Researchers from Ben-Gurion University of the Negev (BGU) in Beersheba have been monitoring children at risk for attention-deficit/hyperactivity disorder (ADHD) – one of the most common neurodevelopmental disorders of childhood – for 18 years. 

It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention or controlling impulsive behaviors (may act without thinking about what the result will be), and they may be overly active.

Fortunately, an article just published in the journal Early Childhood Research Quarterly entitled “From early risk via cognitive functioning to ADHD phenotype: A longitudinal study of boys at familial risk for ADHD” found that an enriching home environment significantly improved the children’s cognitive development. 

The cause of ADHD is very complex and not yet fully understood; it involves both genetic and environmental factors. Genome-wide association studies showed that the genetic risk for ADHD consisted of numerous common DNA variants that may operate separately, they wrote. Each variant explained a small proportion of the variance of ADHD and together explained about one-third of ADHD heritability.  The environmental factors that have been found to increase the risk for ADHD are varied and include, for example, pregnancy and delivery complications, low socioeconomic status and aspects of the home environment, such as psychological adversity. These risk factors may have an indirect effect on the behavioral expression of the disorder 

Surveys the BGU team conducted of parents who have a history of ADHD and whose children had been diagnosed with the condition found that there is a particularly high importance of a rich home environment such as books and games. It seems that these children, who are at higher risk of developing ADHD, may be more sensitive to their home environment, compared to children who are not risk because their parents did not have it. 

Almost 100 boys born at Soroka University Medical Center in Beersheba and their parents were examined and followed up for 18 years so as to find the link between early risk factors and ADHD. Doctoral student Tzlil Einziger, from the laboratory of Prof. Andrea Berger – head of BGU’s psychology department examined time sequence data ranging from the quality of the home environment in early childhood, through the development of cognitive impairments typical of ADHD to the development of the disorder. 

The findings indicated that among children with a low family risk for ADHD, there was no association between the enrichment of the home environment with cognitive stimuli in early childhood and their cognitive function at age seven. However, among children at high family risk for the disorder, the home environment was of great importance; in a non-optimal home environment, children showed low cognitive functions, and under optimal and supportive environment conditions, they showed very good cognitive functions and even performed tasks better than children who were not at risk.

The significant aspect in the home environment that is found to be related to the children’s cognitive development was the existence of appropriate stimuli for the child’s development such as appropriate books and games as well as the parents’ involvement in encouraging the child to participate in enriching activities. 

“Enrichment is reflected not only in the very existence of books and games but also in the deliberate action of the parents of reading books together or assembling puzzles together,” said Einziger. “Children at risk may need more parental mediation so as to engage in activities that require a wider range of attention and patience.”

High cognitive function at age seven predicted fewer symptoms of adolescent ADHD. This suggests that children at family risk for ADHD were more sensitive to the effects of the home environment, for worse but also for better, and that parents with ADHD symptoms who were able to produce the best home environment for their children could thereby reduce their risk of developing the disorder, the researchers wrote. 

“There are very few studies that manage to predict ADHD over a continuum of so many years, from early childhood to adolescence,” Berger explained. “In this study, we were able to show research evidence supporting the great importance of the early home environment. The protective role of a positive, supportive and cognitively rich home environment is known and recognized. Such an environment is important for all children, but it may be especially important for children at family risk for ADHD since, it could be associated with better cognitive functioning and predict fewer ADHD symptoms in the future,” she concluded.