14 February 2011

Health at birth tied to ADHD risk

A baby's health in the first minutes after birth may be linked to his or her risk of developing attention-deficit hyperactivity disorder (ADHD) later on, a new study suggests.


A baby's health in the first minutes after birth may be linked to his or her risk of developing attention-deficit hyperactivity disorder (ADHD) later on, a new study suggests.

The findings, reported in the Journal of Paediatrics, suggest that the so-called Apgar score assigned to all newborns in the first five minutes of life may give some hint of a child's future risk of ADHD, a condition that involves attention problems and impulsive behaviour.

A newborn's Apgar score is based on several physical signs, including breathing, heart rate and muscle tone. A score of seven or higher is considered normal, with a nine or 10 indicating that the baby is in the "best possible condition".

Lower score, higher risk

In the new study, researchers found that among more than 980,000 Danish children, the risk of developing ADHD climbed as Apgar scores dropped.

Compared with children whose scores had been a nine or 10, those with a five or six had a 63% higher risk of ADHD. And those with an Apgar of one to four had a 75% greater risk.

In the US, surveys have found that nearly one in 10 school-aged kids have been diagnosed with the condition, according to the Centres for Disease Control and Prevention.

Actual cause unknown

Exactly what the new findings mean is unclear. An abnormal Apgar score could reflect some sort of stress during pregnancy or birth - like decreased oxygen supply - that might contribute to ADHD development down the road, the researchers speculate.

"There may be a sharing of causes of low Apgar score and ADHD, but our analyses do not point (to) any specific factor here," said Dr Carsten Obel, one of the researchers on the work.

A number of studies have linked preterm birth to an increased risk of ADHD, although the reasons aren't clear, noted Obel, of Aarhus University in Denmark.

Both pre-term birth and a low Apgar score may be markers of less-than-optimal foetal development, he explained.

The findings are based on Danish national registry data for 980,902 children born between 1988 and 2001. Of those children, 8,234 were diagnosed with ADHD - most of them boys.

Other risk factors

Even after the researchers accounted for factors like pre-term birth, family income and mothers' smoking and education levels, the risk of ADHD was higher among kids with Apgar scores below 7.

Still, the vast majority of children in the study were not diagnosed with ADHD, regardless of Apgar score. And it's not clear whether the Apgar-ADHD link might eventually have any practical implications.

In this study group, Obel said, the ability of a child's score to predict ADHD was not that strong.

"We do not find that the predictive value is so good that we routinely should inform parents who (have) a child with a low Apgar score about the higher risk of ADHD," Obel said.

Future studies, he said, could try to uncover the reasons for the link between Apgar score and ADHD. Large population studies might also be able to look at how combinations of factors - like low Apgar score plus a family history of ADHD - come into play. - (Amy Norton/Reuters Health, February 2011)

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Dr Renata Schoeman has been in full-time private practice as a general psychiatrist (child, adolescent and adult psychiatry) since 2008, currently based in Oude Westhof (Bellville). Renata also holds appointments as senior lecturer in Leadership (USB) and as a virtual faculty member of USB Executive Development’s Neuroleadership programme. She serves on the advisory boards of various pharmaceutical companies, as a director of the Psychiatric Management Group (PsychMG) and is the co-convenor of the South African Society of Psychiatrist (SASOP) special interest group for adult ADHD, and co-founder of the Goldilocks and The Bear Foundation ( She is passionate about corporate mental health awareness and uses her neuroscience background to assist leaders in equipping them to become balanced, healthy and dynamic leaders that take their own and their team’s emotional, intellectual, social health and physical needs into account. Renata is academically active and enjoys research and collaborative work, has published in many peer-reviewed journals, and has presented at local and international congresses. She is regularly invited to present at conferences and to engage with the media. During her post-graduate studies, she trained at Harvard, Boston in neurocognition and neuroimaging. Her awards include, amongst others, the Young Minds in Psychiatry award from the American Psychiatric Association, the Discovery Foundation Fellowship award, a Thuthuka award from the NRF, and a MRC Fellowship. She also received the Top MBA student award and the Director’s award from USB for 2015. She was a finalist for the Businesswomen’s Association of South Africa’s Businesswoman of the Year Award for 2016, and received the Excellence in Media Work award from SASOP during 2016.

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