L’ADHD rappresenta attualmente un quadro sindromico complesso e articolato, probabilmente multifattoriale sia in termini patogenetici che descrittivi. Lo scopo di questo contributo è quello di considerare, alla luce delle attuali conoscenze scientifiche, il ruolo dell’attaccamento e dell’esperienza traumatica nella genesi della patologia. Un ulteriore obiettivo è quello di individuare il percorso attraverso il quale, da un punto di vista cognitivo, il bambino, poi l’adolescente e infine l’adulto giungono alla costruzione di un significato personale, con l’obiettivo di elaborare strategie di intervento più funzionali. In questo documento saranno presentati alcuni casi clinici con l’obiettivo di esemplificare i contenuti delle riflessioni proposte. La specificità del nostro contributo è costituito dall’elemento prospettico-prognostico. Mettiamo in risalto la rilevanza della storia di vita, in particolare degli attaccamenti traumatici, nella costruzione dell’identità e nello sviluppo psicopatologico. L’invito per i terapeuti è quello che nella strategia di presa in carico non ci si focalizzi esclusivamente sui deficit performativi e di controllo.
Riferimenti bibliografici
American Psychiatric Association (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR. Washington DC: American Psychiatric Publishing.
Barone L. & Lionetti F. (2013). Quando l’attaccamento si disorganizza. Indicatori e fattori di rischio dell’esperienza traumatica nel ciclo di vita, Psicologia Clinica dello sviluppo, XVII, 1. DOI: 10.1449/73824.
Bruner J. (1990). Acts of meaning. Harvard University Press (trad. it.: La ricerca del significato: per una psicologia culturale. Torino: Bollati Boringhieri, 1992).
Cavicchioli M., Stefanazzi C., Tobia V. & Ogliari A. (2022). The role of attachment styles in attention-deficit hyperactivity disorder: A meta-analytic review from the perspective of a transactional development model. European Journal of Developmental Psychology, 20(3): 436-464. DOI: 10.1080/17405629.2022.2069095.
Clarke L., Ungerer J., Chahoud K., Johnson S. & Stiefel I. (2002). Attention Deficit Hyperactivity Disorder is Associated with Attachment Insecurity. Clinical Child Psychology and Psychiatry, 7(2): 179-198. DOI: 10.1177/1359104502007002006.
Cohen J.A., Bukstein O., Walter H., Benson S.R., Chrisman A., Farchione T.R. et al. (2010). Practice parameter for the assessment and treatment of children and adolescents with posttraumatic stress disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 49(4): 414-30. DOI: 10.1016/j.jaac.2009.12.020.
Craig S.G., Bondi B.C., O’Donnell K.A. et al. (2020). ADHD and Exposure to Maltreatment in Children and Youth: a Systematic Review of the Past 10 Years. Current Psychiatry Reports, 22: 79. DOI: 10.1007/s11920-020-01193-w.
Dahmen B., Pütz V., Herpertz-Dahlmann B. & Konrad K. (2012). Early pathogenic care and the development of ADHD-like symptoms. Journal of Neural Transmission, 119(9): 1023-1036. DOI: 10.1007/s00702-012-0809-8.11.
Dekkers T.J., Hornstra R., van den Hoofdakker B.J., de Jong S.R.C., Schaaf J.V., Bosmans G. & van der Oord S. (2021). Attachment Representations in Children with and without Attention-Deficit/Hyperactivity Disorder (ADHD). Brain Sciences, 11(11), 1516. DOI: 10.3390/brainsci11111516.
Draine J. (2013). Mental Health, Mental Illnesses, Poverty, Justice, and Social Justice. American Journal of Psychiatric Rehabilitation, 16(2): 87-90. DOI: 10.1080/15487768.2013.789684.
Erlandsson S.I., Hornborg C., Sorbring E. & Dauman N. (2023). Is ADHD a way of conceptualizing long-term emotional stress and social disadvantage? Frontiers in Public Health, 3(10), 966900. DOI: 10.3389/fpubh.2022.966900.
Ford J.D. (2002). Traumatic victimization in childhood and persistent problems with oppositional-defiance. Journal of Aggression, Maltreatment & Trauma, 6(1): 25-58. DOI: 10.1300/J146v06n01_03.
Franke S., Kissgen R., Krischer M. & Sevecke K. (2017). Attachment in Children with ADHD. Journal of Behavioral and Brain Science, 7: 497-510. DOI: 10.4236/jbbs.2017.711035.
