Adult Smoking and Depression Are Contributing Factors to ADHD in Children and Adolescents

The authors argue that, given the findings of this study, the awareness of the detrimental effects of both smoking and depression upon children should be raised among parents.

Adult smoking and depression constitute family environmental factors associated with children’s attention-deficit/hyperactivity disorder (ADHD), suggested data from a study published in Asia-Pacific Psychiatry.

The high prevalence of ADHD carries a significant economic burden and the symptoms of hyperactivity, impulsivity, and inattention may continue into adulthood, though with different expression. The authors of the study set out to explore the contribution of the family environment, including not only the parents but also other adult members of the household, as well as the prevalence of physician-diagnosed ADHD.

Yoon Joo Cho, MPharm of the College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, South Korea, and colleagues analyzed data from 23,561 children and adolescents younger than 18 years old in the Korean national health and nutrition examination survey from 2005 to 2014. They estimated the prevalence of ADHD with physician-diagnosed ADHD and considered data on various risk factors including demographics, obesity, and family environment, which included income level, parental age, the presence of depression in adults in the household, and exposure to environmental smoke at home. They used multiple logistic regression to evaluate the relationship between ADHD and the assessed risk factors.

The annual prevalence of physician-diagnosed ADHD increased 4-fold between 2005 and 2014, from 0.35% to 1.36%. Boys constituted the overwhelming majority of diagnosed patients: 78% vs 22% for girls. Total smoking amounts and depression in adults within the household were significantly associated with ADHD in children. The odds ratio (OR) for ADHD prevalence for a total daily smoking amount of ≥15 cigarettes in adults was 1.63 compared with <15 cigarettes. ADHD prevalence was 6.10 times higher in children and adolescents in a household where any adult was diagnosed with depression. After performing multiple logistic regression and adjusting for confounding factors, a total smoking amount of ≥15 cigarettes per day and the presence of depression in household adults were statistically significantly associated with ADHD; however, when the analysis was limited to parental influences, only the paternal smoking amount and depression were associated with the children’s ADHD.

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The study was limited by the self-reported nature of some of the data and by the cross-sectional design of the study, which prohibited confirming the causal relationship between the variables and ADHD prevalence.

The authors argued that given the findings of this study, the awareness of the detrimental effects of both smoking and depression upon children should be raised among parents.


Cho YJ, Choi R, Park S, Kwon J-W. Parental smoking and depression, and attention-deficit hyperactivity disorder in children and adolescents: Korean national health and nutrition examination survey 2005-2015Asia Pac Psychiatry. 2018;10:e12327.