{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:39:00Z","timestamp":1760060340389,"version":"build-2065373602"},"reference-count":83,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Tungs Taichung Metroharbor Hospital, No.699, Section 8, Taiwan Boulevard, Wuqi District, Taichung City 43503, Taiwan","award":["TTMHH-R114-0095"],"award-info":[{"award-number":["TTMHH-R114-0095"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: While attention deficit\/hyperactivity disorder (ADHD) is characterized by neurodevelopmental heterogeneity, the influence of familial structural factors\u2014particularly parental age and skipped-generation caregiving\u2014on comorbidity patterns remains insufficiently studied. This study examined the associations between parent\u2013child age gaps, skipped-generation family structures, and psychiatric comorbidities in children with ADHD. Methods: Data came from Taiwan\u2019s NHIRD (2009\u20132013), including 79,163 ADHD cases and 395,815 matched controls. Key variables included maternal and paternal age at childbirth and grandparent-paid insurance premiums as a proxy for skipped-generation caregiving. Conditional logistic regression was used to estimate odds ratios (ORs) for 20 psychiatric and developmental comorbidities. Results: Children with ADHD exhibited significantly higher odds of various comorbidities, including oppositional defiant disorder (OR = 147.05, 95% CI = 101.0\u2013214.1), somatoform disorder (OR = 25.78, 95% CI = 7.96\u201383.46), anxiety disorder (OR = 24.49, 95% CI = 17.9\u201333.5), emotional disturbances during childhood and adolescence (OR = 13.99, 95% CI = 9.15\u201321.4), and autism spectrum disorder (OR = 8.07, 95% CI = 6.63\u20139.82). Advanced maternal age (&gt;35 years) was associated with increased odds of autism spectrum disorder (OR = 1.47, 95% CI: 1.29\u20131.67) and speech\/language delay (OR = 1.33, 95% CI: 1.17\u20131.52), whereas younger maternal age (\u226425 years) was linked to higher odds of anxiety disorder (OR = 1.23, 95% CI: 1.13\u20131.33) and adjustment reaction (OR = 1.41, 95% CI: 0.95\u20132.11). Maternal age under 20 years showed the highest odds for bipolar disorder (OR = 2.01, 95% CI: 1.04\u20133.88). For paternal age, older age (&gt;35 years) was associated with increased odds of autism (OR = 1.14, 95% CI: 1.04\u20131.26) and speech\/language delay (OR = 1.15, 95% CI: 1.04\u20131.27), whereas paternal age \u226420 years was strongly linked to bipolar disorder (OR = 3.58, 95% CI: 1.54\u20138.32) and anxiety (OR = 1.39, 95% CI: 1.01\u20131.93). Children from skipped-generation families\u2014defined as grandparent-paid insurance premiums without parental cohabitation\u2014had significantly higher odds of bipolar disorder (OR = 2.88, 95% CI: 1.36\u20136.11), personality disorder (OR = 9.23, 95% CI: 2.23\u201338.20), adjustment reaction (OR = 2.23, 95% CI: 1.39\u20133.59), and emotional disturbances during childhood\/adolescence (OR = 1.69, 95% CI: 1.13\u20132.54). Conclusions: Both extremes of parental age and skipped-generation caregiving are linked to specific associations with certain psychiatric comorbidity patterns in children with ADHD. These findings highlight the importance of integrating family structure into diagnostic assessments and treatment planning and support the development of targeted early interventions.<\/jats:p>","DOI":"10.3390\/children12091123","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T14:18:49Z","timestamp":1756217929000},"page":"1123","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of Parental\u2013Child Age Gaps and Skipped-Generation Families on Comorbidities Related to Attention Deficit Hyperactivity Disorder: A Population-Based Case\u2013Control Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3485-7558","authenticated-orcid":false,"given":"Hueng-Chuen","family":"Fan","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Tungs Taichung Metroharbor Hospital, No. 699, Section 8, Taiwan Boulevard, Wuqi District, Taichung City 43503, Taiwan"},{"name":"Department of Life Sciences, Agricultural Biotechnology Center, National Chung Hsing University, Taichung City 402, Taiwan"},{"name":"Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11243, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fang-Chuan","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Hungkuang University, No. 1018, Section 6, Taiwan Boulevard, Shalu District, Taichung City 433304, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4454-3360","authenticated-orcid":false,"given":"Jen-Yu","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Statistics, Feng Chia University, No. 100, Wenhua Rd., Xitun District, Taichung City 407102, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2332-6017","authenticated-orcid":false,"given":"Yu-Mei","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Statistics, Tunghai University, No. 1727, Section 4, Taiwan Boulevard, Xitun District, Taichung City 407224, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kuo-Tung","family":"Chiang","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, No. 60, Xinmin Rd., Beitou District, Taipei City 11243, Taiwan"},{"name":"Giraduate Institution of Medical Science, National Defense Medical Center, No. 161, Section 6, Minquan E. Rd., Nehu District, Taipei City 11490, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9309-0118","authenticated-orcid":false,"given":"Kuo-Liang","family":"Chiang","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology, Kuang-Tien General Hospital, No. 117, Shatian Road, Shalu District, Taichung City 433, Taiwan"},{"name":"Department of Nutrition, Hungkuang University, No. 1018, Section 6, Taiwan Boulevard, Shalu District, Taichung City 433304, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1016\/j.jad.2023.07.071","article-title":"The global prevalence of attention deficit hyperactivity disorder in children and adolescents: An umbrella review of meta-analyses","volume":"339","author":"Ayano","year":"2023","journal-title":"J. Affect. 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