Introduction

Since its reclassification in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) (American Psychiatric Association, 2013), Attention-Deficit Hyperactivity Disorder (ADHD) is the most commonly diagnosed neurodevelopmental disorder and prevalence continues to be increasing (Thapar, Reference Thapar2018; Ayano et al., Reference Ayano, Demelash, Gizachew, Tsegay and Alati2023). ADHD prevalence is consistent across various backgrounds and socioeconomic groups, unaffected by factors like urbanicity (Thapar, Reference Thapar2018; Ayano et al. Reference Ayano, Demelash, Gizachew, Tsegay and Alati2023), and the core symptoms show remarkable uniformity across diverse cultures (Polanczyk et al. Reference Polanczyk, de Lima, Horta, Biederman and Rohde2007), suggesting an evolutionary basis for this condition. There is a compelling argument that ADHD symptoms exist on a spectrum without a distinct pathological cutoff, with clinical significance arising primarily from the degree of functional impairment. This impairment is often context-dependent, suggesting that in WEIRD (Western, Educated, Industrialized, Rich and Democratic) societies, ADHD may be better understood as a product of evolutionary mismatch rather than intrinsic psychopathology (Swanepoel, Reference Swanepoel2024). Despite its widespread prevalence, ADHD remains stigmatized (Godfrey et al. Reference Godfrey, Fuermaier, Tucha, Butzbach, Weisbrod, Aschenbrenner and Tucha2021) and services in Ireland considered insufficient. An evolutionary perspective that recognizes how the modern environment may be mismatched with children’s natural developmental needs could be a potential solution. Viewed through an evolutionary lens, certain behaviors, such as hyperactivity and impulsivity, may be adaptive responses that seem pathological in modern settings (Swanepoel et al. Reference Swanepoel, Music, Launer and Reiss2017). Explanations such as these may have the power to reduce stigma and diagnostic skepticism (Gavin & McNicholas, Reference Gavin and McNicholas2018), both for psychiatrists and their patients.

From an evolutionary perspective, traits linked to ADHD, such as novelty-seeking, may have been advantageous in certain environments. For instance, in hunter-gatherer societies, individuals inclined to explore could have had better survival prospects. Research supports this by indicating a higher occurrence of the ‘novelty-seeking’ genetic variant, associated with ADHD, in people descended from migratory groups. This suggests that seeking new opportunities or escaping danger might have provided survival benefits, enabling individuals to pass on these traits (Matthews & Butler, Reference Matthews and Butler2011).

However, genetic predisposition does not fully account for ADHD either. The interaction between genetic predispositions and environmental factors plays a significant role. For example, children with the 7-repeat allele of the dopamine D4 receptor gene show a stronger association with ADHD symptoms, especially when exposed to insensitive parenting (Faraone & Doyle, Reference Faraone and Doyle2001). They may struggle more with emotional regulation and exhibit disorganized attachment styles (Pappa et al. Reference Pappa, Mileva-Seitz, Bakermans-Kranenburg, Tiemeier and van IJzendoorn2015). Nevertheless, evidence shows that sensitive parenting can help mitigate hyperactivity even in children genetically predisposed to ADHD (Harold et al. Reference Harold, Leve, Barrett, Elam, Neiderhiser, Natsuaki, Shaw, Reiss and Thapar2013).

The concept of ‘differential susceptibility’ suggests that some children are more sensitive to environmental conditions due to their genes (Windhorst et al. Reference Windhorst, Mileva‐Seitz, Linting, Hofman, Jaddoe, Verhulst, Tiemeier, van IJzendoorn and Bakermans‐Kranenburg2015). This sensitivity could be adaptive, allowing for varying responses among offspring that enhance survival in changing environments. Epigenetic research supports the idea of ‘relative plasticity’, where certain genes increase an individual’s responsiveness to their experiences, rather than solely being ‘vulnerability’ genes linked to ADHD (Belsky & Hartman, Reference Belsky and Hartman2014).

