643389

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JADXXX10.1177/1087054716643389Journal of Attention DisordersHanć et al.

Article
Journal of Attention Disorders

Perinatal Risk Factors and ADHD in

1­–9
© The Author(s) 2016
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DOI: 10.1177/1087054716643389

Structure of Disorder Predictors jad.sagepub.com

Tomasz Hanć1, Anita Szwed1, Agnieszka Słopień2, Tomasz Wolańczyk3,

Monika Dmitrzak-Węglarz2, and Joanna Ratajczak1

Abstract
Objective: The aim of the study was to hierarchically assess the predictive power of low and high birth weight, pre-term
and post-term birth, and low Apgar score as the risk factors for ADHD. Method: The data of 132 boys diagnosed with
ADHD and 146 boys from control group, aged 6 to 18 years, have been analyzed. The boys were categorized according to
term of birth, birth weight, and Apgar score. CART method (Classification and Regression Trees) was used for assessment
of the relationship between perinatal factors and the risk of ADHD. Results: Low Apgar score (21.97% vs. 13.01%) and
post-term birth (12.12% vs. 0.68%) were more frequent in the sample than in the control group. CART method additionally
indicated low birth weight as associated with the risk of ADHD. Among analyzed risk factors, Apgar score had the highest
predictive value. Conclusion: The decreased Apgar score is the most important perinatal risk factor of ADHD. Research
results also indicated a high significance of post-term birth in predicting the disorder. (J. of Att. Dis. XXXX; XX(X) XX-XX)

Keywords
ADHD, perinatal factors, Apgar, birth weight, term of birth

Introduction
ADHD is a neuropsychological disorder manifesting in
attention deficits, impulsivity, and increased motor activity
(Milberger, Biederman, Faraone, Guite, & Tsuang, 1997).
The worldwide prevalence of ADHD in childhood is
approximately 5% (Polanczyk, de Lima, Horta, Biederman,
& Rohde, 2007).
Genetic research demonstrated a relationship between
ADHD and, among others, dopamine transporter gene
(DAT) and human dopamine receptor D4 gene (DRD4;
Biederman, 2005). However, irrespective of genetic factors,
a higher risk of ADHD was also associated with harmful
environmental conditions affecting the fetus, such as alco-
hol (Mick, Biederman, Faraone, Sayer, & Kleinman, 2002),
nicotine (Sagiv, Epstein, Bellinger, & Korrick, 2013), toxins
(Ribs-Fito et al., 2007), maternal stress (Motlagh et al.,
2010) and glucocorticoids (French, Hagan, Evans, Mullan,
& Newham, 2004), illicit drug use during pregnancy
(Milberger et al., 1997; Sagiv et al., 2013), and maternal
bleeding (Milberger et al., 1997). Many studies also
assessed the relationship between ADHD and general indi-
cators of sub-optimal in utero environment, such as a
small size at birth (Heinonen et al., 2010), pre-term birth
(Perricone, Morales, & Anzalone, 2013), or a low Apgar
score at 5 min (Li, Olsen, Vestergaard, & Obel, 2011). The
results suggest that a higher risk of ADHD is associated
with pre-term birth (Lindström, Lindblad, & Hjern, 2011),
being small for gestational age (SGA; Heinonen, Järvenpää,
Eriksson, & Andersson, 2008), extremely low birth weight
(Saigal, Pinelli, Hoult, Kim, & Boyle, 2004), very low birth
weight (Indredavik et al., 2004), or low birth weight (Boulet,
Schieve, & Boyle, 2011). However, some studies demon-
strated no relationship between ADHD and pre-term birth
(Harris et al., 2013; Heinonen et al., 2010; Sagiv et al.,
2013), low birth weight (Halmøy, Klungsøyr, Skjaerven, &
Haavik, 2012), or SGA (Indredavik et al., 2004).
Few studies took into account birth term, birth weight,
and Apgar score (Halmøy et al., 2012; Li et al., 2011;
Lindström et al., 2011). The results suggested that a low
Apgar score, low birth weight, and pre-term birth increase
the risk of ADHD in children independently from each
1
Adam Mickiewicz University in Poznań, Poland
2
Poznan University of Medical Sciences, Poland
3
Medical University of Warsaw, Poland
Corresponding Author:
Tomasz Hanć, Department of Human Biological Development, Adam
Mickiewicz University in Poznań, Umultowska 89, 61-614 Poznań, Poland.
Email: tomekh@amu.edu.pl

