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Disorganized Attachment in Infancy: a Review of the Phenomenon and Its Implications for Clinicians and Policy-Makers

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Disorganized Attachment in Infancy: a Review of the Phenomenon and Its Implications for Clinicians and Policy-Makers Disorganized attachment in infancy: a review of the phenomenon and its implications for clinicians and policy-makers The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Granqvist, P., L. A. Sroufe, M. Dozier, E. Hesse, M. Steele, M. van Ijzendoorn, J. Solomon, et al. 2017. “Disorganized attachment in infancy: a review of the phenomenon and its implications for clinicians and policy-makers.” Attachment & Human Development 19 (6): 534-558. doi:10.1080/14616734.2017.1354040. http:// dx.doi.org/10.1080/14616734.2017.1354040. Published Version doi:10.1080/14616734.2017.1354040 Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:34492994 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA ATTACHMENT & HUMAN DEVELOPMENT, 2017 VOL. 19, NO. 6, 534–558 https://doi.org/10.1080/14616734.2017.1354040 Disorganized attachment in infancy: a review of the phenomenon and its implications for clinicians and policy-makers Pehr Granqvista, L. Alan Sroufeb, Mary Dozierc, Erik Hessed, Miriam Steelee, Marinus van Ijzendoornf, Judith Solomong, Carlo Schuengel h, Pasco Fearoni, Marian Bakermans-Kranenburgj, Howard Steelee, Jude Cassidyk, Elizabeth Carlsonb, Sheri Madiganl, Deborah Jacobvitzm, Sarah Fostern, Kazuko Behrenso, Anne Rifkin- Graboip, Naomi Gribneaug, Gottfried Spanglerq, Mary J Wardr, Mary Trues, Susan Spiekert, Sophie Reijmang, Samantha Reiszg,u, Anne Tharnerf, Frances Nkarad, Ruth Goldwynv, June Sroufew, David Pedersonx, Deanne Pedersony, Robert Weigandz, Daniel Siegelaa, Nino Dazzibb, Kristin Bernardcc, Peter Fonagy i, Everett Waterscc, Sheree Tothdd, Dante Cicchettib, Charles H Zeanahee, Karlen Lyons-Ruthff, Mary Maind and Robbie Duschinskyg aDepartment of Psychology, Stockholm University, Stockholm, Sweden; bInstitute of Child Development, University of Minnesota, Minneapolis, MN, USA; cDepartment of Psychological and Brain Sciences, University of Delaware, Newark, NY, USA; dDepartment of Psychology, University of California, Berkeley, CA, USA; ePsychology Department, The New School, New York, NY, USA; fDepartment of Psychology, Education, and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands; gDepartment of Public Health & Primary Care, University of Cambridge, Cambridge, UK; hClinical Child and Family Studies and Amsterdam Public Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; iResearch Department of Clinical, Educational and Health Psychology, University College of London, London, UK; jChild and Family Studies, Leiden University, Leiden, The Netherlands; kPsychology Department, University of Maryland, Washington DC, USA; lDepartment of Psychology, University of Calgary, Calgary, Canada; mDepartment of Psychology, The University of Texas, Austin, TX, USA; nFaculty of Health and Life Sciences, University of Northumbria, Newcastle, UK; oDepartment of Social and Behavioral Sciences, SUNY Polytechnic Institute, Utica, NY, USA; pthe Neurodevelopmental Research Center, the Singapore Institute for Clinical Sciences, Singapore, Singapore; qDevelopmental and Educational Psychology, University of Erlangen-Nuremberg, Erlangen, Germany; rDepartment of Pediatrics, Weill Cornell Medical College, New York, NY, USA; sPsychology Department, St Mary’s College of California, Moraga, NY, USA; tCenter on Human Development and Disability, University of Washington, Seattle, MA, USA; uthe Department of Human Development and Family Sciences, University of Texas at Austin, Austin, TX, USA; vChild and Adolsecent Mental Health Service, Trafford Children and Young Peoples Service, Manchester, UK; wMinnesota Institute for Contemporary Psychotherapy and Psychoanalysis, Minneapolis, MI, USA; xDepartment of Psychology, University of Western Ontario, London, ON, Canada; yUniversity of Western Ontario, London, ON, Canada; zT. Denny Sanford School of Social & Family Dynamics, Arizona State UniversityTempe, AZ, USA; aaSchool of Medicine, University of California, Los Angeles, CA, USA; bbDepartment of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy; ccDepartment of Psychology, Stony Brook University, Stony Brook, NY, USA; ddThe Mt. Hope Family Center, University of Rochester, Rochester, NY, USA; eeInstitute of Infant and Early Childhood Mental Health, Tulane University, New Orleans, LA, USA; ffDepartment of Psychiatry, Harvard Medical School, Boston, MA, USA ABSTRACT ARTICLE