Key Publications
The key publications within the research cluster Attachment in clinical groups
Publications Disorganized attachment
- Madigan, S., Bakermans-Kranenburg, M.J., Van IJzendoorn, M.H., Moran, G., Pederson, D.R., & Benoit, D. (2006). Unresolved states of mind, anomalous parental behavior, and disorganized attachment: A review and meta-analysis of a transmission gap. Attachment and Human Development, 8, 89-111.
Abstract
The current meta-analysis examines the links between unresolved representations of attachment, anomalous parental behavior, and disorganized attachment relationships in 12 studies including 851 families. We found moderate effect sizes for the associations between unresolved states of mind and anomalous behavior (r=.26), unresolved states of mind and infant disorganized attachment relationships (r=.21), and anomalous behavior and disorganized attachment relationships (r=.34). Sample characteristics, observational context, and observational measure were not associated with differences in effect sizes. Only a small part of the association between unresolved states of mind and disorganized attachment relationships was explained by the mediation of anomalous parental behavior (.26* .34=.09). Other factors yet to be uncovered must mediate the influence of unresolved states of mind on infant disorganized attachment; thus, further exploration of infant, parental, ecological, and genetic factors are warranted. - Bakermans-Kranenburg, M.J., Van IJzendoorn, & Juffer, F. (2005). Disorganized infant attachment and preventive interventions: A review and meta-analysis. Infant Mental Health Journal, 26, 191-216.
Abstract
Infant disorganized attachment is a major risk factor for problematic stress management and later problem behavior. Can the emergence of attachment disorganization be prevented? The current narrative review and quantitative meta-analysis involves 15 preventive interventions (N=842) that included infant disorganized attachment as an outcome measure. The effectiveness of the interventions ranged from negative to positive, with an overall effect size of d=0.05 (ns). Effective interventions started after 6 months of the infant's age (d=0.23). Interventions that focused on sensitivity only were significantly more effective in reducing attachment disorganization (d=0.24) than interventions that (also) focused on support and parent's mental representations (d=-0.04). Most sample characteristics were not associated with differences in effect sizes, but studies with children at risk were more successful (d=0.29) than studies with at-risk parents (d=-0.10), and studies on samples with higher percentages of disorganized attachment in the control groups were more effective (d=0.31) than studies with lower percentages of disorganized children in the control group (d=-0.18). The meta-analysis shows that disorganized attachments may change as a side effect of sensitivity-focused interventions, but it also illustsrates the need for interventions specifically focusing on the prevention of disorganization. - Bakermans-Kranenburg, M.J. & Van IJzendoorn, M.H. (2004). No association of the dopamine D4 receptor (DRD4) and -521 C/T promoter polymorphisms with infant attachment disorganization. Attachment and Human Development, 6, 211-218.
Abstract
In a first molecular genetic study Lakatos and colleagues found an association between attachment disorganization and the dopamine D4 receptor (DRD4) gene polymorphism, in particular in the presence of the -521 T allele in the promoter region of the DRD4 gene. Replication of their study in a sample of 132 infants did not confirm the role of the DRD4 7+-allele and the -521C/T promoter gene in disorganized attachment. Although our sample was larger, and contained more children with CT or TT alleles, which enhanced the probability of findin the DRD4 and C/T interaction, the association was nog found. Even when we combined our sample with the Lakatos sample, the interaction effect of the DRD4 and-521 C/T polymorphisms on disorganized attachment was absent. - Van IJzendoorn, M.H., Schuengel, C., & Bakermans-Kranenburg, M.J. (1999). Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants, and sequelae. Developmental Psychopathology, 11, 225-249.
- Schuengel, C., Bakermans-Kranenburg, M.J., & Van IJzendoorn, M.H. (1999). Frightening maternal behavior linking unresolved loss and disorganized infant attachment. Journal of Consulting and Clinical Psychology, 67, 54-63.
Abstract
Main and Hesse's (1990) model in which frightening (threatening, frightened, or dissociated) parental behavior explains why infants pf parents with unresolved loss develop disorganized attachment relationships was tested. Unresolved loss using the Adult Attachment Interview in a nonclinical middle-class sample of 85 mothers who had experienced the loss of someone important was assessed. Disorganized attachment was examined in the Strange Situation. Parental behavior was recorded during 2 2-hr home visits. The model applied to mothers with currently insecure attachment representations. Secure mothers with unresolved loss displayed less frightening behavior than other mothers, and unresolved loss in secure mothers did not predict disorganized attachment of their infants. Frightening behavior predicted infant disorganized attachment irrespective of maternal security.
Publications Attachment and autism
- Rutgers, A.H., Van IJzendoorn, M.H., Bakermans-Kranenburg, M.J., Swinkels, S.H., Van Daalen E., Dietz,C., Naber, F.B.A., Buitelaar, J.K., & Van Engeland, H. (2007) Autism, Attachment and Parenting: A comparison of children with Autism Spectrum Disorder, Mental Retardation, Language Disorder and non-clinical children. Journal of Abnormal Child Psychology, 35, 859-870.
