General Anesthesia Exposure in Relation to ADHD Symptom Dimensions and ODD Comorbidity in Medication-Naïve Children with ADHD
Öz
Background: Evidence regarding the association between early childhood exposure to general anesthesia (GA) and later attention-deficit/hyperactivity disorder (ADHD) remains inconsistent. Moreover, the relationship between GA exposure and oppositional defiant disorder (ODD) comorbidity has not been sufficiently investigated. This study examined whether GA exposure is associated with dimensional ADHD and ODD symptom severity and categorical ODD comorbidity in a medication-naïve clinical sample.
Methods: This cross-sectional study included 92 medication-naïve children aged 7–12 years diagnosed with ADHD (n=63) or ADHD+ODD (n=29). Children with additional psychiatric comorbidities were excluded. GA exposure history (presence, number, and age at exposure) was obtained retrospectively from parents. Dimensional symptoms were assessed using the DSM-IV–based Disruptive Behavior Disorders Rating Scale.
Results: GA exposure was not significantly associated with ADHD+ODD comorbidity (χ²=2.668, p=0.102) or ADHD presentation type (χ²=3.029, p=0.082). After adjustment for age, sex and trauma history, GA-exposed children had higher inattention scores than non-exposed children (F(1,89)=9.278, p=0.003, partial η²=0.094). Inattention scores also significantly differed by number of GA exposures and age at first exposure. However, GA exposure characteristics were not significantly associated with hyperactivity–impulsivity, ODD, or conduct disorder scores.
Conclusions: GA exposure was not associated with ODD symptom severity, categorical ODD comorbidity, ADHD presentation type, or broader disruptive behavior symptom dimensions. Although adjusted analyses suggested higher inattentive symptom severity among GA-exposed children, this finding should be interpreted cautiously. Larger longitudinal studies are needed to clarify whether GA exposure has an independent role in ADHD symptom expression or ODD comorbidity.
Anahtar Kelimeler
General anesthesia, Attention-Deficit/ Hyperactivity Disorder, Oppositional Defiant Disorder, Child, Comorbidity
Destekleyen Kurum
No specific grant from any funding agency in the public, commercial, or not-for-profit sectors was received for this research.
Etik Beyan
The ethical committee approval for this study was obtained from Dr. Behçet Uz Education and Research Hospital of Pediatrics (date: 18.06.2020; approval code: 2020/10-18).
Teşekkür
None.
Kaynakça
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed., text rev. Washington (DC): American Psychiatric Association Publishing; 2022.
- Chen L, Liang X, Lu J, Ran H, Che Y, Fang D, et al. Prevalence of attention-deficit hyperactivity disorder (ADHD) and comorbid psychiatric problems in children 12 years and younger: a systematic review and meta-analysis. J Psychiatr Res. 2025;190:547-556.
- Njardvik U, Wergeland G, Riise E, Hannesdottir D, Öst LG. Psychiatric comorbidity in children and adolescents with ADHD: a systematic review and meta-analysis. Clin Psychol Rev. 2025;118:102571.
- Leffa DT, Caye A, Belangero SI, Gadelha A, Pan PM, Salum GA, et al. The synergistic effect of genetic and environmental factors in the development of attention-deficit/hyperactivity disorder symptoms in children and adolescents. Dev Psychopathol. 2023:1-11.
- Kessi M, Duan H, Xiong J, Chen B, He F, Yang L, et al. Attention-deficit/hyperactive disorder updates. Front Mol Neurosci. 2022;15:925049.
- Jevtovic-Todorovic V, Hartman RE, Izumi Y, Benshoff ND, Dikranian K, Zorumski CF, et al. Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits. J Neurosci. 2003;23(3):876-882.
- Yu D, Jiang Y, Gao J, Liu B, Chen P. Repeated exposure to propofol potentiates neuroapoptosis and long-term behavioral deficits in neonatal rats. Neurosci Lett. 2013;534:41-46.
- Chvojkova M, Kubova H, Vales K. Effects of dizocilpine, midazolam and their co-application on the trimethyltin-induced rat model of cognitive deficit. Brain Sci. 2021;11(3):400.
- Zhou H, Sun W, Ning L, Kang J, Jin Y, Dong C. Early exposure to general anesthesia may contribute to later attention-deficit/hyperactivity disorder (ADHD): a systematic review and meta-analysis of cohort studies. J Clin Anesth. 2024;98:111585.
- Skakum M, Katako A, Mitchell-Dueck J, Ricci MF, Russell K. Risk of attention deficit hyperactivity disorder diagnosis following multiple exposures to general anesthesia in the paediatric population: a systematic review and meta-analysis. Paediatr Child Health. 2024;29(1):29-35.