Attachment disorder is a broad term intended to describe disorders of mood, behavior, and social relationships arising from unavailability of normal socializing care and attention from primary care giving figures in early childhood. Such a failure would result from unusual early experiences of neglect, abuse, abrupt separation from caregivers between three months and three years of age, frequent change or excessive numbers of caregivers, or lack of caregiver responsiveness to child communicative efforts resulting in a lack of basic trust. A problematic history of social relationships occurring after about age three may be distressing to a child, but does not result in attachment disorder.
Reactive attachment disorder (RAD) is described in clinical literature as a severe disorder that can affect children, although these issues do occasionally persist into adulthood. RAD is characterized by markedly disturbed and developmentally inappropriate ways of relating socially in most contexts. It can take the form of a persistent failure to initiate or respond to most social interactions in a developmentally appropriate way—known as the "inhibited form". In the DSM-5, the "disinhibited form" is considered a separate diagnosis named "disinhibited attachment disorder".
An attachment theory is a psychological, evolutionary, and ethological theory concerning relationships between humans. The most important tenet is that young children need to develop a relationship with at least one primary caregiver for normal social and emotional development. The theory was formulated by psychiatrist and psychoanalyst John Bowlby (1907–1990).
Selma Fraiberg (1918–1981) was an American child psychoanalyst, author and social worker.
A form of child abuse, child neglect is an act of caregivers that results in depriving a child of their basic needs, such as the failure to provide adequate supervision, health care, clothing, or housing, as well as other physical, emotional, social, educational, and safety needs. All societies have established that there are necessary behaviours a caregiver must provide for a child to develop physically, socially, and emotionally. Causes of neglect may result from several parenting problems including mental disorders, unplanned pregnancy, substance use disorder, unemployment, over employment, domestic violence, and, in special cases, poverty.
Attachment in children is "a biological instinct in which proximity to an attachment figure is sought when the child senses or perceives threat or discomfort. Attachment behaviour anticipates a response by the attachment figure which will remove threat or discomfort". Attachment also describes the function of availability, which is the degree to which the authoritative figure is responsive to the child's needs and shares communication with them. Childhood attachment can define characteristics that will shape the child's sense of self, their forms of emotion-regulation, and how they carry out relationships with others. Attachment is found in all mammals to some degree, especially primates.
Attachment measures, or attachment assessments, are the various procedures used to assess the attachment system in children and adults. These procedures can assess patterns of attachment and individual self-protective strategies. Some assessments work across the several models of attachment and some are model-specific. Many assessments allow children and adults' attachment strategies to be classified into three primary attachment pattern groups: B-pattern, A-pattern, C-pattern. In most models, each pattern group is further broken down into several sub-patterns. Some assessments are capable of finding additional information about an individual, such as unresolved trauma, depression, history of family triangulation, and lifespan changes in the attachment pattern. Some assessments specifically or additionally look for caregiving behaviors, as caregiving and attachment are widely considered two separate systems for organizing thoughts, feelings, and behavior. Some methods assess disorders of attachment or romantic attachment.
Attachment therapy is a pseudoscientific child mental health intervention intended to treat attachment disorders. It is found primarily in the United States, and much of it is centered in about a dozen clinics in Evergreen, Colorado, where Foster Cline, one of the founders, established his clinic in the 1970s.
Child psychotherapy, or mental health interventions for children refers to the psychological treatment of various mental disorders diagnosed in children and adolescents. The therapeutic techniques developed for younger age ranges specialize in prioritizing the relationship between the child and the therapist. The goal of maintaining positive therapist-client relationships is typically achieved using therapeutic conversations and can take place with the client alone, or through engagement with family members.
In psychology, mentalization is the ability to understand the mental state – of oneself or others – that underlies overt behaviour. Mentalization can be seen as a form of imaginative mental activity that lets us perceive and interpret human behaviour in terms of intentional mental states. It is sometimes described as "understanding misunderstanding." Another term that David Wallin has used for mentalization is "Thinking about thinking". Mentalization can occur either automatically or consciously. Mentalization ability, or mentalizing, is weakened by intense emotion.
Maternal deprivation is a scientific term summarising the early work of psychiatrist and psychoanalyst John Bowlby on the effects of separating infants and young children from their mother. Although the effect of loss of the mother on the developing child had been considered earlier by Freud and other theorists, Bowlby's work on delinquent and affectionless children and the effects of hospital and institutional care led to his being commissioned to write the World Health Organization's report on the mental health of homeless children in post-war Europe whilst he was head of the Department for Children and Parents at the Tavistock Clinic in London after World War II. The result was the monograph Maternal Care and Mental Health published in 1951, which sets out the maternal deprivation hypothesis.
