Editor's note

Attachment problems can be divided into two broad categories. First, attachment insecurity and disorganization characterize patterns of child/caregiver relationship that represent risk factors for later psychopathology. Second, so-called attachment disorders are categorical disorders of disrupted attachment usually associated with early social deprivation, neglect or maltreatment. These latter include both disinhibited attachment disorder, which reveals itself in indiscriminate sociability, and inhibited attachment disorder. In cases of attachment insecurity, various forms of intervention with parents appear to have effectiveness in increasing parental sensitivity but their impact on attachment per se is less clear cut. These interventions appear to work best when they are relatively brief and specifically target caregiver sensitivity. In more severe cases, especially those involving attachment disorder, interventions may require placement of the children in adoptive homes. ‘Holding therapy’ lacks empirical support and may pose serious risk to children.

Introduction

Child attachment refers to particular key characteristics of the relationship between child and specific caregiver that are known to be strongly associated with social development and mental health. Research on normative patterns of attachment in infancy find that attachment insecurity (including ‘disorganization’) is a relative psychosocial risk factor for later development and is best conceptualized as a developmental risk variable on Axis V of a multiaxial classification (Green & Goldwyn, 2002).

Two less common forms of developmental disturbance associated with severe disruption or absence of early attachment relationships are recognized as Axis 1 clinical disorders in both DSM and ICD systems, although neither has yet received robust empirical validation.