Nongenetic Etiology

Injury to the brain, particularly in the anterior region, can produce the symptoms of ADHD. For the developing fetus, malnutrition, exposure to toxins (especially alcohol), and medical illness during pregnancy augment the risk for ADHD symptoms to appear. Circumstances around birth, especially the occurrence of toxemia (toxins in the blood) or hypoxemia (not enough oxygen in the blood), increase the risk for neurological injury in the newborn, which ultimately could result in symptoms of ADHD. During childhood development, many factors, particularly head trauma (by accident or maltreatment), infection, toxic poisoning, and malnutrition can produce ADHD symptoms. Neurologic conditions (e.g., epilepsy) and neurodevelopmental disorders (e.g., dyslexia, autism) are also commonly associated with some symptoms of ADHD. Although all these latter conditions produce ADHD-type symptoms, according to DSM-III-R they must be excluded as etiologic factors to make the diagnosis of the ADHD syndrome. In other words, the diagnosis of ADHD is assigned only where there is no neurodevelopmental disability or injury.

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