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2 Journal of Attention Disorders 
other. Nevertheless, none of the conducted studies evalu-
ated the internal hierarchy of importance of these factors in
assessing the risk of ADHD in children and adolescents.
In addition, to the best of our knowledge, a relationship
between ADHD, post-term birth, and high birth weight has
not been analyzed yet, whereas those two factors can result
in perinatal complications and hypoxia in children (Joseph,
2011; Sjaarda et al., 2014).
The aim of the study is to assess the hierarchy of perina-
tal factors that can increase the risk of ADHD, taking into
account high birth weight and post-term birth. We have
assumed that both pre-term and post-term birth, low and
high birth weight, and a low Apgar score increase the risk of
ADHD, and the assessment of the newborn infant’s general
condition according to Apgar scale is of the greatest predic-
tive importance.
Materials and Method
Ethical Statements
The study has been approved by the Ethics Committee of
the Poznan University of Medical Sciences and has, there-
fore, been performed in accordance with the ethical stan-
dards laid down in the 1964 Declaration of Helsinki and
its later amendments. The participants and their legal
guardians were fully informed about research procedures
and gave written consent to participate in the study.
Participants
The research was carried out in the years 2005 to 2008. The
aim of the study was to assess the growth of children with
ADHD. Boys aged 6 to 18 years were recruited. We have
collected the data of boys with clinically diagnosed ADHD
and of a group of boys selected according to age, without
psychiatric symptoms and coming from a community-based
sample (Hanć, Słopień, Wolańczyk, Dmitrzak-Węglarz,
et al., 2015). The data from this study have been previously
analyzed for the assessment of growth in a subsample of
treatment-naive school-age children with ADHD (Hanć,
Cieślik, Wolańczyk, & Gajdzik, 2012) and assessment of
the relation between ADHD and obesity (Hanć, Słopień,
Wolańczyk, Dmitrzak-Węglarz, et al., 2015; Hanć, Słopień,
Wolańczyk, Szwed, et al., 2015).
Both in the clinical and control group, inclusion criteria
comprised of the agreement of legal guardians to examina-
tion and the age of boys (between 6 and 18 years). Data on
the boys’ health were collected during clinical assessment.
For the purposes of the analyses for the present study,
boys with ADHD-comorbid depression, anxiety disorders,
anorexia, or bulimia were excluded from the clinical group.
Boys with suspected psychiatric disorders were excluded
from the control group. Individuals with endocrine disorders
were excluded from both groups.
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Information concerning the pregnancy, delivery, and
newborn infants’ general condition was collected with the
use of medical registries. Questionnaires filled in by parents
provided, among others, demographic data and data con-
cerning parents’ education and socioeconomic status (SES)
of the family as well as children’s health.
Psychiatric Assessment
Boys with ADHD were recruited in psychiatric clinics and
university outpatient clinics. Diagnoses were confirmed by
a team including a psychiatrist and a psychologist on the
basis of the Conners’ Parent Rating Scale and the Diagnostic
Structured Interview for ADHD and Hyperkinetic Disorder
according to International Classification of Diseases (ICD-
10; World Health Organization, 1994) and Diagnostic and
Statistical Manual of Mental Disorders (4th ed., text rev.;
DSM-IV-TR; American Psychiatric Association, 2000;
Wolańczyk & Kołakowski, 2005). Diagnosis was assumed
as confirmed if both methods indicated that a child fulfills
the ADHD diagnostic criteria. The Diagnostic Structured
Interview for ADHD and Hyperkinetic Disorder according
to ICD-10 and DSM-IV-TR also contains questions concern-
ing oppositional defiant disorder and conduct disorder
(Wolańczyk & Kołakowski, 2005). Mood, anxiety, and eat-
ing disorders were diagnosed based on data from standard
diagnostic psychiatric interview and mental state assess-
ment, according to diagnostic criteria of ICD-10 (WHO,
1994) and DSM-IV-TR (American Psychiatric Association,
2000).
In the case of the control group, only boys with no suspi-
cion of mental problems were enrolled. Assessment of men-
tal health was based on parents’ responses to the following
questions proposed and used with success in other research
(Warring & Lapane, 2008): (a) “Has a doctor or health pro-
fessional ever told you that your child has attention-deficit
disorder, attention-deficit/hyperactive disorder, that is,
Attention Deficit Disorder (ADD) or ADHD?” (b) “Has a
doctor or health professional ever told you that your child
has psychiatric disorders?” (c) “Has a doctor or health
professional ever told you that your child has oppositional
defiant disorder, conduct disorder, emotional problems,
such as depression or anxiety disorder?” Only boys whose
parents had answered “no” to the above questions were
included in the control group.
Family Profile
For the purpose of this study, we had decided to exclude
children from families with low SES (family income level
lower than PLN (Polish New Złoty) 4,000 net, based on the
data of the Central Statistical Office for the years 2005-
2008; Główny Urząd Statystyczny, 2015) and children of
parents with low education (at least one parent having only
Hanć et al. 3
elementary education). Therefore, the compared groups were
