Exploring Attachment in Adults With Autism Spectrum Disorder: A Systematic Review.

This research looked at how adults with autism form emotional bonds (called attachment) with others. The study found that autistic adults are more likely to have insecure attachment styles compared to other adults, which can affect their mental health and relationships. Autistic parents may also find it harder to bond with their own children. The researchers suggest that support programs focusing on building better relationships could help improve wellbeing for autistic adults.

This systematic review examined attachment styles in adults with autism spectrum disorder (ASD) across 12 studies involving 91,424 participants. The review found that individuals with ASD demonstrate higher rates of insecure attachment compared to the general population, which may impact their mental health and well-being. The studies assessed various factors including depression, anxiety, relationship satisfaction, and emotional intelligence. Parents with ASD also showed difficulties establishing bonds with their children.

The review followed PRISMA guidelines with high inter-rater reliability (kappa 0.94-1.0). The findings highlight the need for targeted interventions to improve attachment and bonding in adults with ASD to enhance their overall mental health and well-being.

Results suggest screening for attachment difficulties in adults with ASD may be beneficial. Development of attachment-focused interventions could improve mental health outcomes. Specialized parenting support programs for autistic parents may help improve parent-child bonding and family wellbeing.

The review had a highly skewed gender distribution (98.99% women, 0.38% men), limiting generalizability to men with ASD. The abstract does not specify the quality of included studies or discuss methodological limitations of the primary research, which may affect the reliability of conclusions.

Attachment styles may exert an influence on emotional regulation, specifically, secure attachment has been associated with more adaptative emotion regulation strategies and enhanced adult well-being. Despite the recognized importance of secure attachment in promoting mental health and well-being, little is known about how attachment styles manifest and evolve in adults with autism spectrum disorder (ASD). This systematic review examines "What is the connection between attachment styles and psychological, relational, and clinical variables in individuals with ASD or autistic traits, according to scientific research?". A literature search, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed across PubMed, Web of Science and ProQuest Central databases.

Using HubMeta, 12 studies were selected based on set criteria. Two independent reviewers conducted the entire process, from searching and selecting studies to extracting data and assessing quality. Inter-rater agreement was high, with kappa values ranging from 0.94 to 1. The sample included 91,078 (98.99%) women and 346 (0.38%) men.

Studies assessed attachment, ASD or autistic traits (Broader Autism Phenotype, BAP), intelligence quotient (IQ), depression, anxiety, stress, marital and relationship satisfaction, emotional availability and intelligence, empathy, ASD difficulties, personality traits and motivational processes, and gaming disorder. Individuals with ASD show higher rates of insecure attachment than general population and this could have an impact on their mental health and well-being. Parents with ASD also show difficulties when establishing the bond with their children. This review highlights the importance of developing interventions with adults with ASD with the aim to establish better bonding and reaching greater well-being and mental health.

The PROSPERO Registration: CRD42024628086, (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024628086).