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3. Stressful physical or emotional childhood experiences as ADHD cause


3. Stressful physical or emotional childhood experiences as ADHD cause

3.1. Stressful physical childhood experiences as a (co-)cause of ADHD

3.1.1. Bottle feeding increases, breastfeeding decreases ADHD risk

Infants who were not breastfed showed an increased risk of ADHD as children, while children who were not breastfed as infants showed a decreased risk of ADHD.123 One study reported an almost 3-fold ADHD risk4

The risk of ADHD decreases with the duration of breastfeeding.56 Another study came to a comparable conclusion.7

It is unclear what influence breastfeeding or the food itself has on this. It is known that bisphenol A increases the risk of ADHD. In 2007, bisphenol A was still contained much more frequently in baby bottles than in 2011, which could explain why a study found a fivefold increased risk of ADHD in children fed by bottles in 2007, but no risk increase in children fed by bottles in 2011.8

Breast milk contains many substances that are essential for the development of babies, such as polyunsaturated fatty acids.3

In addition, breastfeeding involves physical affection for the child.

3.1.2. Screaming children (+ 1181 %) Factors that increase the risk of crying children

If the parents are heavy smokers, or if the mother smokes during pregnancy, the risk for a crying child increases by 30 to 150% (quite a few studies); the largest study on this (n = 5845) cites a 69% increased risk.9
In addition, there are several other possible causes that should be systematically excluded.10 Risk increase for ADHD in crying children

Writing babies have a significantly increased risk of ADHD.1112 Another study reported an 11.8 times higher risk of developing hyperactivity at 8 to 10 years of age (plus 1181%), behavioral problems and negative emotional orientation were reported twice as often as in unaffected individuals.13


Given a usual prevalence of 5% to 10% for ADHD (all subtypes), an 11.8-fold increase in risk would mean that 60% to 100% of all crying children will develop some form of ADHD.
In addition, studies report that (former) crying children at 3.5 years of age are more likely to have behavioral problems according to their mothers, but do not have problems with attention span, behavioral regulation, and sociability.14 Cry babies cause significant stress to their parents. 5.6% of all crying children bring their parents to the point of abuse and neglect, including significant bodily harm (shaking, hitting).9

This proves the significant stress experienced by the affected baby over and above the actual cause that causes it to cry. A self-reinforcing system develops: stress of the child causes crying, this causes stress in the parents, which in turn increases the child’s stress.

Yelling is not currently considered a separate first symptom of ADHD.

3.1.3. Feeding problems with infants

Feeding problems in infants correlate with ADHD in adolescence and adulthood.12

3.1.4. Infant sleep problems

Infant sleep problems correlate with ADHD in adolescence and adulthood.12

3.1.5. Subependymal pseudocysts in neonates

Subependymal pseudocysts in newborns increase the risk of ADHD and autism.15

3.1.6. Valproic acid in neonates

Studies in mice suggest that valproate administration to newborns may cause permanent damage similar to that caused by ASA and, in some cases, ADHD.16

3.1.7. Bacterial infections (+ 693 %)

Severe bacterial infections in childhood or adolescence massively increase the risk of severe mental disorders (HR):17

  • ASS: 13,80
  • ADHD: 6.93
    • ADHD medication use: 11.81
  • Tic disorder: 6.19
  • OCD: 3.93
  • Bipolar disorder: 2.50
  • Depressive disorders: 1.93
    • Antidepressant use: 2.96
    • Mood stabilizers intake: 4.51
    • Atypical antipsychotic use: 4.23

Among the bacterial species studied (Streptococcus, Staphylococcus, Pseudomonas, Klebsiella, Hemophilus, Mycoplasma, Tuberculosis, Meningococcus, Escherichia, Chlamydia, and Scrub Typhus), Streptococcus was associated with the most disruptive symptoms. ADHD was associated with eight bacterial pathogen infections.

Antibiotic administration in the second year of life increased the risk of ADHD by 20% to 33% and sleep problems by 24% to 50% in a very large study.18
One small study found more frequent behavioral difficulties and depressive symptoms in 3 1/2-year-old children who received antibiotics in the first year of life.19 Two other studies found no increased risks of mental disorders with antibiotic administration in the first 1 20 to 221 years of life.