homogeneous in terms of factors influencing newborn
infants’ condition, as have been confirmed in many studies
(Kosińska, 2011; Lim, Park, Park, & Kim, 2012; Verropoulou
& Basten, 2014; Young, Weinberg, Vieira, Aschengrau, &
Webster, 2010). Similarly, strict methods of preselection
were previously employed in large projects aimed at estab-
lishing international standards of development from the
conception to the birth (INTERGROWTH-21st; Villar
et al., 2013; Villar et al., 2014), and from birth to 5 years of
age (WHO Multicentre Growth Reference Study [MGRS];
Garza & de Onis, 2004; WHO, 2006), where the sample
was selected, among others, according to education level
and SES.
Newborn Infant Health Evaluation
The participants were divided according to obtained Apgar
score, term of birth, and birth weight. Newborn infants
born before 37th week of pregnancy were classified as pre-
term-born, and those born after 42nd week of pregnancy as
post-term-born (WHO, 2004). Irrespective of term of birth,
birth weight below 2,500 g was classified as low, and birth
weight above 4,000 g as high (Centers for Disease Control
and Prevention [CDC], 2009).
Similarly as in previous research (Halmøy et al., 2012;
Li et al., 2011; Lindström et al., 2011), Apgar score at 5 min
was used in the study. This indicator of newborns’ health
had been proved to be a valid predictor of neonatal mortality,
neurological health, and cognitive development (Almeida
et al., 2008; Casey, McIntire, & Leveno, 2001; Ehrenstein,
2009; Odd, Rasmussen, Gunnell, Lewis, & Whitelew, 2008;
Stark et al., 2006). For the purpose of hierarchical evalua-
tion of risk factors, the following two categories of Apgar
score were distinguished: score of 9 to 10, standing for a
very good general condition of a newborn infant (the new-
born infant does not require additional medical examina-
tion or observation), and score <9, which may stand for a
necessary observation of the newborn infant. The second
category includes newborn infants with a wide range of
symptoms, which may cause difficulties in adaptation to
extra-uterine life. The above way of categorization was
adopted following Li, Olsen, Vestergaard, and Obel (2011).
Data Analysis
Initial assessment of differences between children with
ADHD and the control group included two-tailed Student’s
t test and chi-square test. CART method (Classification and
Regression Trees) was used to assess the influence of poten-
tial interactions between the examined variables on the risk
of ADHD. Gini splitting criterion was adopted as a measure
of goodness of fit. Gini index measures how often a ran-
domly chosen element would be incorrectly labeled if it
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were randomly labeled according to the distribution of
labels in the subset. As an impurity measure, Gini index
reaches a value of zero if only one class is present at a node
and reaches its maximum value when sizes of the class at
the node are equal (StatSoft, 2013). Selection of a tree of the
right size was made with the adoption of the minimal subset
size of 10 and standard error rule of 1.0 as stopping param-
eters (Breiman, Friedman, Olshen, & Stone, 1998; Ripley,
1996). CART method also enabled putting the examined
risk factors in order of their predictive value—from 0 that
stood for a low predictive value to 100 that stood for a high
predictive value.
Results
The examined sample consisted of 132 boys with ADHD,
without comorbid mood and anxiety disorders, and 146
boys in the control group, without suspicion of mental
problems, for whom complete information about Apgar
score (5 min), birth term, and birth weight was obtained.
All of them came from cities with more than 100,000 resi-
dents and were brought up in families characterized by at
least average income level and parents’ level of education
higher than elementary.
Age of the boys at the time of recruitment did not differ
significantly between the groups (ADHD: 11.05 ± 2.63;
Control group: 10.69 ± 1.48, t = 1.40, p = .16). ADHD
combined subtype occurred in 90 (68.18%) boys, attention
deficits disorder in 31 (23.48%) boys, and hyperactive/
impulsive subtype in 11 (8.34%) boys. Comorbid diagnosis
of oppositional defiant disorder was made in 64 (48.49%)
boys, while conduct disorder was observed in 15 (11.36%)
boys with ADHD.
Unadjusted analyses did not show statistically signifi-
cant differences in parents’ age at the time of birth between
boys with and without ADHD. The groups also did not dif-
fer in birth weight. Statistically significant differences were
demonstrated for birth term (χ2 = 16.40, p < .001) and Apgar
score (χ2 = 3.90, p = .04). Pre-term birth was more frequent
in boys from the control group (14.38% vs. 9.85%), and
post-term birth was more frequent in boys with ADHD
(12.12% vs. 0.68%). In addition, boys with ADHD more
often had a lower Apgar score (<9 scores: 21.97% vs.
13.01%) (Table 1).
CART method generated a classification tree including
three divisions, which resulted in four terminal nodes. The
root node (t1) comprises all the examined children (boys
without ADHD: N1 = 146, boys with ADHD: N2 = 132).
Other nodes show the number of a given node (N) and the
number and percentage of boys in the control group and
boys with ADHD (N1 and N2, respectively). Node t1 was
divided based on the term of birth. Full-term- and pre-
term-born children together formed node t2, while post-
term-born children formed terminal node t3. A significant
4 Journal of Attention Disorders 

