The Cause of ADHD or ADD
ByThis article comes from a question from a reader, who asks: “I wanted to ask you, what causes ADHD (Attention Deficit Hyperactivity Disorder)? There is so little information about the causes of ADHD it seems the medical world is at a loss for words. Also if we new what caused it we might be able to cure it rather than treat it.”
(N.B. For this article, and throughout this blog, I use the term ADHD for both ADD and ADHD.)
We will approach this question in two ways:
1) What causes ADHD – in other words – what leads a person to get ADHD in the first place?
2) What causes ADHD symptoms – in other words – when one has ADHD, what leads them to have symptoms of not being able to pay attention, and being hyperactive/impulsive?
Part 1: What causes ADD or ADHD?
The first place to start with the cause of ADD or ADHD is genetics. ADHD is a very genetic disorder.
There is term called ‘heritability’, which refers to how genetic a disorder is. As an example – breast cancer is 30% heritable – meaning that about 30% of the possible causes of breast cancer can be attributed to genetics. Asthma is 40% heritable. Height is 80 to 85 percent heritable. ADHD is about 80 percent heritable.
That means that ADHD is highly genetic. This research comes from twin studies and other family studies, and shows that ADHD is almost as genetic as height.
Now if genes cause 80 percent that means there is about 20 percent that is not caused by genetics. What are the other causes? When it comes to the non-genetic causes of ADHD, we can call these ‘acquired’ cases. When we look at acquired cases, we can separate these into: Prenatal (i.e. causes that affect the person before birth), and Postnatal (i.e. causes that affect the person after birth).
The Prenatal Causes of ADHD:
These are the acquired causes of ADHD that occur during the pregnancy.
- Mother smoking during pregnancy: if the mother smokes cigarettes during pregnancy this increases the risk by 2.5 times (so the child is 2.5 times more likely to develop ADHD than if the mother didn’t smoke during pregnancy)
- Mother drinking alcohol during pregnancy: With alcohol during pregnancy, there is the same increased risk – 2.5 times.
- Prematurity: If there is prematurity at birth, there is a general increased risk for ADHD, however if there is bleeding in the baby’s brain there is a 45 percent chance that that individual will have ADHD.
- Increase in pregnancy complications: If there is an overall increase in pregnancy complications there is a non specific increased risk for ADHD.
Interestingly cocaine or crack exposure is not a risk factor for ADHD once you account for smoking cigarettes and drinking alcohol. Generally speaking a pregnant mother who is using cocaine will also tend to use cigarettes and alcohol.
The Postnatal Causes of ADHD:
These are acquired causes of ADHD that occur after the pregnancy (i.e. after the child is born).
- Head injuries/head Trauma: ADHD can develop after a significant head injury – by significant I mean one that results in loss of consciousness, or a serious concussion
- Brain Hypoxia which means not enough oxygen getting to the brain for a period of time. An example of this could be a near drowning or some other situation like that.
- Brain tumours
- Brain infection.
- Lead poisoning in the preschool years (i.e. before 3 years old)
- Survival from acute lymphoblastic leukemia (ALL) – because the chemotherapy itself can lead to brain changes.
Part 2: What Causes ADHD Symptoms?
The first place to start when talking about what causes ADHD symptoms is the fact that ADHD is a brain disorder. All of the research going into ADHD shows clearly that differences in the ADHD brain are what account for the symptoms.
This means that we can throw out the causes of ADHD which are ‘social’. In other words, all of the descriptions of ADHD coming from: video games, TV, MTV, single parents families, stressed school systems, etc. are all wrong! There is no credibility to these explanations.
Brain research in ADHD is continually improving and progressing. Brain imaging shows that the main area of the brain involved in ADHD symptoms in the prefrontal cortex. This is in the frontal lobe – the part of the brain just behind the forehead. The frontal lobe is the command center of the brain. This is the part that does the planning that we need to do. The frontal lobe tells you to pay attention to this and disregard that because it’s a distraction that’s not important. It tells you to plan, it tells you how to adapt your plan when something comes up that’s difficult. It tells you to inhibit your response – so you don’t swear at someone, even if you’re angry, if it would get you into serious hot water.
