Abstract
Background
Attention deficit/hyperactivity disorder (ADHD) is a common disease among children; it affected 5–7% of the population in 2015. ADHD is a multifactorial disease, and its etiology is still not clearly understood.
Data Sources
This narrative review has been done by searching the PubMed and Embase databases using attention deficit/hyperactivity disorder, ADHD, risk factors; genetics; pediatrics; psychiatrics as keywords.
Results
ADHD is considered to be a hereditary disorder in which genes play the fundamental role in the pathogenesis; however, findings from genetic–environmental studies support the hypothesis that genetic factors can exert effects on an individual’s condition by determining his/her responses to environmental exposures, especially those during the prenatal stage.
Conclusion
ADHD is considered as a hereditary disorder in which genes and prenatal risk factors play fundamental roles in the pathogenesis.
Similar content being viewed by others
References
Thomas R, Sanders S, Doust J, Beller E, Glasziou P. Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics. 2015;135:e994–1001.
Tannock R. Rethinking ADHD and LD in DSM-5: Proposed changes in diagnostic criteria. J Learn Disabil. 2013;46:5–25.
Banerjee TD, Middleton F, Faraone SV. Environmental risk factors for attention-deficit hyperactivity disorder. Acta Paediatr. 2007;96:1269–74.
Sciberras E, Mulraney M, Silva D, Coghill D. Prenatal risk factors and the etiology of ADHD—review of existing evidence. Curr Psychiatry Rep. 2017;19:1.
Thapar A, Cooper M, Eyre O, Langley K. Practitioner review: what have we learnt about the causes of ADHD? J Child Psychol Psychiatry. 2013;54:3–16.
Akutagava-Martins GC, Salatino-Oliveira A, Kieling CC, Rohde LA, Hutz MH. Genetics of attention-deficit/hyperactivity disorder: current findings and future directions. Expert Rev Neurother. 2013;13:435–45.
Eilertsen EM, Gjerde LC, Kendler KS, Røysamb E, Aggen SH, Gustavson K, et al. Development of ADHD symptoms in preschool children: genetic and environmental contributions. Dev Psychopathol. 2019;31:1299–305.
Tarver J, Daley D, Sayal K. Attention-deficit hyperactivity disorder (ADHD): an updated review of the essential facts. Child Care Health Dev. 2014;40:762–74.
Ramtekkar UP, Reiersen AM, Todorov AA, Todd RD. Sex and age differences in attention-deficit/hyperactivity disorder symptoms and diagnoses: implications for DSM-V and ICD-11. J Am Acad Child Adoles Psychiatry. 2010;49:217-28.e1-3.
Takeda T, Stotesbery K, Power T, Ambrosini PJ, Berrettini W, Hakonarson H, et al. Parental ADHD status and its association with proband ADHD subtype and severity. J Pediatr. 2010;157:995–1000.
Thapar A, Cooper M, Jefferies R, Stergiakouli E. What causes attention deficit hyperactivity disorder? Arch Dis Child. 2012;97:260–5.
Faraone SV, Biederman J, Mennin D, Gershon J, Tsuang MT. A prospective four-year follow-up study of children at risk for ADHD: psychiatric, neuropsychological, and psychosocial outcome. J Am Acad Child Adolesc Psychiatry. 1996;35:1449–59.
Bonvicini C, Faraone SV, Scassellati C. Common and specific genes and peripheral biomarkers in children and adults with attention-deficit/hyperactivity disorder. World J Biol Psychiatry. 2018;19:80–100.
Mill J, Petronis A. Pre-and peri-natal environmental risks for attention-deficit hyperactivity disorder (ADHD): the potential role of epigenetic processes in mediating susceptibility. J Child Psychol Psychiatry. 2008;49:1020–30.
Spiers H, Hannon E, Schalkwyk LC, Smith R, Wong CC, O’Donovan MC, et al. Methylomic trajectories across human fetal brain development. Genome Res. 2015;25:338–52.
van Mil NH, Steegers-Theunissen RP, Bouwland-Both MI, Verbiest MM, Rijlaarsdam J, Hofman A, et al. DNA methylation profiles at birth and child ADHD symptoms. J Psychiatr Res. 2014;49:51–9.
Park S, Lee JM, Kim JW, Cho DY, Yun H, Han D, et al. Associations between serotonin transporter gene (SLC6A4) methylation and clinical characteristics and cortical thickness in children with ADHD. Psychol Med. 2015;45:3009–17.
Perroud N, Zewdie S, Stenz L, Adouan W, Bavamian S, Prada P, et al. Methylation of serotonin receptor 3A in ADHD, borderline personality, and bipolar disorders: link with severity of the disorders and childhood maltreatment. Depress Anxiety. 2016;33:45–55.
