Comparing Criteria for Attachment Disorders: Establishing Reliability and Validity in High-Risk Samples

Boris, Neil W.; Hinshaw‐Fuselier, Sarah; Smyke, Anna T.; Scheeringa, Michael S.; Heller, Sherryl Scott; Zeanah, Charles H.

doi:10.1097/00004583-200405000-00010

Cited by 105 publications

(102 citation statements)

References 33 publications

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“…The disorder seems to be rare in clinic samples and in most high-risk samples. For example, Boris et al (2004) reported that there were no cases of RAD among impoverished young children attending a Head Start program and 2 of 25 homeless young children met ICD-10 criteria for disinhibited attachment disorder.…”

Section: Studies Of Maltreated Childrenmentioning

confidence: 99%

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Attachment disorders in family and social context

Zeanah

Smyke

2008

Infant Mental Health Journal

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Serious disturbances of attachment in young children have been increasingly studied in the past decade as they arise in atypical rearing environments. The purpose of this review is to provide an update on recent findings and to consider their implications. Research on children raised in institutions, children adopted out of institutions, and young children who have experienced neglect in families is considered. Reactive attachment disorder may be identified reliably in a minority of children being raised in severely neglectful environments. The emotionally withdrawn/inhibited pattern and the indiscriminately social/disinhibited pattern arise in similar conditions of risk, but respond differently to intervention and appear to have different correlates. Much has been learned about the emotionally withdrawn/inhibited pattern of reactive attachment disorder and the indiscriminately social/disinhibited pattern. Much less is known about so-called secure base distortions or relational disorders of attachment.RESUMEN: Objetivo: Serios trastornos de afectividad en niños pequeños han sido más y más estudiados en la pasada década a medida que han aparecido en ambientes de crianza atípicos. El propísito de esta revisión es proveer una actualización de los resultados recientes y considerar sus implicaciones. Métodos: Se considera la investigación sobre niños criados en instituciones, niños de instituciones que han sido adoptados, y niños pequeños que han experimentado negligencia por parte de sus familias. Resultados: El trastorno de la afectividad reactiva pudiera ser confiablemente identificado en una minoría de niños que son criados en ambientes severamente negligentes. El patrón de despego emocional/inhibición y el patrón de indiscriminación social/desinhibición surgen en condiciones similares de riesgo, aunque responden diferentemente a la intervención y parecen tener correlaciones diferentes. Conclusiones: Se ha aprendido mucho acerca del patrón de despego emocional/inhibición y el de indiscriminación social/desinhibición. Mucho menos se sabe acerca de las llamadas distorsiones de una base segura o los trastornos relacionales de la afectividad.RÉSUMÉ: Objectif: Les troubles sérieux de l'attachement chez les jeunes enfants ont fait l'objet de plus en plus d'études ces dernières dix années dans la mesure où ils apparaissent dans des milieux et contextes dans lesquels ils ontétéélevés atypiques.

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Section: Studies Of Maltreated Childrenmentioning

confidence: 99%

“…Boris et al (2004), for example, used a combination of a structured interview and behavioral assessment to determine if young children met criteria for RAD. This study used a behavioral assessment of attachment behavior designed for use in clinical settings.…”

Section: Measurement Issuesmentioning

confidence: 99%

Attachment disorders in family and social context

Zeanah

Smyke

2008

Infant Mental Health Journal

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“…Thirty-three studies were published between 1988 and 2011, of which the majority were undertaken in the USA (n = 18 24,47,93,94,[96][97][98][99][100][102][103][104]106,111,113,115,116,118,121 ), with the rest spread across the UK (n = 4 50,52,[107][108][109] ), Canada (n = 4 25,105,110,119 ), Germany (n = 2 101,122 ), the Netherlands (n = 2 117,120 ), Romania (n = 1 94 ) and Spain (n = 1 114 ). Table 1 and Box 1.…”

Section: Resultsmentioning

confidence: 99%

“…6 A total of 16 studies identified in this supplementary review used the SSP. 25,93,94,98,102,103,105,106,113,115,116,[118][119][120][121][122] Of these, six used the original ABC classification system 25,93,94,103,105,106 and 10 included the disorganised category in some form. 98,102,113,115,116,[118][119][120][121][122] This procedure has been very influential in the design of subsequent assessment tools, as evidenced by the development of many bespoke and modified versions of the procedure found in this review.…”

Section: The Strange Situation Proceduresmentioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of parenting interventions for children with severe attachment problems: a systematic review and meta-analysis

