This article examines how ‘trauma’ has been conceptualised in the unresolved state of mind classification in the Adult Attachment Interview, introduced by Main and Hesse in 1990. The unresolved state of mind construct has been influential for three decades of research in developmental psychology. However, not much is known about how this measure of unresolved trauma was developed, and how it relates to other conceptualisations of trauma. We draw on previously unavailable manuscripts from Main and Hesse's personal (...) archive, including various editions of unpublished coding manuals, and on Main–Bowlby correspondence from the John Bowlby Archive at the Wellcome Trust in London. This article traces the emergence of the unresolved state of mind classification, and examines the assumptions about trauma embedded in the construct. These assumptions are situated both in the immediate context of the work of Main and Hesse and in terms of wider discourses about trauma in the period. Our analysis considers how a particular form of trauma discourse entered into attachment research, and in doing so partly lost contact with wider disciplinary study of trauma. (shrink)

In this presentation, I delineate five refinements that I and my associates have introduced during the last decade to the literature on religion and spirituality from an attachment-theory perspective. First, I describe the principle of social correspondence as an addition to the idea that religiousness reflects generalizing working models of attachment. Second, I focus on what we have learned from studying implicit processes and utilizing experimental designs in religion-as-attachment research. Third, I describe results from research projects that (...) have used developmentally validated attachment assessments, such as the Adult Attachment Interview. Fourth, I emphasize the need for engaging a wider developmental range in religion-as-attachment research and sum up what we have found using non-adult samples. Finally, I argue for employing a wider research perspective on the attachment-religion/spirituality connection than the central parameters of an attachment framework would suggest, by considering possible mediators between attachment and religious or spiritual outcomes. (shrink)

A modern evolutionary perspective emphasizing life history theory and behavioral ecology is brought to bear on the three core patterns of attachment that are identified in studies of infants and young children in the Strange Situation and adults using the Adult Attachment Interview. Mating and parenting correlates of secure/autonomous, avoidant/dismissing, and resistant/preoccupied attachment patterns are reviewed, and the argument is advanced that security evolved to promote mutually beneficial interpersonal relations and high investment parenting; that avoidant/dismissing (...) attachment evolved to promote opportunistic interpersonal relations and low-investment parenting; and that resistant/preoccupied attachment evolved to foster “helper-at-the-nest” behavior and indirect reproduction. (shrink)

To date, we know very little about the effects of the differences in attachment classifications on the physiological correlates of stress regulation in adolescent age groups. The present study examined for the first time heart rate and heart rate variability during an attachment interview in adolescents. HR and HRV data were collected during a baseline assessment as well as during the administration of the Adult Attachment Projective Picture System in a community-based sample of 56 adolescents. (...) We additionally used the Adult Attachment Interview in 50% of our sample to test the convergent validity. Adolescents with a secure attachment representation showed a higher HRV from baseline to the AAP interview compared to those with an insecure-dismissing and the unresolved group. A comparison between the two insecure attachment groups showed no significant difference related to HR and HRV. Cohen’s Kappa revealed an almost perfect agreement between the AAP and the AAI for the four-group classification. Our results indicate that adolescents with a secure attachment representation are more capable of dealing with attachment-related distress which is represented in higher HRV during an attachment interview. (shrink)

The Mirror Game (MG) is a common exercise in dance/movement therapy and drama therapy. It is used to promote participants’ ability to enter and remain in a state of togetherness. In spite of the wide use of the MG by practitioners, it is only recently that scientists begun to use the MG in research, examining its correlates, validity and reliability. This study joins this effort by reporting on the identification of scale items to describe the nonverbal behaviour expressed during the (...) MG and its correlation to measures of attachment. Thus, we explored the application of the MG as a tool for assessing the embodiment of attachment in adulthood. Forty-eight participants (22 females, mean age = 33.2) played the MG with the same gender-matched expert players. All MG were videotaped. In addition, participants were evaluated on two central measurements of attachment in adulthood: The Adult Attachment Interview (AAI) and the Experience in Close Relationship questionnaire (ECR). To analyse the data, we developed the “mirror game scale” that coded the nonverbal behavior during the movement interaction, using 19 parameters. The sub-scales were reduced using factor analysis into two dimensions referred to as “together” and “free”. The free factor was significantly correlated to both measurements of attachment: Participants classified as having secure attachment on the AAI, received higher scores on the MG free factor than participants classified as insecure (t (46) = 7.858, p =.000). Participants who were high on the avoidance dimension on the ECR, were low on the MG free factor (r (48) =-.-285, p =.007). This is the first study to examine the MG as it is used by practitioners and its correlation to highly standardized measures. This exploratory study may be considered as part of the first steps of exploring the MG as a standardized assessment tool. The advantages of the MG as a simple, non-verbal movement interaction demonstrate some of the strengths of dance/movement and drama therapy practice. (shrink)

