ADHD: Is ADHD Inherited?

About two weeks ago, a couple expecting their first child asked me an intriguing question as they interviewed me for the opportunity to be their pediatrician. They asked if ADHD was inherited. They were concerned because the father had been diagnosed as a child and took medication for many years. The scientific answer is clear. Yes, there is pretty good evidence that from studies of twins and epidemiologic studies of parents and children that if a parent had been diagnosed with ADHD, there was a much greater chance that the child will have ADHD.

ADHD is widely studied, and there are many things known about it. We know that children diagnosed with ADHD but untreated or ineffectively treated have much more problems in school than those whose ADHD is effectively treated. We know that teenagers with ADHD who are untreated have much higher rates of substance abuse problems than those whose ADHD is treated (yes, treated with speed-like medication). There’s a higher rate of ADHD in children raised in households without a father and in which the mother practices inconsistent, unstructured, discipline.

I started to assemble some of these facts. How would the adult with ADHD, untreated, parent a normal child? I'm guessing that there would be a lot of impulsive decisions, inconsistent discipline, and failed relationships. Growing up in a household with a parent with untreated ADHD is likely to make worse any existing problems in the child. It would make an anxious child more anxious, a depressed child more depressed. If the child had some behavior issues, these will become more of a problem with this kind of unstructured household and impulsive, distracted parenting. So a kid with some mild ADHD symptoms--and most normal kids have some (and most normal college students)--might act out enough to get in trouble at school. The impulsive parent might perceive some of these normal behaviors as impossible to manage. Now that the child is having trouble in school and at home, they might cross the diagnostic threshold and meet the official qualifications for ADHD.

Studies have shown that if you smoke, it's more likely that your children will smoke. Is smoking genetically inherited? Kids naturally follow the model behaviors of their parents, even the behaviors we don't want them to copy. But just maybe, children inherit some subtle feature of brain chemistry which responds powerfully to nicotine. So is smoking inherited? I'm not sure what that means.

Some parents with anxiety can't help but share their fears with their children. Won't this make their kids anxious? If the child has a little bit of anxiety of their own, will this make it worse? Does this mean the child inherited anxiety from the parent?

Is ADHD inherited? By studies that have been done on genetics and brain function, yes. But I suspect it is less often inherited when the affected parent has been effectively treated.

There's a couple of general parenting lessons here. First, you are not your parents. The things they did that didn't work for you as a child probably won't work on your own children. But most importantly, every child needs consistency and structure. The more disorganized and unstructured they are, the more valuable a structured environment and consistent parenting will be for them.



Next Post: Does ADHD exist?

Improving the Picky Eater Experience

Love your picky eater.

The perceptive parent knows by now that I will urge them to leave their assumptions at the door. Embracing the inner grandparent (‘well she has to eat something’) isn’t the right approach.

As the child’s need to experiment with control develops, it won’t take long for her to see how important her eating is for her parents. The perceptive child understands that the more emphasis you put on something, the more valuable it is for her to control.

Keep in mind that nobody can be forced to eat. There’s just no way without a hospital-type intervention. Once the child realizes this, the parent has lost all negotiation leverage. (Hey, the point of this series of posts about eating is that you never really had any leverage to begin with.) Think hard before begging or bribing your child, since this will often spiral into increasing demands for sweets or other things you might not want your child to have. Everybody is entitled to skip a meal now and then.

Try very very hard to have a family meal every day. Research has shown that in families who sit down together for dinner, there are fewer eating disorders, less obesity, even less delinquency. For just about everything, parents are the most important models of behavior for their children. Studies show that when the parents eat a varied diet, the kids are more likely to eat a varied diet. When the parents eat healthy, so do the children.

For the picky eater, that one string bean put on their plate can act like a fuse to an explosion. It’s a challenge to the way they have envisioned their mealtime. The perceptive parent will try to see this the way their child sees it, and not provoke him with a string bean. But if everybody’s eating together, and mom and dad are gushing with delight over their string beans, it might be natural for the 1 to 2 year old child to want to try some. Maybe you can tell them that it’s grown-up food and not for them! Mmm, good. This uses the child’s need for independence and control to promote interest in trying a string bean. If they do, make a big deal about how grown up he is and how proud of him you are.

Defusing the mealtime battleground is absolutely essential. When children are fighting for control, they are unlikely to relax and try something new. I always ask the parents, is it worth it? If the child takes one bite of broccoli, gags and cries, what did they learn? Certainly they didn’t get all the good nutrients from broccoli with that one little bite. What did they learn about food, about power, about their parents?

It’s interesting to ask parents about their own adult eating issues. Many of us still don’t like the stuff we refused as kids. We certainly didn’t learn to like it because our parents somehow forced us to eat it. Many of us vividly recall battles with our parents that we had while still in a high chair. Did those battles teach us to eat right?

Siblings and peer friends are also really valuable. When older picky eaters are asked, they will often say that they wanted to learn to eat certain foods because all their friends would eat it and they wanted to fit in.

It’s possible that the child’s pickiness is related to issues of anxiety and need for order. For these children, they will avoid certain social situations such as parties where they know a food they can’t stand will be eaten by everyone else. They may suddenly complain of a stomach ache or say they don’t want to go. It can be hard to distinguish social anxiety from food anxiety. Either way, however, the child is unusually sensitive, and the most important action for the parents is to be as supportive as possible of the child when they feel so vulnerable. Coaxing her into a traumatic situation won’t make her feel closer to you.

We might not be able to transcend the issues of genetic taste preferences and sensory intensity. We can, however, get through the control issues.

Giving them the sense of control that is one of their central drives in life at age 2 is a very powerful technique. Perceptive parents will use this to advantage. Start with asking for their advice. What shall we have in our salad tonight? Carrots or tomatoes? If the answer comes back ice cream, what will usually help is a gentle reminder that mommy and daddy will eat the salad too and ice cream in the salad is silly. Then take the child shopping. Remind them of their menu choices--not just for them but for the whole family. They get to pick out the tomatoes or the carrots. When you get home, they get to prepare the food they chose (maybe with some help and supervision). At dinner time, everybody gets to hear about how they chose the best tomatoes and how they washed them and maybe helped to cut them up and how really delicious the tomatoes are. This positive feedback cycle might work for broccoli, too, and for many foods that need washing or cooking or preparation. Children are more likely to try things they are invested in and already feel good about than things they feel threatened by. Doesn’t that make sense?

Giving the child a sense of ownership of their choices is a technique that perceptive parents will use in many different situations.