ADHD: Risk factors, symptoms & myths

Attention deficit hyperactivity disorder (ADHD) in children, adolescents and adults is one of a group of neurodevelopmental disorders, which is identified by a consistent pattern of inattention and/or hyperactivity-impulsivity. This way of being interferes with functioning and/or development, as defined by diagnostic criteria as detailed in DSM-5-TR (American Psychiatric Association, 2013). 

Risk factors for ADHD

There are a number of risk factors which have been recognised as potential predisposing factors to an individual developing ADHD. Firstly, one’s genetic DNA can increase the likelihood of an individual developing ADHD in their life. It is well documented that the offspring of a family member with ADHD are more likely to have ADHD themselves.

However, aside from DNA, there may well be other learned or environmental factors which increase one’s propensity to develop ADHD. There is an increasing number of clinicians who equate ADHD with the outcome of traumatic events in a person’s life, which, of course, can be treated as a condition, through psychological therapy, and/or eye movement desensitisation and reprocessing (EMDR).

It would make sense that a child, adolescent or young adult exposed to adverse experiences would likely develop ADHD symptoms, interfering with their everyday life. It has further been discovered that exposure to environmental risks during pregnancy or at a young age leads to the development of ADHD. Furthermore, it is now well known that alcohol and tobacco use during pregnancy is a risk factor, alongside head injuries and low birth weight.

Common symptoms of ADHD

ADHD symptoms may vary, but often include:

• emotional dysregulation
• fatigue and restlessness
• time and spatial blindness
• racing thoughts and sensory overwhelm
• choice paralysis
• sleep disturbances
• low self-esteem
• peer and relationship problems (including romantic relationships)
• hyperfocus
• driving problems
• substance misuse
• difficulties with transitions
• depression and anxiety

ADHD statistics

• About 8-12% of youth have an ADHD diagnosis (Danielson, et. al, 2018).
• Some children are misdiagnosed due to overlapping symptoms of other undiagnosed conditions.
• ADHD is more than twice as likely to be diagnosed in boys than in girls.
• Children in lower-income families are more frequently diagnosed.
• White children are more likely to receive an ADHD diagnosis compared with non-white children.

Who receives an ADHD diagnosis?

It has been identified that Black, indigenous and children of colour are underdiagnosed and undertreated compared to their white counterparts. Additionally, female children are underdiagnosed and undertreated compared to their male counterparts (Shi, Y. et al, 2021). 

These inequities in diagnoses have been attributed to:

• teacher and clinician bias
• stigma and structural racism
• policy and funding gaps affecting children
• insurance status and access to care
• differences in psychological literacy (Zhao et al., 2023)

ADHD myths and misconceptions

1. ADHD isn’t real

Fact: Over 10,000 scientific publications support ADHD as a valid condition. While genetics play a role, some experts emphasise the importance of trauma-informed approaches (such as EMDR or talking therapy). Many individuals also benefit from prescribed medication, though not everyone does.

2. Children outgrow ADHD

Fact: About two-thirds of children continue to experience symptoms into adulthood. However, strategies, therapy, and/or medication can help manage these symptoms.

3. ADHD is the result of bad parenting

Fact: ADHD is a neurodevelopmental condition with strong hereditary links. Parenting may influence behaviours, but trauma and environmental factors must also be considered.

4. A positive response to medication can confirm a diagnosis of ADHD

Fact: Stimulant medication can improve attention and executive function in individuals without ADHD.

5. Children who take ADHD medication are more likely to abuse drugs

Fact: Appropriate treatment can actually reduce the risk of substance misuse in people with ADHD.

6: ADHD is the result of a poor diet

Fact: ADHD is primarily neurodevelopmental and genetic. However, dietary changes – such as reducing caffeine, alcohol, and sugar – may help some individuals manage symptoms.

ADHD is a complex and multifaceted condition. Misconceptions and stigma can lead to misunderstanding, underdiagnosis, and inadequate treatment. By addressing myths, recognising symptoms, and acknowledging both genetic and environmental risk factors, we can create a more accurate and compassionate understanding of ADHD.

For those living with ADHD, effective treatment may include a combination of therapy, trauma-informed approaches, lifestyle changes, and/or medication. The key is recognising that ADHD is real, valid, and manageable with the right support.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Danielson ML, Bitsko RH, Ghandour RM, Holbrook JR, Kogan MD, Blumberg SJ. Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016. J Clin Child Adolesc Psychol. 2018 Mar-Apr;47(2):199-212. doi: 10.1080/15374416.2017.1417860. Epub 2018 Jan 24. PMID: 29363986; PMCID: PMC5834391.

Shi, X., Guan, K., Peng, X., Xu, B., Zhou, X., Wang, S., Xu, S., Zheng, M., Huang, J., Wan, X., Guan, W., Su, K.P., Ye, M., Gao, X., Yin, Z., Li, X. (2021) Ghrelin Modulates Dopaminergic Neuron Formation and Attention Deficit Hyperactivity Disorder-like Behaviors: From Animals to Human Models. Brain, behavior, and immunity. 94:327-337.

Zhu F, Zhu X, Bi X, Kuang D, Liu B, Zhou J, Yang Y, Ren Y. Comparative effectiveness of various physical exercise interventions on executive functions and related symptoms in children and adolescents with attention deficit hyperactivity disorder: A systematic review and network meta-analysis. Front Public Health. 2023 Mar 24;11:1133727. doi: 10.3389/fpubh.2023.1133727. PMID: 37033046; PMCID: PMC10080114.