Mealey's sociobiological model of sociopathy could profit from attachment theory, in particular, the theory and research on the basis of the Adult Attachment Interview (Main & Goldwyn 1985–1993). Findings of an adult attachment study in a forensic psychiatric setting are summarized. Three attachment-oriented strategies for families, schools, and forensic settings are proposed to help reduce or prevent secondary sociopathy and criminal recidivism.

Previous studies have reported a significant positive association between ability emotional intelligence and attachment security. However, these studies may, to some extent, be misleading because they relied on self-report measures of attachment security. Furthermore, to our knowledge, no study has yet investigated the relationship between ability EI and mentalization, operazionalized as reflective functioning, although EI and RF were assumed to be “conceptual cousins.” In an attempt to overcome some of the limitations of the previous research, the current study (...) investigated the relationships between ability EI, attachment security, and mentalization measured via the Adult Attachment Interview. Ninety-three volunteer participants from an Italian community population, aged from 27 to 55 years, took part in the study. Significant positive correlations were found between ability EI, attachment security, and RF. The results shed some light on the relationship between different attachment strategies and ability EI. Hyperactivating attachment strategies correlated negatively with ability EI, while the correlation between ability EI and attachment deactivating strategies depend on which defensive strategy is used: avoiding the painful emotional contact with the memory of unpleasant childhood attachment experiences positively correlated with experiential EI, whilst the resort to derogation of the attachment needs correlated with impairment in EI. Findings from the current study suggest that future studies in developmental psychology are needed to investigate the development of the ability EI in relation to the quality of the attachment models more in-depth. (shrink)

Reflective function is defined as an individual’s ability to understand human behavior in terms of underlying mental states including thoughts, feelings, desires, beliefs, and intentions. More specifically, the capacity of parents to keep their child’s mental states in mind is referred to as parental RF. RF has been linked to adult mental health and parental RF to children’s mental health and development. The gold standard measure of RF is the interview-based Reflective Functioning Scale applied to the Parent Development (...) Interview or Adult Attachment Interview, which while well validated, is time-and labor-intensive to administer. Given the increasing need for reliable, valid, and rapid RF assessment in wide-ranging settings, two alternative measures were considered including the Reflective Function Questionnaire and Parental Reflective Function Questionnaire. We determined the convergent validity of these measures in comparison with the PDI-rated RFS. A sample of mothers and fathers was drawn from a sub-study of the ongoing Alberta Pregnancy Outcomes and Nutrition longitudinal cohort when their children were 42–60 months of age. Pearson correlations and multiple linear regression was conducted, followed by splitting the sample to compute Cohen’s kappas measures of agreement. Two subscales of the PRFQ correlated significantly with the gold standard PDI-rated RFS, providing evidence for convergent validity. As a brief multidimensional measure of parental RF, the PRFQ offers an alternative for measurement of RF in large-scale studies of parental development and child health. (shrink)

ObjectiveEven if the relationship between adverse childhood experiences and intimate partner violence has already been established, there are no sufficient studies examining the relationships between these factors and attachment representations, specifically attachment disorganization. Thus, this study aimed to explore, in a sample of women who experienced IPV the presence of interpersonal adversities during childhood, and attachment representations, with a particular focus on disorganization.MethodsWomen’s representations of attachment experiences were investigated through the Adult Attachment Interview, (...) while the presence of various forms of interpersonal adversities during childhood was assessed using the Complex Trauma Questionnaire. The results of the IPV group were compared with those of women with no history of IPV.ResultsWomen in the IPV group showed higher values of multiple forms of adverse experiences within their caregiving system. They presented significantly higher rates of disorganized states of mind regarding attachment, indicative of a lack of resolution regarding traumatic experiences, and of disorganized working models resulting from complex trauma. Our results highlighted that, more than the presence of traumatic experiences, it is their irresolution – reflected in the disorganized states of mind regarding attachment at the Adult Attachment Interview – to be a significant predictor of IPV.ConclusionThese results suggest underline the significance of offering a trauma- and attachment-informed therapy to those who experience IPV. Such results could help both clinicians and researchers in formulating clearer guidelines for IPV interventions. (shrink)

