No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Attachment disorders: Assessment strategies and treatment approaches
Abstract
The aim of this special issue is to examine methods for assessing and treating attachment disorders. This target article outlines existing strategies for assessment and considers which aspects of severe attachment disturbances and disorders may be core features of the disturbance(s). The usefulness of alternative methodologies for assessment are discussed, with particular emphasis on the need for the development of clinical protocol. The applications and implications for treatment are then discussed, with particular emphasis on the nature of the underlying disturbances that should be a focus for intervention. An absence of established treatment guidelines or consensus regarding the mechanisms of change are highlighted as barriers to further progress.
... This is especially true in foster and adoptive families in which children have been abused or neglected as part of their early experiences. Research on foster children and problematic attachment has consistently found that long-term sequela of abuse leads to a complex array of emotional deficiencies and behavioral symptoms that reflect the traumatic effects of maltreatment on children, and create strain on attachment with their adoptive parents (Berry & Barth, 1989;Dyer, 2004;O'Connor & Zeanah, 2003). This strain in the children's lives, often across multiple placements a nd multiple caregivers, increases the likelihood of difficulties across a range of development. ...
... Researchers investigating children adopted at older ages report many of the same symptoms found in foster children with backgrounds of pathogenic care, including a failure to develop secure attachments. Behavioral and emotional descriptions of these older children suggest that they lack impulse control and normal conscience and moral development (Termini & Golden, 2007), and often present as superficially engaging or connected to others, emotionally aloof, and unwilling to participate in treatment, all possibly connected to impaired attachment (Dyer, 2004;O'Connor & Zeanah, 2003). ...
... In recent research regarding long-term family foster care, older children were often described by foster and adoptive parents as suspicious and highly adaptable, all in an effort to control or manipulate people viewed as sources of fear rather than sources of love or security (Schofield & Beek, 2005). Research studies focusing on different methods of attachment related treatment indicate that these children generally present as a diagnostic challenge and were likely to view caregivers as someone who must be controlled through threats and intimidation (Hughes, 2004;O'Connor & Zeanah, 2003). This finding is especially important to the psychological treatment of children, given recent retrospective evidence that most attachment and post-attachment related problems inevitably impact other family members and eventually influence adjustment outside the family. ...
Attachment theory provides a useful conceptual framework for understanding trauma and the treatment of children who have been abused. This article examines childhood trauma and attachment issues from the perspective of behavior analysis, and provides a theoretical basis for two alternative treatment models for previously abused children and their foster or adoptive parents: rational cognitive emotive behavioral therapy and trauma-based psychotherapy. These new treatment approaches are based on the integration of attachment theory and basic concepts and principles of rational thought and behavior analysis. These therapeutic models provide dyadic, cognitive, and emotive interventions that encourage behavior change with foster or adopted children who have been abused or neglected as part of their early experiences. The role of emotion in behavioral causation and the teaching and learning of different behavior are central to the treatment process, just as they are central features in healthy parent child relationships. Conclusions are reached that “familial and therapeutic environments” in which perception and previous learning guide parent child interaction are more important than diagnostic orientation, and implications for specific cognitive and behavioral interventions are suggested.
... According to Mercer (2013), Zaslow attributed emotional disturbances to a lack of attachment and anger issues. Many clinicians felt holding therapy was more harmful than useful (Barth et al., 2005;Dozier, 2003;O'Connor & Zeanah, 2003). Rage induction, shame induction, and being held forcefully are at the center of the intervention (Chaffin et al., 2006;Dozier, 2003;Hughes, 2003;O'Connor & Zeanah, 2003). ...
... Many clinicians felt holding therapy was more harmful than useful (Barth et al., 2005;Dozier, 2003;O'Connor & Zeanah, 2003). Rage induction, shame induction, and being held forcefully are at the center of the intervention (Chaffin et al., 2006;Dozier, 2003;Hughes, 2003;O'Connor & Zeanah, 2003). ...
... According to O'Connor and Zeanah (2003), holding therapy is an intervention where a child is laid across the laps of one or two therapists or a parent and a therapist. The use of touch and eye contact is necessary and encouraged in holding therapy (Chaffin et al., 2006;O'Connor & Zeanah, 2003). ...
Qualitative Dissertation interviewing clinicians who work with children who have been abused and/or neglected.
... The Romanian adoptees in the ERA study were more likely to show atypical patterns of attachment behaviour than British adoptees; there was a doseresponse association of duration of deprivation on development of attachment disorder behaviour at age 4, 6 and 11 (O'Connor et al., in press;O'Connor et al., 2003;. Children reared in Romanian institutions lacked a consistent caregiver; they were reared by multiple caregivers and there was a high ratio of children to staff . ...
... O'Connor and Zeanah (2003) suggest that the core features of attachment disorder described in the DSM-IV and ICD-10 be included in future measures of attachment disorder or attachment disorder behaviour. Although they describe flaws within the diagnostic criteria, they support their use in order to encourage consistency in measurement between different studies. ...
... Although they describe flaws within the diagnostic criteria, they support their use in order to encourage consistency in measurement between different studies. Any measure should therefore cover the two forms of disinhibited and inhibited attachment disorder, including measures of inappropriate approach to strangers, lack of stranger wariness, lack of appropriate physical boundaries, seeking out physical contact with unfamiliar adults and failure to approach the caregiver when distressed (O'Connor & Zeanah, 2003). ...
There is evidence that early deprivation and institutionalisation are linked to difficulties in peer relationships in later childhood and beyond, but to date, little is known about the mechanisms underlying such difficulties. Within normally developing populations it is proposed that early attachment experiences influence peer relationships, although there is still some debate regarding the extent and manner of this influence. Given the strong evidence for the association between deprivation and attachment disturbances reported by studies of ex-institutionalised children, the present study assessed the extent to which the relationship between deprivation and difficulties in peer relationships is mediated by attachment disturbances resulting from early deprivation. Much of the research into attachment and peer relationships has focussed on infancy and thus relied mainly on observations of behaviour. This study assessed internal representations of attachment in children aged 11 years old. 90 children adopted into the UK from Romania following early severe deprivation and 30 children adopted from within the UK before 6 months of age were assessed. Data on attachment pattern was assessed from a standardised interview with the children (the Child Attachment Interview, CAI) using a modified version of the CAI coding scale. The scale focused on three cognitive indicators of attachment pattern (mentalising ability, level of narrative coherence and emotion non-containment) and behavioural indicators of attachment disturbance. Children's peer relationship difficulties were assessed from a semi-structured parent interview. The findings demonstrated a significant dose-response effect of duration of early deprivation on difficulties in peer relationships at age 11. Children who experienced deprivation presented less coherent narratives about attachment relationships and greater levels of atypical attachment behaviour than UK controls. Furthermore there was a significant negative association between deprivation and IQ; group differences in IQ mediated the relationship between deprivation and attachment. There was no evidence that the relationship between deprivation and peer relationship difficulties was mediated by attachment difficulties resulting from early deprivation; this relationship was however mediated by differences in IQ between the groups. The findings are discussed in terms of the implications they have for the focus and methods of supporting children who have experienced global early deprivation.
... More recently literature has begun to examine the link between disinhibited attachment behaviour and symptoms of what has been termed "reactive attachment disorder" (e.g. O'Connor & Zeanah, 2003). ...
... This suggests that early deprivation may result in a fundamental disturbance in wider social functioning rather than attachment relationships per se. These may need to be assessed separately from problems in the parent-child (attachment) relationship and using measures developed specifically for early deprived samples (O'Connor & Zeanah, 2003). The mechanism underlying the seeming catch-up observed in the current study with regards to attachment of children who had experienced greater lengths of deprivation remains unclear and on-going research into stability and change in attachment following early deprivation and particularly the social-cognitive processes that underlie behavioural feature, may provide further clarification. ...
... This supports the notion that the absence of a discriminated attachment figure in infancy such as is the case with children reared in institutions leads to underlying representations and deficits in socio-emotional development which are qualitatively different from deficits observed following other types of maladaptive early care. The fact that attachment disturbances at age 6 were correlated only with atypical behaviours and not with other components of attachment also provides further evidence that social difficulties following deprivation may need to be measured independently of the parent-child relationship (O'Connor & Zeanah, 2003). This again highlights the important question regarding whether the observed patterns of coherence and reflective functioning within the Romanian sample are really manifestations of attachment insecurity or whether they indicate more pervasive difficulties in social, emotional and cognitive functioning which affected their performance in the interview situation. ...
It is well documented that early deprivation has a deleterious effect upon children's subsequent ability to form attachment relationships. However, in most studies it has been difficult to differentiate the effects of early experience from continued exposure to risk and thus there is continued debate regarding, the longitudinal course and stability of attachment disturbances following early institutional care. The aim of the present study was to investigate the long-term effects of profound early deprivation on attachment representations and to examine their associations with children's previous attachment disturbances. The participants, 90 children adopted from Romanian institutions between the ages of 0-42 months and a comparison group of 30 non-deprived UK adoptees, were assessed at age 11 years. A narrative approach to assessment was adopted using the Child Attachment Interview. Previous data regarding children's attachment disturbances at age 6 were also available. ANOVA and ANCOVA analyses using planned contrasts indicated a significant association between deprivation and three of the components of attachment; coherence, reflective functioning and atypical behaviours. In addition attachment disturbances at age 6 were correlated with atypical behaviours at age 11. However, after controlling for IQ the observed associations became non-significant and cognitive functioning demonstrated the strongest mediating effect between early adverse care and later development. The discussion focuses on the role of early experiences in the organisation of attachment and its impact on wider social and cognitive functioning. Possible mechanisms underlying observed patterns of attachment are considered in the context of contemporary literature and theoretical perspectives and limitations of the study and the scientific and clinical implications are discussed.
... After the Strange Situation experiment conducted by Ainsworth, which led to the discovery of secure, insecureavoidant, and anxious-ambivalent attachment styles (Ainsworth et al., 2015;Slade, 1994), and later the disorganized style was added to it (Main & Solomon, 1990), various assessment tools were developed to better understand attachment relationships, which are used at different ages depending on the study or clinical situation. Although questionnaires and direct interviews have advantages for understanding the damage caused by attachment in insufficiently studied children, parents, especially in high-risk families, may be concerned about judgments about their parenting skills or the emergence of child behavioral problems in places like school where parents are not present, making unreliable reports (Aebi et al., 2017;O'CONNOR & Zeanah, 2003). ...
... This study seeks to identify potential patterns that differentiate attachment styles in children by examining specific linguistic indices such as narrative length, speech quality, and argument structure. In the author's view, the necessity and importance of this research lies in the fact that diagnostic tests to determine attachment styles, particularly in the initial stages of diagnosis, are often difficult to execute due to parental or child cooperation, the child's ability to respond, or limitations of mental representation methods (O'CONNOR & Zeanah, 2003). Second, the limitations of tools in measuring attachment relationships in middle childhood are one of the gaps in attachment studies (Boldt et al., 2016). ...
