ADHD Causes & Risk Factors

Causes and Risk Factors for Attention-Deficit Hyperactivity

Disorder
ADHD tends to run in families. More than 20 genetic studies provide evidence that ADHD is an
inherited disorder. At least 2 genes have been associated with the disorder. Most children with
ADHD have a close relative who also has it. The National Institute of Mental Health reports that
about one-third of fathers who suffered from ADHD during childhood have children with it.
Children with affected parents are three times more likely than other children to develop the
disorder, and identical twins are both likely to be affected.

Other possible causes and risk factors of ADHD include the following:

 Brain structure
 Brain chemicals (i.e., neurotransmitters)
 Medical conditions
 Learning disabilities
 Mental health conditions (e.g., conduct disorder, oppositional defiant disorder)
 Tourette's syndrome

Computer imaging of the brain structure of people with ADHD sometimes reveals smaller basal
ganglia and reduced frontal lobe activity. Basal ganglia, or nerve clusters, are involved in
routine behaviors, and the frontal lobes are involved in planning and organizing, attention,
impulse control, and inhibition of responses to sensory stimulation.

The neurotransmitter dopamine is involved in controlling emotions and reactions, concentrating,

reasoning, and coordinating movement. An abnormally low level of dopamine can cause the
three primary symptoms of ADHD: inattention, impulsiveness, and hyperactivity.

Mechanisms involved in the function of dopamine may cause this low level. The fact that
stimulants increase levels of dopamine and other neurotransmitters (i.e., epinephrine and
serotonin) and help reduce ADHD symptoms suggests that complex interactions between these
neurotransmitters are involved in ADHD.

Several medical conditions are associated with ADHD, though ADHD does not necessarily
occur as a result of them. Generally, children who experience brain trauma during pregnancy,
delivery, or immediately after birth, are at a greater risk for ADHD.

About 50% of children with pediatric autoimmune neuropsychiatric disorder associated with
streptococcal (strep) infections (PANDAS) have ADHD.
Alcohol and drug abuse (including nicotine) during pregnancy can cause poor motor and
muscular development and sensory impairment; problems with learning, memory, attention, and
problem solving; and problems with mental health and social interactions.

Lead poisoning found in infants and children exposed to paint that contains lead has been
implicated in ADHD. Specifically, it causes irritability, poor concentration, and distractedness.

The National Institute of Mental Health estimates that 20–30% of the 4,000,000 children in the
United States with learning disabilities also suffer from ADHD. Twenty percent to 40% of
children with learning disabilities may be prone to recurrent defiance or malicious conduct and
may be diagnosed with ADHD and either oppositional defiant disorder (ODD) or conduct
disorder (CD).

About 70% of people who suffer from involuntary twitching or spasms (tics) caused by
Tourette's syndrome also have ADHD. However, Tourette's is not common among people with
ADHD.

Risk factors
By Mayo Clinic staff

Risk factors for ADHD include:

 Maternal exposure to toxins

 Smoking, drinking alcohol or using drugs during pregnancy
 A family history of ADHD or certain other behavioral and mood disorders
 Premature birth

ADHD frequently occurs along with certain other conditions, including:

 Hyperthyroidism
 Having a learning disability or being a gifted learner
 Oppositional defiant disorder

Introduction/Overview

Attention Deficit Hyperactivity Disorder (ADHD) or hyperkinetic disorder is a psychiatric

disorder with a chronic neurobehavioral syndrome demonstrating signs of inattention,
impulsivity, restlessness and hyperactivity. It is important to note that the term Attention Deficit
Disorder is a condition without hyperactivity (1) & (2).
People suffering from ADHD develop antipathy, lack concentration, indecisiveness, and
organizational skills as well as avoid positions of responsibility.

About 5% of children in the age group of 9 – 17 years and 2-4% of adult population are affected
in the US with ADHD. Studies suggest “…that boys are affected approximately five times more
often than girls.” (1)

About 30%-80% of affected children carry this disorder into adulthood.

Other related conditions such as learning disorders, restless legs syndrome, ophthalmic
convergence insufficiency, depression, anxiety disorder, antisocial personality disorder,
substance abuse disorder, conduct disorder, and obsessive-compulsive behavior are more likely
to appear in people suffering from ADHD than in the general public. (3)

Types of ADHD

Based on the symptoms, Attention Deficit Hyperactive Disorders are classified into three types
which include:

Predominantly Inattentive Type:

In this type of disorder, the patient gets easily distracted and forgets daily routines. It is difficult
for an individual suffering from this disorder to organize a task, concentrate and follow
instructions to the smallest detail.

