Validation of the School-age Assessment of Attachment in a short-term longitudinal study

When all is at sea: Attachment insecurity as a mediator of risk in Tamil asylum-seeking children

Limited data exists on the role of attachment in influencing the development and wellbeing of refugee children. Herein we describe patterning and correlates of attachment in an Australian sample of adolescent Tamil refugees. Sixty-eight adolescents, aged 10-18, were assessed for trauma exposure, mental health problems and pattern of attachment. Attachment representations were assessed by discourse analysis of structured attachment interviews. Mothers of the adolescents were assessed for post-migration family stressors, depression, and post-traumatic stress disorder (PTSD) using self-report measures. Inhbitory A and A+ patterns of attachment predominated. Attachment insecurity was associated with child trauma exposure (β = .417), post-migration family stressors (β = .297) and maternal PTSD (β = .409). Path modeling demonstrated that attachment insecurity mediated associations of child trauma exposure, family stressors and maternal PTSD with child mental health problems, the model yielding adequate fit (Comparative Fit Index [CFI] = .957; standardized root mean square residual [SRMR] = .066; R2 .449). Our cross-sectional findings suggest that compromised attachment security is one potential mechanism by which the adverse effects of refugee family trauma and adversity are transmitted to children. Resettlement policy and psychosocial services should aim to preserve and/or reestablish attachment security in child-caregiver relationships through policy that reduces family stressors and interventions that bolster parental mental health and caregiver sensitivity.

Explicit and implicit attachment representations in cognitively able school-age children with autism spectrum disorder: A window to their inner world

The few studies available on quality of attachment in school-age children with autism spectrum disorder (ASD) exclusively used questionnaires assessing explicit attachment representations. Thus, in the current study we assessed both explicit and implicit attachment representations in 23 children with ASD (without intellectual disability), 22 with learning disabilities and 27 with typical development aged from 7 to 13 years. A self-reported measure on the quality of attachment to parents and a semi-structured interview were administered to the children. In addition, a developmental assessment of the child including measures of intelligence and social-communication impairment was conducted. Despite the lack of group differences on explicit attachment representations, we found that children with ASD showed higher rates of at-risk self-protective strategies and psychological trauma compared to the TD group. Children with SLD also showed a high level of at-risk implicit attachment representations than TD, albeit to a lesser extent compared to children with ASD. These results may be related to several factors associated with ASD impairment and developmental pathways, such as the atypical learning process which occur at interpersonal level, the difficulties in social information processing and reflective functioning. Our findings suggested that children with ASD may experience difficulties in the construction of balanced implicit attachment representations. Thus, a more comprehensive assessment of attachment including both implicit and explicit representations is recommended.

CCPP's contribution to the maturing of the DMM

Over a decade, CCPP published many articles, a special issue and two special sections that enabled the DMM to become established as an alternative to both attachment disorganization and psychiatric diagnoses. New clinical authors from many countries contributed to an empirical set of assessment validity studies and findings regarding troubled and highrisk children and families. The outcome was a validated life-span series of assessments of attachment, a coherent body of important clinical findings, especially regarding school-aged children, and family functional formulations as laying the basis for DMM Integrative Treatment.

When things get complicated: At-risk attachment in children and adolescents with chronic pain

Pain is a signal of danger, and danger activates the attachment system. When a parent responds to a child's pain with appropriate protection and comfort, more often than not, the pain resolves. But what happens in families when a child's pain becomes chronic and continues to signal a danger that has long passed? This study explored patterns of attachment in 48 children and adolescents with chronic functional pain and 48 healthy controls using structured attachment interviews. Patterns of attachment were identified using the Dynamic Maturational Model of Attachment. Compared to controls, children and adolescents with chronic functional pain were classified into at-risk patterns of attachment (χ² = 76.4, df = 2, p < .001) and had higher rates of unresolved loss and trauma (χ² = 10.8, df = 1, p = .001), suggesting a long-standing history of relational stress and the disruption of nurturing relationships. The findings suggest that the quality of attachment relationships contribute to the development and maintenance of chronic functional pain. Ongoing anxiety within the attachment relationship, combined with unresolved loss and trauma, may function much like catastrophising, contributing to chronic functional pain by activating the body's arousal systems. The assessment process for chronic functional pain should include a family assessment to identify ruptures in attachment relationships, as well as unresolved loss and trauma events that need to be addressed through family interventions or individual therapy.