For three decades Jeremy Holmes has been a leading figure in psychodynamic psychiatry in the UK and across the world. He has played a central role in promoting the ideas of John Bowlby and in developing the clinical applications - psychiatric and psychotherapeutic - of Attachment Theory in working with adults. Drawing on both psychoanalytic and attachment ideas, Holmes has been able to encompass a truly biopsychosocialperspective. As a psychotherapist Holmes brings together psychodynamic, systemic and cognitive models, alert (...) to vital differences, but also keenly sensitive to overlaps and parallels. This volume of selected papers brings together the astonishing range of Holmes' interests and contributions. The various sections in the book cover: An extended interview - covering Holmes' career and philosophy as a psychodynamic psychiatrist 'Juvenilia' - sibling relationships, the psychology of nuclear weapons, and the psychodynamics of surgical intervention. Psychodynamic psychiatry: Integrative and Attachment-Informed A psychotherapy section inwhich he develops his model of psychotherapeutic change 'Heroes' - biographical pieces about the major influences including, John Bowlby, Michael Balint, David Malan, Jonathan Pedder and Charles Rycroft. 'Ephemera' - brief pieces covering such topics as frequency of psychodynamic sessions and fees. Attachments: Psychiatry, Psychotherapy, Psychoanalysis - The Selected Works of Jeremy Holmeswill be essential and illuminating reading for practitioners and students of psychiatry and psychotherapy in all its guises. (shrink)

Cet article présente un bref historique de la théorie de l’attachement, une définition des concepts, et les développements ultérieurs, tant sur le plan de la recherche que sur le plan plus actuel de la pratique, des liens avec la psychopathologie et des répercussions sur le cadre thérapeutique. Il s’agit de mettre en évidence les bases théoriques et de comprendre leur place dans le champ clinique.

Social attachment can explain well the bond between users and social media, but existing research lacks measures of social attachment scales. To this end, this study takes attachment theory as the basis for scale development. On the basis of the development of multidimensional scales for adult, brand, and local attachment, it combines existing relevant studies on social attachment, selects three representative social media such as TikTok, WeChat, and MicroBlog as theoretical samples, explores the concept (...) and structure of social attachment, and develops a social attachment scale through qualitative interviews and open-ended questionnaires. This study applied SPSS 24.0 and Mplus 7.0 to test the social attachment scale. The findings reveal that social attachment consists of three constructs: social connection, social dependence and social identity, and the scale possesses high reliability and validity. This study has developed and validated a social attachment scale in the context of social software use, realizing a quantitative study of social attachment and providing a basis for future empirical research related to social attachment. (shrink)

Functional relationships between romantic jealousy and traits, such as neuroticism or adult attachment styles, are well-known. For the first time, we conducted a joint analysis of the Big Five traits and attachment dimensions as predictors of jealousy, which considered gender differences as well as differences in infidelity experiences and relationship status. In 847 participants, path modeling showed that higher neuroticism, lower agreeableness, and lower openness predicted higher romantic jealousy. The attachment dimensions “anxiety” and “depend” partly mediated (...) the effect of neuroticism and fully mediated the effect of agreeableness on romantic jealousy. The direct and indirect relationships did not differ as a function of gender, relationship status, and infidelity experiences. These findings contribute to a better understanding of individual differences in romantic jealousy from a personality perspective. (shrink)

This article is concerned with the relationship between adult attachment styles and generalized negativistic social beliefs. Two general dimensions of attachment styles, avoidance and anxiety, are considered to be manifestations of an individual’s image of other people and of the self, respectively. We suggest that both dimensions may be a substantial basis for formulating negative beliefs about the social world. Firstly, we believe that a high level of negativistic social beliefs can be positively predicted by the growth (...) of avoidance and anxiety. Secondly, we formulate an expected interaction effect. Although the nature of such an interaction is ambiguous, it may be argued as having a synergistic as well as antagonistic pattern. These hypotheses were tested and supported on a representative sample of adult Poles. (shrink)

