Social and emotional correlates of attachment in children with high-functioning autism spectrum disorder during middle childhood

Autism Spectrum Disorder (ASD) is defined as a neurodevelopmental disorder characterised by early-emerging and pervasive impairments in social interaction, communication and repetitive and stereotyped behaviours (American Psychiatric Association, 2013). Despite their impairments, research has established that young children with ASD display clearly discriminated, and frequently secure attachments to caregivers. Existing research has primarily focussed on comparing rates of attachment classifications between groups (i.e. ASD vs non-ASD) however the meaning of this attachment quality remains poorly understood in ASD. Recently, there has been renewed interest in better understanding the correlates and consequences of attachment quality in ASD, and this comes with increasing recognition within contemporary attachment literature of the importance of early attachment experiences in shaping core social and emotional capacities. The central aim of this thesis was to examine the attachment quality of cognitively high-functioning primary-school aged children with ASD, and the relationship of attachment quality to child social, emotional and behavioural characteristics, and caregiver emotional and relational characteristics. Three empirical studies were undertaken, using both quantitative and qualitative methodology. There were a total of 26 children with ASD and 24 typically developing children, who each participated with their primary caregiver. A majority of participating caregivers were mothers (n = 45, 90%). Children completed self-report questionnaires assessing for their perceived attachment security, use of insecure coping strategies within the attachment relationship, and anxiety symptoms. Caregivers participated in a semi-structured interview regarding their child’s attachment behaviours, and completed parent-report questionnaires assessing their child’s autism symptoms, anxiety symptoms and externalising problems, and self-report questionnaires assessing their own psychological distress, parenting stress, and romantic attachment style. The first study aimed to describe the qualitative features of the child-caregiver attachment relationship in children with ASD, and contrast this with typically developing dyads. Children with ASD were described as displaying a range of normative attachment behaviours, however there were impairments in more affectively and cognitively complex aspects of the attachment relationship such as the consistent use of the caregiver as a secure base and co-regulating agent. The caregiver’s experience was important in understanding that attachment relationship in ASD. The unique impacts of ASD impairments (i.e. emotion processing, intersubjectivity) on the attachment relationship during middle childhood are discussed. The second study aimed to examine self-reported child attachment security and insecure coping strategies in ASD, alongside the caregivers’ experience in terms of psychological distress, parenting stress and romantic attachment style. Children with ASD were no less secure, however their caregivers reported more psychological distress, parenting stress and attachment-related anxiety compared to typically developing dyads. Child attachment security was related to less caregiver psychological distress and less caregiver attachment-related anxiety, but only amongst typically developing dyads. No such association was found amongst ASD dyads. The possible impact of emotion processing impairments in ASD on the attachment relationship is discussed, as well as implications for understanding the intergenerational transmission of attachment. The third study aimed to examine the relationships between self-reported child attachment security and insecure coping strategies, and child autism symptoms, anxiety symptoms, and externalising problem behaviours, in children with ASD and typically developing children. Lower levels of attachment security were associated with more severe autism symptoms and more problems with defiance/aggression. The use of insecure-preoccupied coping strategies was associated with higher levels of anxiety. Problems with inattention and hyperactivity/impulsivity were not associated with attachment quality. Associations were not moderated by group (i.e. ASD vs typically developing), suggesting a similar profile of attachment correlates in ASD as in typically developing children. Implications for understanding the meaning of attachment quality in ASD are discussed. Taken together, results of the current thesis highlight the child-caregiver attachment relationship in ASD as a complex, bi-directional, and clinically important aspect to the presentation of a child with ASD. Results suggest that there is a reciprocal interplay between ASD impairment, the caregiver experience, and normal attachment processes, which warrants closer study. The current thesis contributes to a broadening of the clinical conceptualisation of ASD, and advocates for the need to better understand the correlates, consequences, and trajectories of attachment quality in ASD.