Three cases are presented in which the emergence of Attention Deficit Hyperactivity Disorder (ADHD) is linked to a lack in sustained parental attention during the first years of the child's life. The deficit in sustained parental attention resulted from different stressors which compromised the early parent-child relationship, leading to adverse and escalating cycles of negative interaction and affecting the attachment relationship. It is argued that family stress and attachment difficulties between parents and infants may play an important role in the development of ADHD in a subgroup of children. It is also argued that this model does not explain all ADHD and that it is not implicitly critical of parents. However by delineating the different possible pathways to ADHD, clinicians may be able to offer subtype specific multimodal treatment programmes which address aetiological components more adequately. Further, ADHD in a subgroup of children may be preventable if early antecedents and risk factors are understood and appropriate intervention is provided.
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