3.1.8. Surgical procedures under anesthesia / anesthesia (+ 39 %)

Children who underwent a single surgical procedure under anesthesia at age 5 or younger were 37% more likely to take ADHD medications at later ages.22 The authors of this large study discuss an increased vulnerability of affected individuals to neurotoxic substances (anesthetics). A Korean cohort study found a 41% increased risk of ADHD as a result of general anesthesia in early childhood. In addition, the duration of general anesthesia correlated with increased ADHD risk.23
One study found a 37% increase in ADHD risk with a single anesthetic given during surgery up to 5 years of age, and a 75% increase with multiple anesthetics.24 Another study came to similar conclusions.25
Another study found significantly increased rates of ADHD among 10- to 16-year-olds who had received surgery for a congenital heart defect as infants.26
In contrast, a cohort study in Taiwan found no increased ADHD risk from anesthetics in the first 3 years of life.27

It may be open to what extent the likelihood of surgical intervention under anesthesia is already influenced by the increased likelihood of accidents in ADHD sufferers. See Consequences of ADHD.

3.1.9. Neurodermatitis / atopic eczema / atopic dermatitis in childhood

Neurodermatitis / atopic eczema / atopic dermatitis in childhood correlates with an increased risk of ADHD.28
In contrast, a cohort study found no appreciable (+ 2%) increased risk of ADHD in childhood neurodermatitis.29

3.1.10. Antihistamines in the first years of life

A large cohort study found that taking antihistamines (especially first-generation antihistamines) in the first years of life significantly increased the risk of later ADHD. A disturbance of REM sleep, which secondarily impaired brain maturation, was cited as a possible cause.30

3.1.11. Passive smoking - Smoking persons in the environment in the first years of life

Nicotine exposure in children is associated with up to a 1.42-fold31 increase in ADHD.6 Children with ADHD were twice as likely to have smokers in the family as unaffected children in one study.32
In the case of passive smoking, a connection to certain MAO-A gene variants is mentioned, which cause a lower serotonin degradation.33

In children, a linear association was shown between salivary cotinine (a nicotine breakdown product) and hyperactivity and behavior problems. This association remained significant after adjusting for family poverty, parental education, a history of ADHD, hostility, depression, caregiver IQ, and obstetric complications, and even after excluding from the calculation children of mothers who had smoked during pregnancy. This indicates that exposure to nicotine in the early years of life alone may increase hyperactivity and behavior problems.34

3.1.12. Childhood air pollution Fine dust and nitrogen oxides

A large cohort study found a statistically significant association between nitrogen oxides and particulate matter (<2.5 pm) in childhood and the development of ADHD.35 A smaller cohort study confirmed this for particulate matter but not for nitrogen dioxide.36 Another cohort study found a 40% to 78% increased risk of ADHD from exposure to PM2.5 in the first to third year of life. The risk was associated with PM2.5 >16 μg/m3 and increased sharply with PM2.5 > 50 μg/m3. No sex-dependent association was found.37
In another study, the ADHD risk increased by 38% for each increase of 10 μg/m3 nitrogen oxide and by 51% for each increase of 5 μg/m3 particulate matter PM2.5. When both factors were considered together, the influence of nitric oxide predominated. Age and sex of the affected persons as well as educational level and income of the parents were excluded. A meta-study of 28 reports found similar results in the majority of reports.38 Nitrogen oxides already influence glutamatergic, opioidergic cholinergic and dopaminergic neurotransmission in the brain at non-toxic doses.39
Another metastudy of 12 studies found a correlation between particulate matter and ADHD in children in 9 of them.40
A Korean cohort study found a 44% increase in ADHD risk in children and adolescents for every 10 µg/m3 increase in PM10, with symptom severity tending to be dose-dependent.41 A Taiwanese registry study found similar results.42

In rats, inhaled printer particles led to 5-fold increases in dopamine levels in one study, though these likely resulted from increased synthesis rather than decreased degradation.43 Renovation fumes, incense, cooking oil vapors

A large Chinese study of 8,692 children 6-12 years old found a significant increase in children’s risk of ADHD due to:44

  • Apartment renovations
  • Incense burning
  • Cooking oil vapors
  • Smokers in the household

3.1.13. Less green growth in the surroundings of the kindergarten / school

A very comprehensive study of nearly 60,000 children (4.4% of whom had an ADHD diagnosis) between the ages of 2 and 17 in 93 kindergartens/schools in Northeast China found a strong negative correlation of the amount of greenery (amount of plant life) in the kindergarten/school environment of children with ADHD. The less greenery there was, the higher the ADHD rate.45 A Canadian cohort study,36 a larger study from New Zealand46 and a smaller study of children in Barcelona47 and a meta-study48 came to similar conclusions.