Objective: By exploring the language abilities of primary school children in attachment narratives and uncover potential associations between attachment styles and expressive indicators, this study investigated whether language performance can serve as a primary predictive measure for diagnosing attachment styles and injuries, particularly in cases where traditional assessment methods fall short. Methods and Materials: This descriptive and qualitative research involved a statistical population of 100 elementary school children selected through random sampling from four locations in Tehran between 2017 and 2019. Attachment styles of the children were assessed using the Finzi questionnaire. Subsequently, two story prompts devised for Iranian children, following the MacArthur Story Completion approach, were administered according to the prescribed protocol. Qualitative coding was employed to analyze all stages of recording, implementation, and children's language performance. Then, the frequency of codes within each attachment style was assessed. Findings: "Speech coherence" emerged as a significant indicator for secure children, while avoidant children displayed "briefness of expression" and "avoidance of response." Anxious children exhibited "talkativeness," "jumping from branch to branch," and "argument slippage," while disorganized children demonstrated "inability to respond" and "ambiguity" as key traits for early diagnosis of attachment style. Furthermore, only disorganized children showed a noticeable difference in the number of words expressed between the two stories. The primary distinction between these stories pertained to the presence of threats from parents or strangers. Conclusion: This study suggests that attachment styles can be predicted through language performance within this sample size. Specifically, "talkative" in anxious attachment style, "avoidance of response" in avoidant attachment style, and "ambiguity and confusion" in disorganized attachment style are noteworthy indicators. Expanding the research to a larger sample size is likely to yield more precise results.
... Disorganised attachment has also been described as a risk factor for psychopathology in high risk groups, particularly in children who have been subject to maltreatment (DeKlyen & Greenberg, 2008;Green & Goldwyn, 2002;Zeanah, Keyes & Settles, 2003). Researchers have also noted the distinctions and similarities between classifying attachment into categories and disorders of attachment (O'Connor & Zeanah, 2003;Sroufe, 1997;Zeanah & Emde, 1994). Furthermore, Green (2003) suggested that Reactive Attachment Disorder (RAD) may represent an extreme form of disorganised attachment classification. ...
... RAD has been recognised in the psychiatric classification systems for over 30 years, however, it remains a poorly understood phenotype. Researchers are continuing to debate the link between RAD and attachment insecurity and this debate is likely to continue until a more conclusive construct can be agreed (Green & Goldwyn, 2002;Minnis et al., 2009;O'Connor & Zeanah, 2003). The complex and dynamic interactions between past abuse and current caregiving environment has an entirely unique impact on each child individually. ...
... Le modèle ASCSE propose donc que certains enfants puissent développer des MIO d'attachement normatifs malgré leur situation de carence. Ce développement normatif serait facilité par la présence d'un donneur de soins stable (O'Connor et Zeanah, 2003) ou lorsque le nombre de donneurs de soins disponibles est limité, et ce, même dans une situation de carence extrême (Smyke, Dumitrescu et Zeanah, 2002). Cette trajectoire est représentée par la flèche pointillée dans la Figure 1. ...
... Cependant, l'utilisation de la SSP avec des enfants atteints de trouble d'attachement se veut problématique en ce qu'elle tient pour acquis qu'un lien d'attachement spécifique au donneur de soins a été formé, ce qui n'est pas nécessairement le cas pour ces enfants (Smyke et al., 2002). Une adaptation du système de codification incluant les comportements de l'enfant face à l'étranger permettrait de mieux évaluer la sélectivité des comportements d'attachement en amenant un niveau de comparaison pour les comportements avec la figure d'attachement O'Connor et Zeanah, 2003). ...
Le modèle de l’Attachement en situation de carence de soins extrême (ASCSE) est un modèle heuristique qui suggère une trajectoire du développement du Trouble réactionnel de l’attachement (TRA) et du Trouble de l’engagement social désinhibé (TESD). L’ASCSE est ancré dans la recherche empirique sur le TRA et le TESD et basé sur la théorie de l’attachement de Bowlby (1969/1982). Il inclut les trajectoires distinctes du TRA et du TESD, qui sont présentés comme des troubles découlant d’une perturbation du système d’attachement, et une trajectoire normative. En tant que modèle intégratif, il offre un cadre à partir duquel plusieurs questions de recherche et pistes d’interventions peuvent être dérivées.
... Also, in institutionalised children IB is observed whether or not children have a favourite caregiver (according to staff reports), and in postinstitutionalised samples it tends to persist after adoption and after the establishment of an attachment relationship with adoptive parents (O' Connor et al., 2000;). In other words, IB may be observed alongside selective, discriminated attachment relationships (even secure ones) with a preferred caregiver ( O'Connor & Zeanah, 2003b). In addition, a measure of the degree of development of attachment to the caregiver observed throughout the Strange Situation Procedure (SSP) in institutionalised children proved unrelated to interview ratings of IB-in contrast to the moderate association with inhibited behaviour ). ...
... As noted already, IB is considered to be essentially orthogonal to the construct of security of attachment Lyons-Ruth et al., 2009;). The basic distinction is that while insecure, and especially disorganised attachment, confers increased risk for maladjusted developmental trajectories, IB has maladjustment as a core feature-in other words, disorganised attachment is not in itself evidence of psychopathology, while IB is considered a disturbed behaviour (Boris & Zeanah, 1999;Gleason et al., 2011;Green, 2003;O'Connor & Zeanah, 2003b;Rutter, Kreppner, & Sonuga-Barke, 2009). Furthermore, classifications of attachment security and insecurity or disorganisation are specific to a relationship dyad-evidence clearly suggests, for example, that children may show different patterns of attachment toward different carers (e.g., Steele, Steele, & Fonagy, 1996). ...
Even though early institutionalisation is known to compromise children’s development, limits remain in the understanding of how and why some children develop a pattern of indiscriminate social behaviour (IB) and others do not. This thesis aims to address that question, by assessing IB using both the caregiver’s report and observations, and by exploring multi-level influences. An introductory background (Chapter 1) reviews the literature on attachment disturbances and IB, and discusses current perspectives on their conceptualisation and what is known about etiological factors. This is followed by a description of the methods employed in various studies of this thesis (Chapter 2). The empirical studies investigate environmental (Chapter 3), neural (Chapters 5 and 6), and genetic (Chapter 7) influences on IB in Portuguese institutionalised children. Firstly, broad indices of adjustment are explored in relation to explanatory variables of the quality of care (Chapter 3). Greater caregiver sensitivity predicted reduced IB, but not other behavioural outcomes, in support of the role of the quality of micro-caregiving in explaining IB and IB as an independent construct. Before introducing the empirical studies of neural functioning, a systematic literature search summarises the findings of electrophysiological studies conducted with institutionalised children (Chapter 4). Next, findings of Event-Related-Potentials (ERPs) recorded while children visualised the face of their caregiver and a stranger are reported. In the first level of analysis, institutionalised children are compared to a group of family-reared children (Chapter 5). Consistent with the literature, institutionalised children showed reduced amplitudes in occipital components. In the second level of analysis, two subgroups of the institutionalised children are compared: those who presented IB and those who did not (Chapter 6). Children with IB showed reduced amplitudes in occipital components, as well as alterations in the processing of the familiar versus unfamiliar face, suggesting that part of the effects attributable to institutionalisation are particularly shown by children who developed IB. Genetic influences on IB are explored in the last empirical study (Chapter 7), by testing the association between variations in one polymorphism of the oxytocin receptor gene and the presence of IB. Carriers of the A allele showed increased levels of IB. The final Chapter 8 integrates these results and discusses their implications for the understanding of IB and the development of children in institutional care, alongside future directions for investigation and policy.
... Already in 2003 O'Connor and Zeanah [21] reviewed the main approaches of assessment. Methods assessing attachment disorder symptoms include behavior observation protocols, interviews, or questionnaires. ...
... A child's general tendency to seek or to avoid contact is thus considered. A point of criticism is due to the fact that the Strange Situation Procedure is used for assessment of attachment disorder behavior, because the SSP is based on the assumption that there is an attachment relationship between the child and the caregiver which is meant to be assessed [21]. Besides, the procedure is relatively short and there is only one observed situation that leads to a diagnosis. ...
Background
Standardized methods for assessing attachment disorders are scarce but needed for research and practice.
Methods
In the current study, several assessments for attachment disorder symptoms are used within a German sample of foster children after being exposed to neglect and maltreatment in their biological families. The symptoms were assessed with four established assessment methods based on both parents’ report and behavioral observation: The Rating for Infant Stranger Engagement, the Stranger at the Door, the Disturbances of Attachment Interview and the Reactive Attachment Disorder Questionnaire.
Results
The foster care sample showed symptoms of both the inhibited and the disinhibited attachment disorder. The degree of symptoms is comparable to previous findings. The results of the different tools investigating the disinhibited type of attachment disorder are correlated to each other, but do not overlap.
Conclusions
Although all approaches are based on the clinical criteria of the DSM-IV, the assessments do not coincide. Each tool provides a different point of view on the symptoms, so a multi methodical approach for assessing attachment disorder symptoms should be implemented. Furthermore, the inhibited and the disinhibited symptoms represent separate categories, as reflected in the DSM-5, requiring separate assessment.
... This special issue exclusively brings together studies on inhibited RAD coming from an attachment perspective that try to give answers to some research lacunas in the field. In a former special issue on attachment disorders, O'Connor and Zeanah (2003) stated that at that time the empirical evidence on RAD was smaller than the amount of reviews on that topic. Since then, two major longitudinal studies on the consequences of early deprivation have been followed up until early adolescence and emerging adulthood (Kumsta et al., 2015;Zeanah, Humphreys, Fox, & Nelson, 2017), and many empirical studies on attachment patterns or RAD assessment in deprived children from different countries and cultures have been published or reviewed (e.g. ...
... Researchers using other assessment approaches report more overlap between both subtypes of RAD (Mayes, Calhoun, Waschbusch, & Baweja, 2017) in small samples. Thus, similarly to the state of the art as reported in the first special issue on attachment disorders (O'Connor & Zeanah, 2003), there still are different approaches for the assessment of RAD that mainly are based on caregiver reports or clinical impression. ...
This special issue brings together studies representing the current state of the art research on inhibited reactive attachment disorder (RAD) from developmental psychology and developmental attachment research. This editorial introduces and discusses conceptual topics of the development and the assessment of inhibited RAD. Next, five empirical studies of this special issue cover timely topics from developmental trajectories and longitudinal stability of RAD to associations with caregiving experiences in institutions, IQ, and psychopathology, moreover aspects of internal working models of children with inhibited RAD are examined. The commentary meta-analytically integrates the empirical evidence of all five studies and offers theoretically derived suggestions for further research. In this editorial, we discuss unsettled issues and future directions for attachment oriented research in this field.
... Há evidências suficientes de que o conceito de transtorno de apego descreve fatores clínicos reais e distintos graves o suficiente para justificar atenção médica, e até se saber algo sobre as condições que causam esses distúrbios, as condições associadas e o curso longitudinal (O'Connor & Zeanah, 2003). Ainda não há consenso ou protocolo para avaliar o transtorno de apego e comportamentos relacionados. ...
