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CHAPTER 37 • Mental Disorders of Childhood and Adolescence

Epidemiology and Risk Factors Although prevalence estimates vary depending on the diagnostic criteria used, the sources of data, and the sampling procedure, ADHD has been diagnosed in as many as 9.8% of children aged 3 to 17 years, an estimated 7 million of children in the United States. Male children are more likely to be diagnosed than female children (15% compared to 8%) (CDC, 2024b). Researchers believe that several risk factors may contribute to the development of ADHD, including a family history of ADHD, environmental factors (such as brain injuries, nutrition, and social environments), substance use during pregnancy, exposures to environmental toxins (such as lead) during pregnancy and/or at a young age, and low birth weight (National Institute of Mental Health [NIMH], 2024a; Sears et al., 2022). Etiology No single explanation for the occurrence of ADHD exists; instead, this disorder is viewed as having multiple causes. Genetic factors are implicated in the etiology of ADHD. They clearly play a fundamental role in the manifestation of ADHD behavior (Kleppesto et al., 2024; Lopez-Martin et al., 2024). In some children, dietary patterns have been investigated as a potential contributing factor to the development of ADHD, specifically those characterized by high consumption of refined grains, processed meats, soft drinks, and saturated fat (Pinto et al., 2022). Biologic Theories Although the etiology of ADHD is uncertain, evidence about neurobiologic dysfunction is pervasive. Research has shown that the frontal lobe and functional connec tions impacted with specific subcortical structures also are dysregulated. One clearly dysfunctional area is the dorso lateral prefrontal cortex, the center of directed attention and the ability to manage emotions or delay emotional reactions. Several neurotransmitters (e.g., dopamine, serotonin, and norepinephrine) are dysregulated (Chepke et al., 2024; Lin et al., 2023; Predescu et al., 2024). Clinically, the hyperactive-impulsive behavior characteris tic of ADHD has been shown to be predominantly related to biologic factors, not psychosocial factors. Psychosocial Theories Although genetic endowment is clearly a fundamental element in the etiology of ADHD, psychosocial factors are also important risk factors. Critical life events, family stress, marital discord, and parental substance use are also associated with exacerbation of ADHD behaviors. Other implicated psychosocial factors are poverty, overcrowded living conditions, and family dysfunction (Jendreizik et al., 2023; Spencer et al., 2022).

Family Response to ADHD Living with a child who has ADHD is a challenge for all family members, particularly those members who also have issues similar to those of the affected child. The family will raise a child who needs a structured environment that helps support focus and attention, and the parents must partner with their children’s school system. For some families, the relationship with the school is positive and supportive. For others, the relationship with the school can be strained and lead to additional stress. It is important that the teachers and parents work together and provide consistent direc tions to the child. If parents also have issues related to attention, impulse, and hyperactivity, home chaos and ineffective parenting practices can occur. If the parents also have ADHD, they might not be able to provide a calm structured environ ment for the child. Effective parenting requires resisting overreacting emotionally, focusing on the child, keeping track of activities, and providing consistency in discipline (Morgan & O’Keefe, 2022). RECOVERY-ORIENTED CARE FOR CHILDREN WITH ADHD Teamwork and Collaboration: Working Toward Recovery Children with ADHD and their families benefit from symptom management, education, and support from various disciplines to have a high-quality life. Successful recovery efforts involve early recognition and treatment. By recognizing the issue early, family members and teachers can structure the child’s interactions, develop meaningful discipline strategies, and modify the physi cal environment so the child can learn coping skills to deal with impulsivity, distractibility, and hyperactivity. Evidence has accumulated over the years that medication is helpful, especially in the early years, but for long-term effects, a combination of medication management and behavioral approaches results in the best outcomes for the children and their families (Peterson et al., 2024; Rios-Davis et al., 2023). ADHD is not an easy disorder to treat or manage. Comorbidity complicates successful recovery. Children with ADHD have more behavior or conduct issues (e.g., run-ins with police), learning disorders, anxiety, and depression (CDC, 2024b). Many other issues interfere with recovery efforts, such as family disruptions and eco nomic issues, as well as naturally occurring changes such as maturational issues during their adolescent years. In addition, children from disadvantaged backgrounds fare worse than those children who have socioeconomic and educational support (Habdank-Kolaczkowski et al., 2023; Hall et al., 2023).

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