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Attachment Representations in Mothers and Their Children Diagnosed with ADHD: Distribution, Transmission and Impact on Treatment Outcome

  • Pernille Darling RasmussenEmail author
  • Niels Bilenberg
  • Yael Shmueli-Goetz
  • Erik Simonsen
  • Anders Bo Bojesen
  • Ole Jakob Storebø
Original Paper

Abstract

Objectives

Little is known about the distribution and intergenerational transmission of attachment representations in ADHD populations and further how attachment may influence the prognosis of ADHD. In this study we aimed to investigate attachment distribution, intergenerational transmission and the potential impact of maternal and child attachment representations on treatment response in a sample of children with ADHD.

Methods

Sixty mother-child dyads from families with offspring ADHD were recruited. Attachment representations were assessed with the Adult Attachment Interview (AAI) and the Child Attachment Interview (CAI). ADHD symptom severity was assessed at four time points with the ADHD-Rating Scale.

Results

Of the children, only 15% and among the mothers, only 23% were securely attached. Contrary to predictions, the association between maternal and child attachment representations (Secure versus Insecure) did not reach statistical significance as we found overall concordance rate to be 63% (kappa = −0.05). Neither child nor maternal attachment significantly predicted treatment response.

Conclusions

In families with offspring ADHD, the prevalence of insecure attachment was remarkably high in the children as well as in the mothers. Intergenerational transmission of attachment was very low and in short-term follow up, attachment representations did not affect treatment outcome. Our findings support previous research in suggesting that the relationship between ADHD and Insecure attachment is complex. Nevertheless, the importance of considering attachment as a factor in the treatment, functional impairment and long term prognosis of children with ADHD remains.

Notes

Author Contributions

P.D.R. designed and executed the study, assisted with the data analyses, and wrote the paper, Y.SG. collaborated in the writing and editing of the final manuscript. E.S. collaborated with the design and writing of the study, A.B.B. analyzed the data and wrote part of the results, N.B. and O.J.S. collaborated with the design and writing of the study.

Funding

This research was supported by a research grant from Produktion, Forskning og Innovation and Lægeforeningens Forskningsfond.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

The participants received written and oral information according to the Helsinki declaration before they gave their consent.