Resumo O objetivo foi investigar como os transtornos de apego são avaliados, compreender quais variáveis os influenciam e descrever como os fatores do desenvolvimento se correlacionam a eles. Realizou-se revisão sistemática de litera-tura nas bases de dados PubMed, Science Direct e Scopus com os descritores attachment, foster, orphan, shelter e instituti. Os resultados descrevem a necessidade de se avaliar os transtornos do apego com múltiplas metodologias, em detrimento do foco em questionários para avaliação da percepção do cuidador acerca da criança. As variáveis associadas aos transtornos de apego são as interrupções nos cuidados, o tempo que passaram em cuidado substituto, a idade que possuíam no momento do acolhimento. Os aspectos do desenvolvimento associados foram problemas de comportamentos e psicopatológicos. Conclui-se que há fragilidades no modo como os transtornos do apego são avaliados, contudo, o diagnóstico precoce ganhou importância em função diminuir problemas de comportamentos e psicopatológicos. Palavras-chave: psicopatologia; criança institucionalizada; infância; cuidados no lar de adoção.
... The inhibited attachment disorder symptoms have a phenotypical similarity to insecure, disorganized attachment [22]. Due to this similarity, van IJzendoorn and Bakermans-Kranenburg [37] highlighted the importance of attachment theory in understanding RAD. ...
Background
Children in foster care constitute a risk population for developing symptoms of attachment disorders. However, little is known about the longitudinal course of attachment disorders and their association with attachment security in foster children.
Method
This longitudinal study assessed attachment disorder symptoms in a sample of foster children (n = 55) aged 12 to 82 months. Foster parents with a newly placed foster child were assessed at three points during the first year of placement. At all assessment points, the Disturbance of Attachment Interview (DAI; Smyke and Zeanah in Disturbances of attachment interview, Tulane University, New Orleans, 1999) and the Attachment Q-sort (AQS; Waters and Deane in Monogr Soc Res Child Dev 50:41–65, 1985 German version as reported (Schölmerich and Leyendecker in Deutsche Übersetzung des attachment behavior Q-Set, revision 3.2. Unpublished manual, Ruhr University Bochum, Bochum, 1999) were used to investigate the interplay between disorder symptoms and attachment security.
Results
The results revealed that the symptoms of attachment disorders decreased. The decrease was more pronounced for the inhibited than for the disinhibited symptoms with marked changes in the first 6 months of placement. There was a noticeable gender difference in the development with boys showing a more pronounced decrease in inhibited attachment disorder symptoms and a stronger increase of attachment security. After 12 months, no significant gender effects were found. Regarding the association between symptoms of attachment disorders and attachment security, a significant negative correlation between the inhibited attachment disorder symptoms and attachment security was found 12 months after placement.
Conclusions
Attachment disorder symptoms decreased in the stable foster care environment. Thus, foster care seems to be an effective placement option regarding children’s attachment development.
... 6 Children with attachment difficulties, especially those with a disorganised bond, tend to demonstrate higher rates of psychopathology 9 and significant difficulties in therapeutic interventions. 10 The study of Ford,et al. 11 found that at least 60% of children in residential care have mental health problems and 72% of those have been diagnosed with a mental health disorder/ condition. A recent Greek study conducted by Andreopoulou et al. 12 showed that children in residential care had higher rates of clinical/borderline range symptoms in internalizing and externalizing problems than their counterparts rearing at home. ...
According to schema theory, early maladaptive schemas (EMS) contribute to the onset and development of psychopathology. Given that research on EMS in children is limited, the contribution of the present study is that it investigates the role of EMS in psychopathology in children living in residential care. Participants of the present study were children who lived in residential care and were referred for assessment to the Day Center "The House of the Child" run by the Organisation "The Smile of the Child". The study sample comprised of 75 children (35 boys, 40 girls), mean age 12.7 years old. The Greek version of the Achenbach Child Behavior Checklist was completed by the child's caregiver, whereas the Greek version of the Schema Questionnaire for Children was administered to children. The research questions were explored by implementing both variable-focused (multiple regression) as well as person-focused (cluster analysis) techniques. The Confirmatory Factor Analysis conducted in the Schema Questionnaire for Children showed acceptable goodness of fit indices. The Vulnerability schema was found to be the highest scoring schema. Social isolation was a strong predictor for most indicators of psychopathology (internalizing and externalizing). Strong predictor for the Symptoms of Withdrawal, Anxiety/Depression, Social Problems and Thought Problems was the EMS of Failure. Hierarchical cluster analysis on schemas revealed two strong clusters, one with low scores and one with high scores in most EMS. In the cluster with high levels of EMS, Emotional deprivation, Failure, Defectiveness, Social isolation and Abandonment showed the highest scores. In this cluster, children presented statistically significant burdened indicators in externalizing psychopathology. Our hypotheses that EMS and, especially, schemas related to the domains of Disconnection/Rejection and Impaired Autonomy/Performance would be predictive indicators of psychopathology were confirmed. Cluster analysis confirmed the above findings and highlighted the role of schemas Emotional deprivation and Defectiveness in the emergence of psychopathology symptoms. The results of the current study highlight the importance of assessing EMS in children who live in residential care and could inform the development of appropriate intervention programs in this population to prevent the establishment of psychopathology.
Keywords: Early maladaptive schemas; children; psychopathology; residential care.
... Όπως προκύπτει από αντίστοιχες μελέτες σε παιδιά και βρέφη που διέμεναν σε δομές φιλοξενίας, οι δείκτες για τον αποδιοργανωμένο δεσμό κυμαίνονται από 66% (Vorria et al 2003) έως 85% (Juffer & Series 2008) με μια μέση εκτίμηση να κυμαίνεται στο 72,8% (Bakermans-Kranenburg et al 2011) σε σύγκριση με το 25% που απαντάται στον πληθυσμό των παιδιών που μεγαλώνουν σε μη ιδρυματικό πλαίσιο (Vorria et al 2003). Παιδιά με δυσκολίες στην προσκόλληση και δη όσα εμφανίζουν αποδιοργανωμένο δεσμό τείνουν να έχουν υψηλότερους δείκτες ψυχοπαθολογίας (Green & Goldwyn 2002) και εμφανίζονται σημαντικές δυσκολίες κατά τη θεραπευτική παρέμβαση (O'Connor & Zeanah 2003). Σε επίπεδο ψυχοθεραπευτικής παρέμβασης, όπως επισημαίνουν οι Zilberstein & Messer (2007), οι θεραπευτικές ανάγκες παιδιών που έχουν βιώσει διαφορετικές μορφές κακοποίησης ή έκθεσης σε αποστερημένο ή ιδρυματικό περιβάλλον κατά τη βρεφική και νηπιακή ηλικία μπορεί να είναι σημαντικά διαφοροποιημένες. ...
The term child poly-victimization (PV) is used to describe the phenomenon of multiple experiences of different types of abuse and neglect that may occur at different
points in a child’s life before entering adulthood. According to schema theory, Early Maladaptive Schemas (EMSs) contribute to the onset and development of psychopathology. The aim of this study was to investigate the relationship between PV and EMSs in children who lived in residential care and were referred for assessment to the Day Center "The House of the Child" run by the NGO. “The Smile of the Child”. The study sample comprised 75 children (35 boys, 40 girls), mean age 12.7 years old. The Greek version of the Juvenile Victimization Questionnaire – SSV (Finkelhor et al. 2005) was completed by the child’s caregiver, whereas the Greek version of the Schema Questionnaire for Children (Stallard & Rayner 2005) was administered to children. The results showed that children in residential care had a history of multiple victimization experiences. It emerged that boys and older children had more experiences of victimization. The Vulnerability schema was found to be the highest scoring schema. The PV was negatively correlated to the Entitlement schema. The profile of children with multiple experiences of victimization showed relatively higher levels in the Distrust/Abuse schema and lower levels in the Entitlement, Unrelenting standards, Dependence, Abandonment, Sacrifice and Submission schema. The results of the current study highlight the importance of assessing victimization experiences in children who live in residential care settings in order to inform the development of appropriate intervention programs to prevent the establishment of maladaptive schema and behaviour patterns.
Key words: Poly-victimization, Early Maladaptive Schemas, children, residential care.
... Sie schaffen eine Voraussetzung für eine gesunde sozial-emotionale und körperliche Entwicklung im Kindes-und Erwachsenenalter (Spangler 2011). Die organisierten Bindungsstile werden in dem Entwicklungsalter der Kindheit differenziert in sichere, unsicher-vermeidende und unsicher-ambivalente Bindungsrepräsentation. Alle drei Bindungsstile stellen adäquate Entwicklungsvarianten dar, unterscheiden sich aber in der jeweiligen Ausprägung der Anpassungs-und Regulationsstrategien bei Stress auslösenden Situationen (Ziegenhain 2009 Die Prävalenz der Bindungsstörung wird auf etwa ein Prozent in der Allgemeinbevölkerung geschätzt und geht in den meisten Fällen mit einer ungünstigen Prognose für die weitere Entwicklung einher (Peters 1995, O'Connor;Zeanah 2003). Aber auch in diesem Bereich fehlt es noch an ausreichender empirischer Evidenz. ...
... Contemporary definitions of detachment emphasize the person's inability to cultivate social ties or engage in situation-appropriate affiliative behaviors (Birtchnell, 1987;Bornstein et al., 2003). It was operationalized in the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders-5-Brief Form (PID-5-BF) as: the lack of attachment toward the primary caregiver, which reflects reactive attachment disorder (O'Connor & Zeanah, 2003). ...
Despite a large population of registered people with drug addiction, child protection in substance-abusing families is a neglected issue in China. The present study aims to investigate the association between parents’ childhood abuse history and the risk of abusing their own children in substance-abusing Chinese families and also to examine the mediating role of detachment and moderating role of social support during the intergenerational transmission of abuse. A total of 173 men and 116 women were selected using cluster sampling from two compulsory drug rehabilitation centers in Jiangsu Province. Results indicated that one’s childhood abuse history was positively associated with the current perpetration of child abuse for both fathers and mothers. Detachment mediated the linkage between a history of childhood maltreatment and perpetration of child abuse in all types of abuse for both men and women except for women’s sexual abuse. Social support from family members buffered the intergenerational transmission of child abuse for fathers but not for mothers. Child maltreatment in substance-abusing families is an urgent issue that needs measures to prevent the intergenerational transmission of violence in China. Intervention programs could involve helping parents cope with their childhood abuse history through rebuilding secure attachment and facilitating social support for their parenting practices, especially for fathers.
... Overall indiscriminate friendliness was expected for post-institutionalized children due to the frequent caregiver rotations and high infant to caregiver ratios commonly experienced in institutions (Zeanah, 2003). The children often lack individualized attention and consistent, stable social relationships while under institutional care, which contributes to their willingness to approach unfamiliar adults. ...
