A referral that says "attachment disorder"
- A group of 35 social work and clinical educators, practitioners and attachment researchers proposes eight core attachment concepts for qualifying child and family social work training: safe haven; child-caregiver security and insecurity; network of relationships; stable, non-abusive, family-based care; sensitivity to the child's signals and needs; mentalizing; alarming caregiver behaviour; poverty and socioeconomic stressors.
- The authors argue that the Strange Situation and other attachment classifications are not critical components of the basic curriculum, because assessments of attachment have not yet been adequately validated for use in applied practice.
- Reactive attachment disorder is described as a rare condition that can follow extreme neglect or multiple early changes of primary caregiver and often resolves with stable and responsive care. Research the authors cite found that practitioners overuse "RAD" and "attachment disorder" for fostered and adopted children.
- Around half of children have at least one insecure safe haven relationship. Caregivers facing five or more socioeconomic risks show frequencies of children displaying alarm similar to samples known to social services for child maltreatment.
The phrase "attachment disorder" turns up in referrals far more often than the condition turns up in clinic. A paper in Social Work Education, written by 35 educators, practitioners and attachment researchers, sets out what child and family social workers should learn about attachment, and which ideas they should learn to question.
Eight concepts for the core curriculum
The first author is at Northumbria University; the proposals were refined in workshops with members of BASW and CoramBAAF. The eight concepts run from the safe haven and the child's network of relationships to caregiver sensitivity, mentalizing, alarming caregiver behaviour and poverty. They concern the child's relational needs, caregiving and context. Sorting children into categories is not on the list.
Labels the authors take apart
Strange Situation classifications serve research, the authors write, but attachment assessments are not validated for applied practice. "Disorganised" attachment is more common among maltreated children, yet it cannot be used to identify maltreatment: not every maltreated infant shows it, and it has other causes. Reactive attachment disorder is rare and often resolves once care is stable and responsive. Practitioners still apply it, and the looser "attachment disorder", to fostered and adopted children too readily.
When the label arrives with the child
My view: read the phrase as a question about its author. Who made the diagnosis, with what assessment, and how long ago? How many placements has the child had? Whom does the child turn to now when hurt or frightened, and what happens when the current carer comforts them?
Then describe instead of repeating. How the child signals distress, how the carer reads and answers it, what in the household alarms the child, what pressures the carer is under. A court or a social worker can act on that. A label reads as a fixed trait, and the authors treat attachment as a description of a current relationship that can change.
Before repeating "attachment disorder" in a report, describe whom the child turns to for comfort and how the current carer responds.
The paper is a curriculum proposal by its authors and reports no new data. It is written for qualifying social work training, and the authors note that some circumstances, such as war or racial discrimination, remain under-researched in attachment work.