Table 1.  Estimation of Differences in Analyzed Variables Between Boys With and Without ADHD.

Boys with ADHD Boys without ADHD

(n = 132) (n = 146) Differences between groups of
M ± 1SD M ± 1SD boys with and without ADHD
Characteristics or n (%) or n (%) (2-tailed t test or χ2 and p)
Mother’s age at birth
  <25 y 56 (42.42) 74 (50,68) χ2 = 1.92, p = .38
  25-35 y 66 (50) 62 (42.47)  
  >25 y 10 (7.58) 10 (6.85)  
Father’s age at birth
  <25 y 36 (27.27) 42 (28.77) χ2 = 0.09, p = .96
  25-35 y 76 (57.58) 83 (56.85)  
  >25 y 20 (15.15) 21 (14.38)  
Birth term
  At term 103 (78.03) 124 (84.93) χ2 = 16.40, p < .001
 Pre-term 13 (9.85) 21 (14.38)  
 Post-term 16 (12.12) 1 (0.68)  
Body weight at birth (g) 3378 ± 555.33 3488 ± 455.48 t = −1.82, p = .07
  Low birth weight 7 (5.30) 3 (2.05) χ2 = 2.21, p = .33
  Normal birth weight 110 (83.33) 124 (84.93)  
  High birth weight 15 (11.36) 19 (13.01)  
Apgar score 9.11 ± 1.44 8.87 ± 2.21 t = 1.07, p = .28
 <9 29 (21.97) 19 (13.01) χ2 = 3.90, p = .04
 9-10 103 (78.03) 127 (86.99)  

