Skip to main content Accessibility help

How evolutionary thinking can help us to understand ADHD

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


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.


  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

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      How evolutionary thinking can help us to understand ADHD
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      How evolutionary thinking can help us to understand ADHD
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      How evolutionary thinking can help us to understand ADHD
      Available formats


Corresponding author

Dr Graham Music, Child and Family Department, Tavistock and Portman NHS Trust, 120 Belsize Lane, London NW3 5BA, UK. Email:


Hide All

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.



Hide All
Abikoff, HB, Thompson, M, Laver-Bradbury, C, et al (2015) Parent training for preschool ADHD: a randomized controlled trial of specialized and generic programs. Journal of Child Psychology and Psychiatry, 56: 618–31.
ADHD Institute (2016) Epidemiology: Gender. ADHD Institute ( Accessed 15 September 2017.
ADHD Solutions (2017) ADHD in childhood. ADHD Solutions ( Accessed 15 September 2017.
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM-5). APA.
Auerbach, JG, Atzaba-Poria, N, Berger, A, et al (2004) Emerging developmental pathways to ADHD: possible path markers in early infancy. Neural Plasticity, 11: 2943.
Bakermans-Kranenburg, MJ, van IJzendoorn, MH (2015) The hidden efficacy of interventions: gene × environment experiments from a differential susceptibility perspective. Annual Review of Psychology, 66: 381409.
Barkley, RA (2012) Executive Functions: What They Are, How They Work, and Why They Evolved. Guilford Press.
Barkley, RA (2017) Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment (4th edn). Guilford Press.
Belsky, J (2004) Differential susceptibility to rearing influence. In Origins of the Social Mind: Evolutionary Psychology and Child Development (eds Ellis, B, Bjorklund, D): 139–63. Guilford Press.
Belsky, J, Schlomer, GL, Ellis, BJ (2012) Beyond cumulative risk: distinguishing harshness and unpredictability as determinants of parenting and early life history strategy. Developmental Psychology, 48: 662–73.
Belsky, J, Hartman, S (2014) Gene–environment interaction in evolutionary perspective: differential susceptibility to environmental influences. World Psychiatry, 13: 87–9.
Brown, TE (2013) A New Understanding of ADHD in Children and Adults: Executive Function Impairments. Routledge.
Cartwright, KL, Bitsakou, P, Daley, D, et al (2011) Disentangling child and family influences on maternal expressed emotion toward children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 50: 1042–53.
Caye, A, Rocha, TB, Anselmi, L, et al (2016) Attention-deficit/hyperactivity disorder trajectories from childhood to young adulthood: evidence from a birth cohort supporting a late-onset syndrome. JAMA Psychiatry, 73: 705–12.
Chen, K, Fortin, N, Phipps, S (2015) Young in class: implications for inattentive/hyperactive behaviour of Canadian boys and girls. Canadian Journal of Economics, 48: 1601–34.
Chen, M-H, Lan, W-H, Bai, Y-M, et al (2016) Influence of relative age on diagnosis and treatment of attention-deficit hyperactivity disorder in Taiwanese children. Journal of Pediatrics, 172: 162–7.
Clearfield, MW, Jedd, KE (2013) The effects of socio-economic status on infant attention. Infant and Child Development, 22: 5367.
Cofnas, N (2016) A teleofunctional account of evolutionary mismatch. Biological Philosophy, 31: 507–25.
DeJong, M (2010) Some reflections on the use of psychiatric diagnosis in the looked after or ‘in care’ child population. Clinical Child Psychology and Psychiatry, 15: 589–99.
Department for Education (2016) School Workforce in England: November 2015. Department for Education (
de Tychey, C, Briançon, S, Lighezzolo, J, et al (2008) Quality of life, postnatal depression and baby gender. Journal of Clinical Nursing, 17: 312–22.
Dockstader, C, Gaetz, W, Cheyne, D, et al (2009) Abnormal neural reactivity to unpredictable sensory events in attention-deficit/hyperactivity disorder. Biological Psychiatry, 66: 376–83.
Dyck, MJ, Piek, JP, Patrick, J (2011) The validity of psychiatric diagnoses: the case of ‘specific’ developmental disorders. Research in Developmental Disabilities, 32: 2704–13.
Eisenberg, DTA, Campbell, B, Gray, PB, et al (2008) Dopamine receptor genetic polymorphisms and body composition in undernourished pastoralists: an exploration of nutrition indices among nomadic and recently settled Ariaal men of northern Kenya. BMC Evolutionary Biology, 8: 173.
Elberling, H, Linneberg, A, Olsen, EM, et al (2014) Infancy predictors of hyperkinetic and pervasive developmental disorders at ages 5–7 years: results from the Copenhagen Child Cohort CCC2000. Journal of Child Psychology and Psychiatry, 55: 1328–35.
