Correlates of the Randolph Attachment Disorder Questionnaire (RADQ) in a Sample of Children in Foster Placement

This study examined mental health and attachment problems in children in foster care. This study also obtained data concerning the validity of the Randolph Attachment Disorder Questionnaire (RADQ). Children were selected according to length of time in placement and age and screened for mental health symptoms using the Child Behavior Checklist and the RADQ. The findings showed that children in foster care have reported symptoms within the range typical of children not involved in foster care. The conclusion is that the RADQ has limited usefulness due to its lack of specificity with implications for treatment of children in foster care.     

Reactive Attachment Disorder: A Biopsychosocial Disturbance of Attachment

The etiology, differential diagnosis, and treatment of Reactive Attachment Disorder (RAD) are discussed utilizing a psychodynamically-informed biopsychosocial approach. Early trauma in childhood attachment experiences alters the structures, neuro-chemicals, and connectivity of the brain. The neurobiological effects of childhood neglect equal and even surpass the impact of abuse and related trauma. This paper discusses structures in the brain involved in early emotional and attachment experiences and how they are affected by pathogenic caregiving, the absence of caregivers, or the disruption of the early caregiving environment. All three types of neglect affect the ability of the Hypothalamic-Pituitary-Adrenal (HPA) axis to regulate the body and brain’s response to stress in a significant and enduring way.     

Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy

Children with histories of maltreatment are at significant risk of developing severe psychiatric problems. Treatment of such children is difficult and there are no empirical studies evaluating the effectiveness of outpatient treatment for children with trauma-attachment disorders. The present study examines the effectiveness of Dyadic Developmental Therapy, a treatment based on attachment theory, provided by one therapist in an outpatient setting. The 64 subjects all had trauma-attachment disorders, met the DSM-IV criteria for Reactive Attachment Disorder, and had histories of serious maltreatment. The 34 children in the treatment group were treated in weekly outpatient therapy at The Center For Family Development with Dyadic Developmental Psychotherapy. The 30 children in the control group were evaluated but did not received Dyadic Developmental Psychotherapy and received treatment from other providers at other clinics. Eligible subjects were children between the ages of five and seventeen years whose case had been closed in 2000 or 2001. All children had significant past histories of abuse, neglect, or orphanage care. Findings for children in the treatment group, as measured by the Achenback and Randolph Attachment Disorder Questionnaire, were significant decreases (p<.01) in symptoms of attachment disorder, withdrawn behaviors, anxiety and depression, social problems, thought problems, attention problems, rule-breaking behaviors, and aggressive behaviors. The findings for children in the control group showed no changes in the variables measured. Dyadic Developmental Psychotherapy appears to be an effective treatment for children with trauma-attachment disorders.The author would like to gratefully acknowledge Ms. Geraldine Gallucci, a master’s level social work intern, who was placed with The Center For Family Development. Ms. Gallucci ensured that the follow-up questionnaires were mailed to the families and returned to the agency.Arthur Becker-Weidmann is affiliated with Center for Family Development, Williamsville, USA.     

Violent children and structural violence: Re-signaling ‘RAD Kids’ to inform the social work professions

This article critically examines representations of children diagnosed with Reactive Attachment Disorder, or “RAD Kids”, and their construction as dangerous subjects. Based on ethnographic research within attachment therapy clinics, and among adoptive families, social workers, and medical professionals in the U.S. and Russia, the author suggests that notions of danger associated with “RAD Kids” actually reflect a social anxiety about the contexts of structural violence in which we are attempting to build families and raise children at the turn of the 21st century. The author culturally and historically contextualizes the signaling of “RAD Kids” as violent within literature on moral panics over children and youth. She explores how these representations function as an attempt to “resignal” public anxieties about the difficulties associated with building families through adoption, and especially, the adoption of formerly institutionalized children. The article provides a model for thinking about complex relationships between children, pathology, and power to inform the social work professions, and particularly practice with children diagnosed with RAD.     

Children adopted from China: Attachment security two years later

Background

This study continues the examination of the process of attachment formation of mothers and their adopted Chinese daughters two years postadoption.

Method

30 children adopted from China (mean age = 13.6 months at adoption) were assessed and followed two years following adoption. They were compared to 31 nonadopted Canadian girls of similar age and family background. In earlier reported longitudinal studies of the adopted children, maternal reports of attachment security were employed. In the current study the Strange Situation Procedure was used.

