Background: An association between child sexual abuse (CSA) and attention deficit hyperactivity disorder (ADHD) has been documented. However, the temporal relationship between these problems and the roles of trauma-related symptoms or other forms of maltreatment remain unclear. This review aims to synthesize available research on CSA and ADHD, assess the methodological quality of the available research, and recommend future areas of inquiry. Methods: Studies were searched in five databases including Medline and PsycINFO. Following a title and abstract screening, 151 full texts were reviewed and 28 were included. Inclusion criteria were sexual abuse occurred before 18 years old, published quantitative studies documenting at least a bivariate association between CSA and ADHD, and published in the past 5 years for dissertations/theses, in French or English. The methodological quality of studies was systematically assessed. Results: Most studies identified a significant association between CSA and ADHD; most studies conceptualized CSA as a precursor of ADHD, but only one study had a longitudinal design. The quality of the studies varied greatly with main limitations being the lack of (i) longitudinal designs, (ii) rigorous multimethod/ multiinformant assessments of CSA and ADHD, and (iii) control for two major confounders: trauma-related symptoms and other forms of child maltreatment. Discussion: Given the lack of longitudinal studies, the directionality of the association remains unclear. The confounding role of other maltreatment forms and trauma-related symptoms also remains mostly unaddressed. Rigorous studies are needed to untangle the association between CSA and ADHD.

Objective: Child maltreatment is a prevalent problem, and a lot remains unknown regarding the prevalence and mechanisms involved in its intergenerational continuity. The present study examines the sequential role of maternal emotional dysregulation and mother-to-child attachment in the intergenerational continuity of specific maltreatment types (Objective 1) as well as cumulative child maltreatment (Objective 2) among mother-young adult dyads. Method: A sample of 186 mothers and their young adult children (18-25 years old) completed an online survey measuring child maltreatment, attachment, maternal emotional dysregulation, and sociodemographic characteristics. The Canadian Survey of Economic Well-Being-Index of Material Deprivation was used to document mothers' material deprivation. Results: Path analyses revealed that physical neglect was the maltreatment type in the mothers' childhood that was the most consistently associated with their emotional dysregulation, attachment, and maltreatment in the next generation. Direct trajectories elucidating the homotypic and heterotypic continuity of child maltreatment were identified. A multigroup analysis revealed significant differences between the nondeprived and deprived groups for Objective 1. Regarding Objective 2, indirect paths indicated that an increase in the number of child maltreatment types that were experienced by mothers was associated with increased emotional dysregulation, which was negatively associated with attachment. In turn, attachment was negatively associated with cumulative child maltreatment in young adults. Conclusions: The present study highlights the importance of including neglect in studies of intergenerational continuity and of exploring the role of material deprivation in depth. The damage caused by cumulative child maltreatment is supported by our findings. Screening for past maltreatment experiences and their impacts on maternal functioning may be warranted when working with distressed families.

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