The conclusions drawn from this are discussed controversially by the authors of the Chinese study:

  • It is conceivable that green has a very general calming effect. Since man was a nomad until 10,000 years ago, a green environment encoded the calming signal of food over millions of years. At that time, humans could not survive for long in regions without green. This corresponds to the biophilia hypothesis.49
  • Green reduces noise. Increased background street noise levels correlate with increased behavioral and sleep problems.50 Noise, meanwhile, was not a risk factor in the Canadian cohort study.36
  • Green serves as a filter for air pollutants and thus reduces particulate matter and nitrogen oxides. Fine dust like nitrogen oxides are discussed as ADHD risk factors (see there).
  • Studies on whether people in green regions do more sports / exercise more than people in less green (urban) environments do not come to clear results.51
    Exercise is a significant factor in preventing/ reducing ADHD symptoms.
  • Poorer immune regulation may show adverse effects on brain development and behavior. Failure of immune regulation correlates with reduced exposure to macroorganisms and microorganisms. Green can enrich the microbial inputs from the environment that induce immune regulation.52

A very large Danish cohort study also concluded that fewer green plants in the home environment correlated with up to a 20% increased risk of ADHD.53
A meta-study came to similar conclusions54

3.1.14. Growing up in urban environment

Children who grew up in a rural environment from the age of 3 had a one-third reduced risk of ADHD, according to a cohort study.55 The lower the proportion of vegetation in the environment, the higher the ADHD risk.

Another study suggests similar results.56

3.1.15. Concussions and traumatic brain injury

Brain injury severity correlates with significantly higher ADHD symptomatology. Default mode network (DMN) morphometry altered by brain injury predicted higher ADHD symptomatology 12 months after injury, whereas salience network (SN) and central executive network (CEN) morphometry were not significant independent predictors.57

One study examined mild (concussion) and severe traumatic brain injury before 10 years of age. The incidence was 1,156 per 100,000 person-years. At age 19, the risk of ADHD was increased by 68% and the risk of learning disability was increased by 29%.58
For more severe traumatic brain injury cases, the association was not statistically significant. In an analysis of cases with possible traumatic brain injury (equivalent to concussion), the result was significant (risk for ADHD increased 105%, risk for learning disability increased 42%). The risk in adulthood was particularly increased in the children with the least severe injuries.

Among 1,709 hockey players 11-17 years of age, rates of concussion correlated with higher self-reported and parent-reported scores for attention problems. Only self-reported hyperactivity, not parent-reported hyperactivity, also correlated significantly with concussion. A T score ≥ 60 combining attention problems and hyperactivity scores (an estimate of probable attention deficit hyperactivity disorder) was not significantly associated with frequency of injury or concussion.59 This is consistent with the known increased risk of accidents and injuries due to ADHD.

3.1.16. Chlorpyrifos

In children aged 1 to 6 years, chlorpyrifos residues in the blood correlated with ADHD risk.60 Vitamin D reduced the risk.
Chlorpyrifos significantly increases ADHD risk even with prenatal contamination of the mother during pregnancy.

3.1.17. Sugar consumption

One study found a correlation between sugar intake at 30 months and risk for ADHD, sleep disorders and anxiety. No correlation was found at 12 months of age.61
Whether this is a causal cause or a consequence of altered food preferences due to the disorder predisposition is an open question.

3.1.18. Ozone exposure

Children between the ages of 3 and 12 in China who were exposed to higher concentrations of ozone showed an increased risk of ADHD. This increased further with exercise7

3.2. Stressful psychological childhood experiences as a (co-)cause of ADHD

Traumatizing experiences, but also stressful experiences that already trigger considerable stress below the threshold of trauma, are risk factors for ADHD. Social risk factors increase the risk of ADHD.6263
Massive maternal stress in the early years of childhood causes significant epigenetic changes in the children’s DNA.64

Children whose parents were unmarried or unemployed or without Social Security or had a “very high” economic burden of child care or who had at least one parent with a disability card had a 21% increased risk of ADHD, a 36% increased risk of learning disability, and an 80% increased risk of ASD at age 5.5 years. This affected 10.8% of the 19,185 children.65

3.2.1. Lack of attachment behavior of the mother/parent in the (first) years of childhood

A lack of secure attachment of the child to the mother, like social and emotional deprivation, has extensive negative effects on the child’s mental health even in later years of life.66

The security of the infant’s attachment to the mother or central caregiver determines the level of the stress hormone cortisol in the babies’ brains.

