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How evolutionary thinking can help us to understand ADHD

  • Annie Swanepoel, Graham Music, John Launer and Michael J. Reiss
Summary

We argue that current debates about attention-deficit hyperactivity disorder (ADHD) can be considered afresh using an evolutionary lens. We show how the symptoms of ADHD can often be considered adaptive to their specific environment. We suggest that, from an evolutionary point of view, ADHD symptoms might be understood to result from an ‘evolutionary mismatch’, in which current environmental demands do not fit with what evolution has prepared us to cope with. For example, in our ancestral environment of evolutionary adaptedness (EEA), children were not expected to sit still and concentrate on academic tasks for many hours a day. Understanding ADHD in terms of such a ‘mismatch’ raises significant issues regarding the management of childhood ADHD, including ethical ones. An approach based on the concept of mismatch could provide an alternative to current debates on whether ADHD results from nature or nurture and whether it is under- or over-diagnosed. It would allow clinicians and policy makers to take both the child and the environment into account and consider what might be desirable and feasible, both in society and for specific children, to lessen the mismatch.

LEARNING OBJECTIVES

  1. Grasp the concept of ADHD as an ‘evolutionary mismatch’
  2. Understand the issues raised by this perspective, including ethical ones
  3. Appreciate how a transparent discussion of these issues might inform decisions about management, medication and schooling

Copyright
Corresponding author
Dr Graham Music, Child and Family Department, Tavistock and Portman NHS Trust, 120 Belsize Lane, London NW3 5BA, UK. Email: gmusic@tavi-port.nhs.uk.
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Declaration of Interest

The authors are members of the evopsychotherapy study group at the Tavistock Clinic. The aim of the group is to promote evolutionary thinking in psychotherapy and psychiatry.

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References
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How evolutionary thinking can help us to understand ADHD

  • Annie Swanepoel, Graham Music, John Launer and Michael J. Reiss
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