Previous studies have found children internationally adopted from institutions more likely to exhibit socioemotional and cognitive deficits. This study examined the relationship between indiscriminate friendliness and executive functioning behaviors in postinstitutionalized (PI) children. Internationally adopted children and non-adopted children were observed and coded for indiscriminate friendliness and assessed using five executive function tasks. Subjects per analysis varied because the study is still ongoing (see participant information, Table 1). The study is part of a larger longitudinal research project. Preliminary data found that post-institutionalized children displayed higher levels of indiscriminate friendliness and lower levels of executive functioning, however no relationship was found between the two variables. When children with IQ levels below 70 were removed from the analysis, a significant relationship was found between working memory and the social disinhibition factor at both sessions. Results suggest that by one year post-adoption, post-institutionalized children continue to show deficits compared to non-adopted children. Further research is necessary to determine appropriate means of intervention.
... Fan et al.'s (2010) research showed that LBC are more likely to develop emotional/behavior problems, particularly if they were left behind earlier in life, for longer time. Some researches confirmed that children who were emotionally deprived could develop insecure attachments to their caregivers, which correspondingly leads to children's negative emotions and their stress cannot be reasonably vented as well (Dai et al., 2017;O'Connor & Zeanah, 2003;Zhao et al., 2011). Ultimately, it may bring an increase of aggressive behavior. ...
There is little investigation on the independent effects of left-behind experience (LBE) on self-esteem and aggressive behavior in Chinese young adult populations, or the interaction effects of LBE and self-esteem on aggressive behavior. Thus, a school-based health survey was conducted in Anhui province in China in 2017. A total of 4,154 college students completed standard questionnaires which contain details of left-behind–related characters, self-esteem, aggressive behavior, and sociodemographic profile. Of included students, 55.3% were those with LBE (LBEs). Compared to students without left-behind experiences (NLBEs), LBEs had significantly increased scores of aggressive behavior and decreased score of self-esteem. The increased aggression in LBEs was highly related to longer left-behind duration, younger age of left-behind for the first time, and decreased self-esteem. On the other side, the aggressive behavior was demonstrated negatively correlated with self-esteem in both LBEs and NLBEs. There was an interaction effect of left-behind duration and self-esteem on physical aggression and of frequency of contacting with parents and self-esteem on verbal aggression. Besides, the interaction of primary caregiver and self-esteem on hostility and aggression toward self were also observed, respectively. Our results indicated LBEs and low self-esteem are associated with increased risk of aggressive behavior in Chinese young adults. The increased aggressive behavior in LBEs were highly related to longer left-behind duration, younger age of left-behind for the first time and decreased self-esteem. In those LBEs with some certain left-behind–related characters, aggressive behavior decreased more prominently with the increase of self-esteem. Strategies to improve self-esteem, particularly among young adults who have certain characters of LBE, should be a significant component of prevention and interventions of aggressive behavior.
... Further, possibly important limitations are the lack of observational data and multiple methods of assessment (triangulation), contrary to expert recommendations for the clinical assessment of RAD and DSED [2,52]. Although common in research on RAD and DSED, also in adolescent samples [6][7][8], the sole use of caregiver report could generate rater bias. ...
Although reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are acknowledged as valid disorders in young children, controversy remains regarding their validity in adolescence. An unresolved question is whether symptoms of RAD and DSED are better conceptualized as other psychiatric disorders at this age. All adolescents (N = 381; 67% consent; 12–20 years old) living in residential youth care in Norway were interviewed to determine the symptoms and diagnosis of RAD/DSED and other common psychiatric disorders using the Child and Adolescent Psychiatric Assessment (CAPA). The construct validity of RAD and DSED, including structural and discriminant validity, was investigated using confirmatory factor analysis and latent profile analysis. Two-factor models distinguishing between symptoms of RAD and DSED and differentiating these symptoms from the symptoms of other psychiatric disorders revealed better fit than one-factor models. Symptoms of RAD and DSED defined two distinct latent groups in a profile analysis. The prevalence of RAD was 9% (95% CI 6–11%), and the prevalence of DSED was 8% (95% CI 5–11%). RAD and DSED are two distinct latent factors not accounted for by other common psychiatric disorders in adolescence. RAD and DSED are not uncommon among adolescents in residential youth care and therefore warrant easy access to qualified health care and prevention in high-risk groups.
... Measurement of attachment has been predominately via observational methods, which are not feasible for screening by busy clinicians in primary care. The SSP has been described as the criterion standard to measure the strength of attachment, but this procedure is not feasible as a screening tool (O'Connor & Zeanah, 2003). Tryphonopoulos, Letourneau, and Ditommaso (2014) recently reviewed six other observational attachment assessment tools (Attachment Q-Sort, Toddler Attachment Sort, CARE-Index, Atypical Maternal Behavior Instrument for Assessment and Classification [AMBIANCE], Massie Campbell Scale of Mother-Infant Attachment Indicators During Stress [ADS], and Risky Situation Procedure). ...
Introduction:
Infant-caregiver attachment is crucial for an infant's immediate and long-term social-emotional development and health. Despite advocacy by the National Institute of Children's Health Quality for infant social-emotional development screening, there is a lack of identified tools for use in primary care. Therefore, we conducted a systematic review to identify caretaker-infant attachment self-report screening tools that would be feasible, reliable, and valid for use in primary care.
Method:
A systematic search identified 340 abstracts/articles, which were screened using inclusion and exclusion criteria. Twelve articles and six self-report attachment tools were examined for reliability, validity, and feasibility characteristics.
Results:
Six caregiver-infant attachment self-report tools were identified. Establishment of feasibility, reliability, and validity are in the early stages.
Discussion:
Potential infant-caretaker attachment screening tools were identified for use in primary care practices. Suggestions for research and practice include informal screening, additional psychometric testing, and development of policies supporting implementation of screening.
... RAD 'is a syndrome characterised by relative failure to develop committed intimate social relationships' (Rutter et al., 2009: 536). However, caution over this diagnosis is necessary, as its definition is controversial and not fully supported by research findings (O'Connor and Zeanah, 2005). It may be viewed as an evolved response to the loss of dedicated parents (Balbernie, 2010) and more an adaptation to disaster than pathology. ...
... Fourth, we expected that the level of psychosocial problems at the time of admission is negatively related to psychosocial development during placement, and specifically distinguishes unfavorably developing foster children from those in the other two settings (e.g., Aarons et al., 2010;Vanschoonlandt et al., 2013). Finally, we hypothesized that a high level of social-emotional detachment at the time of admission contributes to the distinction of unfavorably developing residentially placed children from unfavorably developing children in foster and family-style group care, as children with these problems are less likely to be placed in a family-based setting (Lee, 2010), and their developmental prognoses are poor (e.g., Kay & Green, 2013;O'Connor, 2003). ...
Linking typical baseline child and family characteristics of out-of-home placed children to children's psychosocial development in the various 24-h settings (foster, family-style group, and residential care)
... Fourth, we expected that the level of psychosocial problems at the time of admission is negatively related to psychosocial development during placement, and specifically distinguishes unfavorably developing foster children from those in the other two settings (e.g., Aarons et al., 2010, Vanschoonlandt et al., 2013. Finally, we hypothesized that a high level of social-emotional detachment at the time of admission contributes to the distinction of unfavorably developing residentially placed children from unfavorably developing children in FC and FGC, as children with these problems are less likely to be placed in a family-based setting (Lee, 2010), and their developmental prognoses are poor (e.g., Kay & Green, 2013, O'Connor, 2003. ...
The study consisted of a comparative follow-up study with a pretest-posttest design which explored the association between baseline child, family, and care characteristics and the psychosocial development of 121 school-aged Dutch children (M age = 8.78 years; SD = 2.34 years; 47% female; 59% Caucasian) during their first year of placement in foster care (FC), family-style group care (FGC), and residential care (RC). Potential baseline characteristics were collected from both literature data and pretest data, and measured with standardized questionnaires and case file information. The outcome measure (degree of psychosocial development) was based on pretest and posttest ASEBA measurements of substitute caregivers, by calculating the reliable change index (RCI). Based on this, 58% of the children had favorable psychosocial development, with no significant differences across the settings. Results indicated that sets of baseline characteristics were able to distinguish different groups of favorably developing children as well as unfavorably developing children in different settings, whereby unfavorable development could be estimated more accurately. A history of maltreatment proved to be an important risk factor, particularly for family-based settings (FC, FGC). Furthermore, results indicated that specialized treatment is needed for severe individual problems in children in FGC, as these problems were associated with unfavorable psychosocial development for them in particular. With regard to residentially placed children, child mental illness specifically negatively affected their prognosis. Further research is needed to refine the results in order to make them suitable for both supporting decision-making processes and monitoring out-of-home placements.
The current study explored overlaps and differences between parent reports of Autism Spectrum Disorder (ASD) and Attachment Disorder (AD), and examined profiles of children fulfilling criteria for ASD and AD in terms of behaviour problems and attachment styles. 155 parents whose children had a developmental delay/disorder completed the Social Communication Questionnaire, Randolph Attachment Questionnaire, and Strengths and Difficulties Questionnaire about their children. There was a large overlap in the reported diagnoses and classifications of ASD and AD. Peer problems predicted a reported ASD diagnosis, and conduct problems predicted a reported AD diagnosis. Attachment styles differentiated the diagnosis, with those with ASD showing more ambivalent, and those with AD more avoidant and anxious attachment styles. The current parent reports produced findings similar to those from previous studies using professional ratings, although caution is needed about generalisation given the sample characteristics. The results suggest some fruitful avenues for future studies that could help further differentiate between similar presentations.
As attachment-based interventions can improve caregiver-infant relationships and their subsequent psychological outcomes, the identification of relevant and effective interventions can facilitate their implementation into clinical practice. This systematic review aimed to a) provide an overview of manualised attachment-based interventions, without video-feedback as the main component, for caregivers and infants from conception to two years, and b) determine which of these interventions were effective in demonstrating improvements in caregiver-infant relational outcomes. To identify eligible interventions and their empirical evidence base, two search stages were conducted for 1) relevant interventions and 2) studies of interventions identified in the first stage that focussed on caregiver-infant relational outcomes. All studies included in Stage 2 were quality assessed and findings analysed. Twenty-six interventions were eligible for inclusion at Stage 1 but studies reporting on relational outcomes were identified for 16 interventions only. Forty studies reporting on those 16 interventions met inclusion criteria and were synthesised at Stage 2. Most studies were of good quality. Observer-rated measures were used in 90% of studies. There was evidence for these interventions in relation to improving caregiver-infant relational outcomes: 80% of studies reported a statistically significant positive change in a relational outcome for the intervention compared to pre-intervention or control group. The most promising evidence was identified for Attachment and Biobehavioral Catch-Up (ABC), Minding the Baby (MTB) and Circle of Security (COS). This systematic review offers guidance to healthcare professionals, commissioners and policymakers within perinatal sectors in relation to the training, delivery and implementation of evidenced manualised attachment-based interventions.
Introduction
Interpersonal synchronization involves the alignment of behavioral, affective, physiological, and brain states during social interactions. It facilitates empathy, emotion regulation, and prosocial commitment. Mental disorders characterized by social interaction dysfunction, such as Autism Spectrum Disorder (ASD), Reactive Attachment Disorder (RAD), and Social Anxiety Disorder (SAD), often exhibit atypical synchronization with others across multiple levels. With the introduction of the “second-person” neuroscience perspective, our understanding of interpersonal neural synchronization (INS) has improved, however, so far, it has hardly impacted the development of novel therapeutic interventions.
