Abstract
This study aimed to examine relations between parent and child attachment representations and neuropsychological functions at age 8, as well as relations between these constructs and ADHD symptoms over a 10-year period. A community-based sample of 105 children (52 boys) participated. Measures of attachment representations and a range of neuropsychological functions were collected at age 8. Parents rated emotion dysregulation and ADHD symptoms at age 8 and ADHD symptoms again at age 18. Significant, although modest, relations were found between disorganized attachment and some aspects of neuropsychological functioning in childhood. When studying outcomes in late adolescence and controlling for early ADHD symptom levels, spatial working memory and disorganized attachment remained significant in relation to both ADHD symptom domains, and one measure of inhibition remained significant for hyperactivity/impulsivity. When examining independent effects, spatial working memory and disorganized attachment were related to inattention, whereas spatial working memory and dysregulation of happiness/exuberance were related to hyperactivity/impulsivity. Our findings showing that disorganized attachment is longitudinally related to ADHD symptoms over and above the influence of both neuropsychological functioning and early ADHD symptom levels highlights the importance of including measures of attachment representations when trying to understand the development of ADHD symptoms. If replicated in more “at-risk” samples, these findings could also suggest that parent–child attachment should be taken into consideration when children are referred for assessment and treatment of ADHD.
Similar content being viewed by others
References
Willcutt E (2012) The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics 9:490–499
Biederman J, Faraone SV (2005) Attention-deficit hyperactivity disorder. Lancet 366:237–248
Pelham WE, Foster EM, Robb JA (2007) The economic impact of attention-deficit/hyperactivity disorder in children and adolescents. Ambul Pediatr 7:121–131
Nigg JT (2006) What causes ADHD? Understanding what goes wrong and why. Guilford Press, New York
Biederman J, Faraone SV, Monuteaux MC (2002) Differential effect of environmental adversity by gender: Rutter’s index of adversity in a group of boys and girls with and without ADHD. Am J Psychiatry 159:1556–1562
Johnston C, Mash EJ (2001) Families of children with attention-deficit/hyperactivity disorder: review and recommendations for future research. Clin Child Fam Psychol Rev 4:183–207
Russell G, Ford T, Rosenberg R, Kelly S (2014) The association of attention deficit hyperactivity disorder with socioeconomic disadvantage: alternative explanations and evidence. J Child Psychol Psychiatry 55:436–445
Castellanos FX, Sonuga-Barke EJS, Milham MP, Tannock R (2006) Characterizing cognition in ADHD: beyond executive dysfunction. Trends Cogn Sci 10:117–123
Nigg JT, Willcutt EG, Doyle AE, Sonuga-Barke EJS (2005) Causal heterogeneity in attention-deficit/hyperactivity disorder: do we need neuropsychologically impaired subtypes? Biol Psychiatry 57:1224–1230
Barkley RA (1997) Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull 121:65
Willcutt EG, Doyle AE, Nigg JT, Faraone SV, Pennington BF (2005) Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review. Biol Psychiatry 57:1336–1346
Castellanos FX, Sonuga-Barke EJS, Scheres A, Di Martino A, Hyde C, Walters JR (2005) Varieties of attention-deficit/hyperactivity disorder-related intra-individual variability. Biol Psychiatry 57:1416–1423
Shaw P, Stringaris A, Nigg J, Leibenluft E (2014) Emotion dysregulation in attention deficit hyperactivity disorder. Am J Psychiatry 171:276–293
Sjöwall D, Roth L, Lindqvist S, Thorell LB (2013) Multiple deficits in ADHD: executive dysfunction, delay aversion, reaction time variability, and emotional deficits. J Child Psychol Psychiatry 54:619–627
Welsh MC (2002) Developmental and clinical variations in executive functions. In: Molfese DL, Molfese VJ (eds) Developmental variations in learning: applications to social, executive function, language, and reading skills. Lawrence Erlbaum Associates Publishers, Mahwah, pp 139–185
Sergeant JA (2005) Modeling attention-deficit/hyperactivity disorder: a critical appraisal of the cognitive-energetic model. Biol Psychiatry 57:1248–1255
