Arch Dis Child 97:260-265 doi:10.1136/archdischild-2011-300482
  • Reviews

What causes attention deficit hyperactivity disorder?

Open Access
  1. Evangelia Stergiakouli1,2
  1. 1Department of Psychological Medicine and Neurology, Cardiff University School of Medicine, Cardiff, UK
  2. 2MRC Centre in Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
  1. Correspondence to Anita Thapar, Child and Adolescent Psychiatry Section, Department of Psychological Medicine and Neurology, Cardiff University, School of Medicine, Heath Park, Cardiff, CF14 4XN, UK; thapar{at}
  • Accepted 20 July 2011
  • Published Online First 7 September 2011


Attention deficit hyperactivity disorder (ADHD) affects around 1–3% of children. There is a high level of comorbidity with developmental and learning problems as well as with a variety of psychiatric disorders. ADHD is highly heritable, although there is no single causal risk factor and non-inherited factors also contribute to its aetiology. The genetic and environmental risk factors that have been implicated appear to be associated with a range of neurodevelopmental and neuropsychiatric outcomes, not just ADHD. The evidence to date suggests that both rare and multiple common genetic variants likely contribute to ADHD and modify its phenotype. ADHD or a similar phenotype also appears to be more common in extreme low birth weight and premature children and those exposed to exceptional early adversity. In this review, the authors consider recent developments in the understanding of risk factors that influence ADHD.


  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Open Access This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and