Current Evidence and Diverse Perspectives on Attention-Deficit/Hyperactivity Disorder: A Systematic Review

Asrat Genet Amnie (Health Education Unit, Education Department, Eugenio María de Hostos Community College of The City University of New York, Bronx, NY 10451, the United States)

Article ID: 4384



Introduction:  ADHD is one of the most common neurodevelopmental disorders in childhood and adolescence. Although the disorder starts to manifest early in childhood, a significant proportion of cases often persists into adulthood. ADHD negatively and significantly impacts social and occupational functioning and academic performance.  A number of extant theories and scientific evidence provide insight into the genesis and manifestations of ADHD and the attendant challenges of significant dysfunction that individuals may encounter at home, school, and the workplace. Method: This systematic review was conducted through a literature search for published peer-reviewed articles using standard PRISMA guidelines.  The goal of the study was to explore current theories, models, concepts, and risk factors about ADHD in published in peer-reviewed literature,. We made use of use several online databases— including PsycINFO, PubMed, Web of Science, ScienceDirect, and Medline in the process of searching for relevant studies. Relevant peer-reviewed publications since the 1980s when the term Attention-Deficit/Hyperactivity Disorder (ADHD) was introduced in DSM-III-R were included. Non-peer-reviewed publications, including dissertations,  editorials, commentaries, and materials published in languages other than English were excluded. Results and Discussion: The results of the review indicated that ADHD is characterized by a behavioral reaction that interferes with personal and social functioning. The factors associated with ADHD fall into several major thematic areas, including genetic and hereditary factors; dietary and nutritional factors; parenting and behavioral factors; adverse early life events, and high-risk environmental factors, crystallized by a number of developmental and behavioral theories. The review also identified a number of extant models and theories that attempt to explain the diverse perspectives associated with ADHD. Conclusion: This study has attempted to identify the major risk factors and diverse models and theories associated with ADHD.  The thematic risk factors include genetic and hereditary factors; dietary and nutritional factors; parenting and behavioral factors; adverse early life events, and high-risk environmental factors. The most prominent models identified include the biomedical model and the bio-psycho-social models, the latter being a more holistic approach which aims to treat both the patient and the disease. This review would provide an additional evidence base to individuals, families, and educators to make informed choices and decisions in the best interest of the affected children, including personal growth, healthcare, and medical needs, academic performance, and social skills development. 


ADHD; Developmental disorders; Mental health; Behavioral disorders

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[1] Charach, A., Dashti, B., Carson, P., et al., 2011. Attention deficit hyperactivity disorder: effectiveness of treatment in at- risk preschoolers; long-term effectiveness in all ages; and variability in prevalence, diagnosis, and treatment.

[2] Epstein, J.N., Loren, R.E., 2013. Changes in the definition of ADHD in DSM-5: subtle but important. Neuropsychiatry. 3(5), 455.

[3] Brown, N.M., Brown, S.N., Briggs, R.D., et al., 2017. Associations between adverse childhood experiences and ADHD diagnosis and severity. Academic pediatrics. 17(4), 349-355.

[4] Jensen, P.S., Hinshaw, S.P., Swanson, J.M., et al., 2001. Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): implications and applications for primary care providers. Journal of Developmental & Behavioral Pediatrics. 22(1), 60- 73.

[5] Loe, I.M., Feldman, H.M., 2007. Academic and educational outcomes of children with ADHD. Journal of pediatric psychology. 32(6), 643-654.

[6] De Graaf, R., Kessler, R.C., Fayyad, J., et al., 2008. The prevalence and effects of adult attention-deficit/ hyperactivity disorder (ADHD) on the performance of workers: results from the WHO World Mental Health Survey Initiative. Occupational and environmental medicine. 65(12), 835-842.

[7] Biederman, J., Faraone, S.V., 2006. The effects of attention-deficit/hyperactivity disorder on employment and household income. Medscape General Medicine. 8(3), 12.

