Stress and its impacts on brain alterations: toward a better understanding of ADHD

Attention-Deficit / Hyperactivity Disorder (ADHD) is a complex neurodevelopmental disorder influenced by both genetic and environmental factors. Among these, stress—whether prenatal or postnatal—plays a pivotal role in the brain alterations associated with ADHD. This stress can result from traumatic experiences, adverse socioeconomic conditions, or exposure to harmful substances.

This study investigates how stress affects brain structure, connectivity, and functioning, while examining the mediating mechanisms between stress and ADHD symptoms, offering new perspectives on this critical environmental factor.

Can stress explain brain alterations in ADHD?

Out of 25,026 identified articles, 20 studies meeting strict criteria were selected. These studies leverage brain imaging tools to validate stress exposures and identify structural and functional brain modifications. The primary objective is to better understand the impact of stress on brain development in the context of ADHD. The findings reveal significant impacts of stress on the brain in ADHD:

• Childhood trauma: Alterations in the ventral striatum, amygdala, and hippocampus, affecting reward and attention-related networks.
• Institutionalization and socioeconomic deprivation: Reduced brain volumes, particularly in the prefrontal cortex, and decreased cortical thickness in regions associated with attention and impulsivity.
• Prenatal factors: Exposure to maternal tobacco or alcohol use leads to abnormalities in brain connectivity, influencing inhibitory control, with strong associations to birth weight.

Incorporating stress in ADHD management

This review highlights the critical role of stress in brain alterations associated with ADHD. These findings also underline the need for an integrative approach to ADHD management, combining the prevention and management of environmental risks, personalized care based on environmental risks and individual specificities, and therapeutic innovation to reduce the impacts of stress on the brain.