PCOS and ADHD: An Increased Risk in Children?

Emerging research has shown a link between PCOS and attention deficit hyperactivity (ADHD) in children. This article reviews the research findings and discusses possible causes.

What is ADHD?

Attention deficit hyperactivity disorder (ADHD) usually appears in childhood and is defined by a developmental impairment of the brain’s self-management system causing poor organization, attention or focus deficits, hyperactivity, and impulsive behavior. ADHD is actually the most common psychiatric disorder in childhood that impacts approximately 11% of children and almost 5% of adults in the U.S. Boys (12.1%) continue to be more than twice as likely than girls (5.5%) to have ADHD. The causes of ADHD may include genetics, prenatal and perinatal environmental factors.

Treatment for ADHD can include medication, nutrition, exercise, and behavioral therapy. Additionally, supplements, practicing mindfulness, and spending lots of time outdoors helpful to manage ADHD.

Some people, including myself, who has a child with ADHD, consider it to be a gift. On the hit TV show Shark Tank, Barbara Corcoran said she specifically looks for employees who have ADHD over others who don’t. Why? People with ADHD tend to be more creative and have high energy. ADHD provides many with the advantage of managing numerous tasks or information at once.

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PCOS and ADHD: What the Research Shows

Women with PCOS have been found to have higher ADHD symptoms based on self-reported tests. Emerging research has looked at ADHD in children born from mothers with PCOS.

In a large study, the prevalence of ADHD symptoms was 11% in boys and 9% in girls born from PCOS mothers. Maternal PCOS was associated with a higher risk of offspring ADHD in boys. Maternal testosterone levels were not associated with ADHD-related behavior in children in this study. In general, third-trimester levels of testosterone were found to be higher in mothers with PCOS which could possibly explain why daughters born from PCOS mothers are more likely to be diagnosed with PCOS.

A systematic review and meta-analysis of 19 studies (1,667,851 mothers, 2,260,622 children) also found that mothers with PCOS had an increased odds of children diagnosed with ASD or ADHD and that it didn’t matter what sex the children were.

A longitudinal national register-based study of mothers and their offspring, found that children born to mothers with PCOS had a higher risk of being diagnosed with ADHD. When compared with cousins, the association was higher among girls, suggesting the theory of prenatal androgen exposure influencing the development of ADHD, at least in girls, over genetic factors.

A previous study involving 1,915 mother-child subjects, found maternal hirsutism was related to a higher risk of children’s ADHD and conduct problems.

Exposure to High Testosterone in Pregnancy: A risk for ADHD in Children born from PCOS Mothers

According to researchers, a main theory as to the cause of ADHD in children born from mothers with PCOS, is exposure to increased testosterone levels in pregnancy. Testosterone does pass through the placenta and exposure to elevated androgens in utero might adversely influence brain development.

Prenatal exposure to elevated androgens may cause “permanent alterations (organizational effects) of neural systems leading to ‘hyper-masculine’ behavioral and cognitive traits, thereby increasing the risk for the development of neurodevelopmental and psychiatric disorders (NPD) predominantly found in males such as ADHD and Autism Spectrum Disorder (ASD).”

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Other Factors that may contribute to the link between ADHD and PCOS

The cause of ADHD is still unknown, as is the risk of ADHD in children born to mothers with PCOS. Causes may stem from genetic, environmental, or exposure to hormones, most notably elevated testosterone, in utero. Here are some other possible causes of ADHD in PCOS that have been raised:

Maternal conditions, genetics, environmental and nutrient factors may also influence metabolic conditions and NPD in children.

Prenatal exposure to hyperinsulinemia and increased levels of inflammatory factors was associated with higher risk of offspring having ADHD. Gestational diabetes was also mentioned as a possible risk factor.

Altered gut-microbiota in PCOS mothers may affect fetal brain development explaining a variety of NPD in children, including ADHD.

Factors associated with having received a diagnosis of PCOS and access to health care before or during pregnancy.

Other factors in the environment may increase the likelihood of having ADHD:

  • exposure to lead or pesticides in early childhood
  • premature birth or low birth weight
  • brain injury

Bottom Line

There appears to be a slight increased risk of ADHD in children born from mothers with PCOS. The risk is higher for boys. Association does not mean causation. Many women give birth to children that do not have ADHD. A lot more research is needed to examine the link between ADHD in children born from mothers with PCOS. BMI was not associated with ADHD-related behavior in children.

However, because of the increased risk, researchers suggest close monitoring of children born from mothers with PCOS to provide early intervention if necessary. Based on their evidence, the researchers also suggest early screening and management of women with PCOS or hirsutism for improving their own health.

Further research is needed to understand how PCOS affects pregnancy and the impact on their children. This includes investigating underlying pathways and mechanisms linking PCOS exposure to long-term neurodevelopmental consequences like ADHD or ASD. Understanding of potential mechanisms between maternal PCOS and NPD in children and identification of potential biomarkers is critically needed for developing prevention and intervention strategies.

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PMID: 33872487, PMID: 34750348, PMID: 3006021, PMID: 30857571, PMID: 32106995, PMID: 29648599, PMID: 26449924

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