Ding K, Yang J, Reynolds GP, Chen B, Shao J, Liu R, et al. DAT1 methylation is associated with methylphenidate response on oppositional and hyperactive-impulsive symptoms in children and adolescents with ADHD. World J Biol Psychiatry. 2017;18:291–9.
Palladino VS, McNeill R, Reif A, Kittel-Schneider S. Genetic risk factors and gene–environment interactions in adult and childhood attention-deficit/hyperactivity disorder. Psychiatr Genet. 2019;29:63–78.
Demontis D, Walters RK, Martin J, Mattheisen M, Als TD, Agerbo E, et al. Discovery of the first genome-wide significant risk loci for attention deficit/hyperactivity disorder. Nat Genet. 2019;51:63–75.
Cortese S, Coghill D. Twenty years of research on attention-deficit/hyperactivity disorder (ADHD): looking back, looking forward. Evid Based Ment Health. 2018;21:173–6.
Genro JP, Kieling C, Rohde LA, Hutz MH. Attention-deficit/hyperactivity disorder and the dopaminergic hypotheses. Expert Rev Neurother. 2010;10:587–601.
Purper-Ouakil D, Ramoz N, Lepagnol-Bestel AM, Gorwood P, Simonneau M. Neurobiology of attention deficit/hyperactivity disorder. Pediatr Res. 2011;69:69–76.
Hayman V, Fernandez TV. Genetic insights into ADHD biology. Front Psych. 2018;9:251.
Bralten J, Franke B, Waldman I, Rommelse N, Hartman C, Asherson P, et al. Candidate genetic pathways for attention-deficit/hyperactivity disorder (ADHD) show association to hyperactive/impulsive symptoms in children with ADHD. 2013;52:1204–1212.e1.
Drtilkova I, Sery O, Theiner P, Uhrova A, Zackova M, Balastikova B, et al. Clinical and molecular-genetic markers of ADHD in children. Neuroendocrinol Lett. 2008;29:320–7.
Acosta M, Velez J, Bustamante M, Balog J, Arcos-Burgos M, Muenke M. A two-locus genetic interaction between LPHN3 and 11q predicts ADHD severity and long-term outcome. Transl Psychiatry. 2011;1:17.
Aydin SU, Basay BK, Cetin GO, Aydin AG, Tepeli E. Altered microRNA 5692b and microRNA let-7d expression levels in children and adolescents with attention deficit hyperactivity disorder. J Psychiatr Res. 2019;115:158–64.
Freitag CM, Haenig S, Schneider A, Seitz C, Palmason H, Retz W, et al. Biological and psychosocial environmental risk factors influence symptom severity and psychiatric comorbidity in children with ADHD. J Neural Transm. 2012;119:81–94.
Kim JH, Kim JY, Lee J, Jeong GH, Lee E, Lee S, et al. Environmental risk factors, protective factors, and peripheral biomarkers for ADHD: an umbrella review. Lancet Psychiatry. 2020;7:955–70.
Milberger S, Biederman J, Faraone SV, Chen L, Jones J. Is maternal smoking during pregnancy a risk factor for attention deficit hyperactivity disorder in children? Am J Psychiatry. 1996;153:1138–42.
Weissman MM, Warner V, Wickramaratne PJ, Kandel DB. Maternal smoking during pregnancy and psychopathology in offspring followed to adulthood. J Am Acad Child Adolesc Psychiatry. 1999;38:892–9.
Levin ED, Briggs SJ, Christopher NC, Rose JE. Prenatal nicotine exposure and cognitive performance in rats. Neurotoxicol Teratol. 1993;15:251–60.
Slotkin TA. Fetal nicotine or cocaine exposure: which one is worse? J Pharmacol Exp Ther. 1998;285:931–45.
Ernst M, Moolchan ET, Robinson ML. Behavioral and neural consequences of prenatal exposure to nicotine. J Am Acad Child Adolesc Psychiatry. 2001;40:630–41.
Zhu JL, Olsen J, Liew Z, Li J, Niclasen J, Obel C. Parental smoking during pregnancy and ADHD in children: the Danish national birth cohort. Pediatrics. 2014;134:382–8.
Gustavson K, Ystrom E, Stoltenberg C, Susser E, Surén P, Magnus P, et al. Smoking in pregnancy and child ADHD. Pediatrics. 2017;139:20162509.
Huang L, Wang Y, Zhang L, Zheng Z, Zhu T, Qu Y, et al. Maternal smoking and attention-deficit/hyperactivity disorder in offspring: a meta-analysis. Pediatrics. 2018;141:20172465.
