The literature on attention deficit hyperactivity disorder (ADHD) and attachment is reviewed, and we describe an investigation of the relationship between attachment insecurity and ADHD. Nineteen boys, aged 5-10 years with DSM-IV diagnoses of ADHD were compared with 19 control children on three representational measures assessing internal working models of attachment and the self: the Separation Anxiety Test, the Self Interview, and a Family Drawing rated with an attachment-based scoring system. Consistent support was found for the hypothesis that ADHD is associated with insecurity of attachment, with the ADHD group obtaining poorer scores on all three measures. The nature of attachment insecurity in the ADHD group was one of heightened emotional expression characterized by strong, out of control affects, and was consistent with an anxious-ambivalent or disorganized attachment style. We argue that quality of attachment with primary caregivers should be assessed when children present with symptoms of ADHD, and that where insecure attachment relationships are found, treatment must incorporate relationship-building components.

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In the current climate of evidence-based clinical practice, there is an urgent need to give family therapy research more prominence, and to demystify it for the practitioner. We were curious to discover how a family assessment instrument would behave with families we saw in our clinical practice. This paper describes our first attempt to apply a family measure, the Global Assessment of Relational Functioning, with 51 families in which the referred child presented with a confirmed or suspected diagnosis of AD/H D. The GARF, a one-point measure, assesses three dimensions of family functioning: problem-solving skills, organisational characteristics and emotional climate. We illustrate the use of the measure with the description of two families who rated at the opposite ends of the scale. The potential value and the limitations of the GARF as a family assessmentare discussed.