Neuropsychological Functioning and Attachment Representations in Early School Age as Predictors of ADHD Symptoms in Late Adolescence

Contributions of Attachment and Cognitive Functioning on ADHD Symptoms in Children

ADHD is a neurodevelopmental disorder with multifactorial origins. Several studies have shown that parent-child attachment impacts the expression of ADHD symptoms, while others have highlighted the influence of cognitive impairments on ADHD symptoms. However, few studies have simultaneously examined the respective contributions of child attachment and cognitive functions to ADHD, which is the aim of this study. We included 45 children with ADHD from a university hospital and 44 typically developing children from regular schools. Child attachment was evaluated using a self-report questionnaire, the French Attachment Security Scale (ASS-Fr), and a narrative interview, the Cartes pour l'évaluation de l'Attachement et de la Mentalisation chez l'Enfant (CAME). Cognitive assessment involved both objective and subjective measures. Perceived attachment security to both parents and disorganized attachment were significantly associated with ADHD symptoms, but these relationships were mediated by externalizing symptoms and executive function difficulties. The relationships between attachment and ADHD symptoms are indirect and mediated by the presence of externalizing symptoms and executive function impairments.

Unsupervised machine learning for identifying attention-deficit/hyperactivity disorder subtypes based on cognitive function and their implications for brain structure

BACKGROUND

Structural anomalies in the frontal lobe and basal ganglia have been reported in patients with attention-deficit/hyperactivity disorder (ADHD). However, these findings have been not always consistent because of ADHD diversity. This study aimed to identify ADHD subtypes based on cognitive function and find their distinct brain structural characteristics.

METHODS

Using the data of 656 children with ADHD from the Adolescent Brain Cognitive Development (ABCD) Study, we applied unsupervised machine learning to identify ADHD subtypes using the National Institutes of Health Toolbox Tasks. Moreover, we compared the regional brain volumes between each ADHD subtype and 6601 children without ADHD (non-ADHD).

RESULTS

Hierarchical cluster analysis automatically classified ADHD into three distinct subtypes: ADHD-A (n = 212, characterized by high-order cognitive ability), ADHD-B (n = 190, characterized by low cognitive control, processing speed, and episodic memory), and ADHD-C (n = 254, characterized by strikingly low cognitive control, working memory, episodic memory, and language ability). Structural analyses revealed that the ADHD-C type had significantly smaller volumes of the left inferior temporal gyrus and right lateral orbitofrontal cortex than the non-ADHD group, and the right lateral orbitofrontal cortex volume was positively correlated with language performance in the ADHD-C type. However, the volumes of the ADHD-A and ADHD-B types were not significantly different from those of the non-ADHD group.

CONCLUSIONS

These results indicate the presence of anomalies in the lateral orbitofrontal cortex associated with language deficits in the ADHD-C type. Subtype specificity may explain previous inconsistencies in brain structural anomalies reported in ADHD.

Attachment Styles and Parenting Attitudes in Adults With "Pseudo-Attention-Deficit/Hyperactivity Disorder"