Elberling, H, Linneberg, A, Rask, CU, et al (2016) Psychiatric disorders in Danish children aged 5–7 years: a general population study of prevalence and risk factors from the Copenhagen Child Cohort (CCC 2000). Nordic Journal of Psychiatry, 70: 146–55.
El-Sheikh, M, Kouros, CD, Erath, S, et al (2009) Marital conflict and children's externalizing behavior: pathways involving interactions between parasympathetic and sympathetic nervous system activity. Monographs of the Society for Research in Child Development, 74: 179.
Ersche, KD, Turton, AJ, Chamberlain, SR, et al (2012) Cognitive dysfunction and anxious-impulsive personality traits are endophenotypes for drug dependence. American Journal of Psychiatry, 169: 926–36.
Evans, GW, Schamberg, MA (2009) Childhood poverty, chronic stress, and adult working memory. Proceedings of the National Academy of Sciences, 106: 6545–9.
Faraone, SV, Doyle, AE, Mick, E, et al (2001) Meta-analysis of the association between the 7-repeat allele of the dopamine D4 receptor gene and attention deficit hyperactivity disorder. American Journal of Psychiatry, 58: 1052–7.
de la Cruz, Fernández L, Simonoff, E, McGough, JJ, et al (2015) Treatment of children with attention-deficit/hyperactivity disorder (ADHD) and irritability: results from the multimodal treatment study of children with ADHD (MTA). Journal of the American Academy of Child and Adolescent Psychiatry, 54: 6270.
Fulton, BD, Scheffler, RM, Hinshaw, SP (2015) State variation in increased ADHD prevalence: links to NCLB school accountability and state medication laws. Psychiatric Services, 66: 1074–82.
Ghassabian, A, Herba, CM, Roza, SJ, et al (2013) Infant brain structures, executive function, and attention deficit/hyperactivity problems at preschool age. A prospective study. Journal of Child Psychology and Psychiatry, 54: 96104.
Ghosh, M, Holman, CD, Preen, DB (2015) Exploring parental country of birth differences in the use of psychostimulant medications for ADHD: a whole-population linked data study. Australian and New Zealand Journal of Public Health, 39: 8892.
Griskevicius, V, Tybur, JM, Delton, AW, et al (2011) The influence of mortality and socioeconomic status on risk and delayed rewards: a life history theory approach. Journal of Personality and Social Psychology, 100: 1015–26.
Gudmundsson, OO, Magnusson, P, Saemundsen, E, et al (2013) Psychiatric disorders in an urban sample of preschool children. Child and Adolescent Mental Health, 18: 210–7.
Harold, GT, Leve, LD, Barrett, D, et al (2013) Biological and rearing mother influences on child ADHD symptoms: revisiting the developmental interface between nature and nurture. Journal of Child Psychology and Psychiatry, 54: 1038–46.
Hoshen, MB, Benis, A, Keyes, KM, et al (2016) Stimulant use for ADHD and relative age in class among children in Israel. Pharmacoepidemiology and Drug Safety, 25: 652–60.
Kennedy, M, Kreppner, J, Knights, N, et al (2016) Early severe institutional deprivation is associated with a persistent variant of adult attention-deficit/hyperactivity disorder: clinical presentation, developmental continuities and life circumstances in the English and Romanian Adoptees study. Journal of Child Psychology and Psychiatry, 57: 1113–25.
Kim, P, Evans, GW, Angstadt, M, et al (2013) Effects of childhood poverty and chronic stress on emotion regulatory brain function in adulthood. Proceedings of the National Academy of Sciences, 110: 18442–7.
Krabbe, EE, Thoutenhoofd, ED, Conradi, M, et al (2014) Birth month as predictor of ADHD medication use in Dutch school classes. European Journal of Special Needs Education, 29: 571–8.
Lahey, BB, Lee, SS, Sibley, MH, et al (2016) Predictors of adolescent outcomes among 4–6-year-old children with attention-deficit/hyperactivity disorder. Journal of Abnormal Psychology, 125: 6881.
LD Online (2017) Helping the Student with ADHD in the Classroom: Strategies for Teachers. WETA ( Accessed 15 September 2017.
Matthews, LJ, Butler, PM (2011) Novelty-seeking DRD4 polymorphisms are associated with human migration distance out-of-Africa after controlling for neutral population gene structure. American Journal of Physical Anthropology, 145: 382–9.
McClure, SM, Laibson, DI, Loewenstein, G, et al (2004) Separate neural systems value immediate and delayed monetary rewards. Science, 306: 503–7.
Miller, L (1989) Closely Observed Infants. Duckworth.
Mischel, W (2014) The Marshmallow Test: Understanding Self-control and How To Master It. Little, Brown and Company.
Moore, C, Macgillivray, S (2004) Altruism, prudence, and theory of mind in preschoolers. New Directions for Child and Adolescent Development, 2004 (103): 5162.
Morris, AS, Silk, JS, Steinberg, L, et al (2007) The role of the family context in the development of emotion regulation. Social Development, 16: 361–88.
Mous, SE, Muetzel, RI, El Marroun, H, et al (2014) Cortical thickness and inattention/hyperactivity symptoms in young children: a population-based study. Psychological Medicine, 44: 3203–13.
