Attachment in Toddlers with Autism and Other Developmental Disorders

Abstract

Attachment was assessed in toddlers with Autistic Disorder (n=20), Pervasive Developmental Disorder (n=14), Mental Retardation (n=12), Language Development Disorder (n=16), and a non-clinical comparison group (n=18), using the Strange Situation Procedure (SSP). Children in the clinical groups were more often disorganized and less often securely attached. Severity of autism was associated with more attachment insecurity, and lower developmental level increased the chance for disorganized attachment. Attachment disorganization was related to increased heart rate during the SSP. Controlling for basal cortisol and developmental level, more autistic symptoms predicted lower cortisol responses to the SSP. The findings support the importance of disorganized attachment for children with autism.

A short-term longitudinal study of correlates and sequelae of attachment security in autism

“…Children with autism classified as disorganized in this way had greater average heart rate changes during the separation and reunion episode than those who were not assigned the D classification. These findings were subsequently replicated in a toddler sample by Naber et al (2007a). These findings suggest that when autistic stereotypies are excluded from consideration, the disorganized attachment classification can nonetheless be assigned for children with autism, with expectable correlates (see also Koren-Karie et al, 2009; Van IJzendoorn et al, 2007).…”

“…Studies using the Ainsworth Strange Situation procedure (Ainsworth & Wittig, 1969) find that 40–60% of preschool-age children with autism are classified as securely attached, based on Mary Ainsworth’s original secure/avoidant/resistant classification system (Capps et al, 1994; Koren-Karie et al, 2009; Shapiro et al, 1987; Van IJzendoorn et al, 2007; Willemsen-Swinkles et al, 2000). In the first Strange Situation study conducted with toddlers, Naber et al (2007a) found that 35% of toddlers with a diagnosis of Autistic Disorder and 43% of toddlers with a diagnosis of Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) were classified as securely attached (see also Naber et al, 2008). …”

“…Links between severity of autism symptoms and attachment security have been equivocal. Studies utilizing total scores on the Autism Diagnostic Observation Schedule (ADOS) diagnostic assessment reported significant differences in total scores between securely and insecurely attached children (Naber et al, 2007a; Van IJzendoorn et al, 2007). In contrast, studies comparing children with strictly defined autism to children with diagnoses of PDD-NOS reported similar rates of security in the two groups (Oppenheim et al, 2009; Willemsen-Swinkels et al, 2000).…”

“…In contrast, studies comparing children with strictly defined autism to children with diagnoses of PDD-NOS reported similar rates of security in the two groups (Oppenheim et al, 2009; Willemsen-Swinkels et al, 2000). Finally, disorganization appears specifically linked with intellectual disability in autism (Koren-Karie et al, 2009; Naber et al, 2007a; Van IJzendoorn et al, 2007; Willemsen-Swinkels et al, 2000). However, these findings are correlational and cross-sectional, and further longitudinal research is needed to clarify the exact meaning of these associations.…”

“…Though there is an emerging literature on the social and cognitive correlates of attachment in autism (e.g. Capps, Sigman, & Mundy, 1994; Koren-Karie Oppenheim, Dolev, & Yirmiya, 2009, 2007b; Naber et al, 2007a; Oppenheim, Koren-Karie, Dolev & Yirmiya, 2009; Van IJzendoorn et al, 2007; Willemsen-Swinkles, Bakermans-Kranenburg, Buitelaar, van IJzendoorn, & van Engeland, 2000), the implications of secure attachment for subsequent development in children with autism remains an understudied topic (Kahane & El-Tahir, 2015). To that end, the goals of the present study were to (1) investigate the correlates of individual differences in the quality of attachment organization in children with autism, including maternal sensitivity as well as child cognitive and social skills, and, (2) for the first time, examine the implications of attachment security for subsequent development of these children.…”