Updated 04 July 2014

Environmental factors might raise ADHD risk

A new study from Australia sheds more light on what environmental factors might raise the risk for attention-deficit/hyperactivity disorder.

A new study from Australia sheds more light on what environmental factors might raise the risk for attention-deficit/hyperactivity disorder (ADHD).

"Compared with mothers whose children did not have ADHD, mothers of children with ADHD were more likely to be younger, single, smoked in pregnancy, had some complications of pregnancy and labour, and were more likely to have given birth slightly earlier," said study co-author Dr Carol Bower, a senior principal research fellow with the Centre for Child Health Research at the University of Western Australia. "It did not make any difference if the child was a girl or a boy."

The researchers did find that girls were less likely to have ADHD if their mothers had received the hormone oxytocin to speed up labour. Previous research had suggested its use during childbirth might actually increase the risk of ADHD.

The causes of ADHD remain unclear, although evidence suggests that genes play a major role, said Dr Tanya Froehlich, an associate professor at Cincinnati Children's Hospital Medical Centre.

Numbers have levelled off

"Many prior studies have found an association between ADHD and [tobacco and alcohol exposure in the womb], prematurity and complications of pregnancy and delivery," she said.

One thing is certain: Diagnoses of ADHD have become common in the United States. A survey released in November found that 10% of American children have been diagnosed with the condition, although the rapid increase in numbers seems to have levelled off.

ADHD is more prevalent in boys. Its symptoms include distractibility, inattention and a lack of focus.

In the new study, researchers examined the medical records of nearly 13 000 children and young adults who were born in Western Australia and took stimulant medications for ADHD between 2003 and 2007. Stimulant drugs such as Ritalin and Adderall are typically used to treat ADHD.

The researchers compared the subjects to more than 30 000 other children to see if there were any environmental differences.

Although factors such as a mother's younger age and smoking during pregnancy were linked to a higher risk of ADHD in children, "low birth weight, birth at greater than full term and breathing difficulties in the baby were not more common [in the ADHD group]," Bower said.

ADHD-related genes

What's going on?

"Chronic exposure to smoking in pregnancy may create an imbalance in chemicals that result in ADHD," said study lead author Desiree Silva, a professor of paediatric medicine at the University of Western Australia.

But Froehlich said the picture may be even more complicated.

Some researchers have suggested that "people with ADHD are more likely to smoke, and then may pass on their ADHD-related genes to their children," Froehlich said.

Urinary tract infections also are thought to contribute to inflammation that affects the development of the brain in the foetus, she said. Stress during pregnancy perhaps from being single or a young mother could do the same thing.

"[However], since ADHD is associated with higher rates of teen pregnancy, it is also possible that the younger and single mothers themselves have higher rates of ADHD, and they are passing on their ADHD-related genes to their children," Froehlich said.

The Australian researchers called for more study on the subject.

The study appears online in the print issue of the journal Paediatrics.

Find out more on ADHD here.

More information:

For more about ADHD, visit the US National Library of Medicine.


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Dr Renata Schoeman has been in full-time private practice as a general psychiatrist (child, adolescent and adult psychiatry) since 2008, currently based in Oude Westhof (Bellville). Renata also holds appointments as senior lecturer in Leadership (USB) and as a virtual faculty member of USB Executive Development’s Neuroleadership programme. She serves on the advisory boards of various pharmaceutical companies, as a director of the Psychiatric Management Group (PsychMG) and is the co-convenor of the South African Society of Psychiatrist (SASOP) special interest group for adult ADHD, and co-founder of the Goldilocks and The Bear Foundation ( She is passionate about corporate mental health awareness and uses her neuroscience background to assist leaders in equipping them to become balanced, healthy and dynamic leaders that take their own and their team’s emotional, intellectual, social health and physical needs into account. Renata is academically active and enjoys research and collaborative work, has published in many peer-reviewed journals, and has presented at local and international congresses. She is regularly invited to present at conferences and to engage with the media. During her post-graduate studies, she trained at Harvard, Boston in neurocognition and neuroimaging. Her awards include, amongst others, the Young Minds in Psychiatry award from the American Psychiatric Association, the Discovery Foundation Fellowship award, a Thuthuka award from the NRF, and a MRC Fellowship. She also received the Top MBA student award and the Director’s award from USB for 2015. She was a finalist for the Businesswomen’s Association of South Africa’s Businesswoman of the Year Award for 2016, and received the Excellence in Media Work award from SASOP during 2016.

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