Note. y = years; n = numbers; % = percentage; SD = standard deviation; t = value of Student’s t test; χ2 = value of χ2 test; p = the level of significance;
bold = differences significant at the level of p < .05.

majority of individuals included in node t3 were boys with
ADHD (12.12% of the sample vs. 0.69% of the control
group). Division of node t2 was based on birth weight.
Terminal node t4 consisted of children with low birth
weight, and boys with ADHD are predominant in that node
(5.31% of the sample vs. 2.05% of the control group). Node
t5 included children with normal and high birth weight
(97.26% of the control group and 82.57% of boys with
ADHD) and was divided into two terminal nodes t6 and t7
due to Apgar score. Node t6 included children with Apgar
score of 9 to 10. It accounted for 85.61% of boys from the
control group and 66.67% of boys with ADHD. Node t7
were children with Apgar score below 9 (11.64% of the
control group and 15.44% of boys with ADHD) (Figure 1).
CART method indicated Apgar score as the most impor-
tant predictive factor (predictor importance = 100). The factor
of the lowest importance was birth weight (predictor impor-
tance = 55). Birth term held an intermediate place on the
scale of importance (predictor importance = 80) (Figure 2).
Discussion
The aim of the study was to assess the hierarchy of perinatal
risk factors of ADHD. For this purpose, a low Apgar score,
prevalence of pre-term and post-term birth, and low and
high birth weight were assessed in a group of boys with
ADHD and in the control group. The adopted exclusion
criteria eliminated potential influence of SES, parents’
education, place of residence, and some ADHD-comorbid
disorders on the results.
The majority of available papers demonstrated an
increased risk of ADHD in children with subnormal birth
weight (Anderson et al., 2011; Botting, Powls, Cooke, &
Marlow, 1997; Indredavik et al., 2004; Saigal et al., 2004)
and in pre-term-born children (Anderson et al., 2011;
Lindström et al., 2011; Perricone et al., 2013). Our adjusted
analysis also revealed a relationship between low birth
weight and an increased risk of ADHD. However, the per-
centage of premature infants was higher in the control group
than among boys with ADHD. The lack of a relationship
between ADHD and pre-term birth has also been demon-
strated in several papers published in the recent years
(Halmøy et al., 2012; Harris et al., 2013; Heinonen et al.,
2010). Differences in the obtained results can be due to dif-
ferent methodology and selection criteria. In our study, we
excluded the influence of low SES and low parents’ educa-
tion, which can be factors associating ADHD with pre-term
birth and low birth weight. Both ADHD (Claycomb, Ryan,
Miller, & Schnakenberg-Ott, 2004; Sagiv et al., 2013) and
the mentioned perinatal disorders (Kosińska, 2011; Lim
et al., 2012; Verropoulou & Basten, 2014; Young et al.,
2010) can be related to parents’ worse living conditions.

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Hanć et al. 5

Figure 1.  Classification tree of ADHD risk factors.

Note. t1-t7 = descendant nodes; N = number of observations assigned to a given node; N1 = number of healthy children; N2 = number of children
with ADHD.

Figure 2.  Validity ranking of the analyzed factors significantly increase the risk of ADHD (CART method).
Note. Scale from 0 = lowest validity to 100 = highest validity of the predictor. CART = Classification and Regression Trees.

