ADHD: Nature vs. Nurture… or Both? Part 1

As the stress of my separation and looming divorce overwhelmed me, I found myself asking questions like:

How did I get here?

Why is this my life?

I’m usually smart and successful, so how could I fail this badly at marriage and life?

I searched for answers and understanding because I knew the answers existed in understanding myself.

During that journey, I received my ADHD diagnosis.

To be honest, I had suspected for years that I was the poster child for ADHD. Looking back, the signs were obvious long before we regularly talked about ADHD the way we do today.

As I began sharing my experiences, such as a recent article I wrote connecting ADHD and Rejection Sensitive Dysphoria (RSD), I noticed something interesting. Many people saw parts of themselves reflected in my story. The more I talked about ADHD, the more others recognized similar struggles in their own lives.

That realization inspired this series.

Over the next several articles, I will explore both the research and my personal experiences with ADHD in an attempt to answer a deceptively simple question:

What came first: the ADHD egg or the ADHD chicken?

Most people think ADHD begins when a child receives a diagnosis.

A teacher notices the daydreaming.

A parent notices the forgotten homework.

You get good grades and participate in class, but every report card mentions a lack of self-control.

A doctor notices the symptoms.

You receive a prescription for Adderall or one of its many alternatives.

Suddenly, ADHD appears to enter the family’s story.

But what if it was there long before anyone noticed?

Modern research suggests that ADHD is among the most heritable psychiatric conditions. Studies consistently show that children with ADHD are more likely to have parents who exhibit ADHD traits, whether formally diagnosed or not. Those parents often had parents of their own who displayed similar characteristics.

Looking backward through family history, patterns begin to emerge.

The grandfather who had a multitude of different jobs.

The uncle who was brilliant but impulsive.

The father who constantly started projects but rarely finished them.

The mother who felt overwhelmed by everyday organization despite working twice as hard as everyone around her.

In my own case, as I began to understand my ADHD symptoms, I started recognizing them quite clearly in my father. He particularly embodied many of the traits associated with OCD, poor impulse control, and emotional dysregulation. This became incredibly clear to me during a weeklong road trip across the country with him to settle the estate of his soon-to-be deceased aunt.

At one point, we were sitting in the parking lot of a Walmart while he spoke on the phone with a woman who was nearly 90 years old. She was distraught over the impending loss of one of her closest friends and was pressuring him to arrive more quickly before she passed away. As the stress of the situation mounted, I watched my father’s voice grow louder and louder until he was essentially screaming at this elderly woman over the phone.

Sitting there beside him, all I could think was: My dad has absolutely no impulse control or emotional regulation. I wonder if he has ADHD too?

I should mention that this was not an isolated incident. It was completely on brand for my father. What made this moment stand out was that it gave me a front-row seat to behaviors I had not observed so closely since we stopped living together when I was 12 years old. Through the lens of my own diagnosis, I was suddenly seeing patterns that had always been there.

For generations, these behaviors were rarely recognized as symptoms of a neurological condition. Instead, they were described as personality flaws, character defects, laziness, irresponsibility, or simply:

“That’s just the way that side of the family is.”

The result is that many people grow up believing their struggles began with them when, in reality, they may be inheriting patterns that have existed for decades.

Research has shown that genetics influence attention, impulse control, emotional regulation, novelty-seeking behavior, and executive functioning. Yet genes do not operate in isolation. The same genetics that influence a parent’s behavior also help shape the household environment in which a child is raised.

The child inherits more than DNA.

The child inherits routines.

Habits.

Coping mechanisms.

Stress levels.

Financial decisions.

Relationship patterns.

Emotional responses.

This is where the traditional debate between nature and nurture begins to break down.

Parents contribute the child’s genetics.

Parents also create much of the child’s environment.

Nature is helping create nurture.

Scientists sometimes refer to this interaction as a gene-environment correlation, a process in which inherited traits influence the environments people create and experience.

The most important lesson may be that ADHD is rarely the story of a single individual. It is often the story of a family. The traits that make a child struggle with attention, impulse control, or emotional regulation may have existed in parents, grandparents, aunts, and uncles long before anyone had a name for them. Understanding that does not remove personal responsibility, but it can replace shame with perspective. Sometimes the first step toward understanding yourself is realizing that your story did not begin with you.

For generations, families may have been unknowingly passing an ADHD baton from one runner to the next. Along with genes came habits, coping mechanisms, emotional patterns, and environments shaped by the same underlying traits. The baton changed hands, but the race continued.

Understanding where you received the baton is often the first step toward deciding how you will run your leg of the race.

That raises our next question.

If family chaos can be passed from one generation to the next, does that process begin only after birth?

Or can the environment begin shaping a child before they ever enter the world?

In the next article, we will examine environmental influences that may affect brain development during pregnancy and explore how a child’s first environment begins long before the delivery room.

Next:

Part 2: The First Home - ADHD and Development Before Birth

⸻

References:

Faraone, S. V., Larsson, H. (2019). Genetics of Attention Deficit Hyperactivity Disorder. Molecular Psychiatry, 24, 562-575.

Demontis, D., Walters, R. K., Martin, J., et al. (2019). Discovery of the first genome-wide significant risk loci for ADHD. Nature Genetics, 51, 63-75.

Thapar, A., Cooper, M. (2016). Attention Deficit Hyperactivity Disorder. The Lancet, 387(10024), 1240-1250.

Nikolas, M. A., Burt, S. A. (2010). Genetic and Environmental Influences on ADHD Symptom Dimensions: A Meta-Analysis. Journal of Abnormal Psychology, 119(1), 1-17.

Scarr, S., McCartney, K. (1983). How People Make Their Own Environments: A Theory of Genotype → Environment Effects. Child Development, 54(2), 424-435.

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).