[8] American Psychiatric Association, 2013. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

[9] Borum, R., Lodewijks, H.P., Bartel, P.A., et al., 2020. The structured assessment of violence risk in youth (SAVRY). In Handbook of violence risk assessment. Routledge. pp. 438-461.

[10] Cagigal, C., Silva, T., Jesus, M., et al., 2019. Does diet affect the symptoms of ADHD? Current Pharmaceutical Biotechnology. 20(2), 130-136.

[11] American Psychiatric Association, 2015. Neurodevelopmental disorders: DSM-5® selections. American Psychiatric Pub.

[12] Núñez-Jaramillo, L., Herrera-Solís, A., Herrera-Morales, W.V., 2021. ADHD: Reviewing the causes and evaluating solutions. Journal of personalized medicine. 11(3), 166.

[13] Kooij, J.J.S., Bijlenga, D., Salerno, L., et al., 2019. Updated European Consensus Statement on diagnosis and treatment of adult ADHD. European psychiatry. 56(1), 14-34.

[14] Dekkers, T.J., de Water, E., Scheres, A., 2022. Impulsive and risky decision-making in adolescents with attention-deficit/hyperactivity disorder (ADHD): The need for a developmental perspective. Current opinion in psychology. 44, 330-336.

[15] Merzon, E., Manor, I., Rotem, A., et al., 2021. ADHD as a risk factor for infection with Covid-19. Journal of Attention Disorders. 25(13), 1783-1790.

[16] Pollak, Y., Shoham, R., Dayan, H., et al., 2021. ADHD symptoms predict lower adaptation to the COVID-19 outbreak: financial decline, low adherence to preventive measures, psychological distress, and illness-related negative perceptions.

[17] van de Glind, G., Konstenius, M., Koeter, M.W., et al., 2014. Variability in the prevalence of adult ADHD in treatment seeking substance use disorder patients: results from an international multi-center study exploring DSM-IV and DSM-5 criteria. Drug and alcohol dependence. 134, 158-166.

[18] Harpin, V.A., 2005. The effect of ADHD on the life of an individual, their family, and community from preschool to adult life. Archives of disease in childhood. 90(suppl 1), i2-i7.

[19] Mueller, A.K., Fuermaier, A., Koerts, J., et al., 2012. Stigma in attention deficit hyperactivity disorder. ADHD attention deficit and hyperactivity disorders. 4(3), 101-114.

[20] Bisset, M., Winter, L., Middeldorp, C.M., et al., 2021. Recent attitudes toward ADHD in the broader community: A systematic review. Journal of Attention Disorders. DOI:

[21] Killeen, P.R., 2019. Models of attention-deficit hyperactivity disorder. Behavioral processes. 162, 205- 214.

[22] Clare, A., 2012. Psychiatry in Dissent: Controversial issues in thought and practice second edition. Routledge.

[23] Lehman, B.J., David, D.M., Gruber, J.A., 2017. Rethinking the biopsychosocial model of health: Understanding health as a dynamic system. Social and personality psychology compass. 11(8), e12328.

[24] Engel, G.L., 1981 January. The clinical application of the biopsychosocial model. In The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine. Oxford University Press. 6(2), 101-124.

[25] Cooper, P., 2008. Like alligators bobbing for poodles? A critical discussion of education, ADHD and the biopsychosocial perspective. Journal of Philosophy of Education. 42(3-4), 457-474.

[26] Salamanca, L.M., 2014. Biopsychosocial perspective of ADHD. Open Journal of Epidemiology.

[27] Deacon, B.J., 2013. The biomedical model of mental disorder: A critical analysis of its validity, utility, and effects on psychotherapy research. Clinical psychology review. 33(7), 846-861.

[28] Spitzer, R.L., Williams, J.B., Skodol, A.E., 1980. DSM-III: the major achievements and an overview. The American Journal of Psychiatry.

