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Peer-reviewedCC BY-NC-ND 4.0Journal of Child Psychology and Psychiatry, and Allied Disciplines

Caregiver sensitivity moderates effects of gestational inflammation on child ADHD symptoms

  • Elinor L. Sullivan1,2
  • Jessica M. Tipsord1,2
  • Elizabeth K. Nousen1,2
  • Julia Williams1,2
  • Sara Shao1,2
  • Diana Vazquez Duque1,2
  • Jennifer M. Loftis1,3,4
  • Sarah L. Karalunas5
  • Joel T. Nigg1,2
  • Hanna C. Gustafsson1,2
5 affiliations
  1. 1Department of Psychiatry Oregon Health & Science University Portland OR USA
  2. 2Steven J. Sharp Center for Mental Health Innovation Oregon Health & Science University Portland OR USA
  3. 3VA Portland Health Care System Portland OR USA
  4. 4Department of Behavioral Neuroscience Oregon Health & Science University Portland OR USA
  5. 5Department of Psychology Syracuse University Syracuse NY USA
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Abstract

Background: Increased inflammation during pregnancy may increase the risk for child psychopathology, though prospective data remain preliminary. Child symptoms of attention‐deficit/hyperactivity disorder (ADHD) are particularly important due to ADHD's role as an early precursor of many later forms of externalizing and internalizing problems. Despite strong theories surrounding the ways in which pre‐ and postnatal environmental factors may interact in the prediction of child risk, few studies have examined how the postnatal social environment moderates prenatal effects. This study examined whether gestational inflammation was prospectively related to ADHD symptoms and whether this association was moderated by postnatal caregiving behaviors.

Methods: Data came from a prospective cohort of pregnant individuals and their offspring (N = 302). Second trimester inflammation was assessed in maternal plasma using a comprehensive panel of cytokines. ADHD symptoms were assessed at 36 months of age using parent‐report and clinician ratings. Observer ratings of maternal sensitive caregiving behaviors were assessed when infants were 6 months old.

Results: The effect of gestational inflammation on child ADHD symptoms was moderated by maternal sensitive caregiving during infancy. Increased inflammation during pregnancy was associated with greater child ADHD symptoms only when children experienced lower levels of maternal sensitivity.

Conclusions: Early sensitive caregiving appears to buffer children against the negative effects of gestational inflammation. Interventions that decrease gestational inflammation and those that support early caregiver–child relationships may both be effective at reducing child ADHD risk.

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Cite

BibTeXRIS
BibTeX
@article{sullivan2026caregiver,
  title = {{Caregiver sensitivity moderates effects of gestational inflammation on child ADHD symptoms}},
  author = {Elinor L. Sullivan and Jessica M. Tipsord and Elizabeth K. Nousen and Julia Williams and Sara Shao and Diana Vazquez Duque and Jennifer M. Loftis and Sarah L. Karalunas and Joel T. Nigg and Hanna C. Gustafsson},
  journal = {Journal of Child Psychology and Psychiatry, and Allied Disciplines},
  year = {2026},
  month = jul,
  doi = {10.1111/jcpp.70200},
  url = {https://doi.org/10.1111/jcpp.70200},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Caregiver sensitivity moderates effects of gestational inflammation on child ADHD symptoms
AU  - Elinor L. Sullivan
AU  - Jessica M. Tipsord
AU  - Elizabeth K. Nousen
AU  - Julia Williams
AU  - Sara Shao
AU  - Diana Vazquez Duque
AU  - Jennifer M. Loftis
AU  - Sarah L. Karalunas
AU  - Joel T. Nigg
AU  - Hanna C. Gustafsson
PY  - 2026
DA  - 2026/07/31
JO  - Journal of Child Psychology and Psychiatry, and Allied Disciplines
DO  - 10.1111/jcpp.70200
UR  - https://doi.org/10.1111/jcpp.70200
AB  - Background: Increased inflammation during pregnancy may increase the risk for child psychopathology, though prospective data remain preliminary. Child symptoms of attention‐deficit/hyperactivity disorder (ADHD) are particularly important due to ADHD's role as an early precursor of many later forms of externalizing and internalizing problems. Despite strong theories surrounding the ways in which pre‐ and postnatal environmental factors may interact in the prediction of child risk, few studies have examined how the postnatal social environment moderates prenatal effects. This study examined whether gestational inflammation was prospectively related to ADHD symptoms and whether this association was moderated by postnatal caregiving behaviors.  Methods: Data came from a prospective cohort of pregnant individuals and their offspring (N = 302). Second trimester inflammation was assessed in maternal plasma using a comprehensive panel of cytokines. ADHD symptoms were assessed at 36 months of age using parent‐report and clinician ratings. Observer ratings of maternal sensitive caregiving behaviors were assessed when infants were 6 months old.  Results: The effect of gestational inflammation on child ADHD symptoms was moderated by maternal sensitive caregiving during infancy. Increased inflammation during pregnancy was associated with greater child ADHD symptoms only when children experienced lower levels of maternal sensitivity.  Conclusions: Early sensitive caregiving appears to buffer children against the negative effects of gestational inflammation. Interventions that decrease gestational inflammation and those that support early caregiver–child relationships may both be effective at reducing child ADHD risk.
SN  - 0021-9630
SN  - 1469-7610
ER  -