ADHD in Adolescents- Part 1: Genetics vs. Environment: Which one Matters Most?

Today we will discuss the intricate relationship between genetics and environmental factors in influencing ADHD symptoms, particularly in adolescents. While genetics plays a role in ADHD symptom presentation, did you know the environment often has a greater impact for those with a genetic predisposition to high levels of hyperactivity and inattention?

A study of 16-year old twins by Schwabe et al. (2024), highlighted that in adolescents exhibiting significant hyperactivity or inattentiveness, their environments, such as home, school, and social settings, had a more significant impact on these symptoms than their genetics. 

What Does This Mean When Considering Interventions for Adolescents with ADHD?

This means, when considering adolescents with ADHD, the environment (as opposed to genetic factors) will most likely have an impact on overall functioning when they are described as extremely hyperactive and/or inattentive. Every symptom of ADHD falls on a spectrum for each individual. Impairments in functioning associated with each symptom vary across individuals, types of settings, and over time. 

Factors Associated with Impairments in Functioning: Adolescents with ADHD

All symptoms of ADHD are most likely to impact functioning significantly when the person with ADHD experiences one or more of the following:

• The individual with ADHD is asked to engage in a non-preferred activity/task.
• The activity/task for the adolescent with ADHD is not offered in a way that allows for multi-sensory input, which would take into account different learning and communication styles and preferences.
• The activity is perceived as overwhelming.
• The task is ambiguous, and lacks specificity, making it more likely difficult to organize in terms of time, materials, and activities.
• The activity/task for the person with ADHD is not linked to a personal goal, so it lacks individual meaning.
• The task is not linked to SMART Goals. 
  • Specific
  • Measureable
  • Achievable (based on the perspective of the individual with the goal, the individual is agreeable to the goal)
  • Relevant (connected to a concept/goal of the individual that has personal meaning, reasonable, realistic, resourced, results-based)
  • Timely (time-based, time limited, time/cost limited, timely, time-sensitive). –Audio clip part 2 stop

Prioritizing Environmental Strategies for Adolescents with ADHD

The results of the research by Schwabe et al. (2024) found that when adolescents are described as being highly inattentive or highly hyperactive, environmental changes will more likely influence symptoms. 

In practice, this would mean accommodations and modifications to instructions in different environments, including the home, community, educational, and social settings, for adolescents diagnosed with ADHD, should be prioritized for highly inattentive and hyperactive adolescents. 

Furthermore, consideration should be taken when considering factors that seem to most often exacerbate symptoms of ADHD and levels of overall functioning when problem-solving ways to implement accommodations and modifications for adolescents with ADHD.

In our next blog, we will take a look at specific accommodations and modifications to different environments to facilitate learning and memory for adolescents who exhibit both high levels of inattentiveness and hyperactivity.

Reference

Schwabe, I., Miljan Jović, Kaili Rimfeld, Allegrini, A. G., & van. (2024). Genotype-Environment Interaction in ADHD: Genetic Predisposition Determines the Extent to Which Environmental Influences Explain Variability in the Symptom Dimensions Hyperactivity and Inattention. Behavior Genetics. https://doi.org/10.1007/s10519-023-10168-5