Attachment Style and Family Functioning as Predictors of Trauma Symptoms in Children With ADHD After a Major Disaster

Children with attention deficit hyperactivity disorder (ADHD) are vulnerable to the psychological impact of traumatic events due to inherent difficulties in emotion regulation and executive functioning. This study examines the predictive roles of attachment styles and family functioning on depressive, anxiety, and posttraumatic stress disorder (PTSD) symptoms in children with ADHD following the 2023 Türkiye earthquakes.

A longitudinal design was employed with 124 children diagnosed with ADHD, assessed at 3 months (T1) and 12 months (T2) after the earthquakes. Attachment styles were evaluated using the Three-Dimensional Attachment Styles Scale, and family functioning was assessed via the Family Assessment Device. Psychological symptoms were measured using the Children's Depression Inventory, State-Trait Anxiety Inventory, and Children's Revised Impact of Event Scale-13. Hierarchical multiple regression analyses were conducted to identify predictors of T2 emotional outcomes.

Significant reductions were observed in depressive, state anxiety, and PTSD symptoms between T1 and T2, while trait anxiety remained stable. Poor family functioning and insecure attachment styles, particularly anxious attachment, were robust predictors of elevated emotional symptoms at follow-up. Avoidant attachment was uniquely associated with PTSD symptoms but not with depression or anxiety. Pharmacological treatment was related to lower symptom severity across all domains.

The findings underscore the influence of relational and familial factors in shaping psychological responses to disaster-related trauma in children with ADHD. Post-disaster interventions should incorporate attachment-informed and family-centered approaches alongside pharmacological treatment to optimize recovery in this high-risk group.