Understanding the co-morbidity of ADHD and Attachment Disorders: Implications for Diagnosis and Treatment

This study investigates the comorbidity of ADHD and Attachment Disorders in children referred to therapy for behaviours consistent with ADHD symptomology. Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder widely accepted as a common childhood condition, with prevalence rates estimated to vary from 5% (DSM-5) to 17% in school-age populations (APA, 2013; Scahill & Schwab- Stone, 2000). ADHD is characterised by patterns of behaviour including inattention, impulsivity and hyperactivity and children who experience six or more symptoms listed on the DSM-V criteria will receive a diagnosis if behaviour is present across two or more settings. The diagnostic criteria for children aged 6+ years includes behaviours such as being easily distracted, struggling to pay attention, finding it difficult to organise thoughts, fidgeting and struggling to listen or follow instructions (APA, 2013). Therapists are reporting an increase in the number of referrals for children with behaviours consistent with ADHD symptomology (Hansen, Meisller & Ovens, 2000), which reinforces the conception that ADHD is over-diagnosed (Sciutto & Eisenberg, 2007). Although child therapy research is relatively embryonic, there is an emerging perspective that children referred to therapy for ADHD actually present with symptoms better accounted for by underlying attachment disorders (AD), including Disinhibited Social Engagement Disorder (DSED) and Reactive Attachment Disorder (RAD). DSED and RAD are considerably less well known than ADHD and are associated with children who fail to establish healthy attachments with caregivers during infancy. The deleterious social and emotional consequences of poor attachment experiences during infants’ ‘critical period’ (Bowlby, 1988) has concerned psychologists for decades but recent developments in neuro-scientific research have confirmed that traumatic early attachments impact on brain development (Schore, 2002; Leo, 2014) and predispose individuals to developmental issues requiring therapeutic intervention. This study recruited medical practitioners to evaluate rates of comorbid symptoms using established scales, such as the Child Behaviour Checklist, ADHD Rating Scale and Child Attachment Checklist. Results show statistically significant co-morbidity in the oppositional behaviours presented by children with ADHD and children with attachment issues. These findings have implications for practitioners involved in the diagnosis and treatment of ADHD and attachment disorders.