Charles H. Zeanah Jr. is a child and adolescent psychiatrist who is a member of the council (Board) of the American Academy of Child and Adolescent Psychiatry (AACAP).
Attachment-based therapy applies to interventions or approaches based on attachment theory, originated by John Bowlby. These range from individual therapeutic approaches to public health programs to interventions specifically designed for foster carers. Although attachment theory has become a major scientific theory of socioemotional development with one of the broadest, deepest research lines in modern psychology, attachment theory has, until recently, been less clinically applied than theories with far less empirical support. This may be partly due to lack of attention paid to clinical application by Bowlby himself and partly due to broader meanings of the word 'attachment' used amongst practitioners. It may also be partly due to the mistaken association of attachment theory with the pseudo-scientific interventions misleadingly known as attachment therapy. The approaches set out below are examples of recent clinical applications of attachment theory by mainstream attachment theorists and clinicians and are aimed at infants or children who have developed or are at risk of developing less desirable, insecure attachment styles or an attachment disorder.
Reflective Parenting is a theory of parenting developed from the work of psychoanalyst Peter Fonagy and his colleagues at the Tavistock Clinic in London. Fonagy introduced the concept of “reflective functioning”, which is defined as the ability to imagine mental states in self and others. Through this capacity for reflection, we develop the ability to understand our own behavioral responses and the responses of others as a meaningful attempt to communicate those inner mental states. As Fonagy describes it, “reflective function is the… uniquely human capacity to make sense of each other”.
Daniel S. Schechter is an American and Swiss psychiatrist known for his clinical work and research on intergenerational transmission or "communication" of violent trauma and related psychopathology involving parents and very young children. His published work in this area following the terrorist attacks on the World Trade Center in New York of September 11, 2001 led to a co-edited book entitled "September 11: Trauma and Human Bonds" (2003) and additional original articles with clinical psychologist Susan Coates that were translated into multiple languages and remain among the first accounts of 9/11 related loss and trauma described by mental health professionals who also experienced the attacks and their aftermath Schechter observed that separation anxiety among infants and young children who had either lost or feared loss of their caregivers triggered posttraumatic stress symptoms in the surviving caregivers. These observations validated his prior work on the adverse impact of family violence on the early parent-child relationship, formative social-emotional development and related attachment disturbances involving mutual dysregulation of emotion and arousal. This body of work on trauma and attachment has been cited by prominent authors in the attachment theory, psychological trauma, developmental psychobiology and neuroscience literatures
Patricia McKinsey Crittenden is an American psychologist known for her work in the development of attachment theory and science, her work in the field of developmental psychopathology, and for creation of the Dynamic-Maturational Model of Attachment and Adaptation (DMM).
The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood-Revised is a developmentally based diagnostic manual that provides clinical criteria for categorizing mental health and developmental disorders in infants and toddlers. It is organized into a five-part axis system. The book has been translated into several languages, and its model is utilized for the assessment of children up to five years of age.
Psychodynamic Therapy with Infants and Parents aims to relieve emotional disturbances within the parent(s), the baby, and/or their interaction, for example, postnatal depression and anxiety, infant distress with breastfeeding and sleep, and attachment disorders. It rests on attachment theory and psychoanalysis. Sigmund Freud suggested that a modification of his method could be applied to children, and child analysis was introduced in the 1920s by [Anna Freud].., [Melanie Klein], and Hermine Hug von Hellmuth. Klein speculated on infantile experiences to understand her patients' disorders but she did not practice PTIP. Donald Winnicott, a pediatrician and analyst, focused on the mother-baby interplay in his theorizing and his brief parent-child consultations, but he did not work with PTIP.
The Crowell procedure is a tool used to assess the parent-child relationship. Crowell and Feldman created the assessment tool for use in a study. The tool, which includes seven activities for the parent-child dyad to complete, is used for both preventive and clinical purposes. Crowell and Feldman's 1988 piece introducing the Crowell Method has been cited in over 500 studies. The assessment procedure has also been proven to be a reliable measure in discriminating between clinical and non-clinical dyads. The procedure is also known as the Crowell Parent-Child Interaction Procedure and the Crowell Problem Solving Procedure Rating Scale.
Joy D. Osofsky is a clinical and developmental psychologist, known for her research on infant mental health, how parents nurture their infants and children, and the repercussions that follow exposure to traumatic events and violence. Some of her notable work has examined the aftereffects of Hurricane Katrina, experiences of children raised in broken households, and the impact of the COVID-19 pandemic on communities. Osofsky is employed as a Professor of Pediatrics, Psychiatry, and Public Health at the Louisiana State University Health Sciences Center, and she is Head of the Division of Pediatric Mental Health at the Louisiana State University School of Medicine. Osofsky holds the Barbara Lemann Professorship of Child Welfare at LSU Health New Orleans.
