Abstract
A good understanding of the origin of symptoms is essential to ensure the optimization of therapeutic treatments. This article proposes a critical re-evaluation of both confounding and risk factors associated with attention deficit hyperactivity disorder to avoid over-diagnosis and over-medication as currently observed in Quebec. We provide an in-depth analysis of the nutritional, metabolic, digestive, respiratory and behavioral factors that may contribute to the onset and persistence of symptomatology resembling attention deficit hyperactivity disorder (ADHD), traditionally classified as a neurodevelopmental disorder of genetic origin. Emerging evidence suggests that the symptomatology may result from a multifactorial dysregulation affecting dopaminergic and noradrenergic pathways. It is essential to consider the critical role of nutrition in neurotransmitter synthesis, as deficiencies in amino acids, vitamins, minerals, and essential fatty acids may significantly compromise executive and attentional functions. Among the vulnerability factors, particular attention should be given to the long-term impact of childhood malnutrition on cognitive performance. Optimal therapeutic management of attention deficit hyperactivity disorder (ADHD) also requires evaluating its symptomatology within the broader continuum of metabolic dysfunction, including insulin resistance, glycemic variability, sedentarity and pediatric obesity. These imbalances affect neuroinflammation, neuronal energy production, and neurotransmitter synthesis. In this context, it is relevant to explore the role of the gut microbiota and intestinal permeability in the emergence of symptoms associated with attention-deficit/hyperactivity disorder (ADHD). This includes examining the potential benefits of elimination diets and the behavioral effects of food dyes and additives, thereby highlighting the importance of a personalized, patient-centered approach. Finally, sleep-disordered breathing in children, which has multiple causes, is also common among children with attention deficit hyperactivity disorder and can exacerbate neurocognitive symptoms. To ensure optimal therapeutic direction, it is therefore recommended to evaluate nutritional, metabolic, digestive, respiratory and behavioural factors before making a diagnosis of attention deficit hyperactivity disorder and initiate a treatment. All in all, mental health should not be considered as an isolated entity, but as the expression of a neuro-metabolic imbalance modulated by lifestyle habits on which it is possible to act effectively.