Optimal Management of ADHD in Pediatric Population - Episode 3

Pediatric ADHD Predisposing Factors

An explanation of the typical predisposing factors in pediatric attention-deficit/hyperactivity disorder (ADHD).

Theresa R. Cerulli, MD: To sum up the factors that predispose kids to ADHD [attention-deficit/hyperactivity disorder], I would say the neurobiology is the major factor that predisposes children to ADHD. As we said, besides genetics, that’s 77%, but what makes up the other 23%? There are other things that correlate, such as low birth weight or smoking during pregnancy. We can’t say those things are causative. There are some things that are correlative, but we certainly can’t say causative, andno data point in that direction, but it’s not all genetics. There are some environmental factors that have an influence.

For signs and symptoms of ADHD that prompt evaluation, here’s the hard part for all of us. ADHD is such a heterogeneous condition. What do I mean by that? It presents so differently from person to person that it’s tough to summarize and tough to diagnose. We have our diagnostic criteria in the DSM [Diagnostic and Statistical Manual of Mental Disorders]. We have our 9 inattentive symptoms. We have our 9 hyperactive-impulsive symptoms. There are specific criteria for children; you must meet 6 out of the 9 of those symptom domains to be diagnosed with ADHD. But that doesn’t capture what it really looks like in day-to-day life, and that’s where the challenge lies right now. There are a lot of executive functioning problems; those aren’t on the DSM list.

Executive functioning problems, what do we mean? Things like trouble organizing, trouble with planning ahead, trouble with time management, losing things, being late for appointments, forgetfulness. Folks with ADHD, by the time they’re adolescents or adults they’re saying, “I have a bad memory.” That’s not true; with neuropsychological testing, memory can have phenomenally high scores. It’s attention that’s the problem. It looks like memory because to be able to recall something that you’ve stored well in your brain, in order to have stored it and then recalled it, first you had to have registered it. That means you must have paid attention to that piece of information to log it into your brain before you could possibly then remember it. It’s not a memory problem with ADHD. It’s a logging it in attention problem with ADHD that then ends up looking like the person’s struggling with memory.

Transcript edited for clarity.