Thompson RA (1994) Emotion regulation: a theme in search of definition. Monogr Soc Res Child Dev 59:25–52
Barkley RA (2015) Attention-deficit hyperactivity disorder: a handbook for diagnosis and treatment, 4th edn. Guilford Press, New York
Tamm L, Narad M, Antonini T, O’Brien K, Hawk L Jr, Epstein J (2012) Reaction time variability in ADHD: a review. Neurotherapeutics 9:500–508
Kofler MJ, Rapport MD, Sarver DE, Raiker JS, Orban SA, Friedman LM et al (2013) Reaction time variability in ADHD: a meta-analytic review of 319 studies. Clin Psychol Rev 33:795–811
Martel MM (2009) Research review: a new perspective on attention-deficit/hyperactivity disorder: emotion dysregulation and trait models. J Child Psychol Psychiatry 50:1042–1051
van Lieshout M, Luman M, Buitelaar J, Rommelse NNJ, Oosterlaan J (2013) Does neurocognitive functioning predict future or persistence of ADHD? A systematic review. Clin Psychol Rev 33:539–560
Sonuga-Barke EJS, Dalen L, Remington B (2003) Do executive deficits and delay aversion make independent contributions to preschool attention-deficit/hyperactivity disorder symptoms? J Am Acad Child Adolesc Psychiatry 42:1335–1342
Campbell S, von Stauffenberg C (2009) Delay and inhibition as early predictors of ADHD symptoms in third grade. J Abnorm Child Psychol 37:1–15
Kalff A, Hendriksen JM, Kroes M, Vles JH, Steyaert J, Feron FM et al (2002) Neurocognitive performance of 5- and 6-year-old children who met criteria for attention deficit/hyperactivity disorder at 18 months follow-up: results from a prospective population study. J Abnorm Child Psychol 30:589–598
Bohlin G, Eninger L, Brocki K, Thorell L (2012) Disorganized attachment and inhibitory capacity: predicting externalizing problem behaviors. J Abnorm Child Psychol 40:449–458
Wåhlstedt C, Thorell LB, Bohlin G (2008) ADHD symptoms and executive function impairment: early predictors of later behavioral problems. Dev Neuropsychol 33:160–178
Sjöwall D, Bohlin G, Rydell AM, Thorell LB (2015) Neuropsychological deficits in preschool as predictors of ADHD symptoms and academic achievement in late adolescence. Child Neuropsychol. doi:10.1080/09297049.2015.1063595
Bowlby J (1988) A secure base: parent–child attachment and healthy human development. Routledge, London
Green J, Goldwyn R (2002) Annotation: attachment disorganisation and psychopathology: new findings in attachment research and their potential implications for developmental psychopathology in childhood. J Child Psychol Psychiatry 43:835–846
Greenberg MT, Speltz ML, Deklyen M (1993) The role of attachment in the early development of disruptive behavior problems. Dev Psychopathol 5:191–213
Sroufe LA, Carlson EA, Levy AK, Egeland B (1999) Implications of attachment theory for developmental psychopathology. Dev Psychopathol 11:1–13
van IJzendoorn MH, Schuengel C, Bakermans-Kranenburg MJ (1999) Disorganized attachment in early childhood: meta-analysis of precursors, concomitants, and sequelae. Dev Psychopathol 11:225–250
George C, Solomon J (1990/1996/2000) Six-year attachment doll play classification system. Unpublished protocol and coding manual. Mills College, Oakland
Ainsworth MDS, Blehar MC, Waters E, Wall S (1978) Patterns of attachment: a psychological study of the strange situation. Lawrence Erlbaum, Hillsdale
Kerns KA, Schlegelmilch A, Morgan TA, Abraham MM (2005) Assessing attachment in middle childhood. In: Kerns KA, Richardson RA (eds) Attachment in middle childhood. The Guilford Press, New York, pp 46–70
Kerns KA, Klepac L, Cole A (1996) Peer relationships and preadolescents’ perceptions of security in the child-mother relationship. Dev Psychol 32:457–466
Mikulincer M, Florian V, Tolmacz R (1990) Attachment styles and fear of personal death: a case study of affect regulation. J Personal Soc Psychol 58:273–280
Denckla MB (2002) The behavior rating inventory of executive function: commentary. Child Neuropsychol 8:304–306
Green J, Stanley C, Smith V, Goldwyn R (2000) A new method of evaluating attachment representations in young school-age children: the Manchester child attachment story task. Attach Hum Dev 2:48–70
Solomon J, George C, De Jong A (1995) Children classified as controlling at age six: evidence of disorganized representational strategies and aggression at home and at school. Dev Psychopathol 7:447–463
