Are people with an intellectual disability at increased risk of attachment difficulties? A critical review

Abstract

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.

Individuals with intellectual disabilities experiences of the therapeutic relationship

“…This could be likened to the role of an early caregiver who by caring for a baby, facilitates a secure attachment style. This is something some individuals with ID are deprived of Potharst et al (2012), Giltaij et al (2015), Hamadi and Fletcher (2019). Therefore, the current study suggests that therapy offers an opportunity to experience a warm and responsive relationship that they have not experienced before.…”

“…This may create a sense of fear, and a potential experience of loss of the child they were expecting to have. This could lead to a disconnect with their child with ID, resulting in different styles of interaction, such as reduced eye contact (Hamadi and Fletcher, 2019). Decreased parental engagement may also be precipitated by trying to meet the increased demands of raising a child with ID (Giltaij et al , 2015).…”

Exploring how to deliver videoconference-mediated psychological therapy to adults with an intellectual disability during the coronavirus pandemic

“…This is particularly salient when working with clients whose difficulties are linked to unhelpful attachment styles, the development of which, may have indeed been influenced by inconsistent care. There is some evidence to suggest individuals with ID have a higher prevalence of disorganised and insecure attachment styles (Hamadi & Fletcher, 2019). When engaging in remote therapy with this client group, therapists within the service are recommended to set boundaries with the aim of maintaining consistency and preserving the therapeutic frame as recommended in face to face therapy (Jackson & Beail, 2013).…”

Setting up a new team of support staff for people with mild intellectual disability or borderline intellectual functioning and severe challenging behaviour: A concept mapping study

“…This can create feelings of helplessness and fear about the future (Griffith & Hastings, 2014 ). Moreover, these transfers make it hard to build trusting therapeutic relationships that are necessary to provide feelings of safety and support in dealing with stress (Hamadi & Fletcher, 2021 ; Janssen et al, 2002 ). To break this pattern and improve the quality of support, some healthcare organisations decide to set up a new (residential) home with a new team of support staff for people with intellectual disability who display severe challenging behaviour.…”