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6 Journal of Attention Disorders 
We observed a distinct relationship between an increased
risk of ADHD and post-term birth, which, according to our
knowledge, was not analyzed in earlier studies. The preva-
lence of post-term birth is 8.1% of all live births in Europe
(Zeitlin, Blondel, Alexander, Breart, & Group, 2007) and
5.6% in the United States (Martin et al., 2009). It is related
to perinatal mortality and morbidity, such as operative
delivery, low Apgar score, and macrosomia (Olesen,
Westergaard, & Olsen, 2003; Schierding, O’Sullivan,
Derraik, & Cutfield, 2014), as well as adverse neurodevel-
opmental outcomes in pre-school children (Lindström,
Fernell, & Westgren, 2005). Post-term birth can also be
related to perinatal hypoxia, which is an important risk fac-
tor in later attention deficits, hyperactivity, and impulsivity
(Getahun et al., 2013; Golubnitschaja, Yeghiazaryan,
Cebioglu, Morelli, & Herrera-Marschitz, 2011). Therefore,
the relationship between post-term delivery and an
increased risk of ADHD seems valid; however, it needs to
be confirmed.
Only few earlier studies analyzing the background of
ADHD assessed the combined effect of birth weight, birth
term, and Apgar score. The results suggest that these fac-
tors are associated with ADHD independently from each
other (Halmøy et al., 2012; Li et al., 2011; Lindström et al.,
2011). However, the structure of the relationships between
predictive variables and predictive importance of individ-
ual factors has not been examined so far. Using the CART
method, we confirmed the results of unadjusted analysis,
which showed that both post-term birth and a low Apgar
score are factors increasing the risk of ADHD. The analysis
also indicated low birth weight as a risk factor of ADHD.
The relationship between low birth weight and ADHD was
revealed in a group of pre-term- and full-term-born chil-
dren, whereas the relationship between low Apgar score
was revealed even after previously excluding fractions of
post-term-born boys and boys with low birth weight from
the compared groups.
Predictive importance of a low Apgar score is confirmed
by the ranking of importance of the assessed predictors,
where that variable was ranked the highest. The consider-
able predictive importance of Apgar score presumably
results from its general nature. The score assesses also such
nonspecific indicators of newborn infant health as appear-
ance, pulse rate, reflex irritability, activity and muscle tone,
and respiratory effort (Finster & Wood, 2005). Hence, a
lower Apgar score can be related to many complications
with pregnancy and delivery, to both pre-term and post-
term birth (Kitlinski, Källén, Marsál, & Olofsson, 2003),
and it can also be given to a full-term-born newborn infant
with normal birth weight but with other complications.
Therefore, it can only generally be assumed that a higher
risk of ADHD can be observed in newborn infants after dif-
ficult delivery and/or in a worse general condition, and hav-
ing difficulties in adaptation to extra-uterine environment.
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Nevertheless, similar to earlier studies, our research confirms
that Apgar score is an important predictor of neurodevelop-
mental disorders (Larson et al., 2005; Li et al., 2011; Odd
et al., 2008).
On the basis of the classification tree, it can be concluded
that perinatal risk factors had been observed in as much as
33.33% of boys with ADHD. It proves a strong relationship
between the course of pregnancy and delivery and the risk
of ADHD. However, one should note that terminal node t6
still includes a large group of children with ADHD, that is,
66.67%. It proves the importance of other factors (genetic
or environmental) increasing the risk of ADHD, which were
not addressed in this study, and which do not necessarily
result in worse general condition of a newborn infant.
The limitation of the study is its retrospective nature;
therefore, it was not possible to assess the accuracy of mea-
surement of birth weight and Apgar score. In the study, we
did not control for many psychiatric disorders, which can
be comorbid with ADHD. Exclusion criteria comprised of
depression, anxiety disorders, anorexia, or bulimia; however,
they are not a complete list of ADHD comorbidities. Some
doubts can also be aroused by the method of selecting the
control group. For this purpose, we used questions previ-