Background The number of individuals who experience the onset of attention-deficit/hyperactivity disorder (ADHD)-like symptoms after the age of 12 years has been growing, which does not meet the diagnostic criteria for adult ADHD. We designated this condition as "pseudo-ADHD" and investigated its psychological implications by comparing the parenting attitudes in childhood and attachment styles among individuals with "pseudo-ADHD," those with adult ADHD, and healthy controls. Methods We conducted an online cross-sectional survey of adults aged 18 years. Participants in the analysis included individuals with "pseudo-ADHD" (n = 46), adults with ADHD (n = 23), and healthy controls (n = 758). The Parental Bonding Instrument (PBI) was used to evaluate parenting attitudes, and the Experiences in Close Relationships Inventory for the Generalized Other (ECR-GO) was used to evaluate attachment styles. One-way analysis of variance was performed to compare the PBI and ECR-GO scores among the three groups. Results Regarding the PBI scores, a significant main effect of group was found for the paternal care scores (p = 0.002), and the "pseudo-ADHD" group did not differ significantly from the adult ADHD group or healthy control group (p = 0.378, p = 0.228, respectively). A significant main effect of the group was found for the maternal care scores (p < 0.001). The "pseudo-ADHD" group scored significantly lower than the adult ADHD group (p = 0.005), whereas there was no significant difference compared to the healthy control group (p = 1.000). A significant main effect of the group was also found for the paternal overprotection scores (p < 0.001). The "pseudo-ADHD" group scored significantly lower than the adult ADHD group (p = 0.002), whereas there was no significant difference compared to the healthy control group (p = 0.571). A significant main effect of group was found for the maternal overprotection scores (p < 0.001), and the "pseudo-ADHD" group did not differ significantly from either the adult ADHD group or the healthy control group (p = 0.060, p = 0.161, respectively). Regarding ECR-GO scores, a significant main effect of group was found for the fear of abandonment score (p < 0.001), and the "pseudo-ADHD" group scored significantly lower than the adult ADHD group (p < 0.001) and significantly higher than the healthy control group (p = 0.005). Conclusion This study suggested that the parenting attitudes of parents of individuals with "pseudo-ADHD" were not different from those of the healthy controls. For attachment styles, the fear of abandonment was higher in individuals with "pseudo-ADHD" than in healthy controls, but not as high as in patients with adult ADHD. This study highlights, for the first time, the importance of considering attachment styles in the diagnosis and treatment of individuals with ADHD symptoms in adulthood.

Trust-Based Relational Intervention® (TBRI®) Impact for Traumatized Children-Meaningful Change on Attachment Security and Mental Health after One Year

Children from vulnerable backgrounds often have insecure attachment or disorganized attachment, which are related to psychological troubles, and such children need interventions to help them heal. The attachment system reorganizes in middle childhood, and other important adults play a considerable role in children's lives. Thus, it is essential to weigh the impact of psychosocial interventions, while the main focus of the intervention is the staff member's direct work with the child through a trusting relationship. The primary purpose of this study is to investigate whether children's attachment security and mental health outcomes change after participating in a trauma-informed, attachment-based, Trust-Based Relational Intervention (TBRI) provided in a daycare center. It was a case-series study involving twelve children aged 8-11 years. The child attachment interview (CAI), CBCL/6-18, TRF/6-18, and clinical interviews for parents and children were used, measuring the change between the TBRI implementation in the daycare center and after one year. For ten participants, we noticed an improvement in mental health; for seven participants, security scales improved; for two participants, their disorganized attachment changed into insecure-dismissing. We have preliminary evidence that vulnerable children may benefit in terms of attachment security and mental health from the trusting relationship that staff build using the TBRI.

Extraction of brain function pattern with visual-capture-task fMRI using dynamic time-window method in ADHD children

Attention deficit/Hyperactivity disorder (ADHD) has a great impact on children's development. This paper uses a novel adaptive brain state extraction algorithm to construct a dynamic time-window brain network, which captures the brain function pattern characteristics of ADHD children with higher temporal resolution. The test data were acquired by functional magnetic resonance imaging (fMRI) obtained from 23 children with ADHD during the visual-capture-task [age: (8.27 ± 2.77)]. A spatial standard deviation method is used after the initial data processing, to extract the brain activity pattern state; An improved clustering algorithm is constructed to verify the changes made to the dynamic time-window brain network model. There can be seen clear differences between each state within 0.05 s after the test. The results show that our improved new framework can effectively obtain the characteristics of dynamic brain functional connection strength changes during the task. In addition, the new algorithm is able to capture the dynamic changes of the brain network, with an 80 % improvement compared to traditional methods for the average modularity value Q. This work demonstrates a novel approach to find out the pattern changes between dynamic brain function connections, which can be of great significance for the adjuvant treatment of children with ADHD.

Family Functioning Style as a Predictor of the Quality of Cognitive Functioning of Primary School Students With ADHD

OBJECTIVE

This study aimed to specify whether family communication and satisfaction are predictors of a child's executive functions and whether attention deficit hyperactivity disorder (ADHD) severity lies in the pathway between these variables.

