The Who, What, Where, Why and Huh? of ADHD, Part III: Where Does ADHD Come From?
We conclude this series by asking, “Where does ADHD come from?” (and it ain’t from the cabbage patch).
Those of you who’ve been following this blog know from last week’s post that ADHD comes from a pernicious faery. This ne’er-do-well paranormal creature flits into a sleeping child’s room, sprinkling fouled fairy dust into the unwitting child’s eyes, making irrevocable changes in the kid’s biochemistry. One day, if the child is lucky, a Good Witch counteracts the spell with an antidote (most commonly a stimulant medication, such as Ritalin or Concerta, among others).
But there are other opinions. Yes, yes, I know. The one above seems highly plausible, given the state of learning we’re at with ADHD at the moment, but just for fun, let’s look at the other wacky suggestions flying around out there.
General consensus points to genetics as the culprit. In fact, in adults, it’s usually when they’re hauling their spacey or springy offspring into a clinic for diagnosis that the diagnostician (often a child psychiatrist or pediatrician) will take a sidelong glance and suggest, “Uh, you might want to look into this for yourself, Mom (or Dad).” Or the parent drives away from the appointment, 20 clicks over the speed limit, demonstrates a bout of road rage, and arrives home late for his favorite TV show and suddenly the light bulb goes off: “I might have it, too!”
But keeping it all in the family doesn’t necessarily have to mean it’s inherited. Now, before I stir up outrage and protest, I’ll ask that you keep an open mind and consider that, to date, there is no definitive test for ADHD, neither is there any unequivocal physical evidence of its existence. It’s not like, say, being tall, which has been definitively linked to genetic heritability.
So — (taking a deep breath) — here goes:
At least one researcher points to ADHD as NOT primarily heritable, but rather influenced by the home environment. There. I’ve said it. Ok, settle down, hear me out. It’s not about blame, it’s about boldly going where few researchers (or media reports) are willing to go: unemotionally examining all theories in the interests of bettering the lives of those with ADHD and those who love them.
Let’s face it, it’s a lot easier to blame a gene than a parent, or even an entire society. But subtle messages in body language, tone of voice, even your attitude towards your spouse can affect your child’s mental health. Or so claims Gabor Maté, M.D., in Scattered: How Attention Deficit Disorder Originates And What You Can Do About It.
Maté notes that today’s society places far too much emphasis on genetic causes to explain almost every human illness and trait. He calls this, “genetic fundamentalism.” And it’s easy to see why simplified explanations, served up by the media, are a lot easier to digest than anything that smacks of blame toward the kid’s home environment. Parental and communal guilt are to be avoided at all costs. But it may be that the cost is too high: to the children, the parents themselves, and society at-large. Maybe we are making some mistakes that might better be avoided. Maté, author also of Hold Onto Your Kids: Why Parents Need to Matter More Than Peers, presents a cogent and compelling argument to this effect. Are we brave enough to look at it?
First, the emphasis on genes is not borne out when it comes to ADD, he says, citing studies that show that few diseases are purely genetic. While genes carry potentials, according to Maté,
“Psychological tension in the parents’ lives during the child’s infancy is, I am convinced, a major and universal influence on the subsequent emergence of ADD.” (from Scattered, p. 55)
In families where the parents are struggling with dysfunction and psychological problems of their own, no genes need be involved for ADD to run in families.
“Environment has far greater impact on the structures and circuits of the human brain then was realized even a decade ago. It is what shapes the inherited genetic material. I believe it to be the decisive factor in determining whether the impairments of ADD will or will not appear in a child.” (from Scattered, p. 53)
It seems that for every research paper, or statistic, an equal and opposite paper or stat can be found. For example, Dr. Thomas E. Brown, in his book, Attention Deficit Disorder: The Unfocused Mind in Children and Adults, refers to twin and adoption studies as indicating “high heritability rates for ADHD and components of ADHD.”
In twin pair studies, where identical twins were adopted into different families, it’s suggested that the gene factor can be separated out. These studies show that there’s a 50 to 60% likelihood that if one of the twins has ADD, the other will, too. But, says Maté, if these kids share 100% of the same genes, why isn’t the concordance (the technical term for a shared likelihood of the same trait) not closer to 100%?
What everyone is missing, says Maté, is that these twins not only share the same genes, they’ve both experienced the same in utero environment (which is inherently a traumatized one, adversely affecting brain development in the fetus), and the experience of having been adopted. This, according to Maté, is the real determining factor in both of the children having ADHD. In fact, studies show that the incidence of ADD amongst adoptees is much higher than amongst the non-adopted population, a topic I’ll touch upon in a later post.
Kessler, Z. (2015). The Who, What, Where, Why and Huh? of ADHD, Part III: Where Does ADHD Come From?. Psych Central. Retrieved on June 25, 2016, from http://blogs.psychcentral.com/adhd-zoe/2010/03/the-who-what-where-why-and-huh-of-adhd-part-iii-where-does-adhd-come-from/