Results

Adopted children show signs of having a secure attachment with their mothers two years following adoption. There was some evidence that disorganized attachment characterized these children more so than for children in the comparison group.

Conclusions

The moderate degree of emotional deprivation experienced by Chinese adoptees does not hinder their ability to form a new attachment with adoptive mothers. Attachment appears open to change, even after a time when children should have already formed an attachment relationship and the change is maintained.     

The Impact of Family Therapists’ Adult Attachment Styles on Their Career Choice and Approach to Therapy: An Interpretive Phenomenological Analysis

Attachment theorists have highlighted the role of the therapist in providing a ‘secure base’ for therapy. This raises the question of how therapists with insecure as well as secure attachment styles manage the integration of their personal experience and their therapeutic work. This study explored the relationship between family therapists’ adult attachment styles, influences on their career choice and their approach to therapy. Participants’ (n = 11) attachment styles were previously assessed using the self-report Experiences in Close Relationship questionnaire. Three participants were assessed as having a ‘secure’ attachment style; three were ‘preoccupied’, three ‘fearful’ and two ‘dismissing’. They were interviewed about their practice and the impact of past or current relationships on their development as therapists. Interpretive Phenomenological Analysis was used to analyse the verbatim accounts into cluster of master themes and subthemes. The analysis identified two master themes: understanding one’s self and the impact of family of origin experiences, and the integration between personal experiences and therapeutic work. There were differences in responses relating to the therapists’ attachment styles. Therapists with ‘secure’ adult attachment styles were aware of their challenges and able to utilise their experiences in their practice and respond sensitively to their clients. Conversely, those with ‘insecure’ styles have difficulties in mentalisation and in using counter-transference responses in their practice. We suggest that family therapists, social workers and others engaged in therapeutic work with families should undertake an exploration of the ‘self’ of the therapist in the context of their own family relationships and adult attachment styles as part of their training and continuing professional development.     

Integrating Attachment Theory into Family Therapy

Solution‐focused therapies have had only short‐term effectiveness for clients with serious problems stemming from abuse who come to our family counselling centre in Auckland, New Zealand. In seeking long‐lasting change, we have begun integrating attachment theory into the family systems therapy we have been practising. The Adult Attachment Interview (George, Kaplan, & Main, 1985) has been incorporated into a case in order to study the effectiveness of integrating attachment and family systems theories. This case illustrates how information gathered about the mother's attachment pattern can help the therapist comprehend the client's response to the present crisis, and clear a path through what can appear to be an overwhelming labyrinth of presenting issues.     

Adult Foreign Adoptees: Reactive Attachment Disorder May Grow into Psychic Homelessness

The heterogeneity of the group of adopted children does not allow to draw general conclusions about the nature and quantity of behavioral problems with adopted children. This nature and quantity depend on the chosen comparison group. Older foreign adoptees at placement often show complex physical and psychological problems. Many suffer from some kind of behavioral disturbances. Empirical data show that reactive attachment disorder (RAD) can often be diagnosed. The continuation of this disorder in adulthood will result infeelings of psychic homelessness. Examples are described to make clear what kind of behavioral problem it concerns. Research to select appropriate treatments for RAD and psychic homelessness is still lacking.     

Adult Foreign Adoptees: Reactive Attachment Disorder May Grow into Psychic Homelessness

The heterogeneity of the group of adopted children does not allow to draw general conclusions about the nature and quantity of behavioral problems with adopted children. This nature and quantity depend on the chosen comparison group. Older foreign adoptees at placement often show complex physical and psychological problems. Many suffer from some kind of behavioral disturbances. Empirical data show that reactive attachment disorder (RAD) can often be diagnosed. The continuation of this disorder in adulthood will result in feelings of psychic homelessness. Examples are described to make clear what kind of behavioral problem it concerns. Research to select appropriate treatments for RAD and psychic homelessness is still lacking.     

Adoption,attachment and self-concept

This was a two-tiered study. In the first part of the study, a random sample was drawn from a list of subsidized adoptions with a response rate of 70% (N=197). In the second part of the study approximately 30% of adoptive parents gave permission (N=57) for the adopted child to participate. Attachment from two different perspectives and self-concept were assessed. Results suggest most children with special needs do not evidence selfconcept difficulties. In addition, some indicators of attachment can be used in assessing self-concept; children with better parent-child relations and children who do not evidence ambivalence attachment patterns of relating have higher self-concepts. The implications of these findings for practice are discussed.     