HISTORY Disorganized/Disoriented (D) attachment has seen widespread Received 22 June 2017 interest from policy makers, practitioners, and clinicians in recent Accepted 7 July 2017 years. However, some of this interest seems to have been based on some false assumptions that (1) attachment measures can be CONTACT Pehr Granqvist [email protected]; Robbie Duschinsky [email protected] © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ATTACHMENT & HUMAN DEVELOPMENT 535 used as definitive assessments of the individual in forensic/child KEYWORDS protection settings and that disorganized attachment (2) reliably Disorganized attachment; indicates child maltreatment, (3) is a strong predictor of pathology, infancy; attachment-based and (4) represents a fixed or static “trait” of the child, impervious interventions; maltreatment; attachment disorder to development or help. This paper summarizes the evidence showing that these four assumptions are false and misleading. The paper reviews what is known about disorganized infant attachment and clarifies the implications of the classification for clinical and welfare practice with children. In particular, the differ- ence between disorganized attachment and attachment disorder is examined, and a strong case is made for the value of attach- ment theory for supportive work with families and for the devel- opment and evaluation of evidence-based caregiving interventions. This review paper represents a broadly held consensus concerning what we currently understand about disorganized infant attachment and its implications across clinical and child welfare practices. Our hope is that this review will prove to be useful both in supporting best practice and in highlighting the gaps that occasionally surround the concept of attachment disorganization, particularly between basic theory and research on the one hand and their applications in clinical and child welfare practice on the other. Summary of 10 topics to be elaborated upon in this review (1) The disorganized infant attachment category can be assigned by trained and certified coders to infant behavior (age 12–20 months) in the Strange Situation when there is a sufficient fit to one or several of the behaviors listed under Main and Solomon’s(1986, 1990) seven thematic headings. Persons interested in seeking training to code disorganized attachment should go directly to attach- ment-training.com. (2) Behaviors from Main and Solomon’s list can occur for a variety of reasons. They are quite common at low levels in the Strange Situation among infants from populations facing adversity. Only when these behaviors are sufficiently intense can a classification of disorganized attachment be assigned. (3) Disorganized infant attachment is more common among maltreated infants but does not necessarily indicate maltreatment. As it stands, the disorganized attach- ment classification cannot be used to screen for maltreatment. This is because a significant proportion of maltreated infants do not show disorganized attach- ment in the Strange Situation, and many infants showing disorganized attach- ment in the Strange Situation have not been maltreated. Thus, there are other pathways to disorganized attachment besides maltreatment. (4) These other pathways to disorganized attachment may feature a parent’s unresolved trauma or loss. Such experiences may lead a parent to display subtly frightening, frightened, or dissociative behaviors toward their infant. Other contributing factors for at least some of the behaviors used to classify disorganized attachment may include the infant’s genetic and temperamental susceptibility. In addition, major or repeated 536 P.GRANQVISTETAL. separations can cause disorganized behaviors. Therefore, for children in placement who undergo such separations, disorganized behaviors may be especially misleading regarding the usual state of child–parent attachment. (5) Research at the group level has established disorganized infant attachment as a small-moderate predictor for the development of social and behavior problems. However, disorganized infant attachment does not inevitably cause later pro- blems. When infants classified as disorganized do develop such problems, this may be the result of a continuation of difficult life circumstances rather than solely an effect of early disorganized attachment. (6) Disorganized infant attachment is not a validated individual-level clinical diag- nosis. This is unlike the two attachment-related disorders included in the DSM/ ICD diagnostic systems, developed for the clinical categorization of young children
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