Transcript Infant Disorganised Attachment and ADHD

ADHD/DAMP, attachment
and reactive attachment
disorder (RAD)
Penny Turton
Helen Minnis
Chris Gillberg
ADHD/DAMP, attachment
and reactive attachment
disorder (RAD)
Are attachment problems
important in understanding
ADHD?
Is RAD recognisable as a
syndrome?
Does RAD and ADHD overlap?
Infant Disorganised
Attachment and ADHD
A Prospective Study of
Children Next-Born after
Stillbirth
St George’s University of
London
Grant holder:
Patricia Hughes
Team:
Penelope Turton, Carmen Pinto,
Christopher Gillberg, Sarah White,
Julia Ward, Samantha Riches,
Patricia Hughes
Background
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Neuroanatomical/ biochemical/ genetic
factors can’t explain whole variance in
presentation of ADHD
Environmental factors (e.g.maternal
depression and social disadvantage)
may be implicated in aetiology of ADHD
Some clinical reports suggest history of
insecure attachment might also be
implicated in ADHD
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Disorganised attachment (D) is
established marker of psychological
vulnerability
Both attachment related factors and
neurobiological factors reported as
predisposing to disorganisation
D is associated with problematic stress
management/ elevated risk of problem
externalising behaviours at 6 years
Children with ADHD are usually
disorganized, inattentive and impulsive
from a very young age
Could infant D behaviors be an
indication of incipient ADHD?
AIMS:
 to investigate any association
between infant disorganised
attachment behaviour and later
ADHD
 to identify factors explaining ADHD
outcomes after controlling for
mediating variables
Method
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Subjects: Cohort of 104 children who
had significant levels of disorganised
attachment in infancy
Assessments: Mother / teacher rated
ADHD symptoms* plus observer-rated
hyperactivity, together with range of
relevant maternal variables
*ADHD Rating Scale-IV (DuPaul, Power, Anastopoulos &
Reid, 1998).
Results
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27 (26%) infants were classified as D
8 children (7.8%) met ‘probable’ ADHD
case criteria
11 children (10.7%) met ‘possible’
ADHD case criteria
24 (23.1%) of mothers vs. 25 (24.3%)
of teachers rated the child above cutoff score of 20
Mother and teacher-rated ADHD
scores were highly correlated
Did infant D predict ADHD?
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No clear-cut association of infant
disorganized attachment and later
childhood ADHD caseness.
There was a significant correlation
between infant D and teacher rated
ADHD symptoms (more inattention than
hyperactivity)
What are the attributes of D infants that
teachers (but not mothers) observe
several years later as ADHD symptoms?
Interpretation
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D behaviours (freezing, stilling, sudden
interruptions of intended actions)
present as inattention?
Teachers more sensitive to inattention,
while mothers become habituated?
Mothers have lower tolerance
threshold for hyperactivity? (motherrated hyperactivity was associated with
lower SCID GAF score)
Maternal psychology/behaviour play a
role in mild “ADHD-like” child problems?
Comorbidity in Reactive Attachment Disorder
RAD diagnostic study funded by Chief Scientist Office
of Scottish Executive
Grantholders: Eric Taylor, Tom O’Connor, Anthony
Pelosi, David Young, James Barnes
Research Team: Julie Arthur, Michael Follan, Amanda
Burston, Brenda Connolly
Expert Panel: Jonathan Green, Danya Glaser (with Eric
Taylor and Tom O’Connor)
TEDS collaborators: Robert Plomin, Angelica Ronald
Comorbidity in RAD
DSM-IV Diagnostic Criteria for Reactive
Attachment Disorder
Inhibited type
excessively inhibited, hypervigilant or highly
ambivalent and contradictory responses
Disinhibited type
indiscriminate sociability with marked inability to
exhibit appropriate selective attachments
Comorbidity in RAD
 The RPQ is an 18-item questionnaire for RAD symptoms.
Analysis of RPQ items from 13,472 8 year olds:
•Inhibited and Disinhibited factors separate from each
other in factor analysis but not in cluster analysis
•In factor analysis, RAD factors are distinct from conduct
problems, hyperactivity and emotional problems
Comorbidity in RAD
Diagnostic research in RAD
40 “RAD”
children
aged 5-8
Assessment for
RAD, ADHD,
ODD, CD, ASD
40 GP control
children
aged 5-8
Comorbidity in RAD
Components of RAD assessment
•Structured parental interview for RAD based on
existing measures in CAPA/PAPA format
•CAPA/PAPA modules for CD/ODD and ADHD and
the 3-DI autism module.
•Teacher questionnaire based on RPQ
•Observational measure of child behaviour with
parent and strangers
•Diagnosis checked by panel of experts reviewing
positive interview items and video material
Comorbidity in RAD
Of the first 53 children, (28 controls including 2
with other clinical diagnoses and 25 RAD cases):
•52% (13) RAD cases met criteria for ODD
•12% (3) RAD cases met criteria for Conduct
Disorder
•12% (3) RAD cases met criteria for ASD
•2 children met criteria for ODD and ASD but not
RAD
Comorbidity in RAD
•68% (17) RAD cases met criteria for ADHD
•No children met criteria for ADHD but not RAD
•Of the apparently comorbid RAD/ADHD cases, less
than half (47%) were rated as abnormal (7%) or
borderline (40%) for hyperactivity on the teacher SDQ
Comorbidity in RAD
Future research planned:
•Use our RAD assessment package with children
who have a clinical diagnosis of ADHD
•Qualitative research to understand any
differences in the nature of disinhibition in
ADHD and RAD
Conclusions
Disorganised attachment in infancy does not
predict clinical ADHD
Disorganised attachment in infancy predicts
ADHD-like (mild) behaviours in early school
age
There is a very high rate of comorbid ADHD in
RAD
Future research (and clinical practice?) in
ADHD and RAD needs to take both
“conditions” into account