Why Adoptees Have Higher Rates of ADHD

Understanding the role of maternal stress and early development in ADHD.

Posted November 12, 2025 | Reviewed by Devon Frye

Attention -deficit/hyperactivity disorder ( ADHD ) is a neurodevelopmental condition shaped by both genetics and environment. The ADHD brain is structurally different, and research shows that it’s linked to lower dopamine levels, difficulty regulating dopamine, and increased activity in the brain’s default mode network (DMN).

The DMN, the brain region active during daydreaming and self-reflection, should quiet when a person engages in a task, but tends to remain active in people with ADHD. From a neurological perspective, an inability to regulate dopamine and deactivate the DMN contributes to hallmark ADHD symptoms: interest-based attention, cognitive and/or physical hyperactivity, and emotional dysregulation (Blum et al., 2008; Goulder, 2014; Mason & Rosier, 2025).

ADHD is highly heritable: Twin, family, and adoption studies estimate heritability in childhood between 70 and 80 percent (Brickell, 2019). Yet genetics tells only part of the story. ADHD risk reflects an interplay of genetic, prenatal, perinatal, and post-adoption environmental factors that can amplify vulnerability.

Research consistently finds that adoptees are diagnosed with, or treated for, ADHD at higher rates than their non-adopted peers (Cawthorne et al., 2025). These elevated rates appear across adoption contexts: infants adopted at birth, international adoptees who experienced institutionalized care, and children adopted from foster care (Kennedy et al., 2016; Keyes et al., 2008; Abrines et al., 2015).

Why Adoptees May Be Especially Vulnerable

Understanding adoptees’ heightened ADHD risk requires looking at how biological, prenatal, and postnatal experiences intersect.

Maternal stress during pregnancy .

Maternal stress during pregnancy has a powerful effect on the developing brain’s regulatory systems, increasing a child’s vulnerability to difficulties with attention, impulse control, and executive functioning . Stressors such as significant life events, anxiety or depression , or sustained high cortisol levels can alter fetal brain development and increase the likelihood of ADHD in offspring (Coussons-Read, 2013; Grizenko, 2012; Ronald, Pennell, & Whitehouse, 2011).

Prenatal or perinatal adversity.

Children who are placed for adoption may have experienced non-optimal prenatal conditions, such as maternal stress, substance exposure, malnutrition, or lack of prenatal care, as well as adverse birth or perinatal events.

Early postnatal deprivation .

Some adoptees, particularly those from institutional settings, face early deprivation or neglect during critical stages of brain development. Studies show that institutionalized children adopted later often display ADHD-like symptoms linked to early deprivation (Lindblad, 2010).

Genetic vulnerability and environment.

When a child inherits a biological risk for ADHD and is also exposed to prenatal stress or early adversity, these combined factors may heighten the expression and severity of ADHD symptoms.

Adoption timing and age at placement.

Age at adoption also matters. Children adopted after more extended periods of institutionalization or foster care tend to show higher levels of ADHD symptoms (Lindblad, 2010).

Post-adoption stress and trauma .

The post-adoption environment can compound these risks. Adoptees experience profound losses of birth family , culture, and early caregivers. These early attachment disruptions may further sensitize an already vulnerable nervous system .

Higher rates of ADHD in adoptees are not the result of a single cause but rather the intersection of genetic predisposition, prenatal maternal stress, early life adversity, age, timing of adoption, and post-adoption environmental conditions.

Maternal stress during pregnancy plays a significant role, shaping the developing brain’s regulatory systems and increasing vulnerability to challenges with attention, impulse control, and executive functioning. Recognizing these intersecting factors underscores the need for trauma-informed, adoption-competent, and neurodiversity -affirming care for adoptees.

This research also highlights how systemic inequities, such as limited access to prenatal care, safe housing, mental health services, and economic support, can profoundly affect both mothers and their children. These same inequities often influence a pregnant woman’s decision to relinquish, reminding us that adoption is not necessarily a personal choice, but a reflection of broader social and economic conditions.

Abrines, N., Barcons, N., Brun, C., Marre, D., Sartini, C., & Fumadó, V. (2012). Comparing ADHD symptom levels in children adopted from Eastern Europe and from other regions: Discussing possible factors involved. Children and Youth Services Review, 34(9), 1903–1908. https://doi.org/10.1016/j.childyouth.2012.05.025

Blum, K., Chen, A. L., Braverman, E. R., Comings, D. E., Chen, T. J., Arcuri, V., Blum, S. H., Downs, B. W., Waite, R. L., Notaro, A., Lubar, J., Williams, L., Prihoda, T. J., Palomo, T., & Oscar-Berman, M. (2008). Attention-deficit-hyperactivity disorder and reward deficiency syndrome. Neuropsychiatric disease and treatment, 4(5), 893–918. https://doi.org/10.2147/ndt.s2627

Brikell, I., Kuja-Halkola, R., & Larsson, H. (2019). Heritability of attention-deficit hyperactivity disorder across the lifespan. European Neuropsychopharmacology

Coussons-Read M. E. (2013). Effects of prenatal stress on pregnancy and human development: mechanisms and pathways. Obstetric medicine, 6(2), 52–57. https://doi.org/10.1177/1753495X12473751

Cawthorne, T., & Woolgar, M. (2025). The need for improved recognition of neurodevelopmental conditions in adopted and fostered young people. Adoption & Fostering, 49(2), 123–137. https://doi.org/10.1177/03085759251338324

Grizenko, N., Fortier, M.-E., Zadorozny, C., Thakur, G., Schmitz, N., Duval, R., & Joober, R. (2012). Maternal stress during pregnancy, ADHD symptomatology in children and genotype: Gene–environment interaction. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 21(1), 9–15. https://clinicaltrials.gov/ct2/show/NCT00483106

Kennedy, M., Kreppner, J., Knights, N., Kumsta, R., Maughan, B., Golm, D., Rutter, M., Schlotz, W. and Sonuga-Barke, E.J.S. (2016), Early severe institutional deprivation is associated with a persistent variant of adult attention-deficit/hyperactivity disorder: clinical presentation, developmental continuities and life circumstances in the English and Romanian Adoptees study. J Child Psychol Psychiatr, 57: 1113-1125. https://doi.org/10.1111/jcpp.12576

Lindblad F, Weitoft GR, Hjern A. ADHD in international adoptees: a national cohort study. Eur Child Adolesc Psychiatry. 2010 Jan;19(1):37-44. doi: 10.1007/s00787-009-0038-3. Epub 2009 Jun 19. PMID: 19543791.

Spanner, H. (2025, October 14). What we got wrong about ADHD – and why it matters. BBC Science Focus. https://www.sciencefocus.com/news/new-issue-what-we-got-wrong-about-adhd-and-why-it-matters

Ronald, A., Pennell, C. E., & Whitehouse, A. J. (2011). Prenatal Maternal Stress Associated with ADHD and Autistic Traits in early Childhood. Frontiers in psychology, 1, 223. https://doi.org/10.3389/fpsyg.2010.00223

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Joanne Bagshaw, Ph.D., is a Professor of Psychology and Women’s Studies at Montgomery College and a sex and relationship therapist.

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This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.