Advertisement

European Child & Adolescent Psychiatry

, Volume 15, Issue 6, pp 336–342 | Cite as

Reactive attachment disorder—a theoretical model beyond attachment

  • Helen Minnis
  • Helen Marwick
  • Julie Arthur
  • Alexis McLaughlin
ORIGINAL CONTRIBUTION

Abstract

Despite its importance in public health, reactive attachment disorder (RAD) is an under-researched and little used clinical category. Abnormalities of social relatedness have long been documented in children who have been abused, neglected or institutionalised, but there have been more recent efforts to define these behaviours within the psychiatric nosology. There has been an implicit assumption that the central deficit in RAD is in the attachment system, but this has caused controversy and may have blocked research. We propose that RAD is better construed within the framework of intersubjectivity, which has a central role in the development of core brain and social functions and may also have had an important role in the evolution of a key human characteristic—complex social functioning. This broader framework may potentially explain apparently diverse symptoms such as indiscriminate friendliness and negative or unpredictable reunion responses. Finally, we suggest that a change of name may be useful in progressing the field, but accept that this may be difficult until there is better agreement in the clinical and scientific communities about the core features and aetiology of this disorder.

Keywords

foster care service use costs 

Notes

Acknowledgements

We are grateful to Christine Puckering, Joyce Minnis, Chris Gillberg, Danya Glaser, Amanda Burston and Valerie Murray for comments on earlier drafts.

