How Do Autism and ADHD Affect Child and Mother Mental Health Over Time?

What you need to know

• Children with autism and/or ADHD had more emotional and behavioral problems than other children from age 4-14 years.
• Mothers of children with autism and/or ADHD experienced higher psychological distress than other mothers, starting from when their children were infants.
• The relationship between mother and child mental health differed for families affected by autism/ADHD compared to other families.
• Understanding these patterns can help target mental health support for both children and parents at key times.

The challenges of autism and ADHD

Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are two of the most common neurodevelopmental disorders in children. Autism affects up to 4% of children and involves difficulties with social communication and repetitive behaviors. ADHD affects 5-7% of children and involves problems with attention, hyperactivity and impulsivity.

Both conditions have a strong genetic basis, with heritability rates of up to 90% for autism and 80% for ADHD. The two disorders also frequently occur together - around 40-70% of children with autism also have ADHD, and about a third of children with ADHD also have autism.

Children with autism and ADHD tend to have more emotional and behavioral problems compared to other children. Their parents also experience higher rates of stress, anxiety and depression. However, less is known about how these mental health challenges for both children and parents change over time as children grow up.

A unique long-term study

To explore this question, researchers analyzed data from the Longitudinal Study of Australian Children. This study has been following thousands of children and their families since 2004. The researchers looked at a group of over 5,000 children who were tracked from infancy to age 14.

Within this group, about 4% of children were reported by their parents to have autism, 4% to have ADHD, and 2% to have both conditions. The study collected information on the children’s emotional and behavioral problems and their mothers’ psychological distress every two years as the children grew up.

This allowed the researchers to map out trajectories of mental health for both children and mothers over a 14 year period. They compared families affected by autism and/or ADHD to families without these conditions.

Key findings on child mental health

As expected, children with autism and/or ADHD showed higher levels of emotional and behavioral problems from ages 4-14 compared to other children. Some key patterns emerged:

• Children with both autism and ADHD had the highest level of difficulties overall.
• For children with both conditions, problems peaked around age 8.
• For children with just autism or just ADHD, problems peaked slightly later around age 10.
• In contrast, children without these conditions showed gradually decreasing problems from ages 4-14.

These findings highlight that children with autism and/or ADHD may need extra support with emotional and behavioral challenges, particularly in the pre-teen years around ages 8-10. The earlier peak for children with both conditions suggests they may need this support even sooner.

Maternal mental health trajectories

The study also revealed important patterns in mothers’ psychological distress:

• Mothers of children with autism and/or ADHD had higher distress levels overall compared to other mothers.
• For mothers of children with autism (with or without ADHD), distress tended to increase over time as their children grew up.
• In contrast, for mothers of children with just ADHD, distress tended to decrease over time.
• Mothers of children without these conditions showed gradually decreasing distress from infancy to age 14.

Notably, mothers of children later diagnosed with autism already showed higher distress when their children were infants - well before their children were diagnosed. This may reflect early signs of autism that create challenges, or could relate to genetic factors that increase risk for both autism and mental health issues.

The increasing trajectory of distress for mothers of children with autism is concerning. It suggests these mothers may need ongoing mental health support as their children enter the pre-teen and teen years.

Critical time periods

The study identified some key time periods when mental health challenges peaked:

For children:

• Age 8 for those with both autism and ADHD
• Age 10 for those with just autism or just ADHD

For mothers:

• Around child age 6 for mothers of children with autism and/or ADHD
• Child age 12-14 for mothers of children with autism as they enter adolescence

Additionally, mothers of children with ADHD showed a peak in distress during their child’s infancy.

Understanding these patterns can help target mental health screening and support services to the most critical time periods for different families.

A complex relationship between mother and child mental health

One goal of the study was to explore whether there is a two-way relationship between mother and child mental health over time. In other words, do a mother’s mental health challenges predict later problems for her child, and vice versa?

For families not affected by autism or ADHD, the researchers found evidence of this two-way relationship from ages 4-14. A mother’s psychological distress predicted more emotional/behavioral problems in her child two years later. And a child’s emotional/behavioral problems predicted more maternal distress two years later.

However, this pattern was much less evident for families affected by autism and/or ADHD. There were only a few specific time points where mother and child mental health influenced each other:

• Mother distress at child age 2 predicted child problems at age 4
• Mother distress at ages 8 and 10 predicted child problems two years later
• Child problems at ages 6 and 8 predicted mother distress two years later
• Age 8 was the only time point with a two-way relationship

This suggests the relationship between mother and child mental health may work differently when neurodevelopmental disorders are involved. The genetic and biological factors underlying autism and ADHD may play a larger role in driving both child and parent mental health challenges.

Implications for families and professionals

These findings have several important implications:

1. Mental health screening and support are crucial for both children with autism/ADHD and their mothers, starting from an early age.

2. Support may need to be ongoing, especially for mothers of children with autism who showed increasing distress over time.

3. Key time periods to target include:

   • Ages 8-10 for children’s emotional/behavioral support
   • Child age 6 and early adolescence for maternal mental health support
   • The first year of life for mothers of children with ADHD

4. Improving a child’s emotional/behavioral problems may not automatically improve the mother’s mental health, and vice versa. Both may need to be addressed separately.

5. Earlier identification and support for ADHD may be beneficial, given the average age of diagnosis was 9 years old despite elevated problems from age 4.

6. Interventions should consider the possibility of both autism and ADHD occurring together, given the high overlap between the conditions.

Limitations and future directions

This study provides valuable long-term data, but has some limitations. Diagnoses were based on parent report rather than clinical assessment. The researchers also had to combine autism and ADHD into one group for some analyses due to small sample sizes.

Future research could explore these patterns in larger groups to look at autism and ADHD separately. It would also be valuable to include fathers and look at how other family and environmental factors influence mental health trajectories.

Conclusion

This study sheds important light on the mental health journeys of children with autism and/or ADHD and their mothers over time. It highlights periods of elevated risk and the complex relationship between parent and child wellbeing. While the challenges are significant, understanding these patterns can help families and professionals provide more targeted and effective support.