So the prefrontal cortex, the part of the brain in the frontal lobe just behind the forehead, is the part that’s involved in ADHD.
Brain imaging studies that look at the brain chemicals – called neurotransmitters – show that there is a decrease in the brain chemical dopamine in that area. Another brain chemical impacted in ADHD is norepinephrine (or noradrenaline). Now when a person with ADHD takes an ADHD medicine, it increases the dopamine and/or noradrenaline. This improves the concentration, hyperactivity and impulisivity. If you examined that person under a PET scan – you would see that there is an increase in these brain chemicals in the area that is impacted
Parenting and ADHD:
While we are talking about the causes of ADHD, I need to take a moment and address this important issue: parenting and ADHD. It is very common in society at large to blame parents for their children’s ADHD and/or misbehavior associated with ADHD.
Bad parenting does not cause ADHD. This has been conclusively proven. I’ll repeat it: Bad parenting doesn’t cause ADHD.
If anything, having an ADHD child is very stressful, presents unique challenges, and creates low parenting satisfaction. Why? Because of the ADHD.
As a child psychiatrist and a parent myself – my experience is that most people have kids, and despite the fact that they are not experts in parenting, they try hard (and maybe learn about parenting through reading or classes) and their child turns out fine. You can call this ‘natural intuitive parenting’. Parents then pat themselves on the back and say ‘I’m a great parent’.
In contrast, the parent who has a child with ADHD can do the exact same things but they just don’t work. Instead of them being able to pat themselves on the back, everybody is trying to tell them how to parent their child because their child just doesn’t seem to listen. This leads to a lot of parenting frustration, and it makes it harder for the parents.
Research has shown that when parents use specific strategies designed to help with ADHD, this can improve their effectiveness as parents, and we will cover this more in a future article.
In this article, we have covered the causes of ADHD – i.e. what leads to a person having ADHD. This is mainly genetics, but some acquired causes as well. We have also talked about what causes ADHD symptoms – i.e. the brain! To finish the article, I covered the issue of parenting and ADHD – and how bad parenting is not a cause of ADHD.
At age 65 I suffer from ADHD (inattentive), 50 years of dysthymic disorder, episodes of major depressive disorder and fibromyalgia. by the grace of God and a wonderful wife. I have managed to raise 4 children and stay married for 33 years. I have 30 years of sobriety from alcohol. have worked until April of 2006 when I burned out and have not worked since that time. I hope to recover enough to work again. I take Adderall, Cymbalta and Temazepam.
My questions are:
Are there known connections between these conditions?
Do you have any suggestions for seeking healing?
Thank you
Hi Howard,
Thank you for commenting on this blog and sharing your story.
The reality is that most people with ADD or ADHD have 1 or more comorbid (or coexisting) conditions. About 40% or so of people with ADD also have depression. About 30-40% of people with ADD also have drug or alcohol problems.
Regarding seeking ‘healing’, I suggest a combination of medication and therapy. These are standard approaches for ADD/ADHD. It seems that you are on medication – the question is: is it optimal? I mean are you getting a great response from it. If the answer is no, then it may be worth talking to your doctor about the medicine choices, or dosages.
Also, it is worth pursuing therapy – to help with your depression and ADD. Also, coaching can be helpful. To find a great coach, check out Bonnie Mincu at http://www.thrivewithadd.com.
All the best,
Dr. Kenny Handelman
Hi Kenny,
Why have you left out the improper metabolism of fatty acids as a cause of ADHD, and with that any nutritioinal protocol that would address this issue. I do not mean an elimination diet, but supplementation to help address this issue. I have addressed ADHD in this manner and have achieved noticable results with a young child. The results are noticable when his medication (Ritalin) is wearing off and also on days he is not taking his medication. I would be happy to discuss this further with you.
Hi Kenny,
I have a grandson with this problem and have talked to many people with a child with this. I have been looking everywhere for statistics about the birth order of the children and it seems to me that it almost always is the first born child in a family that has adhd. Do you know of any research in this field? Many people I know say it is the first child and the next one or two are fine and I have a theory that it is somehow caused by a build up of toxins in the mother (pesticides, chemicals etc.) and because they have built up slowly in the mother as she is growing from childhood that the effect of these toxins is passed on to the baby in utero in a giant dose and cause the effects of adhd. If you know of any such studies I would be interested in looking at them.