METHOD

Two hundred Polish children with ADHD, aged 10 to 13, were tested using Conners 3, the PU1 Battery of Cognitive Tests and Stanford-Binet Intelligence Scale, Fifth Edition (SB5). Parents filled out the FACES IV-SOR questionnaire. Structural equation modeling (SEM) was used to test the hypotheses.

RESULTS

The quality of family communication and satisfaction did not predict executive functioning in children with ADHD, and ADHD severity did not play a mediating role neither in boys or in girls. Intelligent quotient was the only predictor of executive functioning in the group of boys.

CONCLUSION

These results contrast with those of previous studies that have shown the existence of similar associations in other cultural contexts.

Dynamic functional connectivity changes of resting-state brain network in attention-deficit/hyperactivity disorder

Patients with attention-deficit/hyperactivity disorder (ADHD) have shown abnormal functional connectivity and network disruptions at the whole-brain static level. However, the changes in brain networks in ADHD patients from dynamic functional connectivity (DFC) perspective have not been fully understood. Accordingly, we executed DFC analysis on resting-state fMRI data of 25 ADHD patients and 27 typically developing (TD) children. A sliding window and Pearson correlation were used to construct the dynamic brain network of all subjects. The k-means+ + clustering method was used to recognize three recurring DFC states, and finally, the mean dwell time, the fraction of time spent for each state, and graph theory metrics were quantified for further analysis. Our results showed that ADHD patients had abnormally increased mean dwell time and the fraction of time spent in state 2, which reached a significant level (p < 0.05). In addition, a weak correlation between the default mode network was associated in three states, and the positive correlations between visual network and attention network were smaller than TD in three states. Finally, the integration of each network node of ADHD in state 2 is more potent than that of TD, and the degree of node segregation is smaller than that of TD. These findings provide new evidence for the DFC study of ADHD; dynamic changes may better explain the developmental delay of ADHD and have particular significance for studying neurological mechanisms and adjuvant therapy of ADHD.

Owner-rated hyperactivity/impulsivity is associated with sleep efficiency in family dogs: a non-invasive EEG study

Subjective sleep disturbances are reported by humans with attention-deficit/hyperactivity disorder (ADHD). However, no consistent objective findings related to sleep disturbances led to the removal of sleep problems from ADHD diagnostic criteria. Dogs have been used as a model for human ADHD with questionnaires validated for this purpose. Also, their sleep physiology can be measured by non-invasive methods similarly to humans. In the current study, we recorded spontaneous sleep EEG in family dogs during a laboratory session. We analyzed the association of sleep macrostructure and deep sleep (NREM) slow-wave activity (SWA) with a validated owner-rated ADHD questionnaire, assessing inattention (IA), hyperactivity/impulsivity (H/I) and total (T) scores. Higher H/I and T were associated with lower sleep efficiency and longer time awake after initial drowsiness and NREM. IA showed no associations with sleep variables. Further, no association was found between ADHD scores and SWA. Our results are in line with human studies in which poor sleep quality reported by ADHD subjects is associated with some objective EEG macrostructural parameters. This suggests that natural variation in dogs' H/I is useful to gain a deeper insight of ADHD neural mechanisms.

Child attachment and ADHD: a systematic review

Attention Deficit/Hyperactivity Disorder (ADHD) is a frequent neurodevelopmental disorder in children. ADHD has a multifactorial origin, combining genetic and environmental factors. Several studies suggested an influence of early parent-child relationships on the symptomatic expression of ADHD. In this review, we examine the studies that have investigated the links between attachment and ADHD in children. We searched for studies published between January 2000 and November 2019 on PsychInfo, PubMed, and Scopus. Selected studies included a theoretically based measure of attachment and an explicit measure of ADHD symptoms or an ADHD diagnosis. Studies that included children from adoption, institutionalization, or mistreatment were not included. We found only 26 studies meeting the inclusion criteria. Almost all these studies indicated a link between the attachment type and the presence of attentional difficulties and hyperactivity. However, associations were better explained, in several studies, by confounding factors such as comorbidities, cognitive difficulties, or contextual factors. The method used to assess attachment and parental mental health also had an impact. An increasing number of studies show a link between the type of attachment and the presence of attentional difficulties and hyperactivity in children. However, the nature of this link remains unclear. Implications for future research are discussed.

