Disorganized attachment in infancy: a review of the phenomenon and its implications for clinicians and policy-makers.

Disorganized/Disoriented (D) attachment has seen widespread interest from policy makers, practitioners, and clinicians in recent years. However, some of this interest seems to have been based on some false assumptions that (1) attachment measures can be used as definitive assessments of the individual in forensic/child protection settings and that disorganized attachment (2) reliably indicates child maltreatment, (3) is a strong predictor of pathology, and (4) represents a fixed or static "trait" of the child, impervious to development or help. This paper summarizes the evidence showing that these four assumptions are false and misleading. The paper reviews what is known about disorganized infant attachment and clarifies the implications of the classification for clinical and welfare practice with children. In particular, the difference between disorganized attachment and attachment disorder is examined, and a strong case is made for the value of attachment theory for supportive work with families and for the development and evaluation of evidence-based caregiving interventions.

Using the adult attachment interview to understand reactive attachment disorder: findings from a 10-case adolescent sample.

A feasibility study was conducted to examine the usability of the Adult Attachment Interview (AAI) and its coding system with 10 adolescents presenting with Reactive Attachment Disorder (RAD). Given that the measure was deemed usable with all 10 participants, the study then sought to identify the attachment status of the sample. Three transcripts were subjected to inter-rater reliability checks. All transcripts indicated a high level of insecurity, with five participants classified as organized-insecure and five assigned to the cannot classify category. However, a number of issues were raised in the administration and coding of the transcripts concerning participant distress, coding of inferred carer behaviour and experiences of unresolved loss or trauma. We also identified two new phenomena, namely extreme derogation and extreme detachment, and discuss possible development of the existing classification system. Our data indicates that cannot classify attachment status in this population may represent a transitional stage to becoming organized, and that organized insecurity may offer a route to future security. Further minimal adaptations to the AAI may promote the validity of its use with this population.

Annotation: attachment disorganisation and psychopathology: new findings in attachment research and their potential implications for developmental psychopathology in childhood.

BACKGROUND: The past 10 years have seen a fruitful line of enquiry building on identification of previously unclassifiable patterns of infant-mother interaction. A critical review of these new findings in attachment theory, highlighting their potential relevance to child psychopathology, is presented. METHOD: Selective literature review relating to disorganised attachment in childhood. RESULTS: Disorganised patterns of attachment have only relatively recently been described. They show characteristic patterns of evolution in development. There is evidence that disorganised attachments are associated with specific forms of distorted parenting, which are distinct from general parental insensitivity and are associated with unresolved loss or trauma in the caregiver. There are also links with aspects of neurodevelopment vulnerability in the child. Attachment disorganisation is a powerful predictor of a range of later social and cognitive difficulties and psychopathology. CONCLUSIONS: The identification of disorganised attachment has greatly increased the potential relevance of attachment theory to general clinical work. However, the concept raises many methodological and theoretical issues. Among issues needing further exploration is the way in which attachment disorganisation relates to children's general mental states and may be affected by cognitive functioning and developmental impairment.