Predominantly Hyperactive-Impulsive Type:

An individual suffering from this type of disorder is always fidgety and talkative. It is difficult
for him or her to sit still for long doing homework or project, and is very impulsive and makes
impulsive decisions.

Combined Type:
An individual suffering from this type has symptoms of both types mentioned above. (4)

Causes & Risk Factors

Even though the exact causes of this disorder are not known, some of them could be connected to
the following issues.

Brain Injury:
One of the earliest theories stated that children who suffered from brain injury might show signs
of ADHD, but it was found that only a small percentage of children suffered from ADHD after a
traumatic brain injury.

Brain Volume:
Brain volume of the children suffering from ADHD is about 3-4% less in regions such as the
frontal lobes, temporal gray matter, caudate nucleus and cerebellum. An interesting point to be
noted here is that the patients treated with appropriate medication had a different brain volume as
compared to the untreated ones. (5)

Brain Chemicals:
Neurotransmitters & dopamine play a major role in controlling emotions and reactions,
concentration, reasoning and coordination. Dopamine dysfunction and low levels of other
neurotransmitters, such as epinephrine and serotonin, cause the three basic symptoms of ADHD -
inattention, impulsiveness and hyperactivity.

Medical Conditions:
Brain trauma experienced by a child during pregnancy, delivery, or post partum (immediately
after birth) are at a higher risk of suffering from ADHD. Approximately 50% of children with
Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections
(PANDAS) suffer from ADHD.

Alcohol and drug abuse by pregnant mothers can cause poor motor and muscular development
and sensory impairment. The newborn child experiences problems in learning, memory, attention
and problem solving; and problems with mental health and social interactions (6).

Environmental Toxins:
Preschool children exposed to Polychlorinated Biphenyls (PCBs) and lead found in paint and
pipes of older buildings are susceptible to ADHD. (7)

Genetic Factors:
Hereditary link of the disease is an important risk factor with 10-35% affected children having
close relatives with a past or present history of ADHD. Studies are in progress to pinpoint two
genes - namely the dopamine-receptor (DRD) gene on chromosome 11, and the dopamine-
transporter gene (DAT1) on chromosome 5. Studies have also shown genetic variations in one of
the dopamine-receptor genes (DRD4) in children suffering from ADHD (8).

Signs & Symptoms

Persistence of six or more of the following signs and symptoms of inattention are indicative of
predominantly inattentive ADHD: (see Types)

1. Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or
other activities.
2. Often has difficulty sustaining attention in tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in
the work place (not due to oppositional behavior or failure to understand instructions).
5. Often has difficulty organizing tasks and activities.
6. Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort.
7. Often loses things necessary for tasks or activities.
8. Is often easily distracted by external stimuli.
9. Is often forgetful in daily activities.
Persistence of six or more of the following symptoms of hyperactivity-impulsivity for a
minimum of six months are indicative of predominantly hyperactive-impulsive ADHD. (see
Types)

Hyperactivity

1. Often fidgets with hands or feet or squirms in seat.

2. Often leaves seat in classroom or in other situations in which remaining seated are expected.
3. Often runs or climbs excessively in situations in which it is inappropriate.
4. Often has difficulty playing or engaging in leisure activities quietly.
5. Is often “on the go” or acts as if “driven by a motor.”
6. Often talks excessively.

Impulsivity

1. Often blurts out answers before questions have been completed.

2. Often has difficulty awaiting turn.
3. Often interrupts or intrudes on others (9).

Medical Tests & Diagnosis Methods/Tools

ADHD is generally diagnosed during childhood or adolescence with no diagnostic laboratory test
for confirming the disorder. Complete medical examination is not only essential, but also
necessary to identify the related conditions of ADHD in order to treat the type. The most
important diagnostic tool is the clinical interview.

Attention-deficit/hyperactivity disorder affects people of all ages but is usually diagnosed during
childhood or adolescence. There is no diagnostic laboratory test for ADHD.

A thorough medical examination is important to identify other conditions that may be

responsible for symptoms that coexist with ADHD and require treatment.

Hearing and vision assessments should be included in the examination. The most important
diagnostic tool is the clinical interview.

