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Apr 2012

Environment, Developmental Origins, and Attention-Deficit/Hyperactivity Disorder

Arch Pediatr Adolesc Med. 2012;166(4):387-388. doi:10.1001/archpediatrics.2011.905

In the current issue of the Archives, we see additional evidence, in a retrospective design, that early developmental events are related to subsequent attention-deficit/hyperactivity disorder (ADHD) in children.1 Attention-deficit/hyperactivity disorder is a costly health condition rivaling traditional medical diseases in its effect on social, financial, and quality-of-life issues. Clinicians held a conviction in the early and mid-20th century that children with ADHD had minimal brain damage or minimal brain dysfunction.2 However, a vague phenotype characterization, the failure to identify the nature of the brain dysfunction in the mid-20th century, and demonstrations of substantial heritability for hyperactivity, inattention, and ADHD in the late-20th century rendered the terminology obsolete and also seemed to discourage investigations of environmental inputs to the condition. Did we discard the concept of brain damage too soon?