Are mothers' protective attachment strategies related to their children's strategies?

AIMS

We explored the relation between mothers' protective attachment strategies and those of their school-age children.

METHODS

In total, 49 child-mother dyads participated in a short longitudinal study when the children were 5.5 and 6.0 years old. Their strategies were first assessed with the Preschool Assessment of Attachment (PAA) and then with the School-age Assessment of Attachment (SAA). Mothers were assessed with the Adult Attachment Interview (AAI). The Dynamic-Maturational Model of Attachment and Adaptation (DMM) was used to classify the assessments.

RESULTS

The validity and precision of the DMM-AAI were supported: Mothers' AAI classifications were related to their referral group (normative or clinical) and measures of stress and distress. The DMM categories were more associated with risk than the Ainsworth categories. Types A, C and A/C were differentiated by trauma, triangulation and depression. Mothers' and children's protective attachment strategies were related, with B mothers having B children and A or C mothers having children using the same or opposite strategy. Children whose classification changed from the PAA to the SAA had mothers with complex traumas.

CONCLUSION

When psychosocial treatment is needed, knowing whether mother and child use the same or different strategies and whether mothers have complex trauma can affect treatment success.

Assessing attachment in school-aged children: Do the School-Age Assessment of Attachment and Family Drawings work together as complementary tools?

AIMS

Our goal was to identify an assessment package that could improve treatment planning for troubled children and their families. To assess the validity of our tools, we tested the relations among the School-Age Assessment of Attachment, the Family Drawing and children's risk status. We used the Dynamic-Maturational Model of Attachment and Adaptation to interpret the assessments in the hope of identifying a gradient of risk, and explore whether a new coding method improved the validity of Family Drawings and their utility as a tool to complement the School-Age Assessment of Attachment.

METHOD

The participants were 89 children, aged between 5 and 12 years; 32 children were involved with mental health services or child protection. Each child completed a School-Age Assessment of Attachment and a Family Drawing.

RESULTS

Both assessments differentiated between clinical and normative referrals with moderate effect sizes when dichotomizing risk versus non-risk attachment. When the analysis incorporated a gradient of six attachment classifications, the effect sizes decreased, but specificity of risk increased.

CONCLUSIONS

The School-Age Assessment of Attachment had greater validity for discriminating risk, and type of risk, than the Family Drawings. With a School-Age Assessment of Attachment and family history, the Family Drawing can provide information about distress that some children do not provide verbally. Integration of the two assessment tools alongside information about parental and family functioning appears to be the key to formulating children's problems.

Validity of the School-age Assessment of Attachment for moderate-risk, rural early adolescents

INTRODUCTION

This study provides evidence of validity of the School-age Assessment of Attachment (SAA) through longitudinal comparison with the Preschool Assessment of Attachment (PAA) and with concurrent attachment assessments and measures of risk and parenting. Determining which assessment had the greatest validity with this moderate-risk sample would be of benefit to those working with troubled young people and their families.

HYPOTHESES

Children's SAA classifications were expected to correspond to their PAA, a behavioral attachment assessment, parenting, and risk. An attachment questionnaire was predicted to not accurately indicate children's risk status.

DESIGN

The design was an 8-year longitudinal follow-up of rural Appalachian American preschoolers.

METHOD

The participants were 21 children and their caregivers. The PAA was completed at age 4. The SAA, a self-report questionnaire, and a parent-child conflict resolution task were completed at age 12. Parents completed assessments of depression, trauma, stress, and perceptions of helplessness.

RESULTS

The PAA was related to the SAA and the dyadic behavioral task. The SAA was consistently associated with measures of parenting and family risk. The attachment questionnaire performed poorly for children with higher risk status, suggesting more (not less) sensitive and responsive parenting.