Physical Distance Between Romantic Partners as a Marker for Attachment in Couples: A Proof of Concept Study

Proximity seeking is at the core of attachment theory. Previously proximity has been studied almost exclusively in psychological terms. In clinical practice, however, couple therapists may interpret physical distance between romantic partners as a marker for the quality of the attachment bond. Unfortunately, this concept of physical distance between partners as an expression of attachment has never been tested. This study examines whether physical distance between romantic partners is associated with attachment. In 53 students and 43 clinical couples physical distance was repeatedly measured from video using novel software with excellent reliability. Attachment was measured with the Experiences in Close Relationships questionnaire. It was found that male attachment anxiety about rejection repeatedly showed statistically significant associations with physical interpersonal distance in student and clinical couples. We conclude that attachment may manifest itself not only in terms of psychological intimacy but also in terms of physical distance. Clinical utility and research implications are discussed.     

Opioid Use Disorder,Attachment, and Parenting: Key Concerns for Practitioners

In the United States, the current epidemic of opioid use disorders impacts many parents and their children. Historically, interventions for parents with substance use disorders have focused on two separate areas, achieving and maintaining abstinence and learning parenting skills. These interventions do not address the parent/child relationship, and the impact of parental opioid use disorder on attachment. Insecure attachment, particularly disorganized attachment, negatively affects the child’s development and safety. Attachment should always be considered when doing a safety assessment or planning an intervention for parents with opioid use disorders. This conceptual paper describes the impact of parental opioid use on attachment across the developmental span of childhood, highlighting research about opioid use disorder, parenting, and attachment which is relevant for practitioners working with parents with opioid use disorders, as child protection workers, substance abuse counselors, or therapists. Identification, attachment assessment tools, and empirical research on attachment-based interventions are discussed.     

Families Experiencing Divorce: Age at Onset of Overnight Stays,Conflict, and Emotional Availability as Predictors of Child Attachment

This study examined the qualities that contribute to postdivorce child attachment in a sample of 24 divorcing mothers and their children, ages 12 to 73 months, in the context of shared parenting time arrangements. Child attachment was assessed using Waters's Attachment Q-Set (AQS). Qualities such as age at onset of overnight stays, interparental conflict and communication, and emotional availability were examined for their importance in attachment security and dependency. Study hypotheses were partially supported. Although the study variables collectively did not predict attachment security and dependency outcomes, as hypothesized, the predictor variable of emotional availability (EA) child involvement proved significantly related with AQS security. Children who involved their mothers more in interaction were more secure with them. Further, EA child involvement contributed to attachment outcomes above and beyond age of onset of overnight stays and parent and partner contributions to interparental conflict.     

Developmental Outcomes of School Attachment Among Students of Mexican Origin

We used a longitudinal community study of 674 grade school children (Grades 5, 6, 7, and 8; 337 males, 337 females) of Mexican origin to examine outcomes of school attachment. Attachment to school is important in this population given the high level of school dropout rates of Mexican‐origin students. Results indicated that, on average, school attachment from fifth to sixth grade remains stable, but declines from sixth to eighth grade. Boys had lower levels of school attachment at fifth grade but followed similar patterns of change as girls did. Attachment to teachers, peer competence, school aspirations and expectations, and substance‐use cognitions emerged as longitudinal outcomes of level or changes in school attachment. Gender moderated associations of school attachment.     

Adult Exploration of Attachment Interview in Family Therapy

The Adult Exploration of Attachment Interview (AEAI) is a therapeutic interview developed by the author to assist adults to understand themselves and their relationships with others, especially with a partner, co‐parent and/or children. It is suitable for individuals and couples struggling to overcome repeated patterns of relating, helping to improve their intimate or parenting relationships through greater self and other understanding. The AEAI explores an adult's early relational learning, especially in regard to attachment needs, in order to allow change. The interview uses specific externalising language to help persons tolerate difficult memories, reduce guilt and shame and integrate their thoughts and feelings. It applies key implications of attachment theory and the approach is illustrated by examples from therapy.     