Attachment and parenting quality also affect ADHD symptoms. Children in unstable or threatening environments tend to be more hypervigilant and restless. Those who experience emotional neglect are more active and less focused, while attuned parenting helps regulate their emotional state. Exposure to trauma, high family stress or violence can trigger extreme stress responses, leading to behaviors often associated with ADHD (Roskam et al. Reference Roskam, Stievenart, Tessier, Muntean, Escobar, Santelices, Juffer, Van Ijzendoorn and Pierrehumbert2014). Consequently, children from adverse backgrounds are more likely to struggle with impulsivity and poor executive functioning, including difficulties with planning, emotion regulation and concentration (Ersche et al. Reference Ersche, Turton, Chamberlain, Müller, Bullmore and Robbins2012).

From a life history theory perspective (Belsky et al. Reference Belsky, Schlomer and Ellis2012), growing up in high-stress environments may prompt a ‘fast life’ strategy, which favors immediate survival over long-term health by enhancing vigilance and stress response systems. Such adaptations, while beneficial in dangerous settings, may present as ADHD-like symptoms in structured environments like schools. Children from low-income or violent neighborhoods, for example, show lower self-regulation abilities and early deprivation is linked to enduring ADHD symptoms and impaired brain development, especially in areas governing executive functioning (Noble et al. Reference Noble, Norman and Farah2005; Kim et al. Reference Kim, Evans, Angstadt, Ho, Sripada, Swain, Liberzon and Phan2013; Mischel, Reference Mischel2014; Kennedy et al. Reference Kennedy, Kreppner, Knights, Kumsta, Maughan, Golm, Rutter, Schlotz and Sonuga‐Barke2016). Chronic stress and trauma can exacerbate executive functions such as in planning and emotional control, leading to ADHD-like symptoms and potentially resulting in misdiagnosis (DeJong, Reference DeJong2010).

Males may have evolved to be more risk-taking and exploratory as part of their mating strategy, and since sexual competition is high, this competitive behavior may have fostered traits such as impulsivity and hyperactivity. This is especially evident in males, who are more frequently diagnosed with ADHD in childhood and display more developmental sensitivity as a result than females (Tronick, Reference Tronick2007; Sander et al. Reference Sander, Amadei and Bianchi2012). These issues are compounded by ADHD traits being less suited to the structured expectations of contemporary society, particularly in educational settings that prioritize passive and compliant behavior in contrast to traditional learning environments where children were more inclined to be more explorative and risk-taking (Kretschmer et al. Reference Kretschmer, Dyble, Chaudhary, Bann and Salali2025).

Another more recent hypothesis grounded in evolutionary theory proposes that trait ‘hypercuriosity’ defined as ‘the heightened and impulsive desire to know, is an evolutionary adaptation that has become mismatched under modern environmental conditions’. This may have been adaptive in ancestral resource-scarce environments with high levels of novelty-seeking and exploratory behaviors being appraised as beneficial but now may be manifesting as distractibility and impulsivity in modern environments (Le Cunff, Reference Le Cunff2024).

Evolutionary perspectives on mental disorders have the potential to reformulate and reframe explanations based on ‘ultimate’ questions of causation in addition to existing proximate mechanistic explanations. ADHD is one such disorder that may benefit from a wider explanatory model. Currently, assessments and interventions based on evolutionary principles are largely absent in mainstream psychiatry. Evolutionary psychiatry is a growing field but is lacking in empirical data regarding application (Abed & St John Smith, Reference Abed and St John-Smith2022). Literature suggests an evolutionary informed approach to ADHD and other disorders can have the potential to reduce stigma and produce positive attitudes (Swanepoel et al. Reference Swanepoel, Reiss, Launer, Music, Wren, Abed and St John-Smith2022, Reference Swanepoel, Music, Launer and Reiss2017; Nesse, Reference Nesse, Abed and St John-Smith2022). Particularly when parents report diagnosis as the single most important intervention which can alleviate cycles of blame and guilt (Gavin & McNicholas, Reference Gavin and McNicholas2018). Evolutionary explanations, complementing existing psychoeducation, could lead to improved outcomes for patients and provide better therapeutic relationships (Abed et al. Reference Abed, Ayton, St John-Smith, Swanepoel and Tracy2019). The effects and attitudes of using evolutionary approaches to mental disorders for psychiatrists is relatively unexplored. Indeed the consideration of how biology and environment shape symptoms of ADHD has been called a ‘significant gap in the literature’ (Gavin & McNicholas, Reference Gavin and McNicholas2018). Here, this study forms part of the first step in investigating the perceptions and attitudes of psychiatrists on evolutionary perspectives on ADHD.