Could the many ear infections my child had as a toddler be the cause of his ADHD?

Some studies, although not all, have found that children with a history of frequent bilateral ear infections had lower language and speech scores, lower reading scores, and more behavior and attention problems during elementary school. Investigators have suggested that children who suffer from intermittent hearing impairments from ear infections do not get enough “practice” in paying attention. This does not mean that your child will have problems in these areas if he has frequent ear infections, but parents and teachers do need to be vigilant about this problem. It is very unlikely that ADHD is caused by ear infections.

My child with iron-deficiency anemia is hyperactive rather than tired. Is that common?

Anemia, although commonly thought to decrease energy, can be a cause of inattention and hyperactivity during early childhood. Pediatricians routinely monitor for anemia, which is most often caused by iron deficiency. Iron replacement corrects both the anemia and the inattention and hyperactivity fairly quickly.

Are children born prematurely at increased risk for ADHD?

The frequency of ADHD in children born prematurely is fairly high. One study compared children who had been born prematurely with children who were from the same social class but had been born at full-term. When the children were evaluated at age 7 years, approximately 20% of those in the premature group had ADHD as compared to about 10% of the other group.Many of the premature children who had ADHD also had additional cognitive, neurological, or academic disabilities (e.g., dyslexia and developmental language disorders).

The rapid advances in medical technology have greatly increased the number of children who survive premature birth. However, as more premature babies survive, there is growing evidence that suggests that there are long term repercussions: many of these children—especially the very small ones—develop major neurological problems. These children appear to be at special risk for ADHD because their frontostriatal circuitry is particularly vulnerable to injury owing to its immaturity at the time of birth. It is wise to carefully monitor children who are born premature.

Can a significant head injury or a minor concussion cause ADHD?

Behavior problems from significant traumatic brain injury include irritability, fatigue, impulsiveness, decreased anger control, disinhibition, decreased motivation, decreased frustration tolerance, decreased initiative, aggressiveness, decreased attention, and hypo- or hyperactivity. This is due at least in part to the fact that a closed-head injury is likely to damage the frontal lobes of the brain. A physician must carefully and indefinitely monitor the classroom attention of a child who has sustained a significant head injury. In contrast, concussions, which are associated with only a brief loss of consciousness, are considered very minor head injuries. Nonetheless, children may have trouble concentrating and focusing for several weeks after a concussion. The effects are transient, but can temporarily affect school performance. Paying attention to the problem will minimize it.

What other environmental factors may cause ADHD?

Although environmental factors are most certainly not the main elements leading to ADHD, evidence suggests that exposures to various agents, such as drugs, chemicals, or illnesses, may increase the risk of ADHD. For example, iron-deficiency anemia and thyroid disorders can cause problems with attention span. Exposure to such substances as lead and mercury may also increase the chances of a child having ADHD.

My child with ADHD can sit and watch TV for hours, but I have heard that watching television can cause ADHD. Is this true?

Researchers have recently reported that for every hour a day preschoolers watch television, their risk of developing ADHD increases by about 10%. These new findings are consistent with previous research showing that television can shorten attention spans. Researchers have speculated that TV might actually overstimulate and permanently “rewire” the developing brain.

The newest study on TV watching assessed more than 1000 children. Parents were questioned about the children’s TV watching habits at 1 and 3 years of age. They rated their children’s behavior at age 7 years on a scale commonly used to diagnose ADHD. About 10% met criteria for a diagnosis of ADHD, about the same frequency as is usually found in 7-year-olds. But the 37% of 1-year-olds who watched 1 to 2 hours daily had a 10% to 20% increased risk of attention problems; the 14% who watched 3 to 4 hours daily had a 30% to 40% increased risk compared with children who watched no TV. Among 3-year-olds, only 7% watched no TV, 44% watched 1 to 2 hours daily, 27% watched 3 to 4 hours daily, almost 11% watched 5 to 6 hours daily, and about 10% watched 7 or more hours daily. These children too were at increased risk for ADHD, and the risk was proportionate to how much TV they watched. Although the research has been done on TV watching, the effects of any repetitive non-educational activity or electronic device, such as playing video games, may be the same.

The TV research is compelling enough that the American Academy of Pediatrics recommends that parents do not permit children under 2 years of age to watch television because of concerns that it affects early brain growth and the development of social, emotional, and cognitive skills. And there are many other reasons that children should not watch television. For example, TV watching has been associated with obesity and aggressiveness. So, even if it is one of the places your ADHD child will sit quietly, it is best to limit TV watching. You need to be creative about finding other things your child would like to do. Reading to your child or encouraging your child to read alone, even if he is reading sports magazines or comic books, is a better alternative.

Was my child born with ADHD, or did it “develop?”

In most cases, to the extent that ADHD is a genetic disorder, your child was born with ADHD. In other words, the genes that contribute to the disorder were present at birth. Some children born with the genes for the disorder do not develop ADHD symptoms at all; some have such slight difficulties with attention that it goes undetected throughout their lives. Nevertheless, the signs can appear and change over time, depending on a variety of circumstances. Environmental factors play a role even when the main cause is genetic. A child with a mild disorder can subsequently manifest extreme inattention or hyperactive behavior in the presence of certain environmental factors, such as parental abuse or neglect, poor living conditions, or other circumstances that stress children emotionally. If ADHD symptoms develop “suddenly,” it is likely that the disorder was present but hidden, only appearing when an environmental factor came into play.