Disorganized attachment behavior is a risk element for ADHD.67 Attachment disorders of children in the first years of life lead to an activation of the DRD4 gene, which is also frequently involved in ADHD, if there is a corresponding genetic disposition.68 Lack of patience of parents has been mentioned as a risk factor for ADHD,6 whereas impatience can be an ADHD symptom and therefore also an expression of ADHD in parents and thus of genetic transmission.

Massive maternal stress in the early years of childhood causes significant epigenetic changes in the children’s DNA.64

Already poor parenting behavior is a psychosocial risk factor for ADHD.69

  • Inconsistency in education
  • Missing rules
  • Frequent criticism and punishment
  • Cold, distant, uncharitable manner


How much time parents can spend with their children is not the decisive factor. It is much more important that children can absolutely rely on being accepted, welcomed, loved in every situation and especially when they misbehave. This does not mean that children are allowed to do everything they want. A good, warm parenting behavior is able to consistently limit inappropriate behavior, and they do so by evaluating an undesirable behavior without at the same time devaluing the child’s person as a whole (your behavior is not okay, you are okay). A lack of rules (and even worse: rules that only sometimes apply) are hardly bearable for children because they take away all security. The question of a mandatory “parenting license” is the subject of legal and ethical discussions.69


10.5 million households in Germany have dogs.70(Stand 2014)
8.1 million families in Germany have underage children (as of 2014).
A Google search for parenting course OR parenting courses finds 169,000 results. (20.10.2015)
A Google search for dog training school finds 1,240,000 results. (20.10.2015)

In Borderline, which typically results from intensely stressful attachment disorders to relationship figures in early childhood (first 2 years) due to physical, sexual, or psychological maltreatment, there is significant comorbidity of ADHD.71

3.2.2. Psychological problems of parents

Psychological problems of the parents increase the ADHD risk for the children.7263

  • Antisocial personality disorder of the father73
    A parent’s antisocial disorder is a huge (and usually violent) risk
  • Alcohol problems with father74
  • Depressive symptoms75
  • Bipolar disorder in parent doubles ADHD risk76
  • Depression of parent increases ADHD risk by 2/376

Parental psychological problems could act as an environmental influence and/or a genetic influence.

3.2.3. Stress of the mother in childhood

Stress experienced by mothers of 5 - 13 year old boys with ADHD tended to increase their ADHD symptomatology 12 months later and significantly worsened the children’s quality of life.77

3.2.4. Incomplete families

Single parent families increase the risk for ADHD.747363

Single parents naturally have a higher risk of not being able to give their children sufficient loving care and security. There are very well single parents who can do this very well. The decisive factor is not the amount of time that (part-time/working) parents can spend (less) with their children, but whether the children have the constant and secure feeling of being accepted and loved at all times, just as they are.

ADHD sufferers experience more frequent breakups in their relationships (even in adulthood) than non-affected individuals.

3.2.5. Family instability, constant quarreling between parents

High stress levels in the primary family increase ADHD risk.747363

Family conflicts and ADHD

Chronic family conflict, decreased family cohesion, and confrontation with parental psychopathology (especially maternal) are found more frequently in families with ADHD sufferers compared with control families.”78
The risk for children to develop ADHD (odds ratio) increases with the level of psychosocial stress (Rutter Indicator, RI). For an RI of 1, the odds ratio is 7; for an RI of 4, it is 41.7 (68). Odds ratios > 1 indicate increased risk.79

Follow-up studies do not find complete persistence even during childhood and adolescence and confirm a frequent coincidence with family problems and parental problems.80 Conversely, high family cohesion and social support has a protective effect against ADHD.81

3.2.6. Young age of parents

Children whose mother does not have ADHD have a 14% increased risk of ADHD if one parent is younger than 20.
Children whose mother has ADHD have a 92% increased risk of ADHD if one parent is younger than 20.82 Another study also reports that younger fathers were more likely to have children with ADHD than older fathers.83 One study reported a 32% decreased risk of ADHD for every 10 years of increased maternal age. However, the correlation was attenuated by other factors. These were:84