Executive Functioning and Emotion Regulation in Children with and without ADHD

Difficulties with emotion regulation affect the majority of youth with attention-deficit/hyperactivity disorder (ADHD) and predict greater functional impairment than ADHD symptoms alone. Deficits in executive functioning are also present for most children with ADHD, and have been linked with emotion regulation difficulties in both clinical and neurotypical populations throughout development. The current study was the first to assess all three core executive functions (working memory, inhibitory control, set shifting) simultaneously in a clinically-diverse sample of children with and without ADHD and common comorbidities and investigate the extent to which they uniquely predict emotion dysregulation. A sample of 151 children ages 8-13 years (M = 10.36, SD = 1.52; 52 girls; 70.2% White/Non-Hispanic) were assessed using a criterion battery of executive functioning tasks, teacher-reported ADHD symptoms, and parent-reported emotion regulation. Results of the bias-corrected, bootstrapped conditional effects path model revealed that better-developed working memory predicted better emotion regulation (β = 0.23) and fewer ADHD symptoms (β = -0.21 to -0.37), that ADHD symptoms (β = -0.18 to -0.20) independently predicted emotion dysregulation, and that working memory exerted indirect effects on emotion regulation through both inattention and hyperactivity/impulsivity (β = 0.04-0.07). Sensitivity analyses indicated that these effects were generally robust to control for age, sex, executive function interrelations, and inclusion/exclusion of children with co-occurring ASD. These findings underscore the importance of working memory (relative to inhibitory control and set shifting) and its relations with ADHD symptoms for understanding children's emotion regulation skills, and may help explain the limited efficacy of first-line ADHD treatments, which do not target working memory, for improving emotion regulation skills.

Convergent neural correlates of prenatal exposure to air pollution and behavioral phenotypes of risk for internalizing and externalizing problems: Potential biological and cognitive pathways

Humans are ubiquitously exposed to neurotoxicants in air pollution, causing increased risk for psychiatric outcomes. Effects of prenatal exposure to air pollution on early emerging behavioral phenotypes that increase risk of psychopathology remain understudied. We review animal models that represent analogues of human behavioral phenotypes that are risk markers for internalizing and externalizing problems (behavioral inhibition, behavioral exuberance, irritability), and identify commonalities among the neural mechanisms underlying these behavioral phenotypes and the neural targets of three types of air pollutants (polycyclic aromatic hydrocarbons, traffic-related air pollutants, fine particulate matter < 2.5 µm). We conclude that prenatal exposure to air pollutants increases risk for behavioral inhibition and irritability through distinct mechanisms, including altered dopaminergic signaling and hippocampal morphology, neuroinflammation, and decreased brain-derived neurotrophic factor expression. Future studies should investigate these effects in human longitudinal studies incorporating complex exposure measurement methods, neuroimaging, and behavioral characterization of temperament phenotypes and neurocognitive processing to facilitate efforts aimed at improving long-lasting developmental benefits for children, particularly those living in areas with high levels of exposure.

Adolescents' executive functions: Links to inattention, hyperactivity-impulsivity, trait mindfulness, and attachment relationships with fathers and mothers

BACKGROUND AND OBJECTIVES

Considering the important role of executive functions (EF) for adjustment across the lifespan, this study aimed to deepen understanding of protective/risk factors for EF in a potentially vulnerable population: adolescents with ADHD. This study compared adolescents with versus without ADHD for differences in EF, attachment relationships with fathers/mothers, and trait mindfulness and investigated these possible protective/risk factors' contributions to EF in both adolescent groups.

