Childhood Adversity and Adult Outcomes in Women with and without Childhood ADHD: A Comparison of Effects Between Threat and Deprivation Dimensions

Background: Childhood adversity is common and linked to negative physical and mental outcomes. Women, especially those with neurodevelopmental conditions like attention-deficit/hyperactivity disorder (ADHD), are at heightened risk for greater adversity exposure and more severe long-term outcomes. A dimensional model of adversity differentiates threat-related adversity (e.g., abuse, violence) from deprivation-related adversity (e.g., neglect, household dysfunction), which may have distinct developmental impacts. This study examined whether adverse childhood experiences (ACEs) in a longitudinal cohort of women with and without childhood ADHD could be separated into threat and deprivation dimensions, and whether these dimensions differentially predict young adult outcomes.Methods: Participants were drawn from a 25-year longitudinal study of 228 girls (140 with childhood ADHD, 88 without). In young adulthood (mean age ~25), participants reported on 10 ACEs. Principal component analysis (PCA) was used to derive threat and deprivation components of adversity. Regression models tested each component’s associations with adult psychopathology (internalizing and externalizing symptom composites) and academic achievement, controlling for childhood ADHD diagnosis and baseline symptom levels.Results: PCA identified two adversity components corresponding to threat and deprivation, consistent with theory. This two-factor structure held for both the ADHD and comparison groups. Women with childhood ADHD reported higher overall ACE exposure than those without ADHD. Higher threat scores uniquely predicted greater young adult internalizing and externalizing symptoms even after accounting for childhood symptom levels and ADHD status. In contrast, deprivation scores were not uniquely associated with these mental health outcomes in combined models, and neither adversity dimension significantly predicted adult academic performance.Conclusions: Distinct dimensions of childhood adversity can be identified and have different predictive relevance. Threat-related adversities in particular conferred persistent risk for psychopathology into early adulthood beyond prior vulnerabilities. Findings point to the importance of trauma-informed interventions and support a dimensional approach to adversity in clinical practice and developmental psychopathology research.