References

  1. Agnew-Blais, J. (2017). Childhood comorbidity and parental mental health problems appear to be associated with ADHD persistence. Evidence-Based Mental Health, 20(3), 2016–2017.  https://doi.org/10.1136/eb-2017-102656.Google Scholar
  2. Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: assessed in the strange situation and at home. Hillsdale: Erlbaum.Google Scholar
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). Washington, DC: American Psychiatric Association.Google Scholar
  4. Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (2009). The first 10,000 adult attachment interviews: distributions of adult attachment representations in clinical and non-clinical groups. Attachment & Human Development, 11(3), 223–263.  https://doi.org/10.1080/14616730902814762.Google Scholar
  5. Barkley, R. A., & Robin, A. L. (1999). Defiant teens: A clinician’s manual for assessment and family intervention. New York: Guilford Publications.Google Scholar
  6. Birmaher, B., Ehmann, M., Axelson, D. A., Goldstein, B. I., Monk, K., Kalas, C., & Brent, D. A. (2009). Schedule for affective disorders and schizophrenia for school-age children (K-SADS-PL) for the assessment of preschool children—a preliminary psychometric study. Journal of Psychiatric Research, 43(7), 680–686.  https://doi.org/10.1016/j.jpsychires.2008.10.003.Google Scholar
  7. Bowlby, J. (1958). The nature of the child’s tie to his mother. Journal of Psychoanalysis, 39, 350–373.Google Scholar
  8. Bowlby, J. (1960a). Grief and mourning in infancy and early childhood. Psychoanalytic Study of the Child, 15, 9–52.Google Scholar
  9. Bowlby, J. (1960b). Separation anxiety. Journal of Psychoanalysis, 41, 89–113.Google Scholar
  10. Bowlby, J. (1973). Attachment and loss. Anxiety and anger (vol. 2). London: Hogarth Press: Institute of Psycho-analysis.Google Scholar
  11. Bowlby, J. (1988). A secure base: clinical applications of attachment theory. London: Routledge.Google Scholar
  12. Cassidy, J. & Marvin, R. (1992). Attachment organization in preschool children: Procedures and coding manual. Unpublished Manuscript, University of Virginia.Google Scholar
  13. Clarke, L., Ungerer, J., Johnson, S., & Stiefel, I. (2002). Attention deficit hyperactivity disorder is associated with attachment insecurity. Clinical Child Psychology and Psychiatry, 7(2), 179–198.  https://doi.org/10.1177/1359104502007002006.Google Scholar
  14. Crittenden, P. M. (1994). The preschool assessment of attachment. Coding manual. Miami: Family Relations Institute.Google Scholar
  15. Crittenden, P. M., & Kulbotton, G. R. (2007). Familial contributions to ADHD: An attachment perspective. Tidsskrift Norsk Psykologorening, 10, 1220–1229.Google Scholar
  16. Dallos, R., & Smart, C. (2011). An exploration of family dynamics and attachment strategies in a family with ADHD / conduct problems. Clinical Child Psychology and Psychiatry, 16(4), 535–550.  https://doi.org/10.1177/1359104510387391.Google Scholar
  17. Dalsgaard, S., Østergaard, S. D., Leckman, J. F., Mortensen, P. B., & Pedersen, M. G. (2015). Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study. The Lancet, 385(9983), 2190–2196.  https://doi.org/10.1016/S0140-6736(14)61684-6.Google Scholar
  18. Deault, L. C. (2010). A systematic review of parenting in relation to the development of comorbidities and functional impairments in children with attention-deficit/ hyperactivity disorder (ADHD). Child Psychiatry and Human Development, 41(2), 168–192.  https://doi.org/10.1007/s10578-009-0159-4.Google Scholar
  19. Dozier, M., Chase Stovall, K., & Albus, K. E. (1999). Attachment and psychopathology in adulthood. In I. J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 497–519). New York: Guilford.Google Scholar
  20. DuPaul, G. J., Power, T. J., Anastopoulos, A. D., & Reid, R. (1998). ADHD rating scale-IV. New York: Guilford.Google Scholar
  21. Egeland, B., & Farber, E. A. (1984). Infant-mother attachment: factors related to its development and changes over time. Child Development, 55(3), 753–771.Google Scholar
  22. Faraone, S. V., Asherson, P., Banaschewski, T., Biederman, J., Buitelaar, J. K., Ramos-Quiroga, J. A., & Franke, B. (2015). Attention-deficit/hyperactivity disorder. Nature Reviews Disease Primers, 1, 1–23.  https://doi.org/10.1038/nrdp.2015.20.Google Scholar
  23. Finzi-Dottan, R., Manor, I., & Tyano, S. (2006). ADHD, temperament, and parental style as predictors of the child’s attachment patterns. Child Psychiatry and Human Development, 37(2), 103–114.  https://doi.org/10.1007/s10578-006-0024-7.Google Scholar
  24. George, C., Kaplan, N., & Main, M., et al. (1985). Attachment interview for adults. Berkeley: University of California. Unpublished Manuscript.Google Scholar
  25. Grice, H. (1989). Paul: Studies in the way of words. Cambridge: Harvard UP.Google Scholar
  26. Hechtman, L. (1996). Families of children with attention deficit hyperactivity disorder: a review. Canadian Journal of Psychiatry Revue, 41(6), 350–360.Google Scholar
  27. Johnston, C., & Mash, E. J. (2001). Families of children with attention-deficit/hyperactivity disorder: review and recommendations for future research. Clinical Child and Family Psychology Review, 4(3), 183–207.  https://doi.org/10.1023/A:1017592030434.Google Scholar
