Editing Attention deficit hyperactivity disorder (section)

=== Environment ===

In addition to genetics, some environmental factors might play a role in causing ADHD.<ref name="Sonu_2013" /><ref name="cdc2016">{{cite web |author=CDC |title=Attention-Deficit / Hyperactivity Disorder (ADHD) |publisher=Centers for Disease Control and Prevention |url=https://www.cdc.gov/ncbddd/adhd/research.html |date=16 March 2016 |access-date=17 April 2016 |url-status=live |archive-date=14 April 2016 |archive-url=https://web.archive.org/web/20160414160548/http://www.cdc.gov/ncbddd/adhd/research.html}}</ref> Alcohol intake during pregnancy can cause [[fetal alcohol spectrum disorder]]s which can include ADHD or symptoms like it.<ref name="Burger_2011">{{cite journal |vauthors=Burger PH, Goecke TW, Fasching PA, Moll G, Heinrich H, Beckmann MW, Kornhuber J |title=[How does maternal alcohol consumption during pregnancy affect the development of attention deficit/hyperactivity syndrome in the child] |language=de |journal=Fortschritte der Neurologie-Psychiatrie |volume=79 |issue=9 |pages=500–506 |date=September 2011 |pmid=21739408 |doi=10.1055/s-0031-1273360 |trans-title=How does maternal alcohol consumption during pregnancy affect the development of attention deficit/hyperactivity syndrome in the child |type=Review |s2cid=140766296}}</ref> Children exposed to certain toxic substances, such as [[lead poisoning|lead]] or [[polychlorinated biphenyls]], may develop problems which resemble ADHD.<ref name="nimh" /><ref name="Eubig_2010">{{cite journal |vauthors=Eubig PA, Aguiar A, Schantz SL |title=Lead and PCBs as risk factors for attention deficit/hyperactivity disorder |journal=[[Environmental Health Perspectives]] |volume=118 |issue=12 |pages=1654–1667 |date=December 2010 |pmid=20829149 |pmc=3002184 |doi=10.1289/ehp.0901852 |bibcode=2010EnvHP.118.1654E |type=Review. Research Support, N.I.H., Extramural. Research Support, U.S. Gov't, Non-P.H.S.}}</ref> Exposure to the [[organophosphate]] [[insecticide]]s [[chlorpyrifos]] and [[Alkyl phosphate|dialkyl phosphate]] is associated with an increased risk; however, the evidence is not conclusive.<ref name="de_Cock_2012">{{cite journal |vauthors=de Cock M, Maas YG, van de Bor M |title=Does perinatal exposure to endocrine disruptors induce autism spectrum and attention deficit hyperactivity disorders? Review |journal=[[Acta Paediatrica]] |volume=101 |issue=8 |pages=811–818 |date=August 2012 |pmid=22458970 |doi=10.1111/j.1651-2227.2012.02693.x |type=Review. Research Support, Non-U.S. Gov't |s2cid=41748237}}</ref> Exposure to tobacco smoke during pregnancy can cause problems with central nervous system development and can increase the risk of ADHD.<ref name="nimh">{{cite web |title=Attention Deficit Hyperactivity Disorder (Easy-to-Read) |url=http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-easy-to-read/index.shtml |publisher=National Institute of Mental Health |year=2013 |access-date=17 April 2016 |url-status=live |archive-date=14 April 2016 |archive-url=https://web.archive.org/web/20160414031036/http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-easy-to-read/index.shtml}}</ref><ref name="Abbott_2012">{{cite journal |vauthors=Abbott LC, Winzer-Serhan UH |title=Smoking during pregnancy: lessons learned from epidemiological studies and experimental studies using animal models |journal=[[Critical Reviews in Toxicology]] |volume=42 |issue=4 |pages=279–303 |date=April 2012 |pmid=22394313 |doi=10.3109/10408444.2012.658506 |type=Review |s2cid=38886526}}</ref> [[Nicotine]] exposure during pregnancy may be an environmental risk.<ref>{{cite journal |vauthors=Tiesler CM, Heinrich J |title=Prenatal nicotine exposure and child behavioural problems |journal=[[European Child & Adolescent Psychiatry]] |volume=23 |issue=10 |pages=913–929 |date=October 2014 |pmid=25241028 |pmc=4186967 |doi=10.1007/s00787-014-0615-y}}</ref>