Methods
To evaluate the potential of INS-based treatments for mental disorders, we performed two systematic literature searches identifying studies that directly target INS through neurofeedback (12 publications; 9 independent studies) or brain stimulation techniques (7 studies), following PRISMA guidelines. In addition, we narratively review indirect INS manipulations through behavioral, biofeedback, or hormonal interventions. We discuss the potential of such treatments for ASD, RAD, and SAD and using a systematic database search assess the acceptability of neurofeedback (4 studies) and neurostimulation (4 studies) in patients with social dysfunction.
Results
Although behavioral approaches, such as engaging in eye contact or cooperative actions, have been shown to be associated with increased INS, little is known about potential long-term consequences of such interventions. Few proof-of-concept studies have utilized brain stimulation techniques, like transcranial direct current stimulation or INS-based neurofeedback, showing feasibility and preliminary evidence that such interventions can boost behavioral synchrony and social connectedness. Yet, optimal brain stimulation protocols and neurofeedback parameters are still undefined. For ASD, RAD, or SAD, so far no randomized controlled trial has proven the efficacy of direct INS-based intervention techniques, although in general brain stimulation and neurofeedback methods seem to be well accepted in these patient groups.
Discussion
Significant work remains to translate INS-based manipulations into effective treatments for social interaction disorders. Future research should focus on mechanistic insights into INS, technological advancements, and rigorous design standards. Furthermore, it will be key to compare interventions directly targeting INS to those targeting other modalities of synchrony as well as to define optimal target dyads and target synchrony states in clinical interventions.
Background:
Attachment refers to an infant's innate tendency to seek comfort from their caregiver. Research shows that attachment is important in promoting healthy social and emotional development. Many parenting interventions have been developed to improve attachment outcomes for children. However, numerous interventions used in routine practice have a limited evidence base, meaning that we cannot be sure if they are helpful or harmful.
Objectives:
This research aimed to conduct a large-scale survey to identify what interventions are being used in UK services to improve child attachment; conduct a systematic review to evaluate the evidence for parenting attachment interventions; and develop recommendations for future research and practice.
Design and methods:
We worked closely with our Expert Reference Group to plan a large-scale survey focused on relevant UK services. We then conducted two systematic reviews. One searched for all randomised controlled trial evidence for any attachment parenting intervention. The second searched for all research for the top 10 routinely used interventions identified from the survey.
Results:
The survey collected 625 responses covering 734 UK services. The results identified the 10 most commonly used interventions. The responses showed a limited use of validated measures and a wide variety of definitions of attachment. For the first review, seven studies were included from 2516 identified records. These were combined with results from previous reviews conducted by the team. Meta-analyses showed that, overall, parenting interventions are effective in reducing disorganised attachment (pooled odds ratio 0.54, 95% confidence interval 0.39 to 0.77) and increasing secure attachment (pooled odds ratio 1.85, 95% confidence interval 1.36 to 2.52). The second review searched the literature for the top 10 routinely used interventions identified by the survey; 61 studies were included from 1198 identified records. The results showed that many of the most commonly used interventions in UK services have a weak evidence base and those with the strongest evidence base are not as widely used.
Conclusions:
There is a need for better links between research and practice to ensure that interventions offered to families are safe and effective. Possible reasons for the disparity include the cost and accessibility of training. There is also a need for improved understanding by professionals regarding the meaning of attachment.
Limitations:
Although the survey had good geographical spread, most respondents were based in England. For review 2 we were unable to access a large number of papers; however, we conducted extensive reference checking to account for this.
Future work:
There is a need for robust research to test the efficacy of routinely used attachment interventions. Research could also explore why routinely used interventions are not consistently subject to thorough evaluation; how to embed dissemination, cost-effectiveness, fidelity and sustainability into research; and how to keep clinical practice up to date with research developments.
Study registration:
This study is registered as PROSPERO CRD42019137362.
Funding:
This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 2. See the NIHR Journals Library website for further project information.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
The current study explored similarities and differences in parenting stress (PSI) and behaviours in parent reports of autism spectrum disorder (ASD) and attachment disorder (AD). 155 parents whose children had developmental delays and disorders completed the social communication questionnaire, Randolph attachment questionnaire, strengths and difficulties questionnaire, PSI, and parent–child relationship inventory. Parents of children with AD reported greater levels of PSI than parents of children with ASD. Parents of children reaching criteria for both disorders reported the greatest levels of PSI. Limit setting was poorest in parents of children with both classifications, followed by parents of children with AD, and then ASD. Limit setting mediated the relationship between PSI and child behaviour problems for parents of children with ASD < but not for parents of children with AD. These findings suggest different areas of difficulty for parents of children with these conditions, which may be of help in designing interventions.
Aim: The current study aimed to compare attachment-based counseling to mothers and the impact of career adaptability education to preschool children on children's career development in city of Isfahan. Methods: The statistical population included all of the preschool children aged 5 to 7 and parents of 5 to 7-year-old preschool children in city of Isfahan. Thirty preschool children, aged 5 to 7, were selected voluntarily and randomly divided into two experiment and control groups (10 children in each group). The parent group received the attachment-based counseling, the children group received the career adaptability education, both in 8 sessions. The control group did not receive any education. Data. were collected with preschool students' career development questionnaire, and were analyzed using SPSS-18 and analysis of covariance. Findings: The results suggest that two methods had a considerable effect on time perspective (P<0/05, F=7/35), internal curiosity (P<0/05, F=3/91), information (P<0.05, F=6/06), and external curiosity (P<0/001, F=10/41), and there was no significant differences between the effectiveness of the two methods (P<0/05). Conclusion: Career education and counseling to preschool children and parents impacted the children's career development.
Objective:
This research aims to characterize parental misattribution to autism of challenging child behaviors related to environmental stress.
Methods:
To identify differences between parental concern about behavioral challenges and child diagnoses, researchers reviewed records of children assessed at a child development clinic (N = 50, mean age = 4.38), genetics clinic (N = 26, mean age = 4.59), and therapeutic preschool (N = 30, mean age = 3.75), comparing referral information with child diagnoses postassessment. Surveys of parental and teacher concerns regarding children at therapeutic preschool who were not referred for consultation (N = 49) were reviewed and compared with the referral population to assess for referral bias.
Results:
A high rate of parental concern about autism/neurodevelopmental disabilities was found in therapeutic preschool referrals (63%) and the child development clinic (74%), with fewer concerns in the genetics clinic (19%), in contrast with substantially lower numbers ultimately diagnosed with autism spectrum disorder (13%, 32%, and 8%, respectively). Across clinics, parents demonstrated greater concern about autism than environmental stress. In all clinics, more children had symptoms related to environmental stress than referrals suggested. Seventy-seven percent of children in the therapeutic preschool, 30% in the child development clinic, and 47% in the genetics clinic were diagnosed with trauma and stressor-related disorders. The results from children not referred for consultation suggest that referral bias plays a role in this phenomenon because parents of these children express similar levels of concern about their child's development (32%) and challenges related to environmental stressors (29%).
Conclusion:
The results suggest a tendency for parents seeking consultation to attribute to autism behavioral symptoms related to environmental stress.
Statutory guidance from the Department for Education places a duty on local authorities in England to safeguard and promote the welfare and educational achievement of looked after children and young people (LACYP). Accordingly, head teachers should, as far as possible, avoid excluding any LACYP. Nonetheless, LACYP are five times more likely to have a fixed-period exclusion than their non-looked after peers (DfE, 2020). LACYP currently lag behind their non-looked after peers on several educational outcome measures. They are also more likely to experience homelessness, high unemployment and be involved with the criminal justice system. Despite their detrimental effects, currently fixed-period exclusion rates for LACYP are rising year on year with no consensus on how best to prevent them. To date, few recent studies have explored the school exclusion experiences of LACYP. Using Bronfenbrenner’s (2005) bioecological systems framework, this study adopts a multi-informant approach to explore the experiences of school exclusion for LACYP from a range of perspectives. Semi-structured interviews were carried out with eleven LACYP. In addition, interviews were conducted with carers (5), a Special Educational Needs Coordinator, a Virtual School Head, and Educational Psychologists (10) to better understand their perceptions of the wider systemic influences on school exclusions. The findings illustrated an overwhelmingly negative narrative from the LACYP associated with their school exclusions. Key themes included: a lack of advocacy and not being listened to; a mismatch between young people and adult expectations/aspirations; and that psychological containment, a sense of school belonging and a positive sense of identity were not nurtured within their secondary schools. Further negative consequences associated with school exclusions included poor mental health, involvement in drugs and crime as well as continued social and economic exclusion as care leavers. Implications for policy and practice at a school, Local Authority (including Educational Psychology Services) and national level are discussed.
Attachment difficulties are associated with a range of adverse outcomes in mental health, and people with intellectual disabilities (IDs) may be at greater risk of experiencing difficulties in their attachment relationships. This review critically evaluated recent research measuring the prevalence of attachment difficulties in people with ID. Eight studies met the inclusion criteria, and a higher prevalence of insecure and disorganized attachment classifications, and symptoms of attachment disorder, was found across a number of subgroups of people with diagnoses of ID. However, the validity and reliability of measures of attachment have not been empirically established in this population, and control groups were not always appropriate. These findings indicate the need to (1) develop reliable and standardized assessments of attachment for people with ID and (2) evaluate the efficacy of attachment-based interventions in relation to reducing psychological distress, mental health problems and expression of behaviours experienced by others as challenging.
This chapter illustrates how the EBP practice decision-making process is undertaken in work with Sally, a 12-year-old biracial girl whose adoptive parents and adoption social worker are concerned about her lack of turning to her parents for nurture when upset and her indiscriminate interactions with other adults. Sally also has both a potential medical issue and a history of serious neglect. Issues of assessment are addressed, and the six steps of the EBP process are each explored in detail. How EBP is done in practice is examined fully as it applies to the specifics of Sally’s, and her parents’, needs and strengths.
The Attachment Behavior Checklist is a promising, but unvalidated, measure designed to assess attachment disturbances. Confirmatory and exploratory factor analyses were conducted. Results revealed a 5-factor solution best fit the data. Individual differences in the factors were examined. The Child Behavior Checklist was used to determine convergent and discriminant validity.
Bindungsstörungen beschreiben zwei Typen von Störungsbildern im Zusammenhang mit einer extrem inadäquaten Betreuungssituation von Kindern: den Typ reaktiver Bindungsstörung mit gehemmtem, emotional zurückgezogenem Verhalten und den Typ der Bindungsstörung mit Enthemmung mit sozial undifferenziertem Verhalten. Die beiden Störungsbilder werden in ihrer Phänomenologie, Ätiologie bzw. ihrem Verlauf beschrieben sowie durch zwei Fallbeispiele illustriert. Bindungsstörungen sind diejenigen Störungsbilder des Kindes- und Jugendalters, die empirisch am wenigsten gut abgesichert sind. Neuere Studien erweiterten die empirische Basis der beiden Störungsbilder. Erste Veränderungen im DSM-5 definieren den Typ des Störungsbildes nicht mehr als Bindungsstörung im engeren Sinne. Danach kann die ungehemmte Form der Störung auch außerhalb einer Bindungsbeziehung auftreten, ebenso wie in abnormen, aber auch in gesunden Beziehungen bzw. in Beziehungen mit Pflege- oder Adoptiveltern.