References

  1. 1.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DCGoogle Scholar
  2. 2.
    Richters MM, Volkmar FR (1994), Reactive attachment disorder of infancy and early childhood. J Am Acad Child Adolesc Psychiatry 33:328–332PubMedGoogle Scholar
  3. 3.
    World Health Organisation (1992) The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines World Health Organisation, GenevaGoogle Scholar
  4. 4.
    Tizard B, Hodges J (1978) The effect of early institutional rearing on the development of eight year old children. J Child Psychol Psychiatry 19:99–118PubMedGoogle Scholar
  5. 5.
    Tizard B, Rees J (1975) The effect of early institutional rearing on the behaviour problems of 4 year old children. J Child Psychiatry Psychol 16:61–73Google Scholar
  6. 6.
    Spitz RR (1945) Hospitalism: an inquiry into the genesis of psychiatric conditions in early childhood. Psychoanal Study Child 1:54–74Google Scholar
  7. 7.
    Goldfarb W (1945a) Psychological privation in infancy and subsequent adjustment. Am J Orthopsychiatry 17:247–255Google Scholar
  8. 8.
    Minde K (2003) Attachment problems as a spectrum disorder: implications for diagnosis and treatment. Attachment Human Dev 5:289–296CrossRefGoogle Scholar
  9. 9.
    Goldfarb W (1945b) Effects of psychological deprivation in infancy and subsequent stimulation. Am J Psychiatry 102:18–33Google Scholar
  10. 10.
    Minnis H, Rabe-Hesketh S, Wolkind S (2002) Development of a brief, clinically relevant, scale of: measuring attachment disorders. Int J Methods Psychiatr Res 11(2):90–98PubMedCrossRefGoogle Scholar
  11. 11.
    O’Connor T (2002) Attachment disorders of infancy and childhood. In: Rutter M, Taylor E (eds) Child and adolescent psychiatry. Blackwell, London pp 776–792Google Scholar
  12. 12.
    Smyke AT, Dumitrescu A, Zeanah CH (2002) Attachment disturbances in young children. I: the continuum of caretaking casualty. J Am Acad Child Adolesc Psychiatry 41(8):972–982PubMedCrossRefGoogle Scholar
  13. 13.
    Fries ABW, Ziegler TE, Kurian JR, et al. (2005) Early experience in humans is associated with changes in neuropeptides critical for regulating social behavior. Proc Natl Acad Sci 102(47):17237–17240PubMedCrossRefGoogle Scholar
  14. 14.
    Chisolm K (1998) A three year follow-up of attachment and indiscriminate friendliness in children adopted from Romanian orphanages. Child Dev 69:1092–1106CrossRefGoogle Scholar
  15. 15.
    Minnis H, Keck G (2003) A clinical/research dialogue on reactive attachment disorder. Attachment Human Dev 5(3):297–301CrossRefGoogle Scholar
  16. 16.
    Dodge KA, Pettit GS, Bates JE (1997) How the experience of early physical abuse leads children to become chronically aggressive, in developmental perspectives on trauma: theory, research and intervention, 8 edn. University of Rochester Press, New York, pp 263–287Google Scholar
  17. 17.
    Arseneault L, Moffitt TE, Caspi A, Taylor PJ, Silva PA (2000) Mental disorders and violence in a total birth cohort. Arch Gen Psychiatry 57:979–986PubMedCrossRefGoogle Scholar
  18. 18.
    Minnis H, Pelosi A, Knapp M, Dunn J (2001) Mental health and foster carer training. Arch Disease Childhood 84:302–306CrossRefGoogle Scholar
  19. 19.
    McCann JB, James A, Wilson S, Dunn G (1996) Prevalence of psychiatric disorders in young people in the care system. Br Med J 313:1529–1530Google Scholar
  20. 20.
    Dimigen G, Del Priore C, Butler S, Evans S, Ferguson L, Swan M (1999) The need for a mental health service for children at commencement of being looked after and accommodated by the local authority: questionnaire survey. Br Med J 319(7211):675Google Scholar
  21. 21.
    Coid J (1999) Aetiological risk factors for personality disorders. Br J Psychiatry 174(530):538Google Scholar
  22. 22.
    Holmes J (2004) Disorganised attachment and borderline personality disorder: a clinical perspective. Attachment Human Dev 61(2):181–190CrossRefGoogle Scholar
  23. 23.
    Bell J, Sim M (2004) Placement issues, in children exposed to parental substance misuse implications for family placement, Phillips R (ed). BAAF, LondonGoogle Scholar
  24. 24.
    Howe D, Fearnley S (1999) Disorders of attachment and attachment therapy. Adoption Fostering 23(2):19–30Google Scholar
  25. 25.
    Boris N, Hinshaw-Fuselier S, Sarah S, Smyke AT (2004) Comparing criteria for attachment disorders: establishing reliability and validity in high-risk samples. J Am Acad Child Adolesc Psychiatry 43(5)Google Scholar
  26. 26.
    Meltzer H, et al. (2002) The mental health of group of young people looked after by local authorities in England. Report of survey from 2002 by the social survey division of the office for National Statistics on behalf of the Department of HealthGoogle Scholar