Clarke L, Ungerer J, Chahoud K, Johnson S, Stiefel I (2002) Attention deficit hyperactivity disorder is associated with attachment insecurity. Clin Child Psychol Psychiatry 7:179–198
Erdman P (1998) Conceptualizing adhd as a contextual response to parental attachment. Am J Fam Ther 26:177–185
Storebø OJ, Darling Rasmussen P, Simonsen E (2016) Association between insecure attachment and ADHD: environmental mediating factors. J Atten Disord 20:187–196
Goldwyn R, Stanley C, Smith V, Green J (2000) The Manchester child attachment story task: relationship with parental AAI, SAT and child behaviour. Attach Hum Dev 2:71–84
Scholtens S, Rydell A-M, Bohlin G, Thorell L (2014) ADHD symptoms and attachment representations: considering the role of conduct problems, cognitive deficits and narrative responses in non-attachment-related story stems. J Abnorm Child Psychol 42:1033–1042
Pinto C, Turton P, Hughes P, White S, Gillberg C (2006) ADHD and infant disorganized attachment: a prospective study of children next-born after stillbirth. J Atten Disord 10:83–91
Thorell LB, Rydell A-M, Bohlin G (2012) Parent–child attachment and executive functioning in relation to ADHD symptoms in middle childhood. Attach Hum Dev 14:517–532
Ladnier RD, Massanari AE (2000) Treating ADHD as attachment deficit hyperactivity disorder. In: Levy TM (ed) Handbook of attachment interventions. Academic Press, San Diego, pp 27–65
Noble KG, Norman MF, Farah MJ (2005) Neurocognitive correlates of socioeconomic status in kindergarten children. Dev Sci 8:74–87
Hughes D (2004) An attachment-based treatment of maltreated children and young people. Attach Hum Dev 6:263–278
Bernier A, Carlson SM, Whipple N (2010) From external regulation to self-regulation: early parenting precursors of young children’s executive functioning. Child Dev 81:326–339
Hammond SI, Müller U, Carpendale JIM, Bibok MB, Liebermann-Finestone DP (2012) The effects of parental scaffolding on preschoolers’ executive function. Dev Psychol 48:271–281
Kraybill JH, Bell MA (2013) Infancy predictors of preschool and post-kindergarten executive function. Dev Psychobiol 55:530–538
Gilliom M, Shaw DS, Beck JE, Schonberg MA, Lukon JL (2002) Anger regulation in disadvantaged preschool boys: strategies, antecedents, and the development of self-control. Dev Psychol 38:222–235
Vondra JI, Shaw DS, Swearingen L, Cohen M, Owens EB (2001) Attachment stability and emotional and behavioral regulation from infancy to preschool age. Dev Psychopathol 13:13–33
von der Lippe A, Eilertsen DE, Hartmann E, Killèn K (2010) The role of maternal attachment in children’s attachment and cognitive executive functioning: a preliminary study. Attach Hum Dev 12:429–444
Bernier A, Beauchamp MH, Carlson SM, Lalonde G (2015) A secure base from which to regulate: attachment security in toddlerhood as a predictor of executive functioning at school entry. Dev Psychol 51:1177–1189
Berlin L, Bohlin G (2002) Response inhibition, hyperactivity, and conduct problems among preschool children. J Clin Child Adolesc Psychol 31:242–251
Berlin L, Bohlin G, Rydell A-M (2003) Relations between inhibition, executive functioning, and ADHD symptoms: a longitudinal study from age 5 to 8½ years. Child Neuropsychol 9: 255–266
Thorell LB, Wahlstedt C (2006) Executive functioning deficits in relation to symptoms of ADHD and/or ODD in preschool children. Infant Child Dev 15:503
Iaboni F, Douglas VI, Baker AG (1995) Effects of reward and response costs on inhibition in ADHD children. J Abnorm Psychol 104:232–240
Kuntsi J, Andreou P, Ma J, Börger NA, van der Meere JJ (2005) Testing assumptions for endophenotype studies in ADHD: reliability and validity of tasks in a general population sample. BMC Psychiatry 5:1–11
Wechsler D (1991) The Wechsler intelligence scale for children 3rd. (Psykologiförlaget AB, Stockholm, Trans). The Psychological Corporation, New York
Alloway TP, Gathercole SE, Pickering SJ (2006) Verbal and vsuospatial short-term and working memory in children: are they separable? Child Dev 77:1698–1716
Wechsler D (2003) Wechsler intelligence scale for children-fourth edition (WISC-IV). Technical and Interpretive Manual. Pearson Assessment, London