Abstract
Children with Autism Spectrum Disorder (ASD) have severe and pervasive impairments in the development of social interaction, which may affect the attachment relationship with their parents and may have an impact on parenting. In the current investigation 89 families with young children (mean age 26.5 months) were involved, who were diagnosed as ASD, mentally retarded (MR), or language delayed (LD), or part of a non-clinical comparison group. Attachment security was observed with the Brief Attachment Screening Questionaire, and several parental self-report questionaires assessed the parenting style, parental efficacy, parental experiences of daily hassles, social support, and psychological problems. Children with ASD were rated as less secure compared to the other clinical and normal comparison groups. Parents of non-clinical children reported higher levels of authoritative parenting than parents in the ASD group and in the total clinical group, and they also received less social support. Parents of children with ASD coped remarkably well with the challenges of raising a child with ASD. - Naber, F.B.A., Swinkels, S.H.N., Buitelaar, J.K., Dietz, C., Van Daalen, E., Bakermans-Kranenburg, M.J., Van IJzendoorn, M.H., & Van Engeland, H. (2007). Joint attention and attachment in toddlers with autism. Journal of Abnormal Child Psychology, (in press).
- Naber, F.B.A., Dietz, C., Van Daalen, E., Swinkels, S.H.N., Buitelaar, J.K., Bakermans-Kranenburg, M.J., Van IJzendoorn, M.H., & Van Engeland, H. (2007). Joint attention development in toddlers with autism. European Journal of Child and Adolescent Psychiatry, ( in press).
- Naber, F.B.A., Dietz, C., Van Daalen, E., Swinkels, S.H.N., Buitelaar, J.K., Bakermans-Kranenburg, M.J., Van IJzendoorn, M.H., & Van Engeland, H. (2007). Play behavior in toddlers with autism. Journal of Autism and Developmental Disorders, (in press).
- Naber, F.B.A., Swinkels, S.H.N., Buitelaar, J.K., Dietz, C., Van Daalen, E., Bakermans-Kranenburg, M.J., Van IJzendoorn, M.H., & Van Engeland, H. (2007). Attachment in toddlers with autism and other developmental disorders. Journal of Autism and Developmental Disorders, 37, 1123-1138.
Abstract
Attachment was assessed in toddlers with Autistic Disorder (n=20), Pervasive Developmental Disorder (n=14), Mental Retardation (n=12), Language Developmental Disorder (n=16), and a non-clinical comparison group (n=18), using the Strange Situation Procedure (SSP). Children in the clinical groups were more often disorganized and less often securely attached. Severity of autism was associated with more attachment insecurity, and lower developmental level increased the chance for disorganized attachment. Attachment disorganization was related to increased heart rate during the SSP. Controlling for basal cortisol and developmental level, more autistic symptoms predicted lower cortisol responses to the SSP. The findings support the importance of disorganized attachment for children with autism. - Van IJzendoorn, M.H., Rutgers, A.H., Bakermans-Kranenburg, M.J., Swinkels, S.H.N., Van Daalen, E., Dietz, C., Naber, F.B.A., Buitelaar, J.K., & Van Engeland, H. (2007) Parental sensitivity and attachment in children with Autism Spectrum Disorder: comparison with mental retardation, with language delays, and with typical development. Child Development, 78, 597-608.
Abstract
This study on sensitivity and attachment included 55 toddlers and their parents. Samples included children with autism spectrum disorder (ASD), mental retardation, language delay, and typical development. Children were diagnosed at 4 years of age. Two years before diagnosis, attachment was assessed with the Strange Situation procedure, and parental sensitivity and child involvement during free play were assessed with the Emotional Availability Scale. Parents of children with ASD were equally sensitive as parents of children without ASD, but their children showed more attachment disorganization and less child involvement. More sensitive parents had more secure children, but only in the group without ASD. Less severe autistic symptoms in the social domain predicted more attachment security. Autism challenges the validity of attachment theory. - Rutgers, A.H., Bakermans-Kranenburg, M.J., Van IJzendoorn, M.H. & Swinkels, S.H.N. (2007) Autism and attachment: the Attachment Q-Sort, Autism, 11, 187-200.
Abstract
Children with autism are able to show secure attachment behaviours to their parents/caregivers. Most studies on attachment in children with autism used a (modified) Strange Situation Procedure (SSP) to examine attachment security. An advantage of the Attachment Q-Sort (AQS) over the SSP is that it can be attuned to the secure-base behaviour of children from special populations. In this study experts in the field of autism (both clinicians and researchers: N=59) defined an AQS criterion sort for children with autism and tested its content validity. Separate criterion sorts were defined for the social subtypes aloof and active-but-odd, but the two criterion sorts could be combined into one AQS criterion sort for children with autism. It is concluded that with minor amendments the original Attachment Q-Sort is applicable in observing the attachment behaviour of children with autism. - Rutgers, A.H., Bakermans-Kranenburg, M.J., Van IJzendoorn, M.H. & Van Berckelaer-Onnes,I.A. (2004) Autism and attachment: a meta-analytic review, Journal of Child Psychology and Psychiatry, 45, 1123-1134.
Abstract
Method: Sixteen studies on attachment in children with autism were reviewed, and ten studies with data on observed attachment security (N=287) were included in a quantitative meta-analysis.
Results: Despite the impairments of children with autism in reciprocal social interaction, the majority of the studies found evidence for attachment behaviours in these children. In four samples using the Strange Situation procedure the average percentage of secure attachments amounted to 53% (n=72). Meta-analytic results showed that children with autism were significantly less securely attached to their parents than comparison children, and the combined effect size for this difference was moderate (r=.24). Children with autism displayed less attachment security than comparisons without autism, but this difference disappeared in samples with children with higher mental development, and in samples in which autism was mixed with less severe symptoms of autistic spectrum disorders.
Conclusions: It is concluded that attachment security is compatible with autism, and can be assessed with Strange Situation type of procedures. The co-morbidity of autism and mental retardation appears to be associated with attachement insecurity.