  27. 27.
    Zeanah CH (1996) Beyond insecurity: a reconceptualization of attachment disorders of infancy. J Consulting Clin Psychol 64:42–52CrossRefGoogle Scholar
  28. 28.
    Chisholm K, Carter MC, Ames EW, Morison SJ (1995) Attachment security and indiscriminately friendly behaviour in children adopted from Romanian Orphanages. Dev Psychopathol 7:283–294CrossRefGoogle Scholar
  29. 29.
    Tizard B (1977) Adoption: a second chance. Open Books, LondonGoogle Scholar
  30. 30.
    O’Connor T, Bredenkamp D, Rutter M (1999) Attachment disturbances and disorders in children exposed to severe early deprivation. Infant Mental Health J 20(1):10–29CrossRefGoogle Scholar
  31. 31.
    Gaensbauer T, Sands K (1979) Distorted affective communication in abused/neglected infants and their caretakers. J Am Acad Child Adolesc Psychiatry 18:236–250Google Scholar
  32. 32.
    George C, Main M (1979) Social interactions of young abused children: approach, avoidance and aggression. Child Dev 50:306–318PubMedCrossRefGoogle Scholar
  33. 33.
    Main M, Solomon J (1986) Discovery of an insecure-disorganized/disorientated attachment pattern. In: Yogman M, Brazleton TB (eds) Affective development in infancy. Ablex, New Jersey, pp 95–124Google Scholar
  34. 34.
    Carlson V, Cicchetti D, Barnett D, Braunwald K (1989) Disorganized/disorientated attachment relationships in maltreated infants. Dev Psychol 25:525–531CrossRefGoogle Scholar
  35. 35.
    Green J, Goldwyn R (2002) Annotation: attachment disorganisation and psychopathology: new findings in attachment research and their potential implications for developmental psychopathology in childhood. J Child Psychol Psychiatry 43:835–846PubMedCrossRefGoogle Scholar
  36. 36.
    van Ijzendoorn MH, Bakermans-Kranenburg MJ (2003) Attachment disorders and disorganized attachment: similar and different. Attachment Human Dev 5:313–320CrossRefGoogle Scholar
  37. 37.
    Main M, Hesse E (1990) Parents’ unresolved traumatic experiences are related to infant disorganized attachment status: is frightened and/or frightening behaviour the linking mechanism? In: Greenberg MT, Cicchetti, Cummings (eds) Attachment in the preschool years, University of Chicago Press, Chicago, pp 161–182Google Scholar
  38. 38.
    O’Connor TG, Zeanah CH (2003) Introduction to the special issue: current perspectives on assessment and treatment of attachment disorders. Attachment Human Dev 5(3):221–222CrossRefGoogle Scholar
  39. 39.
    Cicchetti D, Toth SL (1995) A developmental psychopathology perspective on child abuse and neglect. Am J Child Adolesc Psychiatry 34:541–565CrossRefGoogle Scholar
  40. 40.
    Glaser D (2000) Child abuse and neglect and the brain—a review. J Child Psychol Psychiatry 41:97–116PubMedCrossRefGoogle Scholar
  41. 41.
    O’Connor T, Rutter M (2000) Attachment disorder behavior following early severe deprivation: extension and longitudinal follow-up. J Am Acad Child Adolesc Psychiatry 39:703–712PubMedCrossRefGoogle Scholar
  42. 42.
    Bowlby J (1984) Attachment, 2nd edn. Pelican Books, LondonGoogle Scholar
  43. 43.
    Dunn J (1993) Young children’s relationships: beyond attachment. Sage, Thousand OaksGoogle Scholar
  44. 44.
    Ainsworth MD (1979) Infant–mother attachment. Am Psychol 34:932–937PubMedCrossRefGoogle Scholar
  45. 45.
    Green J (2003) Are attachment disorders best seen as social impairment syndromes? Attachment Human Dev 5(3):259–264CrossRefGoogle Scholar
  46. 46.
    van Ijzendoorn MH, Schuengel C, Bakermans-Kranenburgh MJ (1999) Disorganized attachment in early childhood: meta-analysis of precursors, concomitants, and sequelae. Dev Psychopathol 11:225–249PubMedCrossRefGoogle Scholar
  47. 47.
    Trevarthen C, Aitkin KJ (2001) Infant intersubjectivity: research, theory, and clinnical applications. J Child Psychol Psychiatry 42:3–48PubMedCrossRefGoogle Scholar
  48. 48.
    Trevarthen C (1998) The concept and foundations of infant intersubjectivity. In: Braten S (eds) Intersubjective communication and emotion in early ontogeny. Cambridge University Press, Cambridge, pp 15–46Google Scholar
  49. 49.
    Trevarthen C (1999) Musically and the intrinsic motive pulse: evidence from human psychobiology and infant communication. Musical narrative and the origins of human communication. Musicae Scientae, Special Issue 1999–2000:157–213. Leige: European Society for the Cognitive Sciences of MusicGoogle Scholar
  50. 50.
    Stern DN (1985/2000) The interpersonal world of the infant: a view from psychoanalysis and development psychology. (Second edition), with new introduction). Basic Books, New YorkGoogle Scholar
  51. 51.