  28. Johnston, C., Mash, E. J., Miller, N., & Ninowski, J. E. (2016). Parenting in adults with attention-deficit/hyperactivity disorder (ADHD). Clinical Psychology Review, 32(4), 215–228.Google Scholar
  29. Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., & Ryan, N. D. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36(7), 980–988.  https://doi.org/10.1097/00004583-199707000-00021.Google Scholar
  30. Kissgen, R., Krischer, M., Kummetat, V., Spiess, R., Schleiffer, R., & Sevecke, K. (2009). Attachment representation in mothers of children with attention deficit hyperactivity disorder. Psychopathology, 42(3), 201–208.  https://doi.org/10.1159/000209333.Google Scholar
  31. Licata, M., Zietlow, A.-L., Träuble, B., Sodian, B., & Reck, C. (2016). Maternal emotional availability and its association with maternal psychopathology, attachment style insecurity and theory of mind. Psychopathology, 49(5), 334–340.Google Scholar
  32. Main, M., & Cassidy, J. (1988). Categories of response to reunion with the parent at age 6: predictable from infant attachment classifications and stable over a 1-month period. Developmental Psychology, 24(3), 415.Google Scholar
  33. Main, M., & Solomon, J. (1986). Discovery of an insecure-disorganized/disoriented attachment pattern. In T. B. Brazelton & M. W. Yogman (Eds.), Affective development in infancy (pp. 95–124). Westport: Ablex Publishing.Google Scholar
  34. Main, M., & Solomon, J. (1990). Procedures for identifying infants as disorganized/disoriented during the Ainsworth Strange Situation. In M. T. Greenberg, D. Cicchetti & E. M. Cummings (Eds.), Attachment in the preschool years: Theory, research, and intervention (pp. 121–160). US: University of Chicago Press.Google Scholar
  35. Miljkovitch, R., Pierrehumbert, B., Bretherton, I., & Halfon, O. (2004). Associations between parental and child attachment representations. Attachment & Human Development, 6(3), 305–325.  https://doi.org/10.1080/14616730412331281557.Google Scholar
  36. Molina, B. S., Hinshaw, S. P., Swanson, J. M., Arnold, L. E., Vitiello, B., Jensen, P. S., & Houck, P. R. (2009). The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. Journal of the American Acadamy of Child and Adolescent Psychiatry, 48(5), 484–500.  https://doi.org/10.1097/CHI.0b013e31819c23d0.Google Scholar
  37. Niederhofer, H. (2009). Attachment as a component of attention-deficit hyperactivity disorder. Psychological Reports, 104(2), 645–8.  https://doi.org/10.2466/pr0.104.2.645-648.Google Scholar
  38. Oyen, A.-S., Landy, S., & Hilburn-Cobb, C. (2000). Maternal attachment and sensitivity in an at-risk sample. Attachment & Human Development, 2(2), 203–217.Google Scholar
  39. Pinto, C. (2006). ADHD and infant disorganized attachment: a prospective study of children next-born after stillbirth. Journal of Attention Disorders, 10(1), 83–91.  https://doi.org/10.1177/1087054705286058.Google Scholar
  40. Polanczyk, G., Zeni, C., Genro, J. P., Guimarães, A. P., Roman, T., Hutz, M. H., & Rohde, La (2007). Association of the adrenergic alpha2A receptor gene with methylphenidate improvement of inattentive symptoms in children and adolescents with attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 64(2), 218–224.  https://doi.org/10.1001/archpsyc.64.2.218.Google Scholar
  41. Roy, A., Hechtman, L., Arnold, L. E., Swanson, J. M., Molina, B. S. G., Sibley, M. H., & Stern, K. (2017). Childhood predictors of adult functional outcomes in the multimodal treatment study of attention-deficit/hyperactivity disorder (MTA). Journal of the American Academy of Child and Adolescent Psychiatry, 56(8), 687–695.e7.  https://doi.org/10.1016/j.jaac.2017.05.020.Google Scholar
  42. Seay, B., Hansen, E., & Harlow, H. F. (1962). Mother-infant separation in monkeys. Journal of Child Psychology and Psychiatry, 3(3–4), 123–132.  https://doi.org/10.1111/j.1469-7610.1962.tb02047.x.Google Scholar
  43. Shmueli-Goetz, Y., Target, M., Fonagy, P., & Datta, A. (2008). The child attachment interview: a psychometric study of reliability and discriminant validity. Developmental Psychology, 44(4), 939–956.  https://doi.org/10.1037/0012-1649.44.4.939.Google Scholar
  44. Sonugo-Barker, E. J. S., & Halperin, J. M. (2010). Developmental phenotypes and causal pathways in attention deficit/hyperactivity disorder: potential targets for early intervention? Journal of Child Psychology and Psychiatry, 51(4), 368–389.Google Scholar
  45. Skovgaard, A. M., Olsen, E. M., Houmann, T. B., Christiansen, E., Lichtenberg, A., & Jørgensen, T. (2007). [Markers of mental health problems based on public health nurses’ assessments of 0- to 1-year-old children: the Copenhagen County Child Cohort 2000]. Danish Medical Bulletin, 169(11), 1006–10.Google Scholar
  46. Spencer, T. J., Biederman, J., Wilens, T. E., & Faraone, S. V. (2002). Overview and neurobiology of attention-deficit/hyperactivity disorder. Journal of Clinical Psychiatry, 63(suppl. 12), 3–9.Google Scholar