Through a case vignette, the authors explore the significant diagnostic, systemic, and parental psychological challenges in arriving at an appropriate diagnosis and service plan for children presenting with (often overlapping) symptoms of ASD and TSRD. The supports that are available for children with a diagnosis of ASD are often designed to help families access therapeutic skill builders or support workers that can help teach social skills and pragmatic language skills; resources are offered to provide respite for families. Conversely, children with a TSRD will benefit most from being engaged in therapy with their primary caregiver, thus making outside skill builders and respite care providers less effective for achieving long term goals. While a personal support worker may reduce the amount of time that a child has to build a predictable and secure relationship with their caregiver, the challenge is that parents with a child with a TSRD may be similarly tired as parents of a child with ASD from managing behaviors and would themselves benefit from respite.
This article outlines a conceptual framework for organising an intervention plan for family therapy before starting the sessions. This is based on an integrative coherent theory or frame of understanding called neuroaffective developmental psychology (NADP) (Hart 2008, 2011). NADP is an integration of attachment theory, neuropsychology, developmental psychology, and trauma theory. It has been developed as a tool to navigate in the complex world of emotional development, intersubjectivity, family therapy, and psychotherapy to create relevant intervention plans to meet the needs of an individual family or client. NADP is used as a theoretical frame of understanding, (a) to understand emotional development, personality vulnerabilities and disorders, and the maturation of emotional capacities within attachment‐based relationships, and (b) to translate this understanding into intervention plans discretely adjusted to the complexity of human development and the skills and agency of the professionals working with the families. The theory and clinical application of NADP as an organising frame within a family therapy setting is illustrated by a case example.
Reactive Attachment Disorder (RAD) is presumed to be a consequence of social neglect and deprivation of the kind particularly associated with institutional care. Despite its clinical relevance there is a lack of assessment tools for RAD based on the direct observation of child–caregiver interaction.
Here we describe the development and validation of such a tool for use with preschool children, the Rating of Inhibited Attachment Disordered Behavior (RInAB). The RInAB is composed of 17 ratings grouped in three subscales assessing (1) Attachment, (2) Exploratory, and (3) Socioemotional behavior.
Participants were 134 institutionalized preschool children (M = 54.84 months; SD = 10.83; 60% boys) and their caregivers.
Adequate reliability was found for RInAB subscales and total score. Confirmatory factor analyses documented the three aforementioned RInAB subscales. Correlational analyses documented: (i) construct validity via positive and significant associations with caregiver sensitivity and quality of child–caregiver relationship; (ii) convergence validity via association evidence with some emotionally/withdrawn inhibited items of the Disturbed Attachment Interview (DAI), as well as, with Child Behavior Checklist (CBCL)’s somatic complaints and withdraw syndrome scales; and (iii) discriminant validity via nonsignificant or negative associations with DAI-indiscriminate subscale, Rating of Infant and Stranger Engagement (RISE) and CBCL-externalizing problems. Discussion highlights the contributions complementary roles of RInAB for a comprehensive assessment of child RAD-related functioning.
In formulating his theoretical perspective on the development of human attachment relationships, Bowlby incorporated knowledge from a variety of disciplines, viewpoints, and research paradigms (Ainsworth & Bowlby, 1991; Bretherton, 1992). Psychoanalysis, object relations theory, Sullivanian interpersonal psychiatry, social, experimental and developmental psychology, evolutionary theory, and ethology all exerted major impacts on Bowlby’s hypotheses regarding the origins, course, and sequelae of secure and insecure attachment relationships (Ainsworth, 1967, 1969; Ainsworth, Blehar, Waters, & Wall, 1978; Bowlby, 1969/1982, 1973, 1980; Bretherton, 1987, 1991).
J. Bowlby's influential theory of attachment grew out of concern among clinicians and researchers in the early to mid-twentieth century about problems of young children raised in contexts of less-than-adequate caregiving, with difficulties in social relatedness. The formal classification of clinical disorders of attachment, however, is a relatively recent development. In fact, there has been almost no systematic research devoted to clinical disorders of attachment, and until recently, these disorders have been cited in the literature only rarely. In this chapter, we begin by reviewing research demonstrating some of the deviant and unusual attachment behaviors evident in young children raised in extraordinary caregiving contexts. Afterward, we review several different approaches to defining and classifying disorders of attachment. Then, we turn to what is known about the etiology, epidemiology, differential diagnosis, and course and prognosis. We conclude by describing issues salient to assessment and treatment of attachment in infants and toddlers. Throughout, we emphasize the importance of the integration of theory, research, and clinical application. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This chapter reviews what is currently known about the relations between attachment and psychopathology in childhood. This review focuses on the more common externalizing and internalizing disorders of childhood and does not cover developmental disabilities. The chapter begins with general comments on the role of attachment in the development of psychopathology. It then addresses 2 fundamental questions. First, how has the study of attachment contributed to the understanding of childhood disorders? The answer includes a review of how attachment has been linked to childhood difficulties, a discussion of modes of transmission and differential pathways of influence, and the presentation of a heuristic model for understanding the role of attachment relations. The second question is this: How can the field of childhood psychopathology enrich the further study of attachment? The chapter closes with suggestions for future research. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Presents results of studies investigating the effects of lactation, facial, body surface, motion, and temperature variables upon infant attachment to surrogates. A simplified form of the cloth surrogate, easier to construct, more practical to maintain, and more efficient in elicitation of infant clinging than the original, is described. The role of the surrogate in current and proposed research is discussed.
A sample of 52 Black aggressive, rejected and nonaggressive, rejected children were randomly assigned to receive a social relations intervention or to be in a nonintervention control group. The school-based intervention for fourth-grade children focused on positive social skill training and cognitive-behavioral strategies to promote deliberate, nonimpulsive problem solving. At both the post-treatment and the 1-year follow-up assessments, the social relations intervention was found to be effective only with the aggressive, rejected children. Implications for the importance of assessing subtypes of rejected children are discussed.
This article reviews recent attachment-related studies of early aggression. That aggressive behavior toward peers is related to disorganized or controlling patterns of attachment behavior toward parents but not to avoidant or ambivalent patterns. Longitudinal attachment studies indicate that risk factors identified in cross-sectional studies of aggressive school-age children, such as family adversity, parental hostility, parental depression, and child cognitive deficits, are already evident in infancy and predictive of later aggression, before the onset of coercive child behavior. In infancy, these risk factors are associated with disorganized attachment behaviors toward the caregiver characterized by signs of fear or dysphoria, irresolvable conflict between opposing behavioral tendencies, and elevated cortisol levels after separation. Disorganized attachment behaviors, in turn, predict aggression in school-age children with other family factors controlled.
Some young children are not merely insecurely attached and at risk for later problems; by virtue of the severity of their attachment disturbances they are already disordered. This article reviews and critiques the approaches of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) and the International Classification of Diseases (10th ed.; ICD-10; World Health Organization, 1992) to attachment disorders and finds that they have not made use of findings from developmental research on attachment in developing their criteria. An alternative system of classifying attachment disorders that is compatible with the major findings from developmental research on infant-caregiver attachment is presented. Finally, many areas in need of empirical contributions are indicated.
The primary purpose of this study was to compare the reliability of differing sets of criteria for attachment disorders by using a retrospective case review.
Forty-eight consecutive clinical case summaries from an infant behavior clinic were reviewed by four experienced clinicians. Attachment disorders were coded as present or absent by using competing criteria and were scored by using a continuous scale of relationship functioning.
The reliability of alternative criteria was acceptable, but the reliability of DSM-IV criteria in diagnosing attachment disorders was marginal. Preliminary validity for the criteria was demonstrated by the fact that more severe relationship disturbances were seen in infants diagnosed with attachment disorders than in infants diagnosed with other disorders.
Standardized assessments of at-risk populations should be used to replicate these preliminary results; revision of DSM-IV criteria may be necessary to obtain adequate reliability for diagnosing attachment disorders.
The effectiveness of a parenting program with 394 Head Start mothers was examined. Nine Head Start centers were randomly assigned to either an experimental condition in which parents, teachers, and family service workers participated in the intervention or a control condition in which the regular Head Start program was offered. Mothers in the intervention group were observed at home to have significantly fewer critical remarks and commands, to use less harsh discipline, and to be more positive and competent in their parenting when compared with control mothers. Teachers reported that intervention mothers were more involved in their children's education and that their children were more socially competent. Intervention children were observed to exhibit significantly fewer conduct problems, less noncompliance, less negative affect, and more positive affect than control children. One year later most of the improvements were maintained.
To see whether a behaviourally based group parenting programme, delivered in regular clinical practice, is an effective treatment for antisocial behaviour in children.
Controlled trial with permuted block design with allocation by date of referral.
Four local child and adolescent mental health services.
141 children aged 3-8 years referred with antisocial behaviour and allocated to parenting groups (90) or waiting list control (51).
Webster-Stratton basic videotape programme administered to parents of six to eight children over 13-16 weeks. This programme emphasises engagement with parental emotions, rehearsal of behavioural strategies, and parental understanding of its scientific rationale.
Semistructured parent interview and questionnaires about antisocial behaviour in children administered 5-7 months after entering trial; direct observation of parent-child interaction.
Referred children were highly antisocial (above the 97th centile on interview measure). Children in the intervention group showed a large reduction in antisocial behaviour; those in the waiting list group did not change (effect size between groups 1.06 SD (95% confidence interval 0.71 to 1.41), P<0.001). Parents in the intervention group increased the proportion of praise to ineffective commands they gave their children threefold, while control parents reduced it by a third (effect size between groups 0.76 (0.16 to 1.36), P=0.018). If the 31 children lost to follow up were included in an intention to treat analysis the effect size on antisocial behaviour was reduced by 16%.
Parenting groups effectively reduce serious antisocial behaviour in children in real life conditions. Follow up is needed to see if the children's poor prognosis is improved and criminality prevented.
This article describes a neurobiological basis for the "first attachment" of the primate infant to its caretaker. The infant normally internalizes a neurobiological "image" of the behavioral and emotional characteristics of its caregiver that later regulates important features of its brain function. Current models of sensorimotor analysis and its relation to emotion suggest that sensorimotor stems are also habit and memory systems, their functional status and lability regulated in part by biogenic amine systems. The intertwined development of neural and social functions can sometimes go awry. If the attachment process fails or the caregiver is incompetent, the infant may become socially dysfunctional. This helps explain the developmental psychopathology and later vulnerability to adult psychopathology that result from disruptions of social attachment.
Objective
To examine attachment disturbances and disorder in a sample of children adopted into the U.K. following severe early privation and in a comparison sample of nondeprived, within-country, early-placed adoptees.