BackgroundThis paper represents a portion of the findings from one of the first research studies eliciting the lived experience of adults with an early diagnosis of Phenylketonuria living in Ireland. Ireland has one of the highest prevalence rates of PKU in Europe, however, little is known about the experience of Irish adults with PKU. Furthermore, Ireland is one of the first countries in the world to introduce neonatal screening followed by the introduction of long-term dietary therapy over 50 years ago. (...) This study presents the first comprehensive assessment of the lived experience of Irish adults with PKU on long term dietary therapy.MethodsNarrative data was collected from eleven self-selected participants, using semi-structured interviews. The interviews were divided into five sections focused on eliciting a holistic understanding of the lived experience of adults with PKU living in Ireland. Thematic analysis was guided by Colaizzi's Framework in conjunction with NVivo qualitative data analysis software.FindingsFindings from the original research encompassed a broad understanding of the lived experience of adults with PKU living in Ireland, including factors influencing dietary therapy and managing PHE blood levels. The themes being discussed within this article are those which appear to be least represented within current literature: living with PKU, including reproductive health, the importance of self-management and establishing routine, support networks in adulthood and concerns regarding aging with PKU.ConclusionIt was evident from the findings that a diagnosis of PKU can influence how adults with PKU may experience aging and their own mortality. These findings offer new insight into the vulnerability attached to the experience of aging with PKU and may be beneficial to advocacy groups and for future development of policy and practice. (shrink)

Our objective was to explore the relationships between adult attachment and various aspects of emotional awareness, including alexithymia and level of emotional awareness. Participants were 112 university students who completed the Attachment Style Questionnaire, the Bermond-Vorst Alexithymia Questionnaire (BVAQ), and the Level of Emotional Awareness Scale. We found that alexithymia was positively related to the avoidant attachment style and negatively with the anxious attachment style. Anxious style-but not avoidance-was also related to the level of emotional (...) awareness. An analysis of the four attachment categories revealed subtle differences regarding the subscales of the BVAQ. Findings are discussed with reference to internal working models of self and others, highlighting the relationship between emotional awareness impairment and interpersonal behaviour. Keywords: alexithymia; emotional awareness; attachment; internal working model; BVAQ; LEAS (Published: 7 March 2012) Citation: Socioaffective Neuroscience & Psychology 2012, 2 : 10744 - DOI: 10.3402/snp.v2i0.10744. (shrink)

The relationship between traumatic life events and increased suicide risk has been well reported in literature. However, the complex nature of suicidality phenomena still hinders our ability to comprehend the mediation mechanism underlying this association. In this study, we examined the mediating role of adult attachment and reflective functioning in the relationship between traumatic life events and suicidal ideation. Nine hundred and fifty Italian adults completed an online survey evaluating traumatic life events, adult attachment, reflective functioning (...) and suicidal ideation. The path analysis showed that the positive relationship between traumatic life events and suicidal ideation was partially mediated by attachment anxiety and reflective functioning. From a clinical point of view, these results support the relevance of evaluating and improving patients’ ability to mentalize as a part of psychotherapeutic intervention aimed at reducing suicidality in people with a history of traumatic experiences and attachment anxiety. (shrink)

This study focus on the phenomenon of the preference for co-living among young adults that has manifested in South Korea. The study examines life in a shared house as a living place, which is the representative form of co-living that the younger adults in South Korea have been choosing. The objective of the study is to examine shared housing as living place matters and their possibility of being a home and house for the young generation. The study procedures included reviewing (...) place attachment theory, analyzing the operational structure of shared houses, and interviewing residents to discuss the place attachment of the residential environment in shared houses. The young adult generation who chose to share a house display indecision on the issue of residential choices and behavior in terms of spatial possession. The results are as follows. Although co-living is a realistic residential choice for the reduction of residential costs, the majority of young adults experientially highlight the values of co-living rather than acknowledge the real reasons behind their choices. Such results signify that they recognize such limited residential choices as a means of temporary residence, not rooted to a living place, rather than an ordinal difference between the best and the second best, and ultimately the need to further consider the issues of continuous life and lifestyle on the foundation of the perspective of the universal life cycle of the young adult generation. (shrink)

The mechanism proposed by Del Giudice by which adult attachment style is adapted to the extrinsic risk in the local environment via attachment style during the early years does not fulfill important criteria of an adaptation. The proposed mechanism is neither specific, nor developmentally reliable, nor effective. Therefore, it should not be considered an adaptation.