Extreme [[premature birth]], very [[low birth weight]], and extreme neglect, abuse, or social deprivation also increase the risk<ref>{{cite journal |vauthors=Botting N, Powls A, Cooke RW, Marlow N |title=Attention deficit hyperactivity disorders and other psychiatric outcomes in very low birthweight children at 12 years |journal=[[Journal of Child Psychology and Psychiatry|Journal of Child Psychology and Psychiatry, and Allied Disciplines]] |volume=38 |issue=8 |pages=931–941 |date=November 1997 |pmid=9413793 |doi=10.1111/j.1469-7610.1997.tb01612.x |url=https://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.1997.tb01612.x |access-date=22 March 2022 |url-status=live |archive-url=https://web.archive.org/web/20220517212252/https://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.1997.tb01612.x |archive-date=17 May 2022}}</ref><ref name="nimh" /><ref name="Thapar-2012">{{cite journal |vauthors=Thapar A, Cooper M, Jefferies R, Stergiakouli E |title=What causes attention deficit hyperactivity disorder? |journal=[[Archives of Disease in Childhood]] |volume=97 |issue=3 |pages=260–265 |date=March 2012 |pmid=21903599 |pmc=3927422 |doi=10.1136/archdischild-2011-300482 |type=Review. Research Support, Non-U.S. Gov't }}</ref> as do certain infections during pregnancy, at birth, and in early childhood. These infections include, among others, various viruses ([[measles]], [[Varicella zoster virus|varicella zoster]] [[encephalitis]], [[rubella]], [[enterovirus 71]]).<ref name="Millichap_2008">{{cite journal |vauthors=Millichap JG |title=Etiologic classification of attention-deficit/hyperactivity disorder |journal=[[Pediatrics (journal)|Pediatrics]] |volume=121 |issue=2 |pages=e358–e365 |date=February 2008 |pmid=18245408 |doi=10.1542/peds.2007-1332 |type=Review |s2cid=24339363}}</ref> At least 30% of children with a [[traumatic brain injury]] later develop ADHD<ref name="Eme-2012" /> and about 5% of cases are due to brain damage.<ref name="Erk_2009" />

Some studies suggest that in a small number of children, artificial [[food dye]]s or [[preservatives]] may be associated with an increased prevalence of ADHD or ADHD-like symptoms,<ref name="nimh" /><ref name="pmid22232312">{{cite journal |vauthors=Millichap JG, Yee MM |title=The diet factor in attention-deficit/hyperactivity disorder |journal=[[Pediatrics (journal)|Pediatrics]] |volume=129 |issue=2 |pages=330–337 |date=February 2012 |pmid=22232312 |doi=10.1542/peds.2011-2199 |url=http://pediatrics.aappublications.org/content/129/2/330.long |url-status=live |s2cid=14925322 |archive-url=https://web.archive.org/web/20150911071727/http://pediatrics.aappublications.org/content/129/2/330.long |archive-date=11 September 2015}}</ref> but the evidence is weak and may apply to only children with [[food sensitivities]].<ref name="Sonu_2013" /><ref name="pmid22232312" /><ref name="EncycFoodSafety">{{cite encyclopedia |vauthors=Tomaska LD, Brooke-Taylor S |title=Food Additives&nbsp;– General |pages=[{{google books|mX1XAQAAQBAJ |page=449|plainurl=yes}} 449]–54 |encyclopedia=Encyclopedia of Food Safety |volume=3 |veditors=Motarjemi Y, Moy GG, Todd EC |publisher=Elsevier/Academic Press |location=Amsterdam |edition=1st |date=2014 |isbn=978-0-12-378613-5 |oclc=865335120}}</ref> The [[European Union]] has put in place regulatory measures based on these concerns.<ref name="FDAdyecomm">{{cite web |date=March 2011 |url=https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/FoodAdvisoryCommittee/UCM248549.pdf |title=Background Document for the Food Advisory Committee: Certified Color Additives in Food and Possible Association with Attention Deficit Hyperactivity Disorder in Children |publisher=U.S. Food and Drug Administration |url-status=live |archive-date=6 November 2015 |archive-url=https://web.archive.org/web/20151106080629/https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/FoodAdvisoryCommittee/UCM248549.pdf}}</ref> In a minority of children, [[food intolerance|intolerances]] or [[food allergy|allergies]] to certain foods may worsen ADHD symptoms.<ref name="Nigg_2014" />