Thanks.
Hi Ms. Clark,
You raise an excellent question regarding birth order.
The issue is that I am not aware of any research that documents any reliable information about birth order and ADD/ADHD.
I’m sorry that I can’t help.
Dr. Kenny
Dear Kenny;
I would just like to say “thank you” for your article on what causes ADHD and the statement “you are not a bad parent” My family constantly is telling me, I am not controlling my son properly.
Two weeks ago I was told he had ADHD. For quite some time I have always felt like a failure when it came to parenting. I read so many books and articles on how to parent and nothing has worked.
I am so glad a friend sent me your web information as I have found it so helpful.
Thank you,
The Cause of ADHD or ADD | ADD ADHD Blog.com…
what causes ADHD (Attention Deficit Hyperactivity Disorder)? There is so little information about the causes of ADHD it seems the medical world is at a loss for words….
The Cause of ADHD or ADD…
what causes ADHD (Attention Deficit Hyperactivity Disorder)? There is so little information about the causes of ADHD it seems the medical world is at a loss for words….
The Cause of ADHD or ADD | ADD ADHD Blog.com…
what causes ADHD (Attention Deficit Hyperactivity Disorder)? There is so little information about the causes of ADHD it seems the medical world is at a loss for words….
I’m suspecting that my cousin has ADHD. He’s already 21 years old but its just lately that we realized that there is something wrong with him. He’s very hard headed and often has problem coping up with school. He’s teacher told us that he is not paying attention with his classes and even his classmates are already finding him weird because he keeps on talking though nobody wants to listen to him anymore.
I have checked the net for symptoms of this disorder and most of it are on him. We are worried that the chances of recovery for him might be too late because he wasn’t brought to the doctor during his early years. Is this true? What should we do?
Hi,
Here are a couple of articles about symptoms of Adult ADHD:
http://www.addadhdblog.com/adult-adhd-symptoms-are-different/
http://www.addadhdblog.com/adult-add-adhd-diagnosis/
Take a look at these.
Regarding what to do – your cousin will have to consider this a problem and talk to a doctor for him to get anywhere with this.
I hope these articles help.
Best,
Dr. Kenny
Hi there….Thank you so much for not blaming the parents and for confirming that it is not caused by bad parenting. Another site online suggests that the rewarding centre of the brain does not work the same for ADHD people as the general population I noticed this for years….my son did not seem to value the same the things as his peers and was rarely motivated by reward. Even as an adult he does not seem to value the stuff that most adults do. Any comment?
Hi Dr. Kenny,
Thank you so much for your response. I have read the article that you told me. I was happy because I was able to understand the effect of ADHD on adult. I didn’t realized that it could have a different symptoms when it comes to adult. But I’m worried though because the article just confirmed our suspicion that my cousin has this disorder. We are planning to take him to a psychiatrist for further evaluation. I learned from a friend that ADHD can be caused by early birth. My cousin was premature when he was born. He was only 7 months. I also learned that if this disorder is not treated soon it can lead to schizophrenia? Is that true?
My cousin didn’t have a good childhood it was because he was always scolded since his parent’s thought that he is just hardheaded. He was treated differently from his other siblings because he caused major problems in the family. He would also often run away. Has this experience worsen his situation? Sometimes I would catch him staring at the wall as if he is lost in a deep thought. Please help. I really want him to recover
Hello I am a student researcher and I was wondering your thoughts or opinions on the thought of video games causing ADHD.
Thanks
Hi,
There is no credible evidence to show that adhd is caused by video games.
Dr. Kenny
Thank you for the response. I was also wondering about TV in general causing ADHD. I read something that Dr. Daniel Amen said and he stated that: “As far as excess television is concerned, the research is very clear: Kids who watch the most TV do the worst in school. TV is a “no brain” activity. Everything is provided for it (sounds, sights, plots, outcome, entertainment), and the brain doesn’t have to learn or make new connections. Like a muscle, the more you use your brain, the stronger it becomes and the more it can do. The opposite is also true: The less you work it, the weaker it becomes. Repeatedly engaging in “no brain” activities, such as TV, decreases a person’s ability to focus” (Amen, 29). I know that there is no proof that TV/ video games cause ADHD, for scientists can come to a consensus on one main cause, but I was just proposing that it could possibly cause it.