    Marwick H (2004) Development in companionship—the importance of relationships to the development of language and learning. Keynote, Sure Start National Speech and Language Therapy Conference, WarwickGoogle Scholar
  52. 52.
    Trevarthen C, Marwick H (1986) Signs of motivation for speech in infants, and the nature of a mother’s support for development of language. In: Lindblom B, Zetterstrom R (eds) Precursors of early speech. Macmillan, Basingstoke, pp 279–308Google Scholar
  53. 53.
    Hobson RP (1993) Autism and the development of mind. Hove/Hillside, EarlbaumGoogle Scholar
  54. 54.
    Stern DN (2004) The present moment in psychotherapy and everyday life. WW Norton and Co, New YorkGoogle Scholar
  55. 55.
    Marwick H (2005) Joint imaginative play with ‘representational others’ in preschool children with autism. Inclusive and Supportive Education Congress, International Special Education Conference, Inclusion: Celebrating Diversity? 1st–4th August 2005. Glasgow, Scotland (http://www.isec.2005.org.uk/isec/abstracts/papers_m/marwick)
  56. 56.
    Reddy V (1991) Playing with others’ expectations; teasing and mucking about in the first year. In: Whiten A (ed) Natural theories of mind. Oxford, Blackwell, pp 143–158Google Scholar
  57. 57.
    Bettes BA (2005) Maternal depression and motherese: temporal and intonational features. Child Dev 59:1089–1096CrossRefGoogle Scholar
  58. 58.
    Murray L, Cooper PJ (eds) (1997) Postpartum depression and child development. Guildford Press, New YorkGoogle Scholar
  59. 59.
    Trevarthen C, Aitken KJ, Papoudi D, Robarts JZ (1998) Children with autism: diagnosis and interventions to meet their needs, 2nd edn. Jessica Kingsley, LondonGoogle Scholar
  60. 60.
    Murray L, Kempton C, Woolgar M, Hooper R (1993) Depressed mothers’ speech to their infants and its relation to infant gender and cognitive development. J Child Psychol Psychiatry 34(7):1083–1101PubMedGoogle Scholar
  61. 61.
    Murray L, Woolgar M, Cooper P, Hipwell A (2001) Cognitive vulnerability to depression in 5-year-old children of depressed mothers. J Child Psychol Psychiatry 42(7):891–899PubMedCrossRefGoogle Scholar
  62. 62.
    Kraemer GW (1997) Psychobiology of early social attachment in Rhesus monkeys. Clinical implications. Ann New York Acad Sci 807:401–418Google Scholar
  63. 63.
    Harlow HF, Harlow MK, Suomi SJ (1971) From thought to therapy: lessons from a primate laboratory. Am Scientist 59:538–549PubMedGoogle Scholar
  64. 64.
    Richardson K (1995) Evolution and development. In: Oates J (ed) The foundations of child development. Blackwell/The Open University, OxfordGoogle Scholar
  65. 65.
    Shore AN (1998) The experience-dependent maturation of an evaluation system in the cortex. In: Pribram KH (ed) Brain and values: is a biological science of values possible? Erlbaum, Mahwah, NJ pp 337–358Google Scholar
  66. 66.
    Trevarthen C (2001) Intrinsic motives for companionship in understanding: their origin, development and significance for infant mental health. Infant Mental Health J 22(1–2):95–131CrossRefGoogle Scholar
  67. 67.
    Blaffer Hrdy S (1999) Mother nature Chatto and Winduss, New YorkGoogle Scholar
  68. 68.
    Porges SW (1997) Emotion: an evolutionary by-product of the neural regulation of the autonomic nervous system. In: Carter CS, Lederhendler II, Kirkpatrick B (eds) The integrative neurobiology of affiliation (Annals of the New York Academy of Sciences 807). New York Academy of Sciences, New York, pp 62–78Google Scholar
  69. 69.
    Tronick EZ, Als H, Adamson L, Wise S, Brazelton TB (1978) The infant’s response to entrapment between contradictory messages in face-to-face interaction. J Am Acad Child Psychiatry 17:1–13PubMedCrossRefGoogle Scholar
  70. 70.
    Murray L, Trevarthen C (1985) Emotional regulation of interactions between two-month-olds and their mothers. In: Field TM, Fox NA (eds) Social perception in infants. Norwood NJ, Ablex, pp 177–197Google Scholar
  71. 71.
    Dance C, Rushton A, Quinton D (2002) Emotional abuse in early childhood: relationships with progress in subsequent family placement. J Child Psychol Psychiatry 43:395–407PubMedCrossRefGoogle Scholar
  72. 72.
    Greig A, Howe D (2001) Social understanding, attachment security of preschool children and maternal mental health. Br J Dev Psychol 19:381–393CrossRefGoogle Scholar

Copyright information

© Steinkopff Verlag Darmstadt 2006

Authors and Affiliations

  • Helen Minnis
    • 1
  • Helen Marwick
    • 2
  • Julie Arthur
    • 1
  • Alexis McLaughlin
    • 1
  1. 1.University of Glasgow Section of Psychological MedicineCaledonia House, Yorkhill HospitalGlasgowUK
  2. 2.Dept. of Childhood and Primary StudiesUniversity of Strathclyde, National Centre for Autism StudiesGlasgowUK

Personalised recommendations