  47. Sroufe, A. L. (2005). Attachment and development: a prospective, longitudinal study from birth to adulthood. Attachment and Human Development, 7(4), 349–367.Google Scholar
  48. Starck, M., Grünwald, J., & Schlarb, A. A. (2016). Occurrence of ADHD in parents of ADHD children in a clinical sample. Neuropsychiatric Disease and Treatment, 12, 581–588.Google Scholar
  49. Storebø, O. J., Darling Rasmussen, P., & Simonsen, E. (2013). Association between insecure attachment and ADHD: environmental mediating factors. Journal of Attention Disorders, 20(2), 187–196.  https://doi.org/10.1177/1087054713501079.Google Scholar
  50. Storebø, O. J., & Simonsen, E. (2014). Is ADHD an early stage in the development of borderline personality disorder? Nordic Journal of Psychiatry, 68(5), 289–295.  https://doi.org/10.3109/08039488.2013.841992.Google Scholar
  51. Sundhedsstyrelsen. (2014). National klinisk retningslinje for udredning og behandling af ADHD hos børn og unge [National Clinical Guideline for investigation and treatmen of ADHD in children and adolescents]. https://sundhedsstyrelsen.dk/da/nyheder/2014/~/media/A7931B11333540A184C73465181E29CE.ashx.
  52. Swanson, J. M., Arnold, L. E., Molina, B. S. G., Sibley, M. H., Hechtman, L. T., Hinshaw, S. P., & Kraemer, H. C. (2017). Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: Symptom persistence, source discrepancy, and height suppression. Journal of Child Psychology and Psychiatry and Allied Disciplines, 58(6), 663–678.  https://doi.org/10.1111/jcpp.12684.Google Scholar
  53. Szomlaiski, N., Dyrborg, J., Rasmussen, H., Schumann, T., Koch, S. V., & Bilenberg, N. (2009). Validity and clinical feasibility of the ADHD rating scale (ADHD-RS) a Danish Nationwide Multicenter Study. Acta Paediatrica, International Journal of Paediatrics, 98(2), 397–402.  https://doi.org/10.1111/j.1651-2227.2008.01025.x.Google Scholar
  54. Target, M., Fonagy, P., & Shmueli-Goetz, Y. (2003). Attachment representations in school—age children: the development of the child attachment interview (CAI). Journal of Child Psychotherapy, 29(2), 37–41.  https://doi.org/10.1080/0075417031000138433.Google Scholar
  55. Target, M., Fonagy, P., Shmueli-Goetz, Y., Datta, A., & Schneider, T. (2007). The child attachment interview (CAI) protocol. Unpublished Manuscript, University College London.Google Scholar
  56. Tarver, J., Daley, D., & Sayal, K. (2014). Attention-deficit hyperactivity disorder (ADHD): an updated review of the essential facts. Child: Care, Health and Development, 40(6), 762–774.  https://doi.org/10.1111/cch.12139.Google Scholar
  57. Thapar, A., Cooper, M., Eyre, O., & Langley, K. (2013). Practitioner review: what have we learnt about the causes of ADHD? Journal of Child Psychology and Psychiatry and Allied Disciplines, 54(1), 3–16.  https://doi.org/10.1111/j.1469-7610.2012.02611.x.Google Scholar
  58. Thapar, A., Cooper, M., Jefferies, R., & Stergiakouli, E. (2012). What causes attention deficit hyperactivity disorder? Archives of Disease in Childhood, 97(3), 260–5.  https://doi.org/10.1136/archdischild-2011-300482.Google Scholar
  59. van IJzendoorn, M. H. (1992). Intergenerational transmission of parenting: a review of studies in no clinical populations. Developmental Review, 12, 76–99.Google Scholar
  60. van Ijzendoorn, M. H. (2010). Attachment, emergent morality, and aggression: toward a developmental socioemotional model of antisocial behaviour. International Journal of Behavioral Development, 21(4), 703–728.  https://doi.org/10.1080/016502597384631.Google Scholar
  61. van IJzendoorn, M. H., & Bakermans-Kranenburg, M. J. (1996). Attachment representations in mothers, fathers, adolescents, and clinical groups: a meta-analytic search for normative data. Journal of Consulting and Clinical Psychology, 64(1), 8–21.  https://doi.org/10.1037/0022-006X.64.1.8.Google Scholar
  62. van IJzendoorn, M. H., Feldbrugge, J., Derks, F. C. H., De Ruiter, C., Verhagen, M. F. M., Philipse, M. W. G., & Riksen-Walraven, J. M. A. (1997). Attachment representations of personality-disordered criminal offenders. American Journal of Orthopsychiatry, 67(3), 449.Google Scholar
  63. van IJzendoorn, M. H., Goldberg, S., Kroonenberg, P. M., & Frenkel, O. J. (1992). The relative effects of maternal and child problems on the quality of attachment: a meta‐analysis of attachment in clinical samples. Child Development, 63(4), 840–858.  https://doi.org/10.1111/j.1467-8624.1992.tb01665.x.Google Scholar
  64. Waters, E., Vaughn, B. E., & Egeland, B. R. (1980). Individual differences in infant-mother attachment relationships at age one: antecedents in neonatal behavior in an urban, economically disadvantaged sample. Child Development, 51(1), 208–216.Google Scholar

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Authors and Affiliations

  1. 1.Psychiatric Research UnitSlagelseDenmark
  2. 2.Child and Adolescent Psychiatric DepartmentUniversity of Southern DenmarkOdenseDenmark
  3. 3.Anna Freud National Centre for Children and FamiliesLondonUK
  4. 4.Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
  5. 5.Department of PsychologyUniversity of Southern DenmarkOdenseDenmark

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