Motlagh MG, Katsovich L, Thompson N, Lin H, Kim YS, Scahill L, et al. Severe psychosocial stress and heavy cigarette smoking during pregnancy: an examination of the pre-and perinatal risk factors associated with ADHD and Tourette syndrome. Eur Child Adolesc Psychiatry. 2010;19:755–64.
Minatoya M, Araki A, Itoh S, Yamazaki K, Kobayashi S, Miyashita C, et al. Prenatal tobacco exposure and ADHD symptoms at pre-school age: the Hokkaido Study on Environment and Children’s Health. Environ Health Prev Med. 2019;24:1–9.
Dong T, Hu W, Zhou X, Lin H, Lan L, Hang B, et al. Prenatal exposure to maternal smoking during pregnancy and attention-deficit/hyperactivity disorder in offspring: a meta-analysis. Reprod Toxicol. 2018;76:63–70.
Han JY, Kwon HJ, Ha M, Paik KC, Lim MH, Lee SG, et al. The effects of prenatal exposure to alcohol and environmental tobacco smoke on risk for ADHD: a large population-based study. Psychiatry Res. 2015;225:164–8.
Ikonomidou C, Bittigau P, Ishimaru MJ, Wozniak DF, Koch C, Genz K, et al. Ethanol-induced apoptotic neurodegeneration and fetal alcohol syndrome. Science. 2000;287:1056–60.
Sowell ER, Jernigan TL, Mattson SN, Riley EP, Sobel DF, Jones KL. Abnormal development of the cerebellar vermis in children prenatally exposed to alcohol: size reduction in lobules I–V. Alcohol Clin Exp Res. 1996;20:31–4.
Knopik VS, Jacob T, Haber JR, Swenson LP, Howell DN. Paternal alcoholism and offspring ADHD problems: a children of twins design. Twin Res Hum Genet. 2009;12:53–62.
Konikowska K, Regulska-Ilow B, Rozanska D. The influence of components of diet on the symptoms of ADHD in children. Roczniki Państwowego Zakładu Higieny. 2012;63:127–34.
Martins BP, Bandarra NM, Figueiredo-Braga M. The role of marine omega-3 in human neurodevelopment, including autism spectrum disorders and attention-deficit/hyperactivity disorder—a review. Crit Rev Food Sci Nutr. 2020;60:1431–46.
Masarwa R, Levine H, Gorelik E, Reif S, Perlman A, Matok I. Prenatal exposure to acetaminophen and risk for attention deficit hyperactivity disorder and autistic spectrum disorder: a systematic review, meta-analysis, and meta-regression analysis of cohort studies. Am J Epidemiol. 2018;187:1817–27.
Ystrom E, Gustavson K, Brandlistuen RE, Knudsen GP, Magnus P, Susser E, et al. Prenatal exposure to acetaminophen and risk of ADHD. Pediatrics. 2017;140: e20163840.
Liew Z, Ritz B, Rebordosa C, Lee PC, Olsen J. Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatr. 2014;168:313–20.
Morales DR, Slattery J, Evans S, Kurz X. Antidepressant use during pregnancy and risk of autism spectrum disorder and attention deficit hyperactivity disorder: systematic review of observational studies and methodological considerations. BMC Med. 2018;16:1–14.
Christensen J, Pedersen L, Sun Y, Dreier JW, Brikell I, Dalsgaard S. Association of prenatal exposure to valproate and other antiepileptic drugs with risk for attention-deficit/hyperactivity disorder in offspring. JAMA Netw Open. 2019;2:e186606.
Wiggs KK, Rickert ME, Sujan AC, Quinn PD, Larsson H, Lichtenstein P, et al. Antiseizure medication use during pregnancy and risk of ASD and ADHD in children. Neurology. 2020;95(24):e3232–40.
Hamad AF, Alessi-Severini S, Mahmud S, Brownell M, Fan Kuo I. Prenatal antibiotic exposure and risk of attention-deficit/hyperactivity disorder: a population-based cohort study. CMAJ. 2020;192:E527–35.
Lemelin M, Sheehy O, Zhao JP, Bérard A. Maternal ADHD medication use during pregnancy and the risk of ADHD in children: importance of genetic predispositions and impact of using a sibling analysis. Eur Neuropsychopharmacol. 2021;44:66–78.
Cull-Candy S, Brickley S, Farrant M. NMDA receptor subunits: diversity, development and disease. Curr Opin Neurobiol. 2001;11:327–35.
