Self-protective strategies of parents with ADHD and their children as mediated by sensitivity – a multiple-case study

Publication Date28 November 2019
AuthorMilla Syrjänen,Airi Hautamäki,Natalia Pleshkova,Sinikka Maliniemi
SubjectHealth & social care,Vulnerable groups,Children's services,Sociology,Sociology of the family,Children/youth,Parents,Education,Early childhood education,Home culture,Social/physical development
Self-protective strategies of parents with
ADHD and their children as mediated by
sensitivity a multiple-case study
Milla Syrjänen, Airi Hautamäki, Natalia Pleshkova and Sinikka Maliniemi
Purpose The purpose of this paper is to explore the parental sensitivity and self-protective strategies of
parents with attention deficit hyperactivity disorder (ADHD) and those of their children.
Design/methodology/approach Six parents with ADHD and their under 3-years-old chi ldren
participated. One parent took part with her both children. The data included seven parent-child dyads.
The parents were interviewed with the modified Adult Attachment Interview. Parental sensitivity was
assessed using the CARE-Index. The self-protective strategies of the children were assessed with The
Strange Situation Procedure or the Preschool Assessment of Attachment.
Findings The study showed a variety of the self-protective strategies of parents with ADHD as well as
those of their children. Three subgroups were formed on the basis of risk as indicated by Crittendens
gradient of transformation of information. Parents displayed complex self-protective strategies as well as
unresolved traumas, which impaired their sensitivity and ability to engage in mutual regulation of arousal and
emotion. The parentsneeds of self-protection compromised their ability to protect and comfort their child
that is their sensitivity. The childrens protective strategies matched those of their parents in regard to
complexity as mediated by parental sensitivity.
Originality/value This multiple-case study demonstrates new ideas to be tested with quantitative methods
in larger samples. There are no previous studies which have examined both the attachment strategies and
sensitivity of parents with ADHD connecting these with the evolving attachment strategies of their children.
Keywords ADHD, Attachment, Self-protective strategy, Sensitivity, DMM AAI, CARE-Index, SSP, PAA
Paper type Research paper
Attention deficit hyperactivity disorder (ADHD) is a common psychiatric condition and both
genetic and environmental risk factors contribute to this familial and multifactorial disorder
(Thapar and Cooper, 2016). In attachment theory, ADHD has been conceptualized as a disorder
of self-regulation rooted in troubled early caregiver-child interactions (Clarke et al., 2002), and
connected with insecure and disorganized attachment (see Storebø et al., 2016). These studies
have been made in terms of the ABC+D model in which the category D/disorganized focuses on
particular infant behaviors as indices of breakdown of the attachment system in moments of
heightened stress (Main and Solomon, 1990). In the present study, the Dynamic Maturational
Model of Attachment and Adaptation, DMM (Crittenden, 2016a), another clinical expansion of
Mary Ainsworths original work is used, because it may be better attuned to the issues of parental
adequacy (Spieker and Crittenden, 2018). ADHD appears to be associated with troubled
parenting and insufficient protection and comfort contributing to the bonding breakconnected
to spiraling, deteriorating cycles of coercive interaction, as analyzed by Ladnier and Massanari
(2000) and with the demand-dissatisfaction cycleundermining the creation of a routine of
management,as described by Stiefel (1997) ( for a review of parenting and ADHD, see
Hechtman, 1996 and Deault, 2010). Some more recent studies have shown difficulties in
Received 15 September 2018
Revised 21 February 2019
25 April 2019
Accepted 3 June 2019
The authors would like to thank
Pekka Tani for all his help during
this study and Sami Leppämäki,
Elina Sihvola, Anniina Koski and
Laura Korhonen for taking part in
recruiting the participants for the
study, and also to Patricia
Crittenden for her help coding the
data, Mikael Kivelä for his technical
assistance, the anonymous
reviewers for their feedback and
for the most, all the participants of
this study.
Milla Syrjänen and
Airi Hautamäki are both based
at the University of Helsinki,
Helsinki, Finland.
Natalia Pleshkova is based at
St. Petersburg State University,
St. Petersburg, Russian
Sinikka Maliniemi is a
psychotherapist based in
Helsinki, Finland.
VOL. 14 NO. 4 2019, pp. 278-291, ©Emerald Publishing Limited, ISSN 1746-6660 DOI 10.1108/JCS-09-2018-0018

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