Wright

Barry

Hughes

et al. 2015

Health Technol Assess

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Background and objectivesServices have variable practices for identifying and providing interventions for ‘severe attachment problems’ (disorganised attachment patterns and attachment disorders). Several government reports have highlighted the need for better parenting interventions in at-risk groups. This report was commissioned to evaluate the clinical effectiveness and cost-effectiveness of parenting interventions for children with severe attachment problems (the main review). One supplementary review explored the evaluation of assessment tools and a second reviewed 10-year outcome data to better inform health economic aspects of the main review.Data sourcesA total of 29 electronic databases were searched with additional mechanisms for identifying a wide pool of references using the Cochrane methodology. Examples of databases searched include PsycINFO (1806 to January week 1, 2012), MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations (1946 to December week 4, 2011) and EMBASE (1974 to week 1, 2012). Searches were carried out between 6 and 12 January 2012.Review methodsPapers identified were screened and data were extracted by two independent reviewers, with disagreements arbitrated by a third independent reviewer. Quality assessment tools were used, including quality assessment of diagnostic accuracy studies – version 2 and the Cochrane risk of bias tool. Meta-analysis of randomised controlled trials (RCTs) of parenting interventions was undertaken. A health economics analysis was conducted.ResultsThe initial search returned 10,167 citations. This yielded 29 RCTs in the main review of parenting interventions to improve attachment patterns, and one involving children with reactive attachment disorder. A meta-analysis of eight studies seeking to improve outcome in at-risk populations showed statistically significant improvement in disorganised attachment. The interventions saw less disorganised attachment at outcome than the control (odds ratio 0.47, 95% confidence interval 0.34 to 0.65;p < 0.00001). Much of this focused around interventions improving maternal sensitivity, with or without video feedback. In our first supplementary review, 35 papers evaluated an attachment assessment tool demonstrating validity or psychometric data. Only five reported test–retest data. Twenty-six studies reported inter-rater reliability, with 24 reporting a level of 0.7 or above. Cronbach’s alphas were reported in 12 studies for the comparative tests (11 with α > 0.7) and four studies for the reference tests (four with α > 0.7). Three carried out concurrent validity comparing the Strange Situation Procedure (SSP) with another assessment tool. These had good sensitivity but poor specificity. The Disturbances of Attachment Interview had good sensitivity and specificity with the research diagnostic criteria (RDC) for attachment disorders. In our supplementary review of 10-year outcomes in cohorts using a baseline reference standard, two studies were found with disorganised attachment at baseline, with one finding raised psychopathology in adolescence. Budget impact analysis of costs was estimated because a decision model could not be justifiably populated. This, alongside other findings, informed research priorities.LimitationsThere are relatively few UK-based clinical trials. A 10-year follow-up, while necessary for our health economists for long-term sequelae, yielded a limited number of papers.ConclusionsMaternal sensitivity interventions show good outcomes in at-risk populations, but require further research with complex children. The SSP and RDC for attachment disorders remain the reference standards for identification until more concurrent and predictive validity research is conducted. A birth cohort with sequential attachment measures and outcomes across different domains is recommended with further, methodologically sound randomised controlled intervention trials. The main area identified for future work was a need for good-quality RCTs in at-risk groups such as those entering foster care or adoption.Study registrationThis study is registered as PROSPERO CRD42011001395.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…Although child characteristics, such as temperament, might be implicated in the development of IADB (Zeanah & Fox, 2004), most investigations of attachment disorders have focused primarily on proximal processes related to parental deprivation and neglect (Boris et al, 2004;Rutter, Kreppner, & Sonuga-Barke, 2009;Smyke, Dumitrescu, & Zeanah, 2002;Zeanah & Gleason, 2010, 2015. Findings from such work are in line with the view that parental deprivation and child maltreatment adversely affect multiple aspects of development (Cicchetti & Toth, 2005;Cicchetti & Valentino, 2006), including increased risk of insecure and disorganized attachments (Barnett, Ganiban, & Cicchetti, 1999).…”

Section: Quality Of Care and Iadbmentioning

confidence: 89%

Inhibited attachment disordered behavior in institutionalized preschool children: links with early and current relational experiences

Corval

Belsky

Baptista

et al. 2017

Attachment & Human Development

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Inhibited attachment disordered behavior (IADB) is characterized by difficulty in establishing an attachment relationship with a primary caregiver; is associated with persistent social and emotional problems; and is observed most frequently in contexts of pathological care such as institutional rearing. Here, we seek to enhance understanding of the conditions that give rise to IADB among institutionalized children by examining prior family experiences of neglect and deprivation and concurrent relational experiences at the institution. The sample is comprised of 146 children, between 36 and 78 months. IADB was assessed using a semistructured interview administered to the child's primary caregiver. Results revealed that both pre-institutionalization experiences (e.g. parental abandonment) and current relational ones (e.g. low quality of child-caregiver relationship) predicted IADB. Findings are discussed in light of the need to promote conditions which foster the establishment and maintenance of the child's selective attachment to a caregiving figure.ARTICLE HISTORY

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Comparing Criteria for Attachment Disorders: Establishing Reliability and Validity in High-Risk Samples

Cited by 105 publications

References 33 publications

Attachment disorders in family and social context

Attachment disorders in family and social context

Clinical effectiveness and cost-effectiveness of parenting interventions for children with severe attachment problems: a systematic review and meta-analysis

Inhibited attachment disordered behavior in institutionalized preschool children: links with early and current relational experiences

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