Abstract
The review examines Attention Deficit Hyperactivity Disorder (ADHD in its Child and Adult form) and its various presentations (Hyperactive Impulsive, Inattentive, and Combined) with a particular focus on environmental (incl. social factors), lifestyles and comorbidities. It is argued that ADHD is best understood in a holistic and interactive context and a vast empirical literature is presented to illustrate the point: Environmental factors include stress in general as well as exposure to toxins (phthalates, bisphenol A). Social factors are illustrated by effects of social deprivation and seduction to unhealthy lifestyles. Maternal lifestyle during pregnancy is pointed out (particularly her exposure to nicotine, alcohol, caffeine, and drugs, even seemingly benign medications like acetaminophen), which all tend to be related to ADHD. Family environment is discussed with respect to protective effect of (mainly authoritative and autocratic) parenting styles. Societal factors include mainly economic and political issues: income inequality and poverty (low SES is an ADHD risk factor) and a growing moral dilemma between a humanistic effort to globally spread the knowledge of ADHD and the medicalization and commercialization of the disorder. The second part of the review is devoted to ADHD related lifestyles and resulting comorbidities (e.g., food addiction and obesity, substance abuse, electronic media dependencies and conduct and personality disorders). Although ADHD is a neurodevelopmental disorder, its assessment and treatment are also linked to environmental, behavioral and social factors and their interactions.
Highlights
Reviewed by: Roumen Kirov, Bulgarian Academy of Sciences (BAS), Bulgaria Jean Marc Guile, University of Picardie Jules Verne, France Debora Marques Miranda, Universidade Federal de Minas
From early childhood Attention Deficit Hyperactivity Disorder (ADHD) is associated with certain comorbidities such as Oppositional Defiant Disorder (ODD) and executive dysfunction, in a longitudinal study it was found that high oppositional traits and more severe clinical presentations along with family factors such as having a father with anxiety and internalizing disorders was a strong predictor for ADHD persisting into adolescence
Our article is devoted to a variety of factors which are involved in its onset and presentations; we paid particular attention to factors of an environmental nature spanning from chemical to societal agents which are often neglected – see (Table 1)
Summary
Attention Deficit Hyperactivity Disorder (ADHD) is a lifelong neurodevelopmental disorder marked by its observable behavioral manifestations. The continuum of the symptoms is not always clear and ADHD may or may not continue into adulthood. The disorder presents itself as ‘childhood ADHD’ and ‘adult ADHD,’ with childhood ADHD being more common (Polanczyk et al, 2007). The disorder carries into adulthood approximately 50% of the time (Moreno-Alcázar et al, 2016) but the processes of remission still remain unclear. As of 2013, with the introduction of DSM-5, it is no longer classified as a childhood disorder but as a chronic lifelong disorder
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