Individuals with [[hypokalemic sensory overstimulation]] are sometimes diagnosed as having ADHD, raising the possibility that a subtype of ADHD has a cause that can be understood mechanistically and treated in a novel way. The sensory overload is treatable with oral [[potassium gluconate]].<ref>{{Cite journal |last1=Segal |first1=Michael M. |last2=Rogers |first2=Gary F. |last3=Needleman |first3=Howard L. |last4=Chapman |first4=Catherine A. |date=2007–2012 |title=Hypokalemic Sensory Overstimulation |url=https://journals.sagepub.com/doi/10.1177/0883073807307095 |journal=[[Journal of Child Neurology]] |language=en |volume=22 |issue=12 |pages=1408–1410 |doi=10.1177/0883073807307095 |pmid=18174562 |issn=0883-0738}}</ref>

{{Anchor|ADH and Sugar}}<!-- Do not delete this code as it is used to link to this location regarding sugar and ADHD from other articles.-->
Research does not support popular beliefs that ADHD is caused by eating too much refined sugar, watching too much television, bad parenting, poverty or family chaos; however, they might worsen ADHD symptoms in certain people.<ref name="cdc2016facts">{{cite web |title=Facts About ADHD |publisher=Centers for Disease Control and Prevention |url=https://www.cdc.gov/ncbddd/adhd/facts.html |date=6 January 2016 |access-date=20 March 2016 |url-status=live |archive-date=22 March 2016 |archive-url=https://web.archive.org/web/20160322103310/http://www.cdc.gov/ncbddd/adhd/facts.html}}</ref>

In some cases, an inappropriate diagnosis of ADHD may reflect a [[dysfunctional family]] or a poor [[educational system]], rather than any true presence of ADHD in the individual.<ref>{{cite web |url=http://www.euro.who.int/document/MNH/ebrief14.pdf |title=Mental health of children and adolescents |date=15 January 2005 |access-date=13 October 2011 |archive-url=https://web.archive.org/web/20091024102724/http://www.euro.who.int/document/MNH/ebrief14.pdf |archive-date=24 October 2009 |website=WHO Europe}}</ref>{{Better source needed|date=May 2022|reason=The current source is a briefing for a conference, with unclear provenance.}} In other cases, it may be explained by increasing academic expectations, with a diagnosis being a method for parents in some countries to obtain extra financial and educational support for their child.<ref name="Erk_2009" /> Additionally, children who enter school earlier and are of a younger age than their classmates are more likely to have educational and behavioral problems than their peers, which can make them more likely to be diagnosed with ADHD.<ref>{{Cite journal |last1=Evans |first1=William N. |last2=Morrill |first2=Melinda S. |last3=Parente |first3=Stephen T. |date=1 September 2010 |title=Measuring inappropriate medical diagnosis and treatment in survey data: The case of ADHD among school-age children |url=https://linkinghub.elsevier.com/retrieve/pii/S0167629610000962 |journal=[[Journal of Health Economics]] |volume=29 |issue=5 |pages=657–673 |doi=10.1016/j.jhealeco.2010.07.005 |pmid=20739076 |issn=0167-6296 |quote=As Elder and Lubotsky (2009) demonstrate, younger children in classes are more likely to have educational and behavioral problems compared to their peers, and therefore, some children who are relatively young compared to their classroom peers are more likely to be diagnosed with ADHD. These results suggest that the comparison sample for diagnosis should not be other children in class but rather, other children of a similar age within a class.}}</ref> Behaviours typical of ADHD occur more commonly in children who have experienced violence and emotional abuse.<ref name="NICE 2009">{{cite book |title=Attention Deficit Hyperactivity Disorder: Diagnosis and Management of ADHD in Children, Young People and Adults |author=National Collaborating Centre for Mental Health |series=NICE Clinical Guidelines |volume=72 |publisher=[[British Psychological Society]] |location=Leicester |isbn=978-1-85433-471-8 |date=2009 |url=https://www.ncbi.nlm.nih.gov/books/NBK53652/ |via=NCBI Bookshelf |url-status=live |archive-url=https://web.archive.org/web/20160113133612/http://www.ncbi.nlm.nih.gov/books/NBK53652/ |archive-date=13 January 2016}}</ref>