Identifying risk factors that contribute to attention deficit hyperactivity disorder (ADHD) can identify potential avenues for prevention or treatment. We are publishing a study now that identifies a possible new risk factor. The study by Yang et al. (10.1542/peds.2017-1081) used the knowledge that maternal prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) has been associated as a risk factor with ADHD in their offspring. The investigators decided to see if paternal prenatal use also increased the risk of ADHD. Their Dutch cohort study looked at just less than 800,000 infants born from 1996 to 2008 that were followed through 2013 and identified those fathers who used SSRIs during the last 3 months prior to conception. The results show a 26% increased risk of ADHD in those fathers who used SSRIs even after adjusting for potential confounders compared to those who did not—and similar findings were found when SSRIs were used from 12 months to 3 months prior to conception (when spermatogenesis that leads to conception is not playing a role—suggesting a father’s underlying mental health condition might be).
What do we do about this information? Is it the medication causing the ADHD or could it be a father’s underlying mental health condition that is playing a role in increasing the risk of ADHD or both? We asked Dr. Craig Garfield from Northwestern, who focuses his research on studies about fathers, to share his thoughts on these findings in an accompanying commentary (10.1542/peds.2017-3461). His focus on preconception health of fathers suggests that given the increased risk seen prior to the last three months, that SSRIs are not likely the culprit as much as an underlying mental health problem could be—and doing whatever can be done to control a prospective father’s mental health disorder, even if that means using SSRIs, will be of benefit rather than not using the SSRIs for fear they will result in ADHD in offspring as an adverse effect of their use. Pay attention to this study but also this commentary, and then watch for future studies that begin to put more emphasis on not just maternal but paternal preconceptual health issues and their effect on offspring.