General Anesthesia Exposure in Relation to ADHD Symptom Dimensions and ODD Comorbidity in Medication-Naïve Children with ADHD

Background: Evidence regarding the association between early childhood exposure to general anesthesia (GA) and later attention-deficit/hyperactivity disorder (ADHD) remains inconsistent. Moreover, the relationship between GA exposure and oppositional defiant disorder (ODD) comorbidity has not been sufficiently investigated. This study examined whether GA exposure is associated with dimensional ADHD and ODD symptom severity and categorical ODD comorbidity in a medication-naïve clinical sample.Methods: This cross-sectional study included 92 medication-naïve children aged 7–12 years diagnosed with ADHD (n=63) or ADHD+ODD (n=29). Children with additional psychiatric comorbidities were excluded. GA exposure history (presence, number, and age at exposure) was obtained retrospectively from parents. Dimensional symptoms were assessed using the DSM-IV–based Disruptive Behavior Disorders Rating Scale. Results: GA exposure was not significantly associated with ADHD+ODD comorbidity (χ²=2.668, p=0.102) or ADHD presentation type (χ²=3.029, p=0.082). After adjustment for age, sex and trauma history, GA-exposed children had higher inattention scores than non-exposed children (F(1,89)=9.278, p=0.003, partial η²=0.094). Inattention scores also significantly differed by number of GA exposures and age at first exposure. However, GA exposure characteristics were not significantly associated with hyperactivity–impulsivity, ODD, or conduct disorder scores.Conclusions: GA exposure was not associated with ODD symptom severity, categorical ODD comorbidity, ADHD presentation type, or broader disruptive behavior symptom dimensions. Although adjusted analyses suggested higher inattentive symptom severity among GA-exposed children, this finding should be interpreted cautiously. Larger longitudinal studies are needed to clarify whether GA exposure has an independent role in ADHD symptom expression or ODD comorbidity.