  • Family income
  • Training of the caregiver
  • Polygenic ADHD risk score
  • Breastfeeding duration
  • Prenatal alcohol exposure
  • Prenatal tobacco exposure

In a cohort study, children with ADHD also had mothers who were younger than average85
under 24 years: 1.66 times
25 to 29 years: 0.92 times
30 to 34 years: 0.66 times
over 35 years: 0.58 times

In one larger study, nearly 2 in 3 young mothers reported at least one mental health problem. Nearly 40% had more than one. Young mothers were two to four times more likely to have an anxiety disorder (generalized anxiety disorder, separation anxiety disorder, social phobia, and specific phobia), attention-deficit/hyperactivity disorder, oppositional defiant disorder, or conduct disorder than older comparison mothers or women aged 15-17 years, and two to four times more likely to have more than one psychiatric problem.86

One study found no association between the mother’s age and the offspring’s risk of ADHD.87

3.2.7. Low socioeconomic status of the family of origin

Children from “lower class” families have an increased correlation with ADHD8873 75 and are more likely to receive ADH)S medications.8963
Children from lower strata have about twice the risk of ADHD as children from higher strata (using a 3 strata model).90

Similarly, cramped housing conditions increase children’s ADHD risk.73 Poor family finances correlated with a 2.12-fold increase in ADHD risk at kindergarten age in the United States.91


The overall prevalence of ADHD in children and adolescents was found to be 2.2% in the 2007 Bella study92 (which we consider too low). A Bella sub-study with n= 2500 subjects between 7 and 17 years93 names the prevalence in the parent assessment with about 5%. Both representations confirm a strong discrepancy of the prevalence according to social classes. According to the 2007 Bella study, the middle class is burdened with the average prevalence, while the lower social class has a prevalence of 3.9%, four times higher than the upper class.94 The Bella sub-study reports a prevalence of ADHD in the lower social stratum (at 7.2%) approximately 2.3 times higher than in the upper stratum at 2.8% (for 3 strata).93
Low parental income correlated with a 2.3% increased risk of ADHD in children in a cohort study in Denmark.95 Children of parents who were unemployed and had a low income and a low level of education were found to have a 4.9% increased risk of ADHD. The fact that this pattern is not limited to ADHD, but is found identically in other mental disorders, e.g., anxiety, depression, or social behavior disorders, is considered by us to be strong evidence in support of the thesis of stress as a cause of the development of mental disorders. These other mental disorders, like ADHD, are also based on a multigenetic disposition (see 2.1.3. and 2.1.4.), which are epigenetically manifested by stress exposure in early childhood.969798

Gene candidates and early childhood stress as causes of other mental disorders

Interestingly, in one study, families with a high socioeconomic status did not benefit from behavioral therapy in addition to drug treatment. Only families with low socioeconomic status benefited more from a combination therapy of drug treatment and behavioral therapy than from drug treatment alone.99

We suspect that it is not so much socioeconomic status or the size of the home itself that are relevant factors, but that these circumstances unfortunately often correlate with inappropriate parenting practices and parents’ own problems (the latter of which may influence parents’ socioeconomic status on the one hand and be heritable on the other).

Parents of ADHD children showed elevated levels of cognitive weakness (IQ, reading tasks, verbal fluency), the highest stress scores of all parent groups compared, the most ADHD symptoms, and poor reading performance.100

In addition, there is evidence that (with regard to ADHD-affected children) environment-centered psychotherapies (interventions in the family, with parents, in kindergarten or at school) are more effective than patient-centered behavioral therapies. In some cases, patient-centered behavioral therapies have been denied efficacy.101 This is likely to be particularly true for younger children (up to 6 or 8 years of age).
This may suggest that external factors are a significant cause of ADHD in children.

Among college students, poorer financial resources also appear to correlate with increased ADHD symptomatology.102 There was no correlation with (self-induced) student debt.