METHODS

Ninth graders (N = 91; 49 boys, 42 girls) ages 14-15 years (M = 14.50, SD = 0.50) comprised 45 with ADHD and 46 with typical development (TD). Adolescents completed three self-reports (trait mindfulness, attachment to mother/father). Mothers rated their adolescents' ADHD symptoms and EF.

RESULTS AND CONCLUSION

Significantly more maladaptive outcomes emerged for adolescents with ADHD than TD in their EF, attachment with mothers, and mindfulness. Regression analyses demonstrated the significant risk posed by ADHD symptoms and the protection offered by trait mindfulness and attachment with fathers in explaining EF. Discussion focused on understanding these protective/risk factors' possibly unique and complementary roles, suggesting interventions for adolescents with ADHD in family and school settings.

A Review of Working Memory Training in the Management of Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders among children. Working memory deficits underlie many of the behavioural symptoms of ADHD. Alongside psychostimulant medications, strategies to improve working memory may play an important adjuvant role in the management of ADHD. In this study, we review the role of working memory deficits in ADHD, the evidence surrounding working memory training strategies in the management of the condition, and the factors affecting the success of these strategies in alleviating ADHD symptoms. More specifically, we review several non-pharmacological interventions that target working memory deficits in ADHD, with special emphasis on cognitive working memory training. We conclude that the development of evidence-based interventions such as computerised cognitive training (CCT) could provide an alternative or adjunct to the use of psychostimulants, especially in cases where side effects are a major issue.

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.

Psychological defense mechanisms and use of corporeal discourse: a comparison between patients with irritable bowel syndrome, medical personnel and healthy volunteers

OBJECTIVE

The aim of this study was to compare the use of psychological defense mechanisms and corporeal discourse among patients with irritable bowel syndrome (IBS), medical personnel and healthy volunteers.

METHODS

All participants completed an identical battery of questionnaires: a demographic questionnaire, the Corporeal Discourse Questionnaire, the Defense Style Questionnaire and a Visual Analogue Scale for situational anxiety and depression. Patients and medical personnel were recruited from the Rabin Medical Center, a tertiary university-affiliated hospital. Findings were analyzed according to the study variables and compared among the groups.

RESULTS

Questionnaires were completed by 40 patients with IBS, 39 medical personnel and 40 healthy volunteers. Correlations between the study variables within the entire study group (all study participants, N = 119) revealed that corporeal discourse was found to be significantly correlated with the immature and neurotic class of defense mechanisms (r = 0.41, P < 0.01 and r = 0.20, P < 0.05, respectively), depression (r = 0.46, P < 0.05) and anxiety (r = 0.46, P < 0.05). Differences between IBS and the other two groups were significant for corporeal discourse, depression, anxiety and use of immature defense mechanisms. Posthoc analyses showed that medical personnel differed from IBS patients in all of these measures. Healthy volunteers had an inconsistent pattern of differences from the other two groups.

CONCLUSION

Maturity level of defense mechanisms and the tendency to use corporeal discourse are expressed among IBS patients in a diverse and unique manner. These findings may indicate additional psychological mechanisms that could explain the use of somatic complaints in IBS and support the implementation of tailored psychological interventions.

Attachment Representation and Emotion Recognition Ability in Children with ADHD and Their Parents: A Study Protocol

Background: Few studies in clinical attachment research to date have examined children with an attention-deficit/hyperactivity disorder (ADHD) diagnosis. This is surprising for two reasons: first, there are a number of parallels between the behaviors of children with an insecure and disorganized attachment and the behaviors of children with an ADHD diagnosis. Second, secure attachment has a positive effect on the development of skills in areas in which children with ADHD demonstrate problems (e.g., attention span, impulse control). There are currently no findings on whether or not and how insecure and disorganized attachment and ADHD affect children’s emotion recognition ability. Methods: This is a cross-sectional study, part exploratory and part hypothesis-driven in the context of basic research. A clinical sample of 5- to 10-year-old children with an ADHD diagnosis and their parents is to be compared to a non-clinical unaffected control group. Over a period of 3 years, 80 subjects and their parents are to be recruited in each group for participation in the study. Discussion: This study is the first to examine links between attachment, emotion recognition ability, and ADHD. It is also the first to include not just children with ADHD but also their mothers and fathers in its design. The findings should help reduce the research gap and generate more knowledge for family interventions in the case of ADHD.

