Association between trauma exposure and mental health among adolescents with attention-deficit hyperactivity disorder

Background: Adolescents with attention-deficit/hyperactivity disorder (ADHD) may be particularly vulnerable to trauma; however, patterns of trauma exposure and psychological responses in East Asian contexts remain underexplored.Objective: To examine associations among ADHD, trauma exposure, and psychological outcomes, and to differentiate trauma-specific reactions from broader internalising symptoms.Methods: This cross-sectional study included 295 adolescents aged 12-18 years (149 with ADHD and 146 controls). Adolescents and their caregivers completed validated measures of trauma exposure (Trauma Exposure Experience Questionnaire), trauma reactions (Revised Child's Reaction to Traumatic Events Scale), anxiety (Multidimensional Anxiety Scale for Children), depression (Centre for Epidemiological Studies Depression Scale), and self-esteem (Rosenberg Self-Esteem Scale). All measures demonstrated excellent internal consistency (Cronbach's α = .92-.95). Intergroup differences were examined using chi-square tests and t-tests. Hierarchical regression models incorporating ADHD × trauma exposure interaction terms, along with sex-stratified analyses, were used to evaluate associations.Results: Adolescents with ADHD reported stronger trauma reactions (p = .039), greater depressive symptoms (p = .032), and lower self-esteem (p = .002) than controls. Logistic regression analyses indicated that physical assault (odds ratio = 3.11) and threats of violence (odds ratio = 3.77) were significantly associated with ADHD. Trauma reactions were strongly predicted by anxiety, depression, and trauma exposure across the sample. The interaction between ADHD and trauma exposure was not significant in the total sample (p = .600) or in stratified analyses.Conclusion: Adolescents with ADHD in Taiwan are highly vulnerable to interpersonal trauma. Although ADHD does not moderate the association between trauma exposure and subsequent reactions, trauma responses are closely associated with comorbid anxiety and depression. These findings highlight the need for trauma-informed ADHD care that addresses internalising symptoms within relevant familial and cultural contexts.