Yuen EY, Jiang Q, Chen P, Gu Z, Feng J, Yan Z. Serotonin 5-HT1A receptors regulate NMDA receptor channels through a microtubule-dependent mechanism. J Neurosci. 2005;25:5488–501.
Masuko T, Suzuki I, Kizawa Y, Kusama-Eguchi K, Watanabe K, Kashiwagi K, et al. Monoamines directly inhibit N-methyl-d-aspartate receptors expressed in Xenopus oocytes in a voltage-dependent manner. Neurosci Lett. 2004;371:30–3.
Nilsen FM, Tulve NS. A systematic review and meta-analysis examining the interrelationships between chemical and non-chemical stressors and inherent characteristics in children with ADHD. Environ Res. 2020;180:108884.
Roberts JR, Dawley EH, Reigart JR. Children’s low-level pesticide exposure and associations with autism and ADHD: a review. Pediatr Res. 2019;85:234–41.
Oudin A, Frondelius K, Haglund N, Källén K, Forsberg B, Gustafsson P, et al. Prenatal exposure to air pollution as a potential risk factor for autism and ADHD. Environ Int. 2019;133: 105149.
Lygre GB, Aase H, Haug K, Lie SA, Björkman L. Prenatal exposure to dental amalgam and risk of symptoms of attention-deficit and hyperactivity disorder (ADHD). Commun Dent Oral Epidemiol. 2018;46:472–81.
Jurecka A, Zikanova M, Tylki-Szymanska A, Krijt J, Bogdanska A, Gradowska W, et al. Clinical, biochemical and molecular findings in seven Polish patients with adenylosuccinate lyase deficiency. Mol Genet Metab. 2008;94:435–42.
Antshel KM. ADHD, learning, and academic performance in phenylketonuria. Mol Genet Metab. 2010;99:S52–8.
Antshel KM, Waisbren SE. Developmental timing of exposure to elevated levels of phenylalanine is associated with ADHD symptom expression. J Abnorm Child Psychol. 2003;31:565–74.
Arnold G, Vladutiu CJ, Orlowski C, Blakely E, DeLuca J. Prevalence of stimulant use for attentional dysfunction in children with phenylketonuria. J Inherit Metab Dis. 2004;27:137–43.
Darin N, Andersen O, Wiklund LM, Holmgren D, Holme E. 3-methylcrotonyl-CoA carboxylase deficiency and severe multiple sclerosis. Pediatr Neurol. 2007;36:132–4.
Nagamani SC, Erez A, Lee B. Argininosuccinate lyase deficiency. Genet Med. 2012;14:501–7.
Berry G, Fukao T, Mitchell G, Mazur A, Ciafre M, Gibson J, et al. Neonatal hypoglycaemia in severe succinyl-CoA: 3-oxoacid CoA-transferase deficiency. J Inherit Metab Dis. 2001;24:587–95.
Marazziti D, Baroni S, Picchetti M, Landi P, Silvestri S, Vatteroni E, et al. Psychiatric disorders and mitochondrial dysfunctions. Eur Rev Med Pharmacol Sci. 2012;16:270–5.
Simons A, Eyskens F, Glazemakers I, Van West D. Can psychiatric childhood disorders be due to inborn errors of metabolism? Eur Child Adolesc Psychiatry. 2017;26:143–54.
Chang Z, Lichtenstein P, D’Onofrio BM, Almqvist C, Kuja-Halkola R, Sjölander A, et al. Maternal age at childbirth and risk for ADHD in offspring: a population-based cohort study. Int J Epidemiol. 2014;43:1815–24.
Johnson S, Hollis C, Kochhar P, Hennessy E, Wolke D, Marlow N. Psychiatric disorders in extremely preterm children: longitudinal finding at age 11 years in the EPICure study. 2010;49:453-63.e1.
Heinonen K, Räikkönen K, Pesonen AK, Andersson S, Kajantie E, Eriksson JG, et al. Behavioural symptoms of attention deficit/hyperactivity disorder in preterm and term children born small and appropriate for gestational age: a longitudinal study. BMC Pediatr. 2010.
Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJ. Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis. JAMA. 2002;288:728–37.
Dunn GA, Nigg JT, Sullivan EL. Neuroinflammation as a risk factor for attention deficit hyperactivity disorder. Pharmacol Biochem Behav. 2019;182:22–34.
Smith TF, Schmidt-Kastner R, McGeary JE, Kaczorowski JA, Knopik VS. Pre-and perinatal ischemia-hypoxia, the ischemia-hypoxia response pathway, and ADHD risk. Behav Genet. 2016;46:467–77.