Attachment and Executive Functions in ADHD Symptomatology-Independent Inputs or an Interaction?

Despite a multitude of research on executive functions and attachment in Attention Deficit Hyperactivity Disorder (ADHD), a synthetic approach to the matter seems to have been lacking. In this review, we attempt to check the available data against two hypotheses: (1) executive functions and attachment influence ADHD symptoms independently; (2) executive functions and attachment interact to produce ADHD symptoms. We found no evidence falsifying the former hypothesis and some evidence to refute the latter. Limitations of current study approaches and suggestions for further research are discussed. Specifically, we propose an attachment representation, rather than attachment style, approach to measuring the mediation thereof between executive dysfunctions and ADHD.

An Examination of Relations Among Working Memory, ADHD Symptoms, and Emotion Regulation

Emotion regulation difficulties are present in many, if not most, children with attention-deficit/hyperactivity disorder (ADHD) and confer risk for a host of adverse outcomes. Little is known, however, regarding the neurocognitive and behavioral mechanisms that underlie these difficulties. A well-characterized, clinically evaluated sample of 145 children ages 8-13 years (M = 10.33, SD = 1.47; 55 girls; 69% White/non-Hispanic) were administered multiple, counterbalanced working memory tests and assessed for emotion dysregulation and ADHD symptoms via multiple-informant reports. Bias-corrected, bootstrapped conditional effects modeling indicated that underdeveloped working memory exerted significant direct effects on emotion regulation in all tested models as well as indirect effects on emotion regulation via parent-reported hyperactive/impulsive symptoms (95% CIs excluded zero). Interestingly, hyperactive/impulsive symptoms also predicted emotion dysregulation when controlling for the influence of working memory. Inattention failed to predict emotion regulation difficulties in all tested models (all 95% CIs included zero). This pattern of results replicated across parent and teacher models and were robust to control for mono-informant bias, age, and gender. These findings suggest that emotion dysregulation in ADHD reflects, in part, both a direct outcome of underdeveloped working memory and an affective outcome of hyperactive and/or impulsive symptomatology, both attributable to and independent of the role of underlying working memory deficits.

Evaluating Cognitive and Behavioral Outcomes in Conjunction with the Secure Base Effect for Dogs in Shelter and Foster Environments

Although it is widely accepted that dogs and humans form attachment relationships, characterizing attachment styles in dogs has only recently received attention in the literature. Previous research has shown that pet dogs display patterns of behavior in an attachment test that can be classified into secure and insecure attachment styles, much like human children and their caretakers. However, we currently know relatively little about the role of attachment styles in relation to canine well-being. This question may be of particular interest for the 3.9 million dogs that enter animal shelters in the United States alone each year, as this transition marks the dissolution of prior bonds and the establishment of new attachment relationships. Herein, results are presented from analyses of volunteer-reported canine personality and behavior measures, as well as performance on two cognitive tasks as they relate to attachment styles developed within shelter and foster environments. Results from the Canine Behavioral Assessment and Research Questionnaire (C-BARQ) indicated that foster dogs were scored as having significantly higher levels of attachment and attention-seeking behaviors when compared with shelter dogs. In both environments, dogs categorized as securely attached to a shelter or foster volunteer had lower neuroticism scores. Secure attachment in foster homes was also associated with improved persistence and performance on a point following task. These results provide support for the idea that attachment styles formed with temporary caregivers is associated with other behavioral and personality measures, and therefore may have implications for behavior and welfare in dogs living in foster homes and animal shelters.

Attachment disorder and attachment theory - Two sides of one medal or two different coins?