The clinical interview includes evaluation of signs and symptoms; family history; home
environment; academic, social and emotional functioning, and developmental level. Various
types of evaluative rating scales are provided to patients, parents and teachers in order to sort out
the symptoms of ADHD. (10)

Various psychological tests are used to diagnose ADHD; The Conners' Parent and Teacher
Rating Scale (for children) and the Brown Attention Deficit Disorder Scale (BADDS) for teens
and adults are useful tools for diagnosis of ADHD.
Impulsivity and inattention are assessed with the Conners Continuous Performance Test (CPT),
the Integrated Visual and Auditory (IVA) CPT, or both. The Nadeau/Quinn/Littman ADHD Self-
Rating Scale for Girls is a part of the assessment for all girls. (3)

In children aged 5 years, “soft signs” appear early suggesting the presence of ADHD. Soft signs
include:

 Coordination difficulties
 Impaired motor skills
 Constant, involuntary movement of the eyes (nystagmus)
 Visual-motor control problems (hand-eye coordination)

On the other hand, evaluating ADHD in adults is difficult and consists of understanding the
childhood academic and behavioral history. Adults exhibit some of the coexisting conditions
such as:

 Depression
 Bipolar disorder
 Anxiety disorder
 Obsessive-compulsive disorder
 Substance abuse
 Migraine
 Irritable bowel syndrome
 Thyroid dysfunction (10).

Treatment Options

Presently, the treatment for ADHD involves therapy and/or medication.

Therapy:

A psychiatrist, psychologist, social worker or other mental health care professional provides the
therapy involving counseling or behavior therapy. People suffering from ADHD along with
anxiety disorder or depression can benefit from counseling. Some of the counseling therapies are
as follows:

Psychotherapy: Older children and adults suffering from ADHD are allowed to talk and discuss the
issues that trouble them, explore negative behavioral patterns and learn ways to deal with their symptoms.

Behavior Therapy: In this therapy, teachers and parents learn strategies (contingency
management procedures) to deal with children’s behavior. The strategy includes token reward
system and timeouts. This therapy has proved beneficial for those suffering from ADHD.
Family Therapy: This therapy helps parents and siblings to deal with the stress of living with
those suffering from ADHD.

Social Skills Training: This helps children learn appropriate social behavior.

Support Groups: These groups offer a network of social support, information and education to
adults and children suffering from ADHD and their parents, friends and relatives.

Parenting Skills Training: This helps parents to develop ways to understand and guide the child
in his day-to-day life. The best results are be obtained with teachers, parents and therapists or
physicians working in teams.

Medications:

Psychostimulants are prescribed to treat ADHD. Some of them are as follows:

 Methylphenidate (Ritalin, Concerta)

 Dextroamphetamine/amphetamine (Adderall)
 Dextroamphetamine (Dexedrine)
 Atomoxetine (Strattera) – a non-stimulant with similar effective action is also used.

The above medications are available in oral form and are short-acting (lasting for 4 hours) and
long-acting (6-12 hours) forms. Methylphenidate (brand name – Daytrana), a long acting drug, is
a patch worn on the hip and is used in children of ages 6-12 years. Psychostimulants appear to
boost and balance neurotransmitters.

Medication side effects:

Side effects of psychostimulants are decreased appetite, corresponding weight loss, reduced
growth rate, nervousness, irritability or increased activity and problems sleeping. Some children
also develop jerky muscle movements such as grimaces or twitches (tics). Strattera medication
leads to rare liver problems and signs of suicidal thinking. Adderall is not recommended to those
suffering from cardiac abnormalities. Similar side effects are observed in adults when treated
with the above medications. (11)

Prevention Methods
There are no known methods to prevent ADHD. Avoiding alcohol, drugs and smoking during
pregnancy may help prevent from the child from developing ADHD or similar problems. (12)

Resources:

http://www.mayoclinic.com/health/adhd/DS00275/DSECTION=risk-factors

http://www.mentalhealthchannel.net/adhd/causes.shtml
http://www.omnimedicalsearch.com/conditions-diseases/adhd-introduction-types.html

http://www.omnimedicalsearch.com/conditions-diseases/adhd-causes-risk-factors.html

http://www.omnimedicalsearch.com/conditions-diseases/adhd-symptoms.html

http://www.omnimedicalsearch.com/conditions-diseases/adhd-diagnosis.html

http://www.omnimedicalsearch.com/conditions-diseases/adhd-treatment-options.html