Autism and attachment: A meta-analytic review

Center for Child and Family Studies, Leiden University, The Netherlands.
Journal of Child Psychology and Psychiatry (Impact Factor: 6.46). 10/2004; 45(6):1123-34. DOI: 10.1111/j.1469-7610.2004.t01-1-00305.x
Source: PubMed


Sixteen studies on attachment in children with autism were reviewed, and ten studies with data on observed attachment security (N = 287) were included in a quantitative meta-analysis.
Despite the impairments of children with autism in reciprocal social interaction, the majority of the studies found evidence for attachment behaviours in these children. In four samples using the Strange Situation procedure the average percentage of secure attachments amounted to 53% (n = 72). Meta-analytic results showed that children with autism were significantly less securely attached to their parents than comparison children, and the combined effect size for this difference was moderate (r =.24). Children with autism displayed less attachment security than comparisons without autism, but this difference disappeared in samples with children with higher mental development, and in samples in which autism was mixed with less severe symptoms of autistic spectrum disorders.
It is concluded that attachment security is compatible with autism, and can be assessed with Strange Situation type of procedures. The co-morbidity of autism and mental retardation appears to be associated with attachment insecurity.

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    • "Children's attachment was assessed using the Strange Situation Procedure, which has been extensively used for assessing child–mother attachment in typically developing children. It has also been used in studies of children with developmental disabilities including ASD (Rutgers et al., 2004). The SSP was used without modifications, including two separations and two reunion episodes. "
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    ABSTRACT: The contribution of change over time in parent and child characteristics to parents' resolution of child's diagnosis was examined among 78 mothers and fathers of children with autism spectrum disorder. Children's characteristics (e.g., mental age and severity of symptoms), parental characteristics (e.g., attachment-related anxiety and stress level), and parents' resolution of their child's diagnosis (resolved vs. unresolved) were examined at Time 1, and reassessed 3 years later at Time 2. Results indicated a deferential contribution of change in parent and child characteristics among mothers and fathers. An increase in child symptom severity and in maternal attachment-related anxiety, as well as longer durations of time since receiving the diagnosis, significantly predicted maternal resolved status at Time 2. Conversely, none of the changes in children's or paternal characteristics predicted paternal resolved status at Time 2. Results are discussed in relation to child and parental contributions to resolution, the differences in the adjustment and well-being of mothers and fathers of children with autism spectrum disorder, parental growth following receiving the diagnosis, and the need for intervention components specific to parental resolution and attachment-related anxiety.
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    • "Specific deficits include failure to initiate reciprocal social interactions, verbal and non-verbal communication difficulties, decreased sensitivity to social and emotional cues, and limited perspective-taking abilities. Social withdrawal, avoidance or indifference to affection or physical contact, lack of eye contact, and decreased joint attention and facial responsiveness are also common [2]. In addition to these core features, there is a growing body of literature that describes problematic patterns of emotional reactivity (increased negative and decreased positive emotions) and emotion regulation (increased use of maladaptive and decreased use of adaptive emotion regulation strategies) [3] [4] [5]. "
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    • "More severe autistic symptoms and developmental delays were associated with more insecure and disorganized attachment. These studies have concluded that the children with autism are able to establish secure attachment with their parents, but the ways in which they displayed attachment to their parents tended to be idiosyncratic, asynchronous, less flexible and less responsive towards their parents than typically developing children (Nader et al., 2007; Dawson et al., 1990; Rutgers et al., 2004; Trevarthen & Daniel, 2005). It would become even worse if mothers of these children felt rebuffed, therefore, discouraged in their attempt to engage their child in a dyadic interaction with them (Estes et al., 2009; Rutgers et al., 2007). "
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