[29] Armstrong, T., 2011. The Power of Neurodiversity: Unleashing the Advantages of Your Differently Wired Brain (published in Hardcover as Neurodiversity). Da Capo Lifelong Books.

[30] Jaarsma, P., Welin, S., 2012. Autism as a natural human variation: Reflections on the claims of the neurodiversity movement. Health care analysis. 20(1), 20-30.

[31] Graham, L.J., 2008. From ABCs to ADHD: the role of schooling in the construction of behaviour disorder and production of disorderly objects. International Journal of Inclusive Education. 12(1), 7-33.

[32] Mofokeng, M., van der Wath, A.E., 2017. Challenges experienced by parents living with a child with attention deficit hyperactivity disorder. Journal of Child & Adolescent Mental Health. 29(2), 137-145.

[33] Hawi, Z., Kent, L., Hill, M., et al., 2010. ADHD and DAT1: Further evidence of paternal over transmission of risk alleles and haplotype. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics. 153(1), 97-102.

[34] Mick, E., Biederman, J., Faraone, S.V., et al., 2002. Case-control study of attention-deficit hyperactivity disorder and maternal smoking, alcohol use, and drug use during pregnancy. Journal of the American Academy of Child & Adolescent Psychiatry. 41(4), 378- 385.

[35] Linnet, K.M., Dalsgaard, S., Obel, C., et al., 2003 Jun 1. Maternal lifestyle factors in pregnancy risk of attention deficit hyperactivity disorder and associated behaviors: review of the current evidence. Am J Psychiatry. 160(6), 1028-1040.

[36] Thapar, A., Cooper, M., Jefferies, R., et al., 2012. What causes attention deficit hyperactivity disorder? Archives of disease in childhood. 97(3), 260-265.

[37] Motlagh, M.G., Sukhodolsky, D.G., Landeros-Weisenberger, A., et al., 2011. Adverse effectsof heavy prenatal maternal smoking on attentional control in children with ADHD. Journal of Attention Disorders. 15(7), 593-603.

[38] Pelham, W.E., Lang, A.R., Atkeson, B., et al., 1998. Effects of Deviant Child Behavior on Parental Alcohol Consumption Stress-Induced Drinking in Parents of ADHD Children. American Journal on Addictions. 7(2), 103-114.

[39] Thapar, A., Fowler, T., Rice, F., et al., 2003. Maternal smoking during pregnancy and attention deficit hyperactivity disorder symptoms in offspring. American Journal of Psychiatry. 160(11), 1985-1989.

[40] Motlagh, M.G., Sukhodolsky, D.G., Landeros-Weisenberger, A., et al., 2011. Adverse effects of heavy prenatal maternal smoking on attentional control in children with ADHD. Journal of Attention Disorders. 15(7), 593-603.

[41] Thapar, A., Holmes, J., Poulton, K., et al., 1999. Genetic basis of attention deficit and hyperactivity. The british journal of psychiatry. 174(2), 105-111.

[42] Pondé, M.P., Novaes, C.M., Losapio, M.F., 2010. Frequency of symptoms of attention deficit and hyperactivity disorder in autistic children. Arquivos de Neuro-psiquiatria. 68(1), 103-106.

[43] Cherkasova, M., Sulla, E.M., Dalena, K.L., et al., 2013. Developmental course of attention deficit hyperactivity disorder and its predictors. Journal of the Canadian Academy of Child and Adolescent Psychiatry.

[44] Skoglund, C., Chen, Q., Franck, J., et al., 2015. Attention-deficit/hyperactivity disorder and risk for substance use disorders in relatives. Biological psychiatry. 77(10), 880-886.

[45] Sokolova, E., Oerlemans, A.M., Rommelse, N.N., et al., 2017. A causal and mediation analysis of the comorbidity between attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Journal of autism and developmental disorders. 47(6), 1595-1604.

[46] Banaschewski, T., Hollis, C., Oosterlaan, J., et al., 2005. Towards an understanding of unique and shared pathways in the psychopathophysiology of ADHD. Developmental science. 8(2), 132-140.

