance. Current results also provide guidance for future research on PCEs measurement, screening for comorbidities, and clinical intervention in neurodiverse samples.