Foster – that is a good thought.
And I like that you found a great reference.
My issue with Dr. Amen’s comment is that it seems to be opinion rather than based on science. I’m not sure though…
Dr. Kenny
Hello, my name is Jeff and I was just recently diagnosed with ADHD. It was a life changing diagnosis. I am 38 years old and all my life I have fought cocaine addiction, drinking, and living a chaotic life. I am married with children and like stated before- by the grace of God, still married.. I have always sought adrenaline highs- I was a journeyman Ironworker, own a roofing business and also currently work on oil & gas drilling rigs. I have been on medication- 36 mg Concerta for two months. The meds felt like they were working the first couple weeks but as of recent- the racing thoughts and “chaos” seems to have come back. My neuropsychologist says that I was never diagnosed before because I am very intelligent and as she stated “manipulative”. I am hoping to find out more and is there any kind of blood test that can see if the meds are enough? Any help is very appreciated. Thank-you. Jeff
Jeff – there isn’t a blood test. When you look at average doses for adults of Concerta – it is usually in the range of 54 mg, 72 mg or even 90 mg per day.
Talk to your doctor about that.
Best,
Dr. Kenny
Hi Dr. Kenny,
My daughter was diagnosed with ADD about 15 years ago. My wife is an RN and read every article she could to learn about ADD. One of the things she found was that even back then they thought it might be genetic and in our case there was little doubt as to whos genes contributed so I was also tested. The test confirned that I was. I have tried numerous drug and Adderall appears to work best. I was an engineer for 41 years and at 65 years old I still take adderall. When I started taking medication I could not believe the difference it made in my life and my wife’s life.
My question: The only drug that I know of that was designed for ADD is Concerta and it did not work at all for me. Everything else was designed for something else and just happened to work for ADD.
Are there any new drugs designed to treat ADD symptions, if so what are they and if not why?
Regards,
Don Crowe
I firmly believe that symptoms of AD(H)D are caused by genetic irregularities in the endocrine system. Essentially, this causes the brain to become “locked” in a Theta dominant pattern with reduced Beta activity. In EKG’s, this pattern correctly predicts AD(H)D 94% of the time.
Beta state is the active, waking consciousness in which most people function throughout their day. Theta state is associated with deep meditation. Although non-ADD people can & do enter this state from time to time, either intentionally (focused meditation) or unintentionally (driving long distances & the mind begins to wander- the same concept of focused meditation), individuals with AD(H)D cannot leave this state when desired. I believe that the reduced dopamine levels are an effect produced by the Theta state.
There is much more to this theory, & I am considering partnering with a doctor to write a book on it. Please provide feedback if there is any interest!!
Hi Dr. Kenny,
What is the difference between ADHD and Low Latent Inhibition? Is there a difference? What about Dr. Weathers’ Conditioned Attentional Avoidance Loop? The linked article captured my attention. Are ADHD symptoms simply symptoms of one of the above mentioned conditions? I haven’t bought Dr. Weathers’ book yet but, I’m thinking it’s worth a try. I would love to hear any input from you or anyone about this or this article.
http://hubpages.com/hub/The-cause-and-treatment-of-ADHD-symptoms
Thanks
Terry
T
Sorry- EEG, not EKG! My ADD is showing!
Hey yall I have ADHD and i am looking for advice to coop qith my symtom i am only 14 and in grade 9 asnd i am worried that my grades might be affected any suggestions email me at kalebschaefer14@gmail.com
Wendy,
That is an interesting theory, and it would explain “scatterbrained” and “daydreaming” tendencies…which in turn would affect the ability to focus and remain on task…would love to know more about this research.
I have one question for the MD’s and researchers:
Because a high alkaline balance in the body leaves it susceptible to cancers, (as evidence long-term cocaine users are often eaten up with cancers of all kinds), I fear that taking ANY medication daily, long-term might put one at a greater risk of cancer.
Any evidence either way? Is my logic flawed or reasonable?
Kelly – there is no info (to my knowledge) of long term ADHD medication use leading to cancer.