Do Parents Cause ADHD?

A recent New York Times Op-Ed  suggested that parents are a significant causative agent in ADHD.  Wow!  I cannot believe this type of neanderthalic diatribe is still filling our newspapers and airways.  A retired professor of psychology, Dr. L. Alan Sroufe, in his Op-Ed, Ritalin Gone Wrong, asserted that too many kids are medicated, and that in many cases, poor parenting leads to the condition.  Again I say, WOW!

To start with, yes, the family does exert a significant impact on how we develop. Family reactions to an ADHD child are known to play a significant role in the child’s development of self- esteem, as well as having a role in the development of certain secondary diagnoses, like Oppositional Defiant Disorder.  Multiple studies confirm this.  I refer inquisitive readers to Joel Nigg’s book What Causes ADHD? [1] and Barkley’s Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment [2]. These books are good amalgamations of the body of scientific research on ADHD.  When you look deeper, and aspire to find the facts, you will see that any familial role, outside of genetic inheritance, is secondary to the development of ADHD.  Research continues to point to differences in the brain as the precursors of ADHD symptoms, not problem parents.

For example, the ability to delay an impulse, or wait, is impaired in ADHD, and is, in fact, a diagnostic criterion.  Struggling with waiting, or impulsivity, is, in part, linked to a brain region called the caudate. We know this because when victims of trauma suffer damage to the caudate, impulsivity often appears in people with no prior history of this trait.  Research has also shown that many ADHD boys have irregularities in that part of the brain.  The caudate does not change shape because of the actions of one’s parents. There are gene variants strongly associated with caudate difference in ADHD boys as well.  This is just one of numerous examples that make a compelling case for differences in the structure, size, shape, and functioning of the brain as strongly underlying ADHD.

Further, it is well documented that ADHD involves the frontal dopamine circuits of the brain.  Numerous brain imaging scans have demonstrated this, and the most common medications for ADHD, the stimulants, are known to improve the way the brain metabolizes dopamine.  In addition, several variants of dopamine-involved genes are strongly associated with ADHD.  ADHD is a neurobiological condition.  As with any disorder, the way that parents deal with it does impact the way the child grows and develops.  If the parent of a child with diabetes becomes an overprotective hypochondriac, that child might have some secondary “symptoms” that were precipitated by his or her parents’ behavior.  That fact does not change the truth of the physical condition with which the child must cope.  Blaming parents is counterproductive.  What is needed is more awareness and education about ADHD.

One of the treatments for ADHD is medication and the above-mentioned Op-Ed piece asserts that children are being overmedicated.  There is no research to support that.  I can say, anecdotally, that I encounter more parents who fear medication and resist putting their children on it than I do parents who wholeheartedly embrace the practice.  I suspect that there are some children who take ADHD meds who should not be taking them.  This is part of a broader trend.  Many parents are guilty, for example, of insisting their children be put on antibiotics, even when there is no clear-cut symptomology that warrants it, a fact which is contributing to antibiotic-resistant strains of bacteria.  We still don’t have enough data to make an informed opinion about ADHD over-medication.  Obviously, these are powerful drugs, and parents should go into such a decision with great deliberation and awareness of potential side effects.  I am no great proponent of medication, but I have seen ADHD meds transform lives.

I agree with Dr. Sroufe that medication is proving not to be a good long-term strategy for a significant segment of ADHD people.  Trying to find common ground, I believe that parent training, like that offered by groups like CHADD, is highly beneficial.  Few of us have the natural inclinations to effectively handle the atypical behavioral profile of an ADHD child.  Positive and productive responses can be taught, but those responses, as well-intentioned and executed as they may be, cannot reverse the symptoms of ADHD.  They can help to create a more well-adjusted child, and perhaps minimize some of the troubling secondary conditions that arise with the disorder.  Parents are not to blame.  They deserve compassion and understanding.  Most parents of ADHD children who I deal with have spent incredible energies trying to help their children succeed.  Dr. Sroufe’s article does not help them.  It only pushes them further into shame and inadequacy, emotional states that will certainly not help them or their children.

1. Nigg, J. (2006). What Causes ADHD?: Understanding What Goes Wrong and Why,

New York : Guilford Press.

2.  Barkley, R. (2006). Attention Deficit Hyperactivity Disorder: A Handbook for

Diagnosis and Treatment. New York : Guilford Press.

The following studies further back up the scientific claims I make in this posting.

Bidwell, L., Willcutt, E., McQueen, M., DeFries, J., Olson, R., Smith, S., Pennington, B. (2011). A family-based association study of DRD4, DAT1, and 5HTT and continuous traits of Attention-Deficit Hyperactivity Disorder. Behavior Genetics, 41(1): 165-174.

Depue, B., Burgess, G., Willcutt, E., Bidwell, L., Ruzic, L., Banich, M. (2010).  Symptom-correlated brain regions in young adults with combined-type ADHD: Their organization, variability, and relation to behavioral performance. Psychiatry Research: Neuroimaging Section, vol. 182 Issue 2, 96-97.

Durston, S., Hulshoff, P., Schnack, H.,  Buitelaar, J., Steenhuis, M., Minderaa, R. et al., (2004).  Magnetic resonance imaging of boys with attention deficit disorder and their unaffected siblings.  Journal of the American Academy of Child and Adolescent Psychiatry.  43(3): 332-340.

Swanson, J., Floodman, P., Kennedy, J., Spence, M., Moyzis, R., Schuck, S. (2000). Dopamine genes and ADHD.  Neuroscience and Biobehavioral Reviews, 24.

Tripp, G., Wickens, J. (2010). Neurobiology of ADHD. Neuropharmacology, v. 57 issue 7/8, p. 579-589.

Volkow, N., Wang, G., Fowler, J., Logan, J., Franceschi, D., & Maynard, L. (2002).Relationship between blockade of dopamine transporters by oral methylphenidate and the increases in extracellular dopamine:  Therapeutic implications.  Synapse, 43: 181-187.

Williams, N., Zaharieva, I., Martin, A., Langley, K., Mantripragada, K., Fossdal, R.,Stefansson, H., Stefansson, K., Magnusson, P.,  Gudmundsson, O., Gustafsson, O., Holmans, P., Owen, M., O’Donovan, M., Thapar, A. (2010). Rare chromosomal deletions and duplications in attention-deficit hyperactivity disorder: a genome-wide analysis. Lancet, 2010; DOI: 10.1016/S0140-6736(10)61109-9.

Yang, M., Ishii, J., McCracken, J., McGough, J., Loo, S., Nelson, S., Smalley, S.(2005). Temperament and character profiles and the dopamine D4 receptor gene in ADHD. American Journal of Psychiatry, v. 162, issue 5, 2005, 906-914.