Genetically predicted SD lower socioeconomic status causally predicted 5.3-fold ADHD risk, whereas, conversely, ADHD caused socioeconomic status very little causally. Genetically predicted SD higher family income causally predicted 65% lower ADHD risk. Again, the inverse effect was small.103

3.2.8. Low level of education of parents

Low parental education increases children’s ADHD risk.74
Children of parents with low educational attainment had higher ADHD symptoms and nearly doubled the risk of severe ADHD symptoms. The association was independent of genetic and family environmental factors. The transfer of this model to depression was weaker and could be fully explained by common genetic factors.104
Lower levels of maternal education are reported to correlate with increased screen use by children, which in turn correlates with behavior problems.105
Low parental education correlated with a 3.5% increased risk of ADHD in children in a cohort study in Denmark.95 Children of parents who were unemployed and had low income and education levels were found to have a 4.9% increased risk of ADHD.
An Ethiopian study found an approximately threefold increase in children’s risk of ADHD due to maternal illiteracy.4

A genetically predicted one SD higher education level causally predicted a 70% lower risk of ADHD.103

3.2.9. Unemployment of parents

Parental unemployment correlated with a 2.1% increased risk of ADHD in children in a cohort study in Denmark.95 Children of parents who were unemployed and had low income and education levels were found to have a 4.9% increased risk of ADHD.

3.2.10. Reduced ability of parents to reflect on their parenting role

Lower parental reflective functioning correlated with ADHD in children.75 Parental Reflective Functioning is defined as the ability of parents to reflect on their own and their child’s internal mental experiences.

3.2.11. Low educational attainment and ADHD mutually causal

A large registry study in the Netherlands (n = 1.7 million) found evidence that low educational attainment is a causal factor in the development of ADHD and that ADHD is a causal factor in low educational attainment.106

3.2.12. Growing up in the home

Children who were prenatally exposed to multiple drug use by their mothers and who subsequently grew up in residential care were found to have a 3-fold risk of ADHD between the ages of 17 and 22.107

3.2.13. Growing up in adoption

A study of Chinese adopted girls found an ADHD rate of 16.7 %, which is about three times the usual prevalence.108 Whether this is a consequence of the adoption or a consequence of the problems of the birth parents, which were then also the cause of the adoption, is an open question. There are indications that the latter factor is influential.

3.2.14. Growing up in dysfunctional neighborhood

Children who grow up in a dysfunctional neighborhood/dysfunctional urban environment are at increased risk for ADHD. Interestingly, this seems to be less the case for black children.109

Higher neighborhood poverty correlated with higher parent-reported ADHD and lower parent-reported medication use in bivariate analysis. Poverty no longer correlated with ADHD in multivariate analysis, but medication use still correlated negatively with ADHD.110

3.2.15. Relatively earlier enrollment in school / older classmates

The youngest enrolled children in a class have a 30% increased risk of ADHD compared to the oldest enrolled children in a class. A study of over 400,000 children in the U.S. showed that in states where a fixed age on September 1 determined school enrollment, of children born in August, i.e., who reached school age immediately before the cutoff date, 0.85% had an ADHD diagnosis and 0.52% received ADHD medication, while of children born in September, i.e., who were on average 11 months older, only 0.63% had an ADHD diagnosis and 0.4% received ADHD medication. In states where enrollment was not fixed by age at a cutoff date, those born in August still had a slightly higher ADHD rate compared with those 11 months older, but the difference was no longer 0.21 percentage points but 0.08 percentage points.111
Similarly, a meta-analysis of three Brazilian cohort studies involving 8 million participants and 164,000 ADHD sufferers found that those children in a class who were among the 4 months youngest had a 34% increased risk of ADHD.112 Similar results were found in a study of 1,042,106 English children between the ages of 4 and 15.113 The risk of depression and intellectual impairment increased in parallel with that of ADHD.
A French registry study (n = 58 million) found that the youngest children and adolescents in a class were more likely to be diagnosed with ADHD and prescribed methylphenidate.114 Delaying (pre)school entry by one year dramatically reduced inattention/hyperactivity the following year (effect size = -0.73). The effect was found primarily in girls and persisted into the age of 11 years.115
A Danish study (n = 418,396) found no effect of the age of children within a school grade on (more frequent / less frequent) ADHD medication. The authors attributed this to, among other things, the low ADHD prevalence, clear diagnostic criteria, and high requirements for prescribing ADHD medication in Denmark, and referred to studies in countries with high ADHD prevalence where differences were found.116
A meta-study (19 studies from 13 countries with n = 15.4 million children) confirmed that the relatively youngest in a class have an increased risk of ADHD (17 of 19 studies) and suspected the reason for the lack of effect in Denmark to be the later enrollment of children with developmental deficits practiced there117

