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

ABSTRACT 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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    • "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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    • "symptoms and the presence of intellectual disability seem to significantly reduce the likelihood that a child with ASD will develop secure attachment relations (Rutgers et al. 2004; Naber et al. 2007b). One interpretation of these findings is that it may take children with ASD more time to form coherent expectations about how caregivers will respond to bids for comfort. "
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    • "Some studies have suggested that higher cognitive abilities are associated with a greater preference for mother during reunion (Rogers et al., 1993; Rutgers et al., 2004; Sigman and Ungerer, 1984). Conversely, lower cognitive age equivalents are associated with less appropriate attachment quality in both ASD and typically developing samples (Greig and Howe, 2001; Naber et al., 2007), even after accounting for chronological age (Rutgers et al., 2004, 2007). Thus, overall cognitive development may be at least partly responsible for observed differences in attachment-related behaviors between children with ASD and typical development (Koren-Karie et al., 2009). "
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    ABSTRACT: Most studies examining attachment in children with autism spectrum disorder used a strange situation paradigm and have found few significant group differences between children with autism spectrum disorder and comparisons. However, these studies predominantly used formal attachment categorizations (e.g. secure vs insecure), a method that may obscure more nuanced differences between groups. In this study, we utilized a qualitative approach to examine attachment behaviors in young children with autism spectrum disorder. Based on the results of previous studies, we looked at (a) parental gender, (b) child diagnosis, and (c) child cognitive skills to examine the role of these three factors on attachment behaviors elicited during a modified strange situation paradigm. Participants were 2- to 3-year-old children with autism spectrum disorder (n = 166) or nonspectrum disorders (n = 45), as well as a sample of 56 children with typical development. Over the three groups, 393 observations of a modified strange situation paradigm with mothers and 127 observations with fathers were collected. Parental gender, child diagnosis, and child cognitive skills each had significant main effects on attachment behaviors elicited during reunion. These results underscore the importance of the father's role in parent-child interactions, with implications for both clinical and research efforts. In addition, the results emphasize the importance of considering a child's diagnosis and cognitive skills when examining attachment behaviors.
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