Attachment issues and the cocaine exposed dyad

Through the theoretical lens of attachment theory, the relationship between substance abusing parents and their children exposed prenatally to drugs is explored. Attachment theory, the quality of attachment, attachment classifications, internal working models of attachment, and correlates of attachment classifications are discussed. Case studies of two schoolaged children exposed prenatally to cocaine are presented and interpreted in light of attachment theory set within a social-ecological perspective. Implications for practice and the use of federal policy for this population are explored.     

The Impact of Behavioral Couple Therapy on Attachment in Distressed Couples

Emotion‐focused therapy (EFT; Greenberg & Johnson, 1988 Emotionally focused therapy for couples. New York: Guilford Press) is anchored in attachment theory (Johnson, 2003 Attachment processes in couples and families. New York: Guilford) and considers change in attachment schemas essential in the process of improving satisfaction in relationships (Johnson, 1999, Research and couples therapy: Where do we go from here? American Family Therapy Academy Newsletter). However, there are little data on how measures of attachment change over the course of EFT or any other couple therapy. The current study examines whether increases in attachment security predict improvements in marital satisfaction during behavioral couple therapy, which would suggest that change in attachment style is a key process variable even for a non‐attachment‐focused treatment. Multilevel models of data from 134 couples participating in a randomized clinical trial of integrative behavioral couple therapy and traditional behavioral couple therapy (Christensen et al. Journal of Consulting and Clinical Psychology, 72, 2004, 176) indicate that although there is a trend for early change in attachment‐related anxiety and avoidance to predict later change in marital satisfaction, early change in marital satisfaction strongly predicts change in attachment‐related anxiety through the end of treatment and 2‐year follow‐up. These findings suggest that changes in satisfaction may lead to changes in attachment rather than the reverse and that change in attachment may not be the mechanism of change in all efficacious couple therapy.     

“I Deserve a Family”: The Evolution of an Adolescent’s Behavior and Beliefs About Himself and Others When Treated with Theraplay in Residential Care

This article chronicles a seriously disturbed adopted adolescent’s experience in an attachment focused residential program at which the primary treatment was Theraplay^®. Adopted at age four following significant abuse and neglect, Tom lived in institutions for 5 years before participating in Chaddock’s Developmental Trauma and Attachment Program (DTAP). He now resides successfully in the home of therapeutic foster parents. Theraplay treatment directly meets attachment needs through adult-guided, highly positive, engaging and nurturing interactions to change the child’s working models of attachment and to develop affect regulation. Theraplay was especially useful with this adolescent who was born addicted and who had little ability to participate in insight oriented therapy. Topics include adolescence and attachment, Theraplay theory, process and applications, and the DTAP milieu and treatment program. This case study demonstrates that it is possible to improve the outcome for adolescent development by directly meeting the adolescent’s attachment needs through the Theraplay model.     

A preliminary evaluation: Demographic and clinical profiles and changes in functioning in children receiving psychosocial rehabilitation

The present study is the first to examine the demographic and clinical profiles at intake of children, ages 4 to 18 years, who received Child Psychosocial Rehabilitation (CSPR), a relatively new community-based treatment model for children with emotional disturbance. In addition, the relationship between the relative change in psychosocial, emotional, and behavioral functioning as measured by CAFAS (Hodges, 1989, 1994, 2000) and PECFAS (1994, 2000) scores and the children's age, gender, ethnicity, current living arrangement, internalizing and externalizing behaviors, and severity of impairment at intake were evaluated. Fifty-three children received CPSR for a minimum of six months from a for-profit outpatient child and adolescent mental health clinic located in southwestern Idaho. Significant improvement in the children's overall functioning was found after six months of treatment. Middle or high school age children demonstrated significantly more impairment at intake compared with their younger counterparts. No significant differences in overall functioning were revealed considering the characteristic of gender, living arrangement and clinical profiles at intake.     

Attachment theory and clinical social work

Recent additions have rendered attachment theory potentially viable for clinical social work practice. The author examines its formulations and possible use, seeing it as an important alternative to other psychosocial approaches that attempt to explain how early childhood experiences may affect later mental health. The emphasis of this theory on the cognitive makes it congenial to those who favor cognitive approaches to individual therapy, and its emphasis on patterns of attachment makes it of appeal to family therapists.