Journal of Neural Transmission

, Volume 119, Issue 9, pp 1023–1036

Early pathogenic care and the development of ADHD-like symptoms

Authors

    • Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical FacultyRWTH Aachen University
  • Vanessa Pütz
    • Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical FacultyRWTH Aachen University
  • Beate Herpertz-Dahlmann
    • Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical FacultyRWTH Aachen University
    • JARA-BRAIN Translational Brain Medicine
  • Kerstin Konrad
    • Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical FacultyRWTH Aachen University
    • JARA-BRAIN Translational Brain Medicine
    • JARA-Brain Translational Medicine, Cognitive Development GroupInstitute of Neuroscience and Medicine (INM 3), Research Center Jülich
Biological Child and Adolescent Psychiatry - Review article

DOI: 10.1007/s00702-012-0809-8

Cite this article as:
Dahmen, B., Pütz, V., Herpertz-Dahlmann, B. et al. J Neural Transm (2012) 119: 1023. doi:10.1007/s00702-012-0809-8

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

RADADHDADHD-like symptomsEarly pathogenic careEarly separationNeurodevelopment

Copyright information

© Springer-Verlag 2012