ADHD diagnoses have increased since the first national survey in 1997, and we’re not sure if that’s due to rising prevalence or increased awareness. The once controversial diagnosis has gained legitimacy, and with it the assumption that diagnosis is good, mobilizing resources and better outcomes for the kids.

But Jayanti Owens, assistant professor of sociology and international and public affairs, wondered if it helps everybody. For diagnosis a child has to exhibit problems with attention, self control, and self regulation in at least two contexts—usually home and school. So imagine two students with mild levels of inattention and hyperactivity. If one is in a slightly chaotic classroom and another in a more disciplined environment with expectations of sitting still and listening quietly, who gets noticed?

Owens looked at kids diagnosed between kindergarten and third grade, measuring behavior in fifth grade and academic outcomes in eighth grade. She found the diagnosed mild cases did worse than those who are not diagnosed, whether or not they received medication.

The problem is exacerbated for kids of high socioeconomic status. They’re in an environment where they are more likely to be noticed. Their parents, believing it’s in their kid’s interest, are more likely to push for a diagnosis—and not only have resources, but know how to mobilize them.

“A lot of these kids are getting diagnosed,” says Owens. “And it may not be helping them.” She stresses that millions of kids really need and benefit from diagnosis and treatment, but we should also be thinking more about where the benefits lie.

“There could be alternatives like making sure your kid is getting enough sleep, limiting screen time, and getting enough outdoor playtime,” she says. “What presents as inattention or hyperactivity could really just be the result of a lack of other needs being met.”

The chemical connection

There is no shortage of popular theories about what causes ADHD, and plenty of emerging research. We don’t know a lot with certainty because the condition is clearly complex. Joseph Braun, associate professor of epidemiology and director of Brown’s Center for Children’s Environmental Health, was drawn to the field because of his own childhood ADHD and parallels he saw in how environmental chemicals led to behavioral disorders.

Now he works with a group on a long-term study of kids born to 468 mothers in Greater Cincinnati between 2003 and 2006. Early results helped dial in the role of lead and nicotine exposure as risk factors for ADHD. Lead is known as a bad actor, but screening guidelines focus largely on kids three and younger at high risk of ingesting environmental lead in their homes. “What we’re not thinking about is, maybe kids continue to have lead exposure as they get older,” Braun says. “We might be missing an opportunity to prevent neurodevelopmental disorders like ADHD if we don’t continue screening.”

In 2019 Braun’s Cincinnati work helped connect ADHD behavior to triclosan, a common antimicrobial compound used in consumer products and frequently detected in the urine of pregnant women and children.

Now he and his collaborators have expanded their search to encompass a much bigger collection of suspects. More than 80,000 chemical compounds are used in industry and commerce right now, and few have been properly scrutinized for health effects. Even less is known about how they interact.

Braun and his research partners now have data on nearly 100 different common environmental contaminants at multiple stages of life from gestation into adolescence. Lead, nicotine, triclosan—these are very different substances, working in different ways, yet they all are implicated in ADHD. “What happens when you add them up?” he asks. “That’s what we’re trying to figure out.”