Differentiating “Attachment Difficulties” From Autism Spectrum Disorders and Attention Deficit Hyperactivity Disorder: Qualitative Interviews With Experienced Health Care Professionals

Abstract

Objectives“Attachment difficulties” is an umbrella term often used to describe various forms of non-secure attachment. Differentiating “attachment difficulties” from autism spectrum disorder (hereafter autism) and attention deficit hyperactivity disorder (ADHD) has been characterized as challenging. Few studies have explored how this happens in practice, from the perspective of professionals.DesignQualitative study.MethodsWe conducted in-depth semi-structured interviews with (n = 17) healthcare professionals from five NHS Foundation Trusts in the United Kingdom. Participants were recruited using a combination of snowballing, convenience and purposive sampling. Data were analyzed using a thematic approach.ResultsWe identified six interrelated themes that might reflect difficulties with differential conceptualization. These include: a clinical lexicon of attachment; approaching attachment with caution; contextual factors; perceived characteristic behaviors; assessing attachment and adjacent supports; spotlighting intervention and dual conceptualization.ConclusionOur results indicate some of the ways suspicions around attachment are raised in practice. We advocate for more dialogue between research and practice communities on issues of differential conceptualization. We call for collaboration between a panel of experts consisting of attachment and neurodevelopmental orientated practitioners and researchers, to clarify issues around differentiating between attachment difficulties, ASD, and ADHD.

Case report: Transient symptoms of autism spectrum disorder in a 2‐year‐old boy

“…Ian's parents did not report excessively negative or unusual reactions to the new infant. While significant early deprivation and trauma have been associated with what has been termed “quasi‐autistic patterns”, 35 these attachment disorders are differentiable from ASD 36 . In Ian's case, there was no evidence of abuse or neglect; quite the contrary, Ian is being raised in a warm, loving environment, as documented by hours of video recorded in the home of Ian interacting with his parents and grandparents, who are highly engaged in his care, vigilant to his needs, and quick to seek help for his developmental delays.…”