Symptoms of Disordered Attachment in High-Risk Populations: Prevalence, Risk-Factors, and Prevention

The term Attachment Disorders covers two patterns of social relatedness in children, an inhibited, socially withdrawn pattern and a disinhibited, indiscriminately social pattern, caused by experiences of pathogenic care. Due to a lack of research, there is still an ongoing discussion regarding phenomenology, etiological mechanisms, and developmental course of attachment disorders. Moreover, neither effective intervention approaches nor any evidence-based prevention approaches are available to date. Therefore, two studies have been conducted to investigate etiology and course of attachment disorder symptoms as well as the impact of improvements in the care environment on development and course of symptoms in two high-risk samples. The first study analyzes prevalence and course of attachment disorder symptoms in a sample of 55 one-to-six-year-old foster children during the first year after placement in long-term foster care. A multi-method approach was chosen to assess attachment disorder symptoms. Data revealed that marked signs of attachment inhibition were very rare, and symptoms remitted in most children within the first six months of placement. However, a third of the foster children displayed at least mild disinhibited symptoms at time of placement and although foster parents reported a significant symptom reduction, observational data indicated persistence of symptoms over time. Prior placement in emergency foster care was related with lower levels of inhibited attachment behavior. However, children placed at later age and children with more severe early adverse care experiences displayed higher levels of attachment disorder symptoms at placement, while psychiatric problems of the biological parents and ongoing visitation with the biological parents predicted symptom stability. In a sample of high-risk mother-child dyads, the second study evaluated whether an attachment-based video-feedback intervention (Ulm Model), designed to increase maternal sensitivity, can effectively prevent the development of indiscriminate social behavior. Mothers in the intervention group (n = 32) were trained with the Ulm Model, while the control group (n = 18) received services as usual. Indiscriminate social behavior was assessed in a standardized laboratory session when the children were 12 months old (RISE). Maternal sensitivity was observed during four home visits (pre- and post-intervention, 6 and 12 months). Familial adversity factors, maternal psychological distress, and maternal social contact and support were assessed by maternal self-report. It was found that the prevalence of marked signs of indiscriminate social behavior was significantly lower in the intervention group than in the control group. However, the effect was not significant within the subgroup of adolescent mothers. The intervention effect was neither mediated by changes in maternal sensitivity nor by changes in maternal psychological distress. Infant indiscriminate social behavior was significantly predicted by severe maternal distress indicated by a cumulation of familial risks and maternal psychological problems. The findings implicate that inhibited attachment disorder symptoms are very rare in foster children, and the symptoms are highly susceptible to improvements in the caregiving environment. On the contrary, the prevalence of indiscriminate social behavior appears to be highly increased in children with early adverse care experiences, while improvements in the care conditions do not seem to be sufficient for symptom remission. Therefore, there is an urgent need to develop effective interventions for the children. Moreover, the implementation of early attachment-based interventions with families in multiple-risk conditions seems to have the potential to prevent the development of indiscriminate social behavior in children