20 CHILD ANDADOLESCENTDISORDERS 487
Prenatal exposure to alcohol, tobacco, and lead and
severe malnutrition in early childhood increase the
likelihood of ADHD. Although the relation between
ADHD and dietary sugar and vitamins has been
studied,results have been inconclusive (McCracken,
2000 a;Pary et al., 2002).
Brain images of people with ADHD have sug-
gested decreased metabolism in the frontal lobes,
which are essential for attention, impulse control,
organization, and sustained goal-directed activity.
Studies also have shown decreased blood perfusion of
the frontal cortex in children with ADHD and frontal
cortical atrophy in young adults with a history of
childhood ADHD. Another study showed decreased
glucose use in the frontal lobes of parents of children
with ADHD who had ADHD themselves (McCracken,
2000 a;Pary et al., 2002). Evidence is not conclusive,
but research in these areas seems promising.
There seems to be a genetic link for ADHD that
is most likely associated with abnormalities in cate-
cholamine and possibly serotonin metabolism. Having
a first-degree relative with ADHD increases the risk
of the disorder by four to five times that of the general
population (McCracken, 2000a). Despite the strong
evidence supporting a genetic contribution, there are
also sporadic cases of ADHD with no family history
of ADHD; this furthers the theory of multiple con-
tributing factors.
Risk factors for ADHD include family history
of ADHD; male relatives with antisocial personal-
ity disorder or alcoholism; female relatives with som-
atization disorder; lower socioeconomic status; male
gender; marital or family discord, including divorce,
neglect, abuse, or parental deprivation; low birth
weight; and various kinds of brain insult (McCracken,
2000 a).
Cultural Considerations
Crijen, Achenbach & Verhulst (1999) conducted a
study of 19,647 children from 12 cultures in which
parents used the Child Behavior Checklist to rate
problem behaviors in their children. The total scores
for all the categories showed little differences based
on culture, but individual category scores varied as
much as 10% based on culture. This finding supports
the consideration that parents from various cultures
have a different threshold for tolerating specific be-
haviors and that rates of problems differ among cul-
tures. The authors concluded that an instrument such
as the Child Behavior Checklist can be used across
cultures to determine problems (indicated by total
score), but the focus of the problems (indicated by
individual category scores) would vary according to
the culture of the child and parents.
ADHD is known to occur in various cultures. It
is more prevalent in Western cultures, but that may
be the result of different diagnostic practices rather
than actual differences in existence (APA, 2000).Treatment
No one treatment has been found effective for ADHD;
this gives rise to many different approaches such as
sugar-controlled diets and megavitamin therapy.
Parents need to know that any treatment heralded
as the cure for ADHD is probably too good to be true
(McCracken, 2000a). ADHD is chronic; goals of treat-
ment involve managing symptoms, reducing hyper-
activity and impulsivity, and increasing the child’s
attention so that he or she can grow and develop nor-
mally. The most effective treatment combines phar-
macotherapywith behavioral, psychosocial, and
educational interventions (Pary et al., 2002).◗ SYMPTOMS OFADHD
INATTENTIVE BEHAVIORS HYPERACTIVE/IMPULSIVE BEHAVIORS
Misses details Fidgets
Makes careless mistakes Often leaves seat, (e.g., during a meal)
Has difficulty sustaining attention Runs or climbs excessively
Doesn’t seem to listen Can’t play quietly
Does not follow-through on chores or homework Is always on the go; driven
Has difficulty with organization Talks excessively
Avoids tasks requiring mental effort Blurts out answers
Often loses necessary things Interrupts
Is easily distracted by other stimuli Can’t wait for turn
Is often forgetful in daily activities Is intrusive with siblings/playmatesAdapted from Pary et al and McCracken 2000a.