Ethological attachment theory is a landmark of 20th century social and behavioral sciences theory and research. This new paradigm for understanding primary relationships across the lifespan evolved from John Bowlby's critique of psychoanalytic drive theory and his own clinical observations, supplemented by his knowledge of fields as diverse as primate ethology, control systems theory, and cognitive psychology. By the time he had written the first volume of his classic Attachment and Loss trilogy, Mary D. Salter Ainsworth's naturalistic observations in Uganda and Baltimore, and her theoretical and descriptive insights about maternal care and the secure base phenomenon had become integral to attachment theory. Patterns of Attachment reports the methods and key results of Ainsworth's landmark Baltimore Longitudinal Study. Following upon her naturalistic home observations in Uganda, the Baltimore project yielded a wealth of enduring, benchmark results on the nature of the child's tie to its primary caregiver and the importance of early experience. It also addressed a wide range of conceptual and methodological issues common to many developmental and longitudinal projects, especially issues of age appropriate assessment, quantifying behavior, and comprehending individual differences. In addition, Ainsworth and her students broke new ground, clarifying and defining new concepts, demonstrating the value of the ethological methods and insights about behavior. Today, as we enter the fourth generation of attachment study, we have a rich and growing catalogue of behavioral and narrative approaches to measuring attachment from infancy to adulthood. Each of them has roots in the Strange Situation and the secure base concept presented in Patterns of Attachment. It inclusion in the Psychology Press Classic Editions series reflects Patterns of Attachment's continuing significance and insures its availability to new generations of students, researchers, and clinicians.
Analyzed adoptive parents' view of their children's development within an attachment framework. Found six patterns of adoption ranging from secure/stable to insecure to nonattached. These patterns highlight the influence of care prior to adoption on the quality of present adoption placements. (HTH)
Rorschach data confirm the results of previous studies (see
17: 3268;
18: 2307, 2636) which show that institutional rearing of infants has a deep and permanent effect. The tendency to extremely loose perceptions is the most distinctive trait of the institution group on the Rorschach. In contrast to the foster-home group, the institution child may be described as less controlled and less capable of developing logical constructs. The Rorschach agrees with other experimental and clinical findings in showing that, in contrast to the foster-home children, the institutional children tend to be (1) less mature, less controlled, less differentiated, and more impoverished, and (2) more passive and apathetic, less ambitious, and less capable of adjustment related to conscious intention or goal. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Reviews and compares empirical findings on attachment and childhood behavior problems in normal, at-risk, and clinical samples. Concludes from these comparisons that as we move along a continuum of risk to clear diagnosis, the likelihood of secure attachment decreases and the likelihood of disorganized, controlling, and insecure-other attachment increases. Because these are normally rare patterns and, in the case of the disorganized and insecure-other categories, not clearly defined strategies, this is consistent with the notion that clinic samples include attachment patterns that fall outside of the established schemes. Further differentiation within these categories based on clinic samples may prove to be more useful than are the normatively derived classification schemes in linking attachment and psychopathology. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This chapter begins by describing how attachment relationships between rhesus monkey infants and their mothers are normally established and maintained throughout development. Next, those features that are unique to rhesus monkey infant–mother attachment relationships are examined, as is conflict within these relationships. Attachment relationships in rhesus monkeys and other primates are subject to influence from a variety of sources, and some of these influences are reviewed next. Some long-term biobehavioral consequences of different early attachment experiences are then examined in detail. Finally, the implications for attachment theory of recent findings regarding cross-generational transmission of specific attachment patterns in rhesus monkey families are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The learning experiences and developmental progress of 75 institutionalized infants in the 1st year of life were compared repeatedly with 75 babies reared in families. Procedures adopted included the Gessel Developmental Examination and the Hetzer-Wolf Baby Test, physical and neurological examinations and measurements, behavioral observations, the taking of case histories, and interviews with those responsible for the infant's care. Certain behavior patterns were found to be deviant in all institutionalized babies, other patterns of development were common to the 2 groups. It is concluded that severe deprivation of maternal care has an adverse effect upon the development of infants. Implications for both institutional and foster home mothering are offered. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This volume begins by examining how the construct of disorganization corresponds to central elements of J. Bowlby's classic theory of attachment. In particular, disorganization is discussed as the consequence of the extreme insecurity that results from feared or actual separation from the attachment figure. The chapters investigate psychological and biological dimensions of the phenomenon. The contributions of frightening and frightened caregiving to disorganization are explored, and views on the impact of unresolved trauma in a parent's own attachment history are delineated. Also addressed are child temperament and other individual factors, as well as disorganization in such populations as children from divorced families, children with disabilities, and undernourished children. Presenting significant findings on longitudinal developmental outcomes, it demonstrates how infant and early childhood disorganization affects relationships, behavior, and coping skills in middle childhood and beyond. A measure of attachment in adults is also presented. This book's audience includes researchers and teachers of developmental psychology, child psychology and psychiatry, social work, pediatrics, and nursing; practitioners working with children; and graduate-level students in these fields. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The goal of this chapter is to examine how attachment theory and research have influenced clinical practice, with a particular focus on infant–parent psychotherapy and other preventive interventions that promote infant mental health by addressing early disturbances in parent–child relationships. The first section describes the shared psychoanalytic origins of attachment theory and infant–parent psychotherapy, provides an overview of infant–parent psychotherapy and its relation to attachment theory and psychoanalysis, and explores attachment theory's evolving contributions to clinical practice. The second section illustrates the integration of attachment theory and infant–parent psychotherapy into several clinical programs for infants and toddlers. The third section describes other programs and approaches influenced by attachment theory. The final section reviews the few studies evaluating the efficacy of attachment-focused interventions. Some brief concluding remarks highlight the importance of a trusting working alliance, empathy, and sensitive responsiveness to emotional signals as the hallmarks of clinical approaches based on attachment theory. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Contains reports on the Hampstead Nurseries written during the war years (1939-1945). The case for and against residential nurseries, and major scientific conclusions drawn from these reports of infants without families are presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This chapter presents case examples of children who have suffered maternal rejection, focusing on "affect hunger." The term is used to mean an emotional hunger for maternal love and those other feelings of protection and care implied in the mother-child relationships. The term has been utilized to indicate a state of privation due primarily to a lack of maternal affection, with a resulting need, as of food in a state of starvation. The author focuses on individuals who have suffered lack of maternal love in the early years of life. Assuming for the moment the value of maternal love as an essential component in the development of the emotional life, what happens when this element is left out of the primary social relationship? Is it possible that there results a deficiency disease of the emotional life, comparable to a deficiency of vital nutritional elements within the developing organism? Examples of adopted children who could not attach to their adoptive parents are provided. The case studies indicate certain basic responses to affect hunger, showing a group in which there are pathologic residues due to an extreme deficiency; second, a group in which the restoration of maternal love has marked therapeutic effect; and third, a group which demonstrates specialized difficulties in social relationships that are derivatives of a primary affect hunger. This chapter was abridged from the American Journal of Psychiatry, 1937, 94, 643-652 (see record
1938-02985-001) and reprinted by permission of the author and The American Psychiatric Association. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Describes a neurobiological basis for the 1st attachment of the primate infant to its caretaker. The infant normally internalizes a neurobiological image of the behavioral and emotional characteristics of its caregiver that later regulates important features of its brain function. Current models of sensorimotor analysis and its relation to emotion suggest that sensorimotor systems are also habit and memory systems, their functional status and lability regulated in part by biogenic amine systems. The intertwined development of neural and social functions can sometimes go awry. If the attachment process fails or the caregiver is incompetent, the infant may become socially dysfunctional. This helps explain the developmental psychopathology and later vulnerability to adult psychopathology that result from disruptions of social attachment. 16 comments follow, and the author responds. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Six per cent of child in a sample of 111 children who were adopted into U.K. families from Romania, and who were systematically assessed at the ages of 4 and 6 years, showed autisticlike patterns of behaviour. A further 6% showed milder (usually isolated) autistic features. Such autistic characteristics were not found in a similarly studied sample of 52 children adopted in the first 6 months of life within the U.K. The children from Romania with autistic patterns showed clinical features closely similar to “ordinary” autism at 4 years but they differed with respect to the improvement seen by age 6 years, to an equal sex ratio, and to a normal head circumference. The children from Romania with autistic features tended to differ from the other Romanian adoptees with respect to a greater degree of cognitive impairment and a longer duration of severe psychological privation.
Abstract The psychosocial development of 16 boys placed in permanent substitute families between the ages of 5 and 9 was examined at 1, 12, 60 and 96 months into placement. Conduct and emotional problems fell significantly over the first year but relationship difficulties and overactivity changed little. There was no significant change beyond 12 months. By 8 years, 19% of placements had disrupted and 15% of the remainder had a poor outcome. The level of preptacement adversity predicted poor or disrupted outcomes, but outcomes for those with high adversity were hotter when parenting was very positive.
This article is an introduction to the Special Issue. Reactive Attachment Disorder (RAD) has been in the psychiatric nosology since 1980, when DSM-III was published. Since 1980, however, there has been little research on RAD as a diagnostic category. On the other hand, research on the development of patterns of attachment has informed clinical practice. In this article, selected diagnostic issues are reviewed and a model for conceptualizing the continuum of levels of attachment adaptation in infants and young children is presented. The articles in this Special Issue are introduced and the issues they address are highlighted.
Fifty-one children who had spent their first 2–7 years in institutions, and who had been previously visited at the age of 41/2 years, were reassessed at the age of 8. Seven children had never left the institutions, the rest had been adopted, fostered, or restored to their biological parent. The children's behaviour during psychological testing was assessed, and information was obtained from their parents and teachers. According to the parents’ reports, the ex-institutional children did not present any more problems than the comparison groups. The teachers, however, found many differences between the ex-institutional children and their classmates. Despite very frequent staff changes, the institutional children were not retarded. The adopted children had the highest mean I. Q, and reading achievements; this finding appears to be related to the higher social class of the adoptive parents and the poorer emotional adjustment of the children restored to their biological families.
A group of 193 children, classified as high or low reactive to stimulation at 4 months and observed again at 14 and 21 months, were observed at 4½ years of age for behavioral signs of inhibited or uninhibited behavior. Children who had been high reactive were less spontaneous and less sociable than those who had been classified as low reactive, but only a small proportion of children maintained a consistently inhibited or uninhibited phenotype at all ages.
The behavioral problems and affectional relationships of 26 children aged 4 1/2, continuously reared in institutions since early infancy, were compared with those of 30 working class children living at home. Thirty nine children of the same age who had been adopted from an institution or restored to their mothers between the ages of 2 and 4 were also studied. The institutional children had different, but no more frequent problems than the working class children; the adopted children had significantly fewer problems than the institutional children. A minority of the institutional and ex institutional children were 'over friendly' to strangers and indiscriminately affectionate; most of the adopted but few of the institutional children were believed to have formed close attachments to adults.
The adolescents described in the preceding companion article (J. Child Psychol. Psychiat. 30, 53-75, 1989) had experienced multiple changing caregivers until at least 2 years old. Such maternal deprivation did not necessarily prevent them forming strong and lasting attachments to parents once placed in families, but whether such attachments developed depended on the family environment, being much more common in adopted children than in those restored to a biological parent. Both these groups alike, however, were more oriented towards adult attention, and had more difficulties with peers and fewer close relationships than matched comparison adolescents, indicating some long term effects of their early institutional experience.
