Biological Child and Adolescent Psychiatry - Review article

Journal of Neural Transmission

, Volume 119, Issue 9, pp 1023-1036

Early pathogenic care and the development of ADHD-like symptoms

  • Brigitte DahmenAffiliated withDepartment of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, RWTH Aachen University Email author 
  • , Vanessa PützAffiliated withChild Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, RWTH Aachen University
  • , Beate Herpertz-DahlmannAffiliated withDepartment of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, RWTH Aachen UniversityJARA-BRAIN Translational Brain Medicine
  • , Kerstin KonradAffiliated withChild Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, RWTH Aachen UniversityJARA-BRAIN Translational Brain MedicineJARA-Brain Translational Medicine, Cognitive Development Group, Institute of Neuroscience and Medicine (INM 3), Research Center Jülich

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Abstract

Early pathogenic care that is characterised by disregard for the child’s basic emotional needs can lead to severe global psychosocial and cognitive dysfunction and deviant developmental trajectories of brain maturation. Reactive attachment disorder (RAD) is a developmental disorder associated with early pathogenic care that is characterised by markedly disturbed ways of relating socially in most contexts. In addition to other severe emotional dysfunctions, children suffering from RAD often display a high number of comorbid attention deficit/hyperactivity disorder (ADHD) symptoms such as inattention, impulsivity and hyperactivity. It is not yet clear whether ADHD-like symptoms in children exposed to pathogenic care represent a true comorbidity of ADHD or similarities in behavioural dysfunction with a different neurodevelopmental pathway in terms of a phenocopy. In this review, we summarise the findings on the neurobiological consequences of early pathogenic care. Pathogenic care is considered a form of care by a primary caretaker involving a lack or a loss of expectable care, e.g., by early separation, frequent change in caregivers, institutionalisation or neglect. The reviewed studies suggest that a primary dysfunction of limbic brain circuits after early pathogenic care might lead to an interference by motivational or emotional cues impinging on prefrontal executive functions resulting in behavioural similarities with ADHD. Thus, the complex phenotype observed after early pathogenic care might be best described by a dimensional approach with behavioural and neurobiological similarities to ADHD coinciding to a certain degree as a function of early experience. Based on this evidence, suggestions for the treatment of ADHD-like symptoms in children after adverse early life experiences are provided.

Keywords

RAD ADHD ADHD-like symptoms Early pathogenic care Early separation Neurodevelopment