Life history theory suggests that in risky and uncertain environments the optimal reproductive strategy is to reproduce early in order to maximize the probability of leaving any descendants at all. The fact that early menarche facilitates early reproduction provides an adaptationist rationale for our first two hypotheses: that women who experience more risky and uncertain environments early in life would have (1) earlier menarche and (2) earlier first births than women who experience less stress at an early age. Attachment (...) theory and research provide the rationale for our second two hypotheses: that the subjective early experience of risky and uncertain environments (insecurity) is (3) part of an evolved mechanism for entraining alternative reproductive strategies contingent on environmental risk and uncertainty and (4) reflected in expected lifespan. Evidence from our pilot study of 100 women attending antenatal clinics at a large metropolitan hospital is consistent with all four hypotheses: Women reporting more troubled family relations early in life had earlier menarche, earlier first birth, were more likely to identify with insecure adult attachment styles, and expected shorter lifespans. Multivariate analyses show that early stress directly affected age at menarche and first birth, affected adult attachment in interaction with expected lifespan, but had no effect on expected lifespan, where its original effect was taken over by interactions between age at menarche and adult attachment as well as age at first birth and adult attachment. We discuss our results in terms of the need to combine evolutionary and developmental perspectives and the relation between early stress in general and father absence in particular. (shrink)

The aim of this study was to examine preliminary evidence of the validity of the Trauma Reflective Functioning Scale and to investigate reflective functioning and attachment in pregnant women with histories of trauma, with a particular focus on the capacity to mentalize regarding trauma and its implications for adaptation to pregnancy and couple functioning. The Adult Attachment Interview was used to assess attachment, unresolved trauma and mentalization (measured as reflective function; RF) regarding relationships with (...) class='Hi'>attachment figures (RF-G) and trauma (RF-T) in 100 pregnant women with histories of abuse and neglect. The majority (63%) of women had insecure attachment states of mind and approximately half were unresolved regarding trauma. Furthermore, the majority of women manifested deficits specific to RF-T. Their RF-T was significantly lower than their RF-G; the findings indicate that women with histories of childhood abuse and neglect do not manifest a generic inhibition of reflectiveness, but a collapse of mentalization specific to trauma. Low RF-T, indicative of difficulty in considering traumatic experiences in mental state terms, was associated with difficulty in investment in the pregnancy and lack of positive feelings about the baby and motherhood. In addition, low RF-T was also associated with difficulties in intimate relationships. Results of a regression analysis with RF indicated that RF-T was the best predictor of investment in pregnancy and couple functioning. In sum, the study provides preliminary evidence that RF-T can be reliably measured and is a valid construct that has potential usefulness for research and clinical practice. It highlights the importance of mentalization specifically about trauma and suggests that it is not the experience of trauma per se, but the absence of mentalization regarding trauma that is associated with difficulties in close relationships and in making the transition to parenthood. (shrink)

Peirce’s anti-psychologism hinges on two main assumptions. First, logic and psychology belong to two separate disciplines – respectively, the normative sciences and the experimental sciences. Second, externalism must be understood as a crucial and inescapable epistemological criterion. The introspectionist illusion, according to which individuals have direct and epistemologically flawless access to their own internal states, should be dismissed. As Colapietro (2003) and Calcaterra (2006) observe, Peirce’s standpoint is far different from the Kantian classical account of anti-psychologism. This original take on (...) anti-psychologism leaves room for a functional distinction between logic and psychology, emerging from a semiotic and communicative continuity. This means that psychology, unlike logic as a formal doctrine of signs, will be epistemologically appropriate for dealing with internal psychological states, on the condition that this inquiry be focused on the communicative processes through which these internal states are expressed and conveyed. Such a Peircean account of anti-psychologism forms the epistemological background of this paper. My goal is to show how Peirce’s approach to communication and semiosis can be applied in order to discuss a specific psychological theory, in this case, attachment theory. Specifically, I propose employing Giovanni Maddalena’s Peircean distinction between complete and incomplete gestures (Maddalena 2015) to account for the distinction between secure, dismissing and preoccupied attachment patterns. To this end, I will be discussing three different measurements of attachment: the Adult Attachment Interview (AAI, George, Kaplan & Main 1985), the Adult Attachment Projection (AAP, George & West 2006), and the Patient Attachment Coding System (PACS, Talia, Miller-Bottome & Daniel 2015). Throughout this discussion, I will examine the connection between the semiotic and phenomenological category of completeness, and the psychological category of security. This connection involves an interesting normative import, which I briefly discuss in the conclusions. (shrink)

