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| |    Causes of ADHD by Robert Needlman, M.D., F.A.A.P. reviewed by Robert Needlman, M.D., F.A.A.P. Years ago, doctors called ADHD "minimal brain dysfunction." They believed that there must be something wrong with the brain even though the problem couldn't be seen (hence the "minimal"). Currently, most experts still believe that ADHD is caused by brain dysfunction. Our understanding is deeper than before, but still far from complete. Parts of the brain that are affected With ADHD, a crucial area of the brain is the frontal lobe. The frontal lobe, located nearest the forehead, is the where the brain weighs alternatives before deciding on a course of action. It is also important for maintaining attention. Another important area, (the striatum) plays a key role in translating impulses into an action. These areas of the brain (and many others) are connected through a complex network of neurons. Neurons communicate with each other by giving off tiny amounts of certain chemicals called neurotransmitters into the spaces between the neurons (the synapses). ADHD has been connected with abnormal levels of two neurotransmitters--dopamine and norepinephrine--that play a major role in this network. There is a lot of evidence that links ADHD to problems in the norepinephrine and dopamine neurons that connect the frontal lobe and the striatum. Not surprisingly, the medications most commonly used to treat ADHD have their main effect on the levels of dopamine and norepinephrine in the synapses of the brain. Causes of brain dysfunction ADHD runs in families. Very often a father or other close relative has the condition. I've heard from many grandmothers that their sons (the fathers of my patients) acted "just like that when they were boys." Certain early life events also are linked to ADHD. Smoking cigarettes during pregnancy, drinking alcohol, and using cocaine and other illegal drugs all increase the risk that a child will develop attention problems. In infancy, having high blood lead, low iron, or significant under-nutrition can lead to ADHD as well, although not always. Rarely, ADHD seems to follow a serious brain infection or serious trauma to the brain. But most children with ADHD don't have any of these risk factors (except the family history). Don't blame the parents ADHD is not caused by bad parenting, although the results of stress, overtiredness, spoiling, and other problems can sometimes be mistaken for ADHD. That is one reason that a careful, expert evaluation is so important. Parenting is still important, of course. Children with ADHD demand that their parents are extra patient, extra energetic, and extra skillful. Just being a good parent isn't usually enough.
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