Murray, L, Kempton, C, Woolgar, M, et al (1993) Depressed mothers' speech to their infants and its relation to infant gender and cognitive development. Journal of Child Psychology and Psychiatry, 34: 1083–101.
Music, G (2016) Nurturing Natures: Attachment and Children's Emotional, Social and Brain Development. Psychology Press.
NHS Choices (2016) Attention deficit hyperactivity disorder (ADHD). NHS Choices ( Accessed 27 October 2016.
Noble, KG, Norman, MF, Farah, MJ (2005) Neurocognitive correlates of socioeconomic status in kindergarten children. Developmental Science, 8: 7487.
Panzer, A, Viljoen, M (2005) Supportive evidence for ADHD as a neurodevelopmental disorder. Medical Hypotheses, 64: 755–8.
Pappa, I, Mileva-Seitz, VR, Bakermans-Kranenburg, MJ, et al (2015) The magnificent seven: a quantitative review of dopamine receptor d4 and its association with child behavior. Neuroscience and Biobehavioral Reviews, 57: 175–86.
Pingault, J-B, Tremblay, RE, Vitaro, F, et al (2011) Childhood trajectories of inattention and hyperactivity and prediction of educational attainment in early adulthood: a 16-year longitudinal population-based study. American Journal of Psychiatry, 168: 1164–70.
Polanczyk, GV, Willcutt, EG, Salum, GA, et al (2014) ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. International Journal of Epidemiology, 43: 434–42.
Posner, MI, Rothbart, MK, Sheese, BE, et al (2014) Developing attention: behavioral and brain mechanisms. Advances in Neuroscience, 1 May (doi:10.1155/2014/405094).
Richards, LM (2013) Is it time for a more integrated bio-psycho-social approach to ADHD? Clinical Child Psychology and Psychiatry, 18: 403503.
Roskam, I, Stievenart, M, Tessier, R, et al (2014) Another way of thinking about ADHD: the predictive role of early attachment deprivation in adolescents' level of symptoms. Social Psychiatry and Psychiatric Epidemiology, 49: 133–44.
Sander, L (2007) Living Systems, Evolving Consciousness, and the Emerging Person: A Selection of Papers from the Life Work of Louis Sander. Routledge.
Schwandt, H, Wuppermann, A (2016) The youngest get the pill: ADHD misdiagnosis in Germany, its regional correlates and international comparison. Labour Economics, 43: 7286.
Simonoff, E, Pickles, A, Wood, N, et al (2007) ADHD symptoms in children with mild intellectual disability. Journal of the American Academy of Child & Adolescent Psychiatry, 46: 591600.
Singh, I (2012) VOICES: Voices on Identity, Childhood, Ethics and Stimulants. Children Join the Debate. ADHD Voices.
Storeb⊘, OJ, Simonsen, E, Gluud, C (2016) Methylphenidate for attention-deficit/hyperactivity disorder in children and adolescents. JAMA, 315: 2009–10.
Swanepoel, A, Sieff, DF, Music, G, et al (2016) How evolution can help us understand child development and behaviour. BJPsych Advances, 22: 3643.
Thapar, A, Cooper, M (2016) Attention deficit hyperactivity disorder. Lancet, 387: 1240–50.
Timimi, S/Taylor, E (2004) ADHD is best understood as a cultural construct (debate). British Journal of Psychiatry, 184: 89.
Tronick, EZ, Weinberg, MK (2000) Gender differences and their relation to maternal depression. In Stress, Coping, and Depression (eds Johnson, SL, Hayes, AM, Field, TM, et al): 2334. Lawrence Erlbaum Associates.
Tronick, E (2007) The Neurobehavioral and Social Emotional Development of Infants and Children. Norton.
van Ijzendoorn, MH, Bakermans-Kranenburg, MJ (2015) Genetic differential susceptibility on trial: meta-analytic support from randomized controlled experiments. Development and Psychopathology, 27: 151–62.
Verlinden, M, Jansen, PW, Veenstra, R, et al (2015) Preschool attention-deficit/hyperactivity and oppositional defiant problems as antecedents of school bullying. Journal of the American Academy of Child & Adolescent Psychiatry, 54: 571–9.
Wanless, SB, McClelland, MM, Lan, X, et al (2013) Gender differences in behavioral regulation in four societies: The United States, Taiwan, South Korea, and China. Early Childhood Research Quarterly, 28: 621–33.
Washbrook, E, Propper, C, Sayal, K, et al (2013) Pre-school hyperactivity/attention problems and educational outcomes in adolescence: prospective longitudinal study. British Journal of Psychiatry, 203: 265–71.
Wedge, M (2012) Why French kids don't have ADHD. Psychology Today, 8 March (Blog: Suffer the Children).
Windhorst, DA, Mileva-Seitz, VR, Linting, M, et al (2015) Differential susceptibility in a developmental perspective: DRD4 and maternal sensitivity predicting externalizing behavior. Developmental Psychobiology, 57: 3549.

How evolutionary thinking can help us to understand ADHD

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


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

How evolutionary thinking can help us to understand ADHD

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


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *