What causes ADHD? Diagnosis, prevention, and treatment

Overview: What is ADHD?

Attention deficit hyperactivity disorder (ADHD) is a neurological disorder characterized by difficulty concentrating, impulsivity, distractibility, mood swings, difficulty sitting still, and high activity. ADHD is most often diagnosed in children and adolescents, though some cases persist into adulthood. It’s common: about 6.1 million children in the U.S. have been diagnosed with ADHD, and its lifetime prevalence among adults in the U.S. is 4.4%

The exact causes of ADHD are unknown, but research indicates that genetics may play a role. It’s likely that other factors also may be linked to ADHD, such as low birth weight, premature birth, brain injury, brain abnormalities, epilepsy, and exposure to some substances in utero.

What causes ADHD?

It’s not yet exactly clear what causes ADHD, but current medical knowledge indicates that heredity and other factors most likely contribute.

• Genetics: Experts believe that genetics play a significant role in the presence of ADHD, though it’s not necessarily inherited through a single gene. 

• Behavioral factors during pregnancy: Substance use during pregnancy has been linked to ADHD. 

• Conditions at birth: Low birth weight and premature birth may be causes of ADHD.

• Injury: Brain injury may contribute to the development of ADHD.

• Brain structure: There is emerging evidence of anatomical differences in some parts of the brain between children who have ADHD and those who do not.

Research has ruled out some ADHD causes, like vaccinations, exposure to TV, or eating too much sugar.

Risk factors for ADHD

The most common risk factors for developing ADHD are:

• Genetics: There is strong evidence to suggest that genetics are the greatest factor in whether someone will develop ADHD. People whose parents or siblings have ADHD are more likely to experience the condition than those without a family history.

• Sex: ADHD is more common in males than in females.

• Injury: People who have experienced brain injuries are more at risk for developing ADHD. 

• Condition at birth: Premature birth and low birth weight have also been linked to ADHD. 

• Pregnancy-related factors: Using tobacco, alcohol, caffeine, and some psychotropic medication during pregnancy may increase the risk of a child developing ADHD.

• Lead exposure: Elevated exposure to lead during pregnancy or in early childhood may increase the risk of developing ADHD.

• Other medical conditions: ADHD often co-occurs with other conditions, like mood disorders, anxiety, learning disorders, and substance use disorders. People with epilepsy are more likely to develop ADHD. 

• Environmental factors: Childhood trauma has also been linked to an increased risk of ADHD, though the causal relationship is likely low.

Is ADHD serious? When to see a doctor

ADHD does not typically require immediate medical attention unless the person has become a threat to themselves or others. Generally, symptoms are managed by medication and behavioral therapy. For those who find that ADHD interrupts their lives, early and regular interventions can mitigate the symptoms.

ADHD can affect a person’s self-esteem and relationships. It can also increase the likelihood of impulsive behaviors. 

In children, ADHD can cause major disruptions in school and at home. ADHD often co-occurs with other conditions, like learning disorders and conduct disorders, which can increase the risk of a child having trouble in school, making careless mistakes, engaging in dangerous behavior, and experiencing mental health conditions like anxiety and depression. Early intervention in the form of medication, behavioral therapy, and educational therapy can greatly improve a child’s quality of life.  

Adults with severe cases may find it hard to hold a job or carry out routine tasks, and ADHD can cause major problems in daily life. People with ADHD are at an increased risk of school failure, accidents, criminal behavior problems, divorce, suicide, substance abuse, and unsafe sexual behavior. Medication and therapy can mitigate these symptoms, and adults with ADHD can live safe, productive lives.

If the symptoms of ADHD mean that the person is a danger to themselves or others, seek help at an emergency room. Otherwise, a clinical mental health provider, pediatrician, or general practitioner can help.

How is ADHD diagnosed?

ADHD is most commonly diagnosed by a clinical mental health professional, like a psychiatrist, or a pediatrician. 