The results of the study are partly consistent with the fact that, according to a study in Canada, successful ice hockey players were disproportionately likely to be among the older children in a class. The same was seen among Belgium’s soccer players, where the birth date of the particularly successful players was for a long time primarily in August and September, because the cut-off date for age determination for player selection of a year group was August 1. After this cutoff date was moved to January 1, the most successful players most often had birthdays in January and February. Another study confirmed this “relative age effect” across Europe.118
The effect is likely to be due, on the one hand, to the selection criteria. However, this could only explain the differences in athletes that may result from different support. The parallel to ADHD, however, suggests that at the same time there might be an effect of the developmental lever of the opportunity/risk genes.

How these differences are explained in relation to ADHD is unclear.

One hypothesis in this regard is that younger children would be pathologized at an above-average rate by the assessing teachers because of their naturally more immature behavior.119

Another hypothesis interprets behavioral problems less as a social consequence of the relatively young age within a class than as an absolute consequence of early school entry in general. In this study, however, no difference was found for ADHD.120 In our view, it also suggests that younger children are more likely to be enrolled in school too early than older children. It remains to be seen how large this influence is on ADHD.

Our hypothesis on this is that being among the youngest (and thus the weakest) in a class could also represent a psychological stressor. That low social rank is a significant stressor is well known. Studies on whether or to what extent this influences ADHD diagnoses in school children are not yet known to us.

3.2.16. Early massive stress experiences

Early childhood stress and chronic stress may be involved in the development of ADHD.12163 20% to 50% of all children who experience early childhood trauma develop clinical ADHD symptoms.121122123

See in detail at Trauma as a cause of ADHD

3.2.17. Stressful experiences in childhood and early adolescence cause persistent ADHD in adulthood

A study of stress levels in children with ADHD found that severe stress levels in childhood and adolescence were associated with severe ADHD-HI or ADHD-I progression into adulthood, whereas children with mild stress levels in childhood and adolescence often showed remitting ADHD (ADHD-HI as ADHD-I).124

3.2.18. Early television consumption

Early television viewing at ages 1 and 3 correlates with attention problems at age 7.125

It must be questioned whether high television consumption by children at an early age is a causal cause of attention problems or whether parents with a poor capacity for attention due to their own psychological problems frequently leave children to their own devices and park them in front of the television. In the latter case, television consumption could also be merely a correlation and not necessarily a causal cause of ADHD. For there are - as will be described below - countless studies that prove that an affectionate, warm and secure attachment style can prevent ADHD even in the presence of a genetic disposition.
So while it is assured that intense parental attention is good protection against ADHD, no studies are known on this side that television withdrawal prevents ADHD.
That intensive TV consumption as a substitute for personal attention correlates with a lack of personal attention is the more conclusive link from this side’s point of view. That consumption of television and Internet with content unsuitable for the age group can cause further damage is also likely to be certain.

3.2.19. Media consumption amount does not cause ADHD, media consumption addiction correlates with ADHD

The amount of social media use has no influence on ADHD. Only media consumption addiction is associated with increased ADHD levels.126 Nevertheless, increased screen use in children seems to be able to impair attention.127

It has also been reported that screen use of more than 4 hours can cause “virtual autism” in children under 6 years of age. However, this regresses after the screen consumption is reduced.128

3.2.20. Natural disaster in early childhood

A natural disaster during early childhood increased ADHD risk.129

3.3. Characteristics without risk increase of ADHD

  • Bilingual growing up130
  • Immigrant status of parents (reduced risk of ADHD)131

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  2. Mimouni-Bloch, Kachevanskaya, Mimouni, Shuper, Raveh, Linder (2013): Breastfeeding may protect from developing attention-deficit/hyperactivity disorder. Breastfeed Med. 2013 Aug;8(4):363-7. doi: 10.1089/bfm.2012.0145.

  3. Golmirzaei, Namazi, Amiri, Zare, Rastikerdar, Hesam, Rahami, Ghasemian, Namazi, Paknahad, Mahmudi, Mahboobi, Khorgoei, Niknejad, Dehghani, Asadi (2013): Evaluation of attention-deficit hyperactivity disorder risk factors. Int J Pediatr. 2013;2013:953103. doi: 10.1155/2013/953103.

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