Results from a large national study performed in the 1960s indicated that a number of nongenetic factors can affect the risk of ADHD. The children evaluated in that study were followed from conception until 7 years of age. Risk factors for ADHD included a history of smoking, alcohol use, drug use or anemia during pregnancy, breech birth, chorioamnionitis (infection of the placenta) during labor, premature birth, and small head size at birth. A family history of mental retardation and low socioeconomic status also appeared to be risk factors. Neurological problems in the first month of life increase the risk of ADHD at age 7 years from 2% to 50%. In infancy, delayed development and increased activity predict ADHD at age 7 years.When a 4-yearold child has a small head size, astigmatism, or visual motor, fine motor, or gross motor deficits, the risk of ADHD is increased.
Psychosocial problems at home are also risk factors for ADHD. A Hawaiian study revealed a 200% to 400% increased risk of ADHD in children from families where there was a lot of conflict in the home. In a Swedish study, unsatisfactory family life was the largest risk factor for ADHD, overriding any other medical problems.
Having a risk factor or even several risk factors does not mean that ADHD is going to occur, but it makes ADHD more likely than in someone who has no risk factors. The various risk factors predispose a child to ADHD to different degrees.
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