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Attention Deficit Hyperactivity Disorder

Probability of Children Having ADD

09/24/2009

Question:

If a women has ADD, what are the probabilities of her children having ADD if she becomes pregnant?

Answer:

ADD is a popular term for ADHD inattentive type. Girls and adults with ADHD are more likely than boys to have inattentive type (as compared to hyperactive-impulsive type or combined type). ADHD is highly but not completely heritable. First-degree relatives (sibs, parents, children) of people with ADHD have about a 1/3 risk of also having ADHD, although not necessarily of the same severity. However, there is a sex difference, so that first-degree female relatives have a lower risk and first-degree male relatives have a higher risk because of the basic sex difference in prevalence (2:1 or 3:1 male:female). It appears that heritability is a bit higher for females with ADHD: first-degree relatives of females with ADHD have a somewhat higher risk for ADHD than first-degree relatives of males with ADHD. A possible explanation could be that for a female to show ADHD symptoms, the genetic loading has to be greater, thus increasing the genetic factor relative to environmental factors. Paradoxically, a woman with ADHD has a greater chance of passing ADHD to her sons than to her daughters. Because a father with ADHD also has a greater chance of passing it to sons rather than to daughters, the risk is greater for sons no matter which parent has ADHD. In no case, however, is the risk 100%. Although having ADHD is not in itself considered a reason for a woman not to have children, there are some special considerations that could contribute to a successful mothering experience. A woman with ADHD may have more difficulty organizing and attending to the duties of motherhood, and this added to the possibility of having a baby with ADHD could lead to considerable frustration unless some forethought is given to the support system and preparation. She may need more help than most mothers in all stages (gestation to remember daily prenatal vitamins, neonatal period learning to interpret baby's needs while overcoming postpartum blues, toddlerhood setting healthy structure and limits, preschool in helping the child develop readiness skills, etc.). Additionally, women with or without ADHD are at risk for mild or borderline iron deficiency secondary to blood loss of menstruation and childbirth. Iron deficiency can aggravate or even mimic ADHD symptoms, even at borderline levels that do not result in frank anemia. Therefore a woman (or adolescent girl) with ADHD should ask her physician to pay special attention to here iron status.

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Response by:

L Eugene Arnold, MD, MEd L Eugene Arnold, MD, MEd
Professor Emeritus of Psychiatry
College of Medicine
The Ohio State University