Dachew BA, Scott JG, Mamun A, Alati R. Pre-eclampsia and the risk of attention-deficit/hyperactivity disorder in offspring: findings from the ALSPAC birth cohort study. Psychiatry Res. 2019;272:392–7.
Wiegersma AM, Dalman C, Lee BK, Karlsson H, Gardner RM. Association of prenatal maternal anemia with neurodevelopmental disorders. JAMA Psychiat. 2019;76:1294–304.
Liu X, Dalsgaard S, Munk-Olsen T, Li J, Wright RJ, Momen NC. Parental asthma occurrence, exacerbations and risk of attention-deficit/hyperactivity disorder. Brain Behav Immun. 2019;82:302–8.
Joelsson P, Chudal R, Uotila J, Suominen A, Sucksdorff D, Gyllenberg D, et al. Parental psychopathology and offspring attention-deficit/hyperactivity disorder in a nationwide sample. J Psychiatr Res. 2017;94:124–30.
Class QA, Abel KM, Khashan AS, Rickert ME, Dalman C, Larsson H, et al. Offspring psychopathology following preconception, prenatal, and postnatal maternal bereavement stress. Psychol Med. 2014;44:71–84.
Clements CC, Castro VM, Blumenthal SR, Rosenfield HR, Murphy SN, Fava M, et al. Prenatal antidepressant exposure is associated with risk for attention-deficit hyperactivity disorder but not autism spectrum disorder in a large health system. Mol Psychiatry. 2015;20:727–34.
Leppert B, Havdahl A, Riglin L, Jones HJ, Zheng J, Smith GD, et al. Association of maternal neurodevelopmental risk alleles with early-life exposures. JAMA Psychiat. 2019;76:834–42.
Chang CH, Yu CJ, Du JC, Chiou HC, Chen HC, Yang W, et al. The interactions among organophosphate pesticide exposure, oxidative stress, and genetic polymorphisms of dopamine receptor D4 increase the risk of attention deficit/hyperactivity disorder in children. Environ Res. 2018;160:339–46.
Kahn RS, Khoury J, Nichols WC, Lanphear BP. Role of dopamine transporter genotype and maternal prenatal smoking in childhood hyperactive-impulsive, inattentive, and oppositional behaviors. J Pediatr. 2003;143:104–10.
Brookes KJ, Mill J, Guindalini C, Curran S, Xu X, Knight J, et al. A common haplotype of the dopamine transporter gene associated with attention-deficit/hyperactivity disorder and interacting with maternal use of alcohol during pregnancy. Arch Gen Psychiatry. 2006;63:74–81.
Altink ME, Arias-Vásquez A, Franke B, Slaats-Willemse DI, Buschgens CJ, Rommelse NN, et al. The dopamine receptor D4 7-repeat allele and prenatal smoking in ADHD-affected children and their unaffected siblings: no gene–environment interaction. J Child Psychol Psychiatry. 2008;49:1053–60.
Wang Y, Hu D, Chen W, Xue H, Du Y. Prenatal tobacco exposure modulated the association of genetic variants with diagnosed ADHD and its symptom domain in children: a community based case–control study. Sci Rep. 2019;9:1–9.
Neuman RJ, Lobos E, Reich W, Henderson CA, Sun L-W, Todd RD. Prenatal smoking exposure and dopaminergic genotypes interact to cause a severe ADHD subtype. Biol Psychiatry. 2007;61:1320–8.
Ornoy A, Finkel-Pekarsky V, Peles E, Adelson M, Schreiber S, Ebstein PR. ADHD risk alleles associated with opiate addiction: study of addicted parents and their children. Pediatr Res. 2016;80:228–36.
Knopik VS, Sparrow EP, Madden PA, Bucholz KK, Huziak JJ, Reich W, et al. Contributions of parental alcoholism, prenatal substance exposure, and genetic transmission to child ADHD risk: a female twin study. 2005;35:625–35.
Knopik VS, Heath AC, Jacob T, Slutske WS, Bucholz KK, Madden PA, et al. Maternal alcohol use disorder and offspring ADHD: disentangling genetic and environmental effects using a children-of-twins design. 2006;36:1461–71.
Funding
None.
Author information
Authors and Affiliations
Contributions
NK: conceptualization and writing—original draft. NS: conceptualization, writing—review and editing, and supervision. NR: conceptualization, writing—review and editing, and supervision.
Corresponding author
Ethics declarations
Ethical approval
Not required for this review article.
Conflict of interest
No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kian, N., Samieefar, N. & Rezaei, N. Prenatal risk factors and genetic causes of ADHD in children. World J Pediatr 18, 308–319 (2022). https://doi.org/10.1007/s12519-022-00524-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12519-022-00524-6