Hanna Gustafsson, Ph.D., and Elinor Sullivan, Ph.D., on early ADHD risk and sensitive caregiving

Children whose mothers had higher levels of inflammation during pregnancy were more likely to show attention-deficit/hyperactivity disorder (ADHD) symptoms at age three, but sensitive caregiving during infancy appeared to offset that risk, according to a study published in the Journal of Child Psychology and Psychiatry.

The study was led by co-authors and Oregon Health & Science University’s School of Medicine professors, Hanna Gustafsson, Ph.D., associate psychiatry professor and Elinor Sullivan, Ph.D.

The findings come from an ongoing longitudinal study of more than 300 families in the Portland, Oregon, metropolitan area. Researchers enrolled participants during the second trimester of pregnancy and conducted assessments throughout pregnancy and the postpartum period. During infancy, caregivers and children came to the lab for observed interaction sessions.

Gustafsson, Sullivan and their colleagues found that higher maternal inflammation during pregnancy was linked to greater ADHD symptoms in children at age three. But sensitive caregiving, meaning the degree to which a caregiver notices, understands, and responds to a child's cues and emotional needs in warm and supportive ways, appeared to buffer children against that risk. The researchers said the finding suggests supportive early relationships may help offset biological risk established before birth.

In this interview with Managed Healthcare Executive, Gustafsson and Sullivan discuss how the prenatal and postnatal environments work together to shape ADHD risk. Sullivan also points to the practical barriers new parents face during the postpartum period, including sleep deprivation, lifestyle disruption, and reduced access to social support, that can make consistent sensitive caregiving harder to sustain.

Sullivan points to parent-child interaction therapy as an existing, evidence-based resource that is available in Oregon and covered by the Oregon Health Plan, though she said many families do not learn about it early enough for it to have the most impact. She suggested normalizing parenting education broadly and offering practical tools, such as ways to soothe a crying infant, during pregnancy rather than after a child is born, so parents already have strategies in place before reaching a sleep-deprived breaking point.