Clinical phenotypes occurring after adverse childhood events: Differences and similarities with attention deficit and hyperactivity/impulsivity disorder

Background Attention-Deficit/Hyperactivity Disorder (ADHD) and Adverse Childhood Experiences (ACEs) share overlapping symptoms, complicating differential diagnosis and increasing misdiagnosis risk. There is a critical need for screening that differentiates ADHD symptoms from those associated with ACEs. Objectives This study aims to distinguish children and adolescents with ADHD from those with ACEs-related conditions by analyzing demographic characteristics, cognitive functioning, caregiver-reported adaptive behavior, caregiver-reported emotional and behavioral symptoms, and global functioning. Participants and settings A cross-sectional, retrospective study was conducted with 122 participants from a Child and Adolescent Neuropsychiatry Unit, divided into two groups: ADHD (n = 51) and ACEs (n = 71). Methods Data were collected on demographic variables (sex, age), cognitive level (nonverbal intelligent quotient, nvIQ), caregiver-reported adaptive behavior (conceptual, practical, social domains), caregiver-reported emotional and behavioral symptoms, and global functioning. Results Key predictors of group classification included sex, nvIQ, conceptual and practical adaptive behavior, internalizing symptoms (somatic complaints, attention problems), and global functioning impairment. ADHD Group were more likely male, exhibited higher nvIQ scores, and displayed more attention problems but fewer somatic complaints than the ACEs Group. Externalizing behaviors did not differentiate the groups, indicating their transdiagnostic nature. Conclusions Externalizing behaviors are common across both conditions rather than disorder-specific markers. However, sex, nvIQ, and internalizing symptoms may assist in differential diagnosis. Comprehensive assessments incorporating demographic, cognitive, and affective factors are crucial for improving diagnostic accuracy and informing targeted interventions.