Beyond Nature vs. Nurture: Genes, Trauma and ADHD

ADHD isn’t just a standalone condition, it’s layered with complexity. Recent research in JAMA Psychiatry finds that higher genetic risk for ADHD and a genetic predisposition to lower educational attainment are associated with a greater likelihood of experiencing childhood maltreatment. It offers critical insight into how genetic risk can amplify early-life vulnerability and how the interplay between biology and environment shapes life trajectories.

Importantly, the study’s authors stress that genetics do not cause maltreatment. Rather, they shape vulnerability, and that distinction is crucial for effective prevention.

This aligns with the concept of gene-environment correlation, where genetic factors influence the environments people experience, especially in childhood. The result is that genetic risk can increase exposure to adverse environments, creating a feedback loop that worsens outcomes.

The Danish Study

The research, led by scientists at Aarhus University with international collaborators including the University of Glasgow and King’s College London, analysed data from over 100,000 individuals in the Danish iPSYCH cohort. The study examined individuals diagnosed with five major psychiatric conditions: ADHD, Autism Spectrum Disorder, Schizophrenia, Bipolar Disorder, and Major Depressive Disorder, alongside population controls.

What they found:

1. Individuals with a high polygenic score for ADHD, an estimate of their inherited genetic risk for the condition, were significantly more likely to have experienced childhood maltreatment by age 30.
2. Lower polygenic scores for educational attainment were independently associated with increased risk of childhood maltreatment across all groups.
3. Parental psychiatric diagnoses doubled the risk of childhood maltreatment. Crucially, high polygenic scores for ADHD further elevated risk within this group.
4. Females with psychiatric diagnoses and high polygenic risk scores for ADHD faced nearly triple the absolute risk of childhood maltreatment compared to males with similar profiles, highlighting significant sex-based inequalities likely influenced by highlighting profound sex-based disparities likely driven by environmental and societal factors rather than biology alone.

From Evidence to Equity

This study isn’t about genetic determinism.

It deepens our understanding of how genetic vulnerability intersects with environmental adversity, and it strengthens the case for urgent, equity-driven reform across systems. Specifically, it highlights the need to:

1. Reframe Vulnerability: Combat stigma by promoting a nuanced understanding of vulnerability’s complex origins and proactively support families where genetic risk factors are present.
2. Prioritise Girls and Young Women: The stark sex disparity in childhood maltreatment risk demands urgent attention. ADHD remains underdiagnosed in girls, often misunderstood in schools, and too frequently pathologised rather than supported. Girls with ADHD may present differently (e.g., internalising rather than externalising behaviours), yet may be at exceptionally high risk of maltreatment. Early recognition and tailored support are critical.
3. Early Identification: Equip teachers, GPs, social workers, and health visitors to recognise ADHD traits as potential risk amplifiers, enabling earlier support for vulnerable children, especially girls, who are too often overlooked.
4. Address the ADHD Crisis: ADHD is not just an educational or behavioural issue, it’s a significant factor in child vulnerability. Long waits for NHS assessments and inconsistent post-diagnosis support leave children and families without the help they urgently need.
5. Integrated Family Support: Parental mental illness compounds child vulnerability. A “whole family” approach is essential, one that supports parents, protects children, and bridges generational risk.
6. Trauma-Informed: Given the strong links between childhood maltreatment and ADHD, all frontline services interacting with children and adults must adopt trauma-informed practices.
7. Break Down Silos: Integrate child protection, adult mental health, education, and primary care services to ensure joined-up responses that reflect real-world complexity.

Beyond Genetics

This study is about recognising that genetics is not destiny.

Understanding the genetic architecture of vulnerability is not about assigning blame. A high polygenic score for ADHD does not mean a child will be maltreated; it means that unseen biological factors can amplify environmental adversity.

The findings:

• show additive effects of genetics and environment, not deterministic causality.
• indicate that sex differences reflect societal and environmental risks more than biology.
• highlight the need for early, targeted support for neurodivergent children and for parents with mental illness.

We must therefore look deeper at how risk accumulates and how systems are responding. It is time to confront uncomfortable truths:

• neurodivergent children are routinely failed by systems not designed for them
• that maltreatment is not evenly distributed, it clusters around vulnerability
• ADHD traits in girls are too often dismissed or misread, until crisis hits

The consequences of the double hit of genes and trauma are particularly profound for girls and women. When mothers face unrecognised ADHD and untreated trauma, they often encounter barriers to support, perpetuating cycles of adversity across generations.

If we are serious about reducing the burden of childhood maltreatment, we must treat neurodivergence as a public health priority and design systems that respond with empathy, insight, and evidence. This is not just about science, it’s about justice.