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Empirical tests of natural selection-based evolutionary accounts of ADHD: a systematic review

Published online by Cambridge University Press:  08 April 2016

Marthe S. Thagaard
Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark
Stephen V. Faraone
Departments of Psychiatry and of Neuroscience and Physiology, State University of New York (SUNY) Upstate Medical University, Syracuse, New York, USA K.G. Jebsen Centre for Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway
Edmund J. Sonuga-Barke
Academic Unit of Psychology, University of Southampton, Southampton, UK Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
Søren D. Østergaard*
Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
Søren Dinesen Østergaard, Psychosis Research Unit, Department of Clinical Medicine, Aarhus University Hospital, Skovagervej 2, 8240 Risskov, Denmark. Tel: +45 61282753; Fax: +45 7847 1609; E-mail:



ADHD is a prevalent and highly heritable mental disorder associated with significant impairment, morbidity and increased rates of mortality. This combination of high prevalence and high morbidity/mortality seen in ADHD and other mental disorders presents a challenge to natural selection-based models of human evolution. Several hypotheses have been proposed in an attempt to resolve this apparent paradox. The aim of this study was to review the evidence for these hypotheses.


We conducted a systematic review of the literature on empirical investigations of natural selection-based evolutionary accounts for ADHD in adherence with the PRISMA guideline. The PubMed, Embase, and PsycINFO databases were screened for relevant publications, by combining search terms covering evolution/selection with search terms covering ADHD.


The search identified 790 records. Of these, 15 full-text articles were assessed for eligibility, and three were included in the review. Two of these reported on the evolution of the seven-repeat allele of the ADHD-associated dopamine receptor D4 gene, and one reported on the results of a simulation study of the effect of suggested ADHD-traits on group survival. The authors of the three studies interpreted their findings as favouring the notion that ADHD-traits may have been associated with increased fitness during human evolution. However, we argue that none of the three studies really tap into the core symptoms of ADHD, and that their conclusions therefore lack validity for the disorder.


This review indicates that the natural selection-based accounts of ADHD have not been subjected to empirical test and therefore remain hypothetical.

Review Article
© Scandinavian College of Neuropsychopharmacology 2016 

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