Although Meyer and Freud believed that the seeds of mental health are sown in childhood, systematic research has proved difficult and disappointing, and theory has remained intensely controversial. Research of the past two decades by developmental psychologists using an ethologically based theory of socioemotional bonds, however, is yielding findings that consistently confirm predictions. The author outlines this research, giving examples of the results, which are shown to be compatible with findings of epidemiological studies of depressed adults. He holds that a person's degree of vulnerability to stressors is strongly influenced by the development and current state of his or her intimate relationships.
Classical “affectionless psychopathy” of institutionalization is no longer a commonly found syndrome in residential care. The individual clinical features which make up the syndrome, however, are each described as occurring very commonly. A psychiatric study of a group of children in long stay residential care suggests that the main features of the syndrome have a different aetiology. Antisocial behaviour is found to relate to aspects in the child's family, and relationship difficulties to an early admission to care. The implications of these findings are discussed.
The psychosocial development of 16 boys placed in permanent substitute families between the ages of 5 and 9 was examined at 1, 12, 60 and 96 months into placement. Conduct and emotional problems fell significantly over the first year but relationship difficulties and overactivity changed little. There was no significant change beyond 12 months. By 8 years, 19% of placements had disrupted and 15% of the remainder had a poor outcome. The level of preplacement adversity predicted poor or disrupted outcomes, but outcomes for those with high adversity were better when parenting was very positive.
In this paper the effectiveness of preventive or therapeutic interventions aiming at enhancing parental sensitivity and children's attachment security is addressed. Sixteen pertinent studies have been reviewed, and 12 studies have been included in a quantitative meta-analysis (N = 869). Results show that interventions are more effective in changing parental insensitivity (d = .58) than in changing children's attachment insecurity (d = .17). Longer, more intensive, and therapeutic interventions appear to be less effective than short-term preventive interventions. Interventions which are effective at the behavioral level may not necessarily lead to changes in insecure mental representations of the parents involved. The implications of changes at the behavioral level (sensitivity; attachment) without accompanying changes at the representational level will be discussed.
This study evaluated the enduring effectiveness of a skill-based training program to enhance maternal sensitivity between 6 and 9 months of age. 82 mothers and their toddlers were evaluated at 18 and 24 months, and 79 at 31/2 years on the bases of observations of free play, everyday interaction, problem solving, and peer interaction. Most of the significant behavioral changes noted in the second year pertain to attachment security, indices of maternal sensitivity across situations, and child cooperation. Some enduring effects on indices of sensitivity appear to be attachment-mediated. In the third year, results revealed direct enduring intervention effects on parental responsiveness and child cooperation. Attachment-mediated effects were evident for maternal assistance, child security, and positive peer contact. Attachment pattern also predicted differences in attractiveness of the focal child as an interactive partner.
Although an inability to form normal social attachments characterizes many forms of psychopathology, there has been little study of the neural basis of social bond formation. The primary purpose of this article is to describe a novel approach to the neurobiology of attachment.
The author reviews animal research on two closely related neuropeptides, oxytocin and vasopressin, implicated in the central mediation of attachment behaviors. These neuropeptides appear to be important for the initiation of pair bonds and parental behaviors as well as the infant's response to social separation.
Both cellular and molecular studies have begun to reveal the mechanisms by which oxytocin and vasopressin neural pathways are regulated, leading to a preliminary understanding of how these hormones act within the brain to influence complex social behaviors.
Although their function in the human brain has yet to be demonstrated, the available evidence suggests that oxytocin and vasopressin may prove to be important in the pathophysiology of clinical disorders, such as autism, characterized by an inability to form normal social attachments.
Attachment and indiscriminately friendly behavior were assessed in children who had spent at least 8 months in a Romanian orphanage (RO) and two comparison groups of children: a Canadian-born, nonadopted, never institutionalized comparison group (CB) and an early adopted comparison group adopted from Romania before the age of 4 months (EA). Attachment was assessed using 2 measures: an attachment security questionnaire based on parent report, and a Separation Reunion procedure that was coded using the Preschool Assessment of Attachment. Indiscriminately friendly behavior was examined using parents' responses to 5 questions about their children's behavior with new adults. Although RO children did not score differently from either CB or EA children on the attachment security measure based on parent report, they did display significantly more insecure attachment patterns than did children in the other 2 groups. In addition, RO children displayed significantly more indiscriminately friendly behavior than both CB and EA children, who did not differ in terms of indiscriminate friendliness. RO children's insecure attachment patterns were not associated with any aspect of their institutional environment, but were related to particular child and family characteristics. Specifically, insecure RO children had more behavior problems, scored lower on the Stanford-Binet Intelligence Scale, and had parents who reported significantly more parenting stress than RO children classified as secure.
A group of 193 children, classified as high or low reactive to stimulation at 4 months and observed again at 14 and 21 months, were observed at 4 1/2 years of age for behavioral signs of inhibited or uninhibited behavior. Children who had been high reactive were less spontaneous and less sociable than those who had been classified as low reactive, but only a small proportion of children maintained a consistently inhibited or uninhibited phenotype at all ages.
The purpose of this paper is to review existing behavioral and neuroendocrine perspectives on social attachment and love. Both love and social attachments function to facilitate reproduction, provide a sense of safety, and reduce anxiety or stress. Because social attachment is an essential component of love, understanding attachment formation is an important step toward identifying the neurobiological substrates of love. Studies of pair bonding in monogamous rodents, such as prairie voles, and maternal attachment in precocial ungulates offer the most accessible animal models for the study of mechanisms underlying selective social attachments and the propensity to develop social bonds. Parental behavior and sexual behavior, even in the absence of selective social behaviors, are associated with the concept of love; the analysis of reproductive behaviors, which is far more extensive than our understanding of social attachment, also suggests neuroendocrine substrates for love. A review of these literatures reveals a recurrent association between high levels of activity in the hypothalamic pituitary adrenal (HPA) axis and the subsequent expression of social behaviors and attachments. Positive social behaviors, including social bonds, may reduce HPA axis activity, while in some cases negative social interactions can have the opposite effect. Central neuropeptides, and especially oxytocin and vasopressin have been implicated both in social bonding and in the central control of the HPA axis. In prairie voles, which show clear evidence of pair bonds, oxytocin is capable of increasing positive social behaviors and both oxytocin and social interactions reduce activity in the HPA axis. Social interactions and attachment involve endocrine systems capable of decreasing HPA reactivity and modulating the autonomic nervous system, perhaps accounting for health benefits that are attributed to loving relationships.
This study was undertaken to assess the effects of holding therapy on children who have a history of aggressive and delinquent behaviors. The study design was a prospective, pre-post, quasi-experimental controlled study. The subjects were recruited through the Attachment Center at Evergreen, Colorado. Eligible subjects were adopted children between the ages of 5-14 years, living in the present adopted home for at least one year. All children had a history of aggressive and delinquent behaviors, which prompted the contact with Evergreen. Findings resulted in significant decrease in the outcome variable for the treatment group within this study.
This article describes children with significant attachment problems and summarizes the actions needed to increase the probability that such children can be successfully adopted. Healthy and disordered attachment patterns are detailed, as well as the principles and strategies that are important in parenting such children and the parenting characteristics that should be sought in selecting families for children with attachment disorder. Psychological treatment and other postadoption services necessary to support the adoption and the child's ability to successfully form a secure attachment with the adoptive parents are also highlighted.
To examine attachment disturbances and disorder in a sample of children adopted into the U.K. following severe early privation and in a comparison sample of nondeprived, within-country, early-placed adoptees.
The subjects, 165 children adopted from Romania and 52 adoptees from the U.K., were assessed at age 6 years; longitudinal data (at ages 4 and 6 years) were available on the 111 Romanian adoptees placed in U.K. homes before 24 months of age and on all U.K. adoptees. Information on attachment disorder was derived from a semistructured interview with the parent; in addition, data on children's cognitive and social development were assessed using standardized assessments.
Analyses revealed a close association between duration of deprivation and severity of attachment disorder behaviors. In addition, attachment disorder behaviors were correlated with attentional and conduct problems and cognitive level but nonetheless appeared to index a distinct set of symptoms/behaviors. Finally, there was marked stability in individual differences in attachment disorder behaviors and little evidence of a mean decrease over this 2-year period.
The findings offer construct validation for the attachment disorder construct and highlight clinical and conceptual questions that require further research.
The current study examined the predictors of parent-child relationship quality and developmental change in a sample of children adopted into the U.K. following severe early privation, and in a comparison sample of nondeprived, within-country adoptees. One hundred and fifty-eight children adopted from Romania and 52 U.K. adoptees were assessed at age 6 years; longitudinal data (age 4 and 6 years) were available on the 110 Romanian adoptees placed into U.K. homes before 24 months of age and all U.K. adoptees. Ratings of parent-child positivity and negativity during a semistructured interaction task were obtained from coders who were blind to the child's background. Results indicated that adoptive parent-child relationship quality was related to duration of deprivation and that cognitive/developmental delay mediated this association. The magnitude of this effect was modest and diminished over time. Longitudinal analyses revealed that positive change in parent-child relationship quality was most marked among children who exhibited cognitive catch-up between assessments. The direction of effects appeared to be primarily child to parent. The findings underscore the need for further research on the long-term impact of early experiences on psychosocial development.
To assess convergence among three different measures of indiscriminate behavior and to assess the relationship of indiscriminate behavior to having an attachment figure and to aggressive behavior among young children living in a Romanian institution.
Caregivers in the institution were interviewed with semistructured interviews regarding the behavior of 61 children with special emphasis on indiscriminate behavior. The study was conducted in Bucharest, Romania (1999).
Substantial convergence among measures of indiscriminate behavior was demonstrated. Indiscriminate behavior was common whether or not these children had a preferred attachment figure. Indiscriminate behavior was independent of aggressive behavior.
Differing explanations for indiscriminate behavior in young children derive from differing interpretations of similar findings rather than different findings with different measures. Indiscriminate behavior was largely independent of aggression in these institutionalized young children. Indiscriminate behavior may represent an independent problem rather than a type of reactive attachment disorder as suggested by DSM-IV criteria.
To determine whether signs of disordered attachment were greater in young children being reared in more socially depriving caregiving environments.
Three groups of children were studied by means of structured interviews with caregivers that were administered over several months in Bucharest, Romania, in 1999: (1) 32 toddlers living in a typical unit (standard care) in a large institution in Bucharest; (2) 29 toddlers living in the same institution on a 'pilot unit" designed to reduce the number of adults caring for each child; and (3) 33 toddlers living at home who had never been institutionalized. The presence of attachment disorders and other behavioral problems was assessed by caregiver/ parent report.
Children on the typical unit (standard care) had significantly more signs of disordered attachment than children in the other two groups. Both the emotionally withdrawn and the indiscriminately social pattern of attachment disorder were apparent in these children, but cluster analysis suggested that mixed patterns are more typical.
The continuum of caretaking casualty is reflected by increasing signs of disordered attachment in toddlers living in more socially depriving environments.