ously asked by other researchers in screening examinations
(Finster & Wood, 2005; Getahun et al., 2013; Golubnitschaja
et al., 2011), which cannot replace clinical diagnosis of the
disorder. The initial study focused on multifactor determi-
nants of growth and obesity, and the procedure consisted of
many questionnaires and inventories. On the other hand, we
have tried to achieve the greatest possible sample size. We
assumed that detailed assessment of psychiatric disorders in
control group might discourage parents and their children to
participate in the study. Therefore, we decided to use the
method that was less detailed but more suitable for popula-
tion study. Although we cannot exclude that the control
group also contains individuals with undiagnosed emo-
tional disorders, we are sure that the employed procedure
limited the possibility as much as possible.
It is possible that mode of delivery may also be involved
with the risk of ADHD. One recent study found higher
levels of symptoms of ADHD in children born at term
by Caesarean section, but only if preceded by induced
labor (Talge, Allswede, & Holzman, 2016). Most of other
studies have not shown, however, the relationship between
Caesarean section and an increased risk of ADHD (Curran
et al., 2016; Curran et al., 2015). Because in our study we
gathered data on the type of delivery only for children with
ADHD, it was therefore not possible to carry out analysis of
relationship of Caesarean section with the risk of the dis-
order. Our records indicate that 20% of children with
ADHD in our sample (children born in 1987-2002) were
born by Caesarean section. For comparison, the rate of
births by Caesarean section in Poland was 18.5% in 1991
(Słupczyński, Jezierska, & Ratoń, 1996) and 29.2% in
Hanć et al. 7
2001-2002 (Stasiełuk, Langowicz, Kosińska-Kaczyńska,
Pietrzak, & Wielgoś, 2012). The comparison of the data
suggests that Caesarean section is not more common in
children with ADHD and, therefore, does not increase the
risk of the disorder.
Conclusion
A reduced Apgar score was determined as the most impor-
tant among the assessed risk factors of ADHD in the
research aided by hierarchical analysis with simultaneous
control of many disturbing factors. The obtained results
also indicated the necessity of control of post-term birth as
an important predictor of ADHD, not assessed in earlier
studies.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support
for the research, authorship, and/or publication of this article: The
research was partially supported by the Polish Ministry of Science
and Higher Education (Grant N N303 0175 33).
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Author Biographies
Tomasz Hanć is an adjunct in the Department of Human
Biological Development, Institute of Anthropology, Faculty of
Biology, Adam Mickiewicz University in Poznań, an auxologist,
psychologist, and a cognitive-behavioral therapist.
Anita Szwed is an assistant professor in the Department of
Human Biological Development, Institute of Anthropology,
Faculty of Biology, Adam Mickiewicz University in Poznań, a
physical anthropologist and auxologist. Her research examines
the environmental factors affecting optimal human development
across the life span.
Agnieszka Słopień is head of the Department of Child and
Adolescent Psychiatry of Poznan University of Medical Sciences,
Poland, since 2015. She is a specialist in psychiatry, child and ado-
lescent psychiatry, and is a certified psychotherapist. She is author
of 130 scientific publications.
Tomasz Wolańczyk is head of the Department of Child Psychiatry
of Warsaw Medical University, Poland, since 2002. He is a spe-
cialist in neurology, child psychiatry, and cognitive-behavioral
therapist. He is author of 130 scientific publications.
Monika Dmitrzak-Węglarz is an assistant professor in the
Department of Psychiatric Genetics (Poznan University of Medical
Sciences), a specialist in medical laboratory genetics. Her current
research interests include genetics background of psychiatric
disorders especially with disturbances of circadian rhythms and
neurodevelopmental components. She is author of more than 70
scientific publications.
Joanna Ratajczak is a doctoral student in the Department of
Human Biological Development, Institute of Anthropology,
Faculty of Biology, Adam Mickiewicz University in Poznań. Her
current research interests include the impact of stress and emo-
tional reactivity on biological development of children at early
school age.