Child attachment and ADHD: a systematic review

Abstract

Attention Deficit/Hyperactivity Disorder (ADHD) is a frequent neurodevelopmental disorder in children. ADHD has a multifactorial origin, combining genetic and environmental factors. Several studies suggested an influence of early parent-child relationships on the symptomatic expression of ADHD. In this review, we examine the studies that have investigated the links between attachment and ADHD in children. We searched for studies published between January 2000 and November 2019 on PsychInfo, PubMed, and Scopus. Selected studies included a theoretically based measure of attachment and an explicit measure of ADHD symptoms or an ADHD diagnosis. Studies that included children from adoption, institutionalization, or mistreatment were not included. We found only 26 studies meeting the inclusion criteria. Almost all these studies indicated a link between the attachment type and the presence of attentional difficulties and hyperactivity. However, associations were better explained, in several studies, by confounding factors such as comorbidities, cognitive difficulties, or contextual factors. The method used to assess attachment and parental mental health also had an impact. An increasing number of studies show a link between the type of attachment and the presence of attentional difficulties and hyperactivity in children. However, the nature of this link remains unclear. Implications for future research are discussed.

Is ADHD a way of conceptualizing long-term emotional stress and social disadvantage?

“…Many authors [cf. ( 10 – 12 )] argue that ADHD is a heterogeneous, multifactorial problem and often with comorbidities, why the search for one explanatory factor must be abandoned. Such a view is not new, however.…”

“…Accordingly, Murdock and Fagundes ( 29 ) have illustrated how attachment can work as a mediator between socioeconomic disadvantage during childhood and negative health outcomes in adulthood. Wylock et al ( 12 ) conducted a systematic literature review aimed to clarify the nature of the relationship between ADHD and child attachment and the results showed that the link still seems to remain unclear. One explanation was that many studies tend to consider ADHD as a homogeneous disorder, but the observed differences among studies could also be a matter of the methodology used to measure attachment.…”

The impact of the COVID-19 pandemic on the mental health of families dealing with attention-deficit hyperactivity disorder

“…However, children with an insecure attachment style often respond maladaptively to stressful situations as they do not have responsive caregivers to help foster the resilience required during hardship. There has been extensive work highlighting how children with ADHD often exhibit insecure attachment styles [62][63][64][65]. The genesis of this relational interaction is a chicken-and-egg problem.…”

Attachment Representation Moderates the Effectiveness of Behavioral Parent Training Techniques for Children with ADHD: Evidence from a Randomized Controlled Microtrial

“…Also, motivational problems, such as altered reward and punishment sensitivity, can complicate learning from parenting behaviors. Indeed, an increasing number of studies demonstrate an association between insecure or disorganized attachment styles and ADHD (Wylock et al, 2021), differences between children with ADHD and typically developing children in attachment representations (ADHD less secure/ more disorganized) (Dekkers et al, 2021b), and a recent meta-analysis reported a significant link between attention problems and insecure and disorganized attachment styles (Pallini et al, 2019). Taken together, it could be that children with ADHD respond differently to (changes in) parenting, due to neurobiological difficulties related to (safety) conditioning (Tripp & Wickens, 2008).…”