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Early pathogenic care and the development of ADHD-like symptoms
Brigitte Dahmen1, Vanessa Pütz, Beate Herpertz-Dahlmann
1Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, RWTH Aachen University, Neuenhofer Weg 21, 52074 Aachen, Germany. bdahmen@ukaachen.de
Insights
Early pathogenic care can cause developmental disorders like reactive attachment disorder (RAD), leading to ADHD-like symptoms. Research suggests brain circuit dysfunction, not true ADHD, may explain these behavioral similarities in children with adverse early experiences.
Area of Science:
- Neuroscience
- Developmental Psychology
- Child Psychiatry
Background:
- Early pathogenic care, marked by emotional neglect, severely impacts psychosocial, cognitive, and brain development.
- Reactive attachment disorder (RAD) is a condition linked to pathogenic care, featuring disturbed social interactions.
- Children with RAD often exhibit symptoms similar to attention deficit/hyperactivity disorder (ADHD), raising questions about comorbidity versus phenocopy.
Purpose of the Study:
- To review the neurobiological effects of early pathogenic care.
- To explore whether ADHD-like symptoms in children with pathogenic care history are true ADHD or a phenocopy.
- To provide treatment suggestions for ADHD-like symptoms in children with adverse early life experiences.
Main Methods:
- Review of existing studies on the neurobiological consequences of early pathogenic care.
- Analysis of research comparing ADHD-like symptoms in children with pathogenic care to established ADHD criteria.
- Examination of neurodevelopmental pathways, focusing on limbic and prefrontal brain circuits.
Main Results:
- Early pathogenic care can lead to dysfunction in limbic brain circuits.
- This limbic dysfunction may interfere with prefrontal executive functions, causing behavioral similarities to ADHD.
- The complex phenotype is potentially better understood through a dimensional approach reflecting early experiences.
Conclusions:
- ADHD-like symptoms in children exposed to pathogenic care may stem from neurobiological changes in brain circuits, resembling ADHD but potentially having a different developmental origin.
- A dimensional perspective incorporating early life experiences is crucial for understanding these complex behavioral and neurobiological presentations.
- Evidence supports tailored treatment strategies for ADHD-like symptoms in children with histories of adverse early care.
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.
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