The role of attachment styles in attention-deficit hyperactivity disorder: A meta-analytic review from the perspective of a transactional development model

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by pervasive alterations in self-regulation. Attachment patterns could be involved in maintaining the clinical features of ADHD during development. This meta-analytic review summarizes the findings of 26 cross-sectional and longitudinal studies that assessed correlations between attachment styles and ADHD features among children and adolescents. Results show that insecure attachment highlighted significant correlations with ADHD inattention and hyperactivity symptoms. Dismissive/avoidant attachment was associated with inattention features. Ambivalent/preoccupied attachment correlated with hyperactivity symptoms. Disorganized attachment was associated with inattentive symptoms. Insecure attachment was prospectively associated with later ADHD symptoms. Cross-sectional correlations between insecure attachment and ADHD symptoms were comparable to longitudinal ones. This might suggest a transactional developmental model of ADHD considering mutual reinforcement effects of insecure attachment patterns and core clinical features of the disorder. Clinical samples with ADHD should be assessed in order to support this theoretical framework.