Gleason M.M., Fox N.A., Drury S., Smyke A., Egger H.L., Nelson C.A. et al. (2011). Validity of evidence-derived criteria for reactive attachment disorder: indiscriminately social/disinhibited and emotionally withdrawn/inhibited types. Journal of the American Academy of Child & Adolescent Psychiatry, 50: 216.e-231.e. DOI: 10.1016/j.jaac.2010.12.012.
Liotti G., Intreccialagli B. & Cecere F. (1991). Esperienza di lutto nella madre e disturbi dissociativi nella prole: uno studio caso-controllo. Rivista di Psichiatria, 26: 283-91.
Minnis H., Green J., O’Connor T.G., Liew A., Glaser D., Taylor E. et al. (2009). An exploratory study of the association between reactive attachment disorder and attachment narratives in early school-age children. Journal of Child Psychology and Psychiatry, 50(8): 931-42. DOI: 10.1111/j.1469-7610.2009.02075.x.
Nigg J.T., Karalunas S.L., Feczko E. & Fair D.A. (2020). Toward a Revised Nosology for Attention-Deficit/Hyperactivity Disorder Heterogeneity. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 5(8): 726-737. DOI: 10.1016/j.bpsc.2020.02.005.
Pliszka S. & Issues, AWGoQ. (2007). Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 46(7): 894-921. DOI: 10.1097/chi.0b013e318054e724.
Richards L.M. (2013). It is time for a more integrated bio-psycho-social approach to ADHD. Clinical Child Psychology and Psychiatry, 18(4): 483-503. DOI: 10.1177/1359104512458228.
Ruiter M., Görlich E., Loyens S., Wong J. & Paas F. (2022). Effects of Desk-Bike Cycling on Phonological Working Memory Performance in Adolescents with Attention Deficit Hyperactivity Disorder. Frontiers in Education, 7, 841576. DOI: 10.3389/feduc.2022.841576.
Sonuga-Barke E.J.S., Becker S.P., Bölte S., Castellanos F.X., Franke B., Newcorn J.H., Nigg J.T., Rohde L.A. & Simonoff E. (2023). Annual Research Review: Perspectives on progress in ADHD science – from characterization to cause. Journal of Child Psychology and Psychiatry, 64(4): 506-532. DOI: 10.1111/jcpp.13696.
Storebø O.J, Gluud C., Winke P. & Simonsen E. (2012). Social-skills and parental training plus standard treatment versus standard treatment for children with ADHD – the randomised SOSTRA trial. PLoS One, 7(6): e37280. DOI: 10.1371/journal.pone.0037280.
Szymanski K., Sapanski L. & Conway F. (2011). Trauma and ADHD association or diagnostic confusion? A clinical perspective. Journal of Infant, Child, and Adolescent Psychotherapy, 10(1): 51-9. DOI: 10.1080/15289168.2011.575704.
Taylor E. (2011). Antecedents of ADHD: a historical account of diagnostic concepts. Attention deficit and hyperactivity disorders, 3(2): 69-75. DOI: 10.1007/s12402-010-0051-x.
Thorell L.B., Rydell A.M. & Bohlin G. (2012). Parent-child attachment and executive functioning in relation to ADHD symptoms in middle childhood. Attachment & Human Development, 14(5): 517-532. DOI: 10.1080/14616734.2012.706396.
Van der Kolk B.A. (1987). The drug treatment of post-traumatic stress disorder. Journal of Affective Disorders, 13(2): 203-213. DOI: 10.1016/ 0165-0327(87)90024-3.
Weinstein D., Staffelbach D. & Biaggio M. (2000). Attention-deficit hyperactivity disorder and posttraumatic stress disorder: differential diagnosis in childhood sexual abuse. Clinical Psychology Review, 20(3): 359-378. DOI: 10.1016/s0272-7358(98)00107-x.
Weiss M.D., McBride N.M., Brandt T., Esmaeilpour D. & Jensen P. (2019). Symptom profiles specific to trauma in a child inpatient unit. Journal of the American Academy of Child & Adolescent Psychiatry, 58(8): 818-820 DOI: 10.1016/j.jaac.2019.03.024.
Williamson D., Johnston C., Noyes A., Stewart K. & Weiss M.D. (2017). Attention-deficit/hyperactivity disorder symptoms in mothers and fathers: family level interactions in relation to parenting. Journal of Abnormal Child Psychology, 45(3): 485-500. DOI: 10.1007/s10802-016-0235-8.
World Health Organization (2022). International classification of diseases, XI revision. Geneva: World Health Organization.