Can attachment predict core and comorbid symptoms of attention-deficit/hyperactivity disorder beyond executive functions and emotion regulation?

OBJECTIVE: Previous findings propose an association between attachment and symptoms of attention-deficit/hyperactivity disorder (ADHD). However, the predictive ability of attachment beyond deficits in executive functioning (EF) and emotion regulation is understudied.

METHOD: Using a dimensional perspective, we examined the longitudinal role of attachment on ADHD and comorbid symptoms, accounting for EF and emotion regulation. The sample consisted of 84 children (aged 8-13 years), oversampled for ADHD symptoms (42% had a diagnosis of ADHD). We assessed attachment with the Child Attachment Interview, EF with laboratory tests, and emotion regulation with parental ratings. Parents and teachers rated symptoms at baseline (T1) and at follow-up 2 years later (T2).

RESULTS: Attachment insecurity was positively correlated with ADHD symptoms at T2 but with no unique contribution to symptoms beyond EF and emotion regulation. In contrast, poor EF and emotion regulation contributed to more ADHD and ODD/CD symptoms at T2. Poor emotion regulation contributed to more anxiety at T2.

CONCLUSIONS: The results have important implications for understanding the mechanisms underpinning symptom expression in middle childhood/early adolescence and may guide the search for tailored interventions to reduce and prevent symptoms.

PRACTITIONER POINTS: Executive functions and emotion regulation should be explored as targets for intervention in personalized treatment. The current results do not support attachment as a target for intervention at a group level, although this does not rule out that individuals/families with attachment difficulties may benefit from training programmes promoting secure attachment bonds.