Park S, Holzman PS, Goldman-Rakic PS (1995) Spatial working memory deficits in the relatives of schizophrenic patients. Arch Gen Psychiatry 52:821–828
Rydell A-M, Berlin L, Bohlin G (2003) Emotionality, emotion regulation, and adaptation among 5- to 8-year-old children. Emotion 3:30–47
Sjöwall D, Backman A, Thorell L (2015) Neuropsychological heterogeneity in preschool ADHD: investigating the interplay between cognitive, affective and motivation-based forms of regulation. J Abnorm Child Psychol 43:669–680
Rydell A-M, Thorell LB, Bohlin G (2007) Emotion regulation in relation to social functioning: an investigation of child self-reports. Eur J Dev Psychol 4:293–313
DuPaul GJ, Power TJ, Anastopoulos AD, Reid R (1998) ADHD rating scale—IV: checklists, norms, and clinical interpretation. Guilford Press, New York
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders: DSM-IV. American Psychiatric Association, Washington
Tabachnick BG, Fidell LS (2013) Using multivariate statistics, 6th edn. Pearson, Boston
Brocki K, Eninger L, Thorell L, Bohlin G (2010) Interrelations between executive function and symptoms of hyperactivity/impulsivity and inattention in preschoolers: a two year longitudinal sudy. J Abnorm Child Psychol 38:163–171
Brocki KC, Nyberg L, Thorell LB, Bohlin G (2007) Early concurrent and longitudinal symptoms of ADHD and ODD: relations to different types of inhibitory control and working memory. J Child Psychol Psychiatry 48:1033–1041
Fearon RP, Bakermans-Kranenburg MJ, Van Ijzendoorn MH, Lapsley A-M, Roisman GI (2010) The significance of insecure attachment and disorganization in the development of children’s externalizing behavior: a meta-analytic study. Child Dev 81:435–456
Sroufe LA (1983) Infant-caregiver attachment and patterns of adaptation in preschool: the roots of maladaptation and competence. In: Perlmutter M (ed) Minnesota symposium in child psychology. Lawrence Erlbaum, Hillsdale, pp 41–81
Weinfield NS, Sroufe LA, Egeland B, Carlson E (2008) Individual differences in infant-caregiver attachment: Conceptual and empirical aspects of security. In: Cassidy J, Shaver PR (eds) Handbook of attachment: theory, research and clinical applications, 2nd edn. The Guilford Press, New York, pp 78–101
Schoemaker K, Mulder H, Deković M, Matthys W (2013) Executive functions in preschool children with externalizing behavior problems: a meta-analysis. J Abnorm Child Psychol 41:457–471
Nigg JT, Hinshaw SP, Carte ET, Treuting JJ (1998) Neuropsychological correlates of childhood attention-deficit/hyperactivity disorder: explainable by comorbid disruptive behavior or reading problems? J Abnorm Psychol 107:468–480
Bühler E, Bachmann C, Goyert H, Heinzel-Gutenbrunner M, Kamp-Becker I (2011) Differential diagnosis of autism spectrum disorder and attention deficit hyperactivity disorder by means of inhibitory control and ‘Theory of Mind’. J Autism Dev Disord 41:1718–1726
Truedsson E, Bohlin G, Wåhlstedt C (2015) The specificity and independent contribution of inhibition, working memory, and reaction time variability in relation to symptoms of ADHD and ASD. J Atten Disord. doi:10.1177/1087054715587093
National Institute for Health and Care Excellence (2013) Attention deficit hyperactivity disorder: diagnosis and management of ADHD in children, young people and adults. NICE clinical guideline 72. [cited 17 June 2015] http://www.nice.org.uk/guidance/cg72
American Academy of Pediatrics (2011) ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 128:1007–1022
Cavell TA (2001) Updating our approach to parent training. I: the case against targeting noncompliance. Clin Psychol Sci Pract 8:299–318
Eyberg SM, Funderburk BW, Hembree-Kigin TL, McNeil CB, Querido JG, Hood KK (2001) Parent-Child Interaction Therapy with behavior problem children: one and two year maintenance of treatment effects in the family. Child Fam Behav Ther 23:1–20
Acknowledgments
This research was funded by a grant from the Swedish Research Council to the last author.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Salari, R., Bohlin, G., Rydell, AM. et al. Neuropsychological Functioning and Attachment Representations in Early School Age as Predictors of ADHD Symptoms in Late Adolescence. Child Psychiatry Hum Dev 48, 370–384 (2017). https://doi.org/10.1007/s10578-016-0664-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10578-016-0664-1