Attachment disturbances and disorders in children exposed to early severe deprivation

Attachment disorder has garnered considerable attention in recent years. Despite the clear clinical and theoretical importance of attachment disorder, however, there are remarkably few systematic studies of attachment disorder behaviors or their etiology, course, and associated features. Evidence of attachment disorder behaviors was examined in a sample of 111 children who experienced institutional upbringing and were later adopted into the United Kingdom, and a comparison sample of 52 intracountry adopted children not exposed to early deprivation. All children were 4 years of age at the time of assessment. Information was obtained from a semistructured interview with the parent, questionnaires, and direct assessment of the children. Results indicated that attachment disorder behaviors were positively associated with duration of severe deprivation, but a substantial number of children exposed to even prolonged severe early privation did not exhibit these symptoms. Retrospective parental reports further indicated that children with concurrent disturbances in attachment behavior were likely to have displayed disturbances early on (i.e., at placement), but there was also considerable evidence for discontinuity. The discussion focuses on how these findings address conceptual and diagnostic issues of attachment disorder. In addition, case illustrations are offered to extend the empirical findings and to highlight central aspects of attachment disorder that require further attention.