Dissertations and Theses

Date of Award


Document Type




First Advisor

Sarah O’Neill


Attention-Deficit/Hyperactivity Disorder; Object Relations; Attachment; Defense Mechanisms; Interpersonal Relationships; Social Functioning; Emerging Adults


Impaired interpersonal functioning, often persistent from childhood through adulthood, is common in ADHD. Symptoms of ADHD such as restlessness and impulsivity may result in behaviors such as being overly talkative, interrupting or intruding on others already engaged in activities, while inattentive symptoms may result in a person being perceived as aloof, indifferent, and/or uncaring (APA, 2013; Friedman et al., 2003). As compared to adults without a history of elevated ADHD symptoms, more impaired interpersonal functioning has been found among young adults with ADHD, and this increased impairment in adults with ADHD is often a primary reason they pursue therapy (Horowitz et al., 1988). Psychoanalytic/psychodynamic principles may help to understand the risk for social problems given that ADHD behaviors, often perceived by others to be frustrating and irritating, tend to emerge in early childhood, and it is in this context that the child-caregiver relationship develops. Caregiver sensitivity and warmth aid the development of the child’s behavioral and emotional self-regulation, promoting healthy and mature defenses. Conversely, those with difficulty self-regulating may rely on immature defenses into adulthood, negatively impacting interpersonal relationships. Therefore, it is hypothesized that immature defenses will mediate the relation between poor quality of object relations and greater interpersonal difficulties in college adults. Further, the magnitude of mediation will be stronger among adults who had elevated childhood ADHD symptoms.

This study had a large under-represented minority sample (82%) encompassing undergraduate students from a large, public college in the northeastern U.S who were racially, ethnically, and socioeconomically diverse (N=188). For Part I, participants completed online questionnaires, providing subjective reports of childhood ADHD behaviors (The Wender Utah Rating Scale), and object relations and attachment (The Adult Attachment Scale), defense mechanisms (Defense Style Questionnaire), and social functioning (Outcome Questionnaire) in adulthood. Hayes’ PROCESS model #8 was used to test the moderated mediation model.

Based on responses from Part I, participants were divided into one of two groups, “‘Low’ and ‘High’ Childhood ADHD” for Part II, which tested the simple relations among these constructs using more objective measurements. ADHD diagnosis was assessed using (The MINI Neuropsychiatric Interview), object relations and defense mechanisms were assessed using the (Mutuality of Autonomy scale) and (Defense Mechanism Manual), respectively, for the Thematic Apperception Test, and self-reported social functioning was assessed using the (Social Functioning Questionnaire).

This study suggests that those with a childhood history of elevated ADHD symptoms have greater struggles with interpersonal relationships than those without ADHD symptoms. Even when those symptoms remit, or begin later in development, some degree of social difficulties remain. Attachment interacts with childhood ADHD symptomatology to impact risk for social problems, such that protective effects of low childhood ADHD are removed for individuals with insecure attachment styles, especially Dismissing and Fearful classifications. Individuals with high childhood ADHD symptoms and adult Fearful classification experience the greatest interpersonal problems in adulthood. Higher levels of Immature defenses, the least sophisticated forms of defenses, also increase risk for poorer social functioning. Last, there is emerging evidence for a complex interplay of the health of a person’s self-other representations, the sophistication of their defenses, and severity of ADHD behaviors in childhood on the quality of their adult social interactions. For individuals who showed elevated ADHD behaviors in childhood, Preoccupied attachment was related to worse social functioning through greater use of Immature defenses.

Findings suggest that for individuals with a history of ADHD where interpersonal problems are a primary complaint, treatment may be enhanced by addressing deeper-rooted psychodynamic factors. This may include a focus on object-relational conflicts, attachment insecurity, and the continuous use of immature defense mechanisms.

Available for download on Tuesday, August 08, 2023

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