Culture Vs. Biology: What Causes ADHD?

Most AD/HD researchers are convinced that heredity determines who gets the disorder and who doesn’t. But Michael Ruff, M.D., a clinical associate professor of pediatrics at Indiana University, believes that there is more to the story than DNA. He is convinced that at least some cases of AD/HD are a byproduct of our fast-paced, stressed-out, consumer-driven lifestyles. Recently, Carl Sherman, Ph.D., asked Dr. Ruff about his controversial theory.

In a recent article in Clinical Pediatrics, you called AD/HD an 'epidemic of modernity.' What did you mean?

I’m talking about the cultural environment that prevails today — the modern way of life and its impact on the developing brain. Today’s children are immersed in a world of instant messaging and rapid-fire video games and TV shows. Today’s parents are rushing around and working so hard to earn money to buy more stuff that they have less time to spend with their kids.

When kids get accustomed to such a rapid tempo, it’s hard for them to adjust to the comparatively slow pace of the classroom. They transfer the sense of urgency they’ve seen at home to their academic endeavors.

But there's evidence that AD/HD has a biological basis. Doesn’t that mean it's hereditary?

Not entirely. The young brain is highly malleable. As it matures, some brain cells are continually making new connections with other brain cells, a process known as “arborizing,” while others are being “pruned” back. Arborizing and pruning determine how circuitry is wired in the prefrontal cortex, the region that is largely responsible for impulse control and the ability to concentrate. We’ve failed to acknowledge the extent to which environmental factors influence these processes.

It's an interesting theory, but is there any evidence to support it?

There hasn’t been much research on the role of the environment in AD/HD, but some studies are suggestive. In 2004, University of Washington researchers found that toddlers who watch lots of TV are more likely to develop attentional problems. For every hour watched per day, the risk rose by 10 percent.

My group practice, in Jasper, Indiana, cares for more than 800 Amish families, who forbid TV and video games. We haven’t diagnosed a single child in this group with AD/HD. Obesity is also virtually nonexistent in this population.

On the other hand, we care for several Amish families who have left the church and adopted a modern lifestyle, and we do see AD/HD and obesity in their kids. Obviously, the genes in these two groups are the same. What’s different is their environment.

There’s also some evidence to suggest that academic problems are rare in social and cultural groups that traditionally place a high value on education, hard work, and a tight-knit family structure. For example, a 1992 Scientific American study found that the children of Vietnamese refugees who settled in the U.S. did better in school and had fewer behavior problems than their native-born classmates. The researchers noted that the Vietnamese kids spent more time doing homework than did their peers, and that their parents emphasized obedience and celebrated learning as a pleasurable experience.

How can parents reduce the likelihood that their children will develop severe AD/HD?

I counsel parents to limit the amount of TV their kids watch. I urge them to read to their kids every day, starting at age one, and to play board games and encourage other activities that promote reflection and patience. I also urge parents to do more slow-paced, step-by-step activities with their children, like cooking and gardening. Carve out more quiet time, when you’re not so busy. Put down the cell phone, and stop multitasking.

If a child already has AD/HD, can a change in the environment help control symptoms?

Possibly. The brain can relearn executive functions like planning and attention well into the fourth decade of life. Consistent discipline, less TV and video games, and an emphasis on exercise, seem to be key. Exercise promotes on-task behavior and helps relieve the “desk fatigue” that makes it hard for kids to sit still in class.

How about medication?

There’s no doubt that medication can help control symptoms of AD/HD. However, it’s problematic when doctors and parents believe AD/HD to be simply the result of a “chemical imbalance,” while failing to consider that a “lifestyle imbalance” may also be involved. Even if medication is part of your child’s treatment plan, you still need to get the TV out of his bedroom.

This article comes from the February/March 2006 issue of ADDitude.

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