[47] Martin, J., Taylor, M.J., Rydell, M., et al., 2018. Sex-specific manifestation of genetic risk for attention deficit hyperactivity disorder in the general population. Journal of Child Psychology and Psychiatry. 59(8), 908-916.

[48] Grizenko, N., Fortier, M.E., Zadorozny, C., et al., 2012. Maternal stress during pregnancy, ADHD symptomatology in children and genotype: gene-environment interaction. Journal of the Canadian Academy of Child and Adolescent Psychiatry. 21(1), 9.

[49] Quinn, P.O., Madhoo, M., 2014. A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis. The primary care companion for CNS disorders. 16(3), 27250.

[50] Nigg, J.T., Holton, K., 2014. Restriction and elimination diets in ADHD treatment. Child and Adolescent Psychiatric Clinics. 23(4), 937-953.

[51] Gustafsson, P., Rylander, L., Lindh, C.H., et al., 2015. Vitamin D status at birth and future risk of attention deficit/hyperactivity disorder (ADHD). PloS one. 10(10), e0140164.

[52] Greenblatt, J.M., Delane, D.D., 2017. Micronutrient deficiencies in ADHD: A global research consensus. Journal of Orthomolecular Medicine. 32(6).

[53] Ly, V., Bottelier, M., Hoekstra, P.J., et al., 2017. Elimination diets’ efficacy and mechanisms in attention deficit hyperactivity disorder and autism spectrum disorder. European child & adolescent psychiatry. 26(9), 1067-1079.

[54] Brunault, P., Frammery, J., Montaudon, P., et al., 2019. Adulthood and childhood ADHD in patients consulting for obesity is associated with food addiction and binge eating, but not sleep apnea syndrome. Appetite. 136, 25-32.

[55] Froehlich, T.E., Anixt, J.S., Loe, I.M., et al., 2011. Update on environmental risk factors for attention-deficit/hyperactivity disorder. Current psychiatry reports. 13(5), 333.

[56] Singh, A., Yeh, C.J., Verma, N., et al., 2015. Overview of attention deficit hyperactivity disorder in young children. Health psychology research. 3(2).

[57] Germán, M., Belamarich, P.F., Oyeku, S.O., 2016. Associations between adverse childhood experiences and ADHD diagnosis and severity. Academic Pediatrics. 1(7).

[58] Antshel, K.M., Kaul, P., Biederman, J., et al., 2013. Posttraumatic stress disorder in adult attention-deficit/hyperactivity disorder: Clinical features and familial transmission. The Journal of Clinical Psychiatry. 74(3), 14855.

[59] Bilbow, A., Berry, C., Brunet, J., et al., 2021. Understanding ADHD in Girls and Women. Jessica Kingsley Publishers.

[60] Herbert, M., 2008. Developmental problems of childhood and adolescence: Prevention, treatment and training.

[61] Ronald, A., Pennell, C.E., Whitehouse, A.J., 2011. Prenatal maternal stress associated with ADHD and autistic traits in early childhood. Frontiers in psychology. 1, 223.

[62] Vizzini, L., Popovic, M., Zugna, D., et al., 2019. Maternal anxiety, depression and sleep disorders before and during pregnancy, and preschool ADHD symptoms in the NINFEA birth cohort study. Epidemiology and psychiatric sciences. 28(5), 521-531.

[63] Counts, C.A., Nigg, J.T., Stawicki, J.A., et al., 2005. Family adversity in DSM-IV ADHD combined and inattentive subtypes and associated disruptive behavior problems. Journal of the American Academy of Child & Adolescent Psychiatry. 44(7), 690-698.

[64] Munoz-Silva, A., Lago-Urbano, R., 2016. Child ADHD severity, behavior problems and parenting styles. Ann Psychiatry Ment Health. 4(3), 1066.

