Family structure, birth order, and aggressive behaviors among school-aged boys with attention deficit hyperactivity disorder (ADHD)

  • Yuan-Chang Hsu
  • Chih-Tsai Chen
  • Hao-Jan Yang
  • Pesus ChouEmail author
Original Paper



To evaluate the associations between family structure, birth order, and aggressive behaviors among school-aged boys with attention deficit hyperactivity disorder (ADHD).


We conducted a matched case–control study. Data were retrieved from medical records at a psychiatry center in northern Taiwan. School-aged boys with ADHD who first visited the outpatient department at the psychiatric center between 2000 and 2011 were identified. The Child Behavior Checklist was used for aggressive behavior assessment. Boys with ADHD with T scores higher than 70 on the aggressive subscale were classified as cases and others with T scores lower than 70 were classified as controls at a 1:4 ratio. After controlling for other familial, personal, and parental factors, a multivariate conditional logistic regression was performed to evaluate the effects of family structure and birth order on aggressive behaviors of boys with ADHD.


277 cases and 1108 controls were included in the final analysis. Compared with living in a traditional family with both parents, living in a non-traditional family in which one or both parents were absent increased the risk of aggressive behaviors by 1.47-fold, with the highest risk for those in single parent families. Being the firstborn increased risk by 1.45-fold and the risk was higher when the firstborn had siblings.


Living in non-traditional families in which one or both parents were absent, and being the firstborn increased risk of aggression in school-aged boys with ADHD. Identification of this high-risk population and development of adequate preventive strategies are warranted.


ADHD Aggression Family structure Birth order 



This work was supported by a funding Grant from the Ministry of Health and Welfare, Taiwan. We thank the team at Tao-Yuan Psychiatric Center for data collection and management. We also appreciate all the helpful suggestions from professors and students at National Yang-Ming University, Taiwan.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

Ethical approval for this study was obtained from the institution review board of the Tao-Yuan Psychiatric Center, Ministry of Health and Welfare, Taiwan. The study was conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Yuan-Chang Hsu
    • 1
    • 2
  • Chih-Tsai Chen
    • 1
  • Hao-Jan Yang
    • 3
  • Pesus Chou
    • 2
    • 4
    Email author
  1. 1.Department of Child and Adolescent PsychiatryTao-Yuan Psychiatric Center, Ministry of Health and WelfareTaoyüanTaiwan
  2. 2.Institute of Public HealthNational Yang-Ming UniversityTaipeiTaiwan
  3. 3.Department of Public HealthChung-Shan Medical UniversityTaichungTaiwan
  4. 4.Community Medicine Research CenterNational Yang-Ming UniversityTaipeiTaiwan

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