Mothers with prenatal substance use disorder often show broad deficits in their reflective functioning, implying severe risk for the relationship with their baby. Two different types of prenatal maternal RF may be important for parenting: adult attachment-focused-RF, regarding parent's own childhood experiences, and parenting-focused RF regarding their own current process of becoming a parent. However, their inter-relations and potentially different roles for parenting intervention outcomes are not clear. This study examined the associations between mothers' prenatal AAI-RF and pre- (...) and post-natal PRF, and their role in mother-infant interaction and substance use as treatment outcomes. The participants were 57 treatment-enrolled pregnant mothers with SUD and 50 low-risk comparison mothers. AAI-RF was measured with the Adult Attachment Interview. For a subsample of 30 mothers with SUD, PRF was measured with Pregnancy Interview, and with Parent Development Interview at 4 months. Mother-infant interaction was measured with Emotional Availability Scales at 4 and 12 months, and maternal substance use by post-natal substance relapses. Prenatal AAI-RF and pre- and post-natal PRF were highly associated with each other. Only higher prenatal PRF predicted better mother-infant interaction quality at 4 months and less substance use during the child's first year. Interestingly, prenatal PRF and AAI-RF predicted opposite changes in mother-infant interaction: lower prenatal PRF, but higher AAI-RF predicting more positive change. AAI-RF was especially associated with a change in maternal intrusiveness and hostility, indicating that it represents a more general regulatory tendency. Further studies are needed in larger and lower-risk samples. Our results suggest, however, that AAI-RF and PRF are partially distinct and should be uniquely targeted in perinatal interventions. (shrink)

Attachment orientations reflect individuals’ expectations for interpersonal relationships and influence emotion regulation strategies and coping. Previous research has documented that anxious and avoidant attachment orientations have deleterious effects on the trauma recovery process leaving these survivors vulnerable to posttraumatic stress disorder symptoms. However, avoidant attachment may be more complicated. Prior work has also found those high in avoidant attachment but also low in anxious attachment may not experience such vulnerabilities. Further, avoidant attachment individuals often (...) report higher self-efficacy than their anxiously attached counterparts. The present study examined trauma coping self-efficacy as a previously unexamined mechanism of action between adult attachment and PTSD symptoms. Structural equation modeling results showed that anxious attachment was associated with lower CSE-T and greater PTSD symptoms six weeks later. Further, a significant indirect effect of anxious attachment on PTSD symptoms through CSE-T was found. Contrary to hypotheses, avoidant attachment also exhibited an indirect effect on PTSD symptoms through CSE-T, such that avoidant attachment was associated with lower CSE-T, which in turn, was associated with greater PTSD symptoms. Also contrary to hypotheses, the interaction between anxious and avoidant attachment was not significantly associated with either CSE-T or PTSD symptoms. Results suggest that both anxious and avoidant attachment orientations contribute to poor self-regulation following trauma, as they undermine perceptions of trauma coping self-efficacy. (shrink)

Attachment style, relationship status, gender and relational competences among young adults The seeking of a lifetime partner/spouse, establishing and maintaining close relationships are central developmental tasks in young adulthood. In successful achievement of these tasks relational competences may play a crucial role, thus making it reasonable to study their conditions. This article provides a theoretical and empirical analysis of the relationship between relational competences and attachment style, relationship status, and gender. It presents a study of a normal sample (...) of 423 young adults, aged 20-35, who completed The Questionnaire of Relational Competences in Intimate Relationships, Revised Adult Attachment Scale, and Demographic Questionnaire. The analysis of the data revealed that in the description of various relational competences all three factors play an important role. It has also turned out that the association between relational competences and attachment style is influenced by the circumstances pertaining to relationship status. (shrink)

Objectives“Attachment difficulties” is an umbrella term often used to describe various forms of non-secure attachment. Differentiating “attachment difficulties” from autism spectrum disorder and attention deficit hyperactivity disorder 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 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. (shrink)