[65] Frodl, T., Skokauskas, N., 2012. Meta analysis of structural MRI studies in children and adults with attention deficit hyperactivity disorder indicates treatment effects. Acta Psychiatrica Scandinavica. 125(2), 114-126.

[66] Froehlich, T.E., Anixt, J.S., Loe, I.M., et al., 2011 Oct 1. Update on environmental risk factors for attention-deficit/hyperactivity disorder. Current Psychiatry Reports. 13(5), 333.

[67] Wilens, T.E., Spencer, T.J., 2010. Understanding attention-deficit/hyperactivity disorder from childhood to adulthood. Postgraduate medicine. 122(5), 97-109.

[68] Smith, M.J., Woods. C.R., 2010 Jun 1. On-time vaccine receipt in the first year does not adversely affect neuropsychological outcomes. Pediatrics. 125(6), 1134-1141.

[69] Deault, L.C., 2010. A systematic review of parenting in relation to the development of comorbidities and functional impairments in children with attention-deficit/hyperactivity disorder (ADHD). Child Psychiatry & Human Development. 41(2), 168-192.

[70] Ellis, B., Nigg, J., 2009. Parenting practices and attention-deficit/hyperactivity disorder: New findings suggest partial specificity of effects. Journal of the American Academy of Child & Adolescent Psychiatry. 48(2), 146-154.

[71] Storebø, O.J., Rasmussen, P.D., Simonsen, E., 2016. Association between insecure attachment and ADHD: environmental mediating factors. Journal of Attention Disorders. 20(2), 187-196.

[72] Geier, D.A., Kern, J.K., Geier, M.R., 2018. A cross-sectional study of the relationship between blood lead levels and reported attention deficit disorder: an assessment of the economic impact on the United States. Metabolic Brain Disease. 33(1), 201- 208.

[73] Chronis-Tuscano, A., O’Brien, K.A., Johnston, C., et al., 2011. The relation between maternal ADHD symptoms & improvement in child behavior following brief behavioral parent training is mediated by change in negative parenting. Journal of abnormal child psychology. 39(7), 1047-1057.

[74] Barrett, J.R., 2019. Attention worthy: Prenatal phthalate exposure and subsequent ADHD diagnosis. Environmental health perspectives. 127(3), 034001.

[75] Mick, E., Biederman, J., Faraone, S.V., et al., 2002. Case-control study of attention-deficit hyperactivity disorder and maternal smoking, alcohol use, and drug use during pregnancy. Journal of the American Academy of Child & Adolescent Psychiatry. 41(4), 378- 385.

[76] Pohlabeln, H., Rach, S., De Henauw, S., et al., 2017. Further evidence for the role of pregnancy-induced hypertension and other early life influences in the development of ADHD: results from the IDEFICS study. European child & adolescent psychiatry. 26(8), 957-967.

[77] Tole, F., Kopf, J., Schröter, K., et al., 2019. The role of pre-, peri-, and postnatal risk factors in bipolar disorder and adult ADHD. Journal of Neural Transmission. 126(9), 1117-1126.

[78] Talbot, P., Astbury, G., Mason, T., (Eds.), 2010. Key concepts in learning disabilities. Sage.

[79] Wade, D.T., Halligan, P.W., 2017. The biopsychosocial model of illness: a model whose time has come. Clinical rehabilitation. 31(8), 995-1004.

[80] Johnson, K.A., Wiersema, J.R., Kuntsi, J., 2009. What would Karl Popper say? Are current psychological theories of ADHD falsifiable? Behavioral and Brain Functions. 5(1), 1-11.

[81] Mather, B.A., 2012. The social construction and reframing of attention-deficit/hyperactivity disorder. Ethical Human Psychology and Psychiatry. 14(1), 15. Psychiatry. 16(2), 57.

[82] Timimi, S., Taylor, E., 2004. ADHD is best understood as a cultural construct. The British Journal of Psychiatry. 184(1), 8.


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