Healthcare providers in the U.S. use criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to diagnose ADHD in children and adults.

To diagnose ADHD, the provider will ask questions related to common symptoms, like the ability to devote attention to a single task, forgetfulness, difficulty listening, and trouble completing tasks, as well as the severity of those symptoms and when they first occurred. They may also ask about family medical history. Adults with ADHD may experience fewer or different symptoms than children experience, and providers will take this into consideration.

 The provider may conduct a physical exam, including hearing and vision testing, to rule out other possible causes of the symptoms. 

Is ADHD hereditary?

Studies have shown that ADHD runs in families, with a heritability of 74%, and is one of the most heritable psychiatric disorders. People whose parents or siblings have ADHD are likelier to have the condition.

However, current medical research indicates that heredity alone may not be responsible and that there are other risk factors and potential causes of the disorder. Brain injury, lead exposure, low weight at birth, and premature birth may all increase the risk of developing ADHD.

Is ADHD curable?

It’s not understood yet whether ADHD is curable, but it is treatable. Two-thirds of children with ADHD will have impairing symptoms of the disease in adulthood, but the symptoms of ADHD can be successfully managed with a combination of behavioral therapy and medication.

Stimulants and non-stimulant medications are common treatments for ADHD Your healthcare provider may prescribe a mild stimulant, like Ritalin (methylphenidate),

Zenzedi (dextroamphetamine), Focalin (dexmethylphenidate), and Adderall (amphetamine-dextroamphetamine). Non-stimulants, like Qelbree, Strattera (atomoxetine), and guanfacine, are also used.

How to prevent ADHD

Medical research has not yet found a way to prevent ADHD. Heredity is one of the most significant risk factors for developing the condition, but managing some environmental factors may help prevent or manage symptoms.

• Promote prenatal and maternal health: Avoiding the use of alcohol, tobacco, caffeine, and some psychotropic medications during pregnancy may lower the risk of a child developing ADHD.

• Early detection of symptoms: Research suggests that early intervention in preschool-aged children may help prevent some of the negative long-term consequences of ADHD. Working with a healthcare provider to create a treatment plan and following through with medications and behavioral therapies will help.

FAQs about ADHD causes

Are people born with ADHD?

Current medical knowledge indicates that ADHD is largely an inherited condition, with symptoms most commonly appearing before age 12.

Is ADHD caused by trauma?

Childhood trauma is considered a risk factor for developing ADHD, though the correlation between trauma and the neurological disorder is not thought to be strong.

Is ADHD caused by a chemical imbalance?

So far, there is no clear evidence that ADHD is a result of a chemical imbalance, though anatomical brain differences may contribute. 

What’s next? Additional resources for people with ADHD

Test and diagnostics

• Symptoms and diagnosis of ADHD, Centers for Disease Control and Prevention

• Diagnosis of ADHD in adults, CHADD 

• Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents, Journal of Clinical Child & Adolescent Psychology

Treatments

• ADHD treatment and medication, SingleCare

• ADHD medication and children, SingleCare

• Everything to eat (and avoid) if you have ADHD, SingleCare

• Treatment of ADHD, Centers for Disease Control and Prevention

Scientific studies and clinical trials

• Improving the outcomes of adolescents with ADHD via a pre-visit question prompt list/video intervention, National Institutes of Health

• Clinical and functional outcome of childhood ADHD 33 years later, JAMA

• Comparing attention deficit hyperactivity disorder to severely impairing irritability: investigations of brain function, National Institutes of Mental Health

• Sugar consumption, sugar-sweetened beverages, and attention deficit hyperactivity disorder, Complementary Therapies in Medicine

More information on related health conditions

• Learning disorders in children, Centers for Disease Control and Prevention

• ADHD medication and substance-related problems, American Journal of Psychiatry

• Disruptive, impulse-control, and conduct disorders, American Psychiatric Association

• When depression co-occurs with ADHD, CHADD

• Autism spectrum disorder, American Psychiatric Association