INTRODUCTION

Currently, attachment quality and attachment disorder exist in parallel, but the mutual association is still insufficiently clarified. For policy makers and clinical experts, it can be difficult to differentiate between these constructs, but the distinction is crucial to develop mental-health services and effective treatment concepts. We aimed to investigate the association between attachment representations (AR) and attachment disorders (AD), including Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) in children aged between 5 and 9.

METHODS

A total of 135 children aged between 5 and 9 years (M=7.17 years, SD=1.40, 63% male) and their primary caregivers participated in the study. Children were interviewed with the story stem method to assess AR, and the primary caregiver completed diagnostic interviews and questionnaires on mental disorders, AD, emotional and behavioral problems, and intelligence and development.

RESULTS

The prevalence of AR in children with AD was 28.6% for the 'secure' form of AR, 17.1% for the 'insecure-avoidant' form, 25.7% for the 'insecure-ambivalent' form, and 28.6% for the 'disorganized' form. Prevalences of the various AR forms did not differ statistically significantly, indicating that AR is conceptionally distinct from AD. Children with disorganized attachment scored significantly lower on language and intelligence skills than children with secure attachment. AD was significantly associated with a higher number of comorbidities, emotional and behavioral problems, and lower language skills.

CONCLUSIONS

Longitudinal studies using standardized assessment instruments are needed to systematically provide comparable and reliable empirical findings to improve current understanding of AR and AD as well as their etiological models.

Attachment and attention problems: A meta-analysis

Attachment theorists have argued that securely attached children tend to exhibit flexible attention; the attention of children with resistant attachments is centered on attachment-related worries; children with avoidant attachments defensively focus attention away from attachment-related emotions/thoughts; and children with disorganized attachments exhibit the collapse of attention and disorientation. In this meta-analysis, a relation between attachment security status and attention problems (APs) in children (18 years and younger) was found. In total, 62 studies (67 samples) met the inclusion criteria. Children with insecure attachments were higher in APs than those with a secure attachment (r = 0.21); those with avoidant or resistant attachments were higher than securely attached children (rs = 0.10 and 0.21, respectively); children with disorganized attachments were higher than those with organized attachments (r = 0.27). Effects were larger when attachment and APs were measured concurrently/closer in time (for secure versus all; disorganized versus organized attachment); for representational versus observational measures of attachment, non-parental reports of APs, and attachment assessed at an older age (for disorganized versus organized attachment); for samples with proportionally fewer boys (secure versus resistant attachment); in recent studies (secure versus avoidant attachment); and when disorganized children were in a high-risk sample or resistant children were in a low-risk condition.

Longitudinal Neuropsychological Assessment in Two Elderly Adults With Attention-Deficit/Hyperactivity Disorder: Case Report

The neuropsychological deficits in attention-deficit/hyperactivity disorder (ADHD) may present clinical features similar to mild and/or major neurocognitive disorder and may act as a confounding factor, making it difficult to detect cognitive decline. In this paper, we present the results of longitudinal neuropsychological evaluations in two elderly women with ADHD. Three neuropsychological assessments were performed in two women with ADHD (60 and 77 years old) between 2010 and 2013 at intervals varying from 12 to 15 months. We used structural magnetic resonance imaging to rule out significant abnormalities that could account for cognitive impairment. The results showed two different cognitive profiles with fluctuations in performance over these 2 years, sometimes with improvement and sometimes with decline of some functions such as attention, memory, inhibitory control, and reaction time. To minimize confounding aspects of these fluctuations in clinical practice, we used a longer follow-up with the application of a reliable change index and a minimum of three spaced assessments to provide a more consistent baseline cognitive profile. Our findings did not indicate a consistent cognitive decline, suggesting a less pessimistic perspective about cognitive impairments that could be a prodrome of ADHD-related dementia.

Can working memory training work for ADHD? Development of central executive training and comparison with behavioral parent training

OBJECTIVE

Working memory deficits have been linked experimentally and developmentally with attention-deficit/hyperactivity disorder (ADHD)-related symptoms/impairments. Unfortunately, substantial evidence indicates that extant working memory training programs fail to improve these symptoms/impairments. We hypothesized that this discrepancy may reflect insufficient targeting, such that extant protocols do not adequately engage the specific working memory components linked with the disorder's behavioral/functional impairments.

METHOD

The current study describes the development, empirical basis, and initial testing of central executive training (CET) relative to gold-standard behavioral parent training (BPT). Children with ADHD ages 8-13 (M = 10.43, SD = 1.59; 21 girls; 76% Caucasian/non-Hispanic) were treated using BPT (n = 27) or CET (n = 27). Detailed data analytic plans for the pre/post design were preregistered. Primary outcomes included phonological and visuospatial working memory, and secondary outcomes included actigraphy during working memory testing and two distal far-transfer tasks. Multiple feasibility/acceptability measures were included.

RESULTS

The BPT and CET samples did not differ on any pretreatment characteristics. CET was rated as highly acceptable by children and was equivalent to BPT in terms of feasibility/acceptability as evidenced by parent-reported high satisfaction, low barriers to participation, and large ADHD symptom reductions. CET was superior to BPT for improving working memory (Group × Time d = 1.06) as hypothesized. CET was also superior to BPT for reducing actigraph-measured hyperactivity during visuospatial working memory testing and both distal far-transfer tasks (Group × Time d = 0.74).

CONCLUSIONS

Results provide strong support for continued testing of CET and, if replicated, would support recent hypotheses that next-generation ADHD cognitive training protocols may overcome current limitations via improved targeting. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

[Attachment and Externalizing Behavior Problems in Primary School Children with ADHD]

Attachment and Externalizing Behavior Problems in Primary School Children with ADHD When examining children with ADHD, attachment research does not usually differentiate between the different clinical pictures within the disorder. This study examines attachment and ADHD in children who display a simple or unspecified form of ADHD, in order to be able to draw specific conclusions about this particular group. Attachment, ADHD symptoms as well as externalizing behavior problems were assessed from 93 children aged five to nine years, 48 of whom had an ADHD diagnosis. The distributions of attachment representations between children with ADHD and those without ADHD differ greatly. In addition, externalizing behavior problems differ between attachment classifications. Attachment seems to be an important factor in the etiology of ADHD, however, ADHD as well as externalizing behavior problems as a global construct are too unspecific to determine the influence of attachment on the disorder. Subsequent studies should first focus on specific symptom patterns within the clinical picture whereas clinical practice should consider the parent-child relation an important factor in the development as well as the treatment of ADHD.

The Attachment Doll Play Assessment: Predictive Validity with Concurrent Mother-Child Interaction and Maternal Caregiving Representations

Attachment is central to the development of children’s regulatory processes. It has been associated with developmental and psychiatric health across the life span, especially emotional and behavioral regulation of negative affect when stressed (Schore, 2001; Schore and Schore, 2008). Assessment of attachment patterns provides a critical frame for understanding emerging developmental competencies and formulating treatment and intervention. Play-based attachment assessments provide access to representational models of attachment, which are regarded in attachment theory as the central organizing mechanisms associated with stability or change (Bowlby, 1969/1982; Bretherton and Munholland, 2008). The Attachment Doll Play Assessment (ADPA, George and Solomon, 1990–2016; Solomon et al., 1995) is a prominent established representational attachment measure for children aged early latency through childhood. This study examines the predictive validity of the ADPA to caregiving accessibility and responsiveness assessed from mother-child interaction and maternal representation. Sixty nine mothers and their 5–7-year-old children participated in this study. Mother-child interaction was observed during a pre-separation dyadic interaction task. Caregiving representations were rated from the Caregiving Interview (George and Solomon, 1988/1993/2005/2007). Child security with mother was associated with positive dyadic interaction and flexibly integrated maternal caregiving representations. Child controlling/disorganized attachments were significantly associated with problematic dyadic interaction and dysregulated-helpless maternal caregiving representations. The clinical implications and the use of the ADPA in clinical and educational settings are discussed.