Attachment Disturbances in Young Children. I: The Continuum of Caretaking Casualty

doi:10.1097/00004583-200208000-00016

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 41, Issue 8, August 2002, Pages 972-982

https://doi.org/10.1097/00004583-200208000-00016 Get rights and content

ABSTRACT

Objective

To determine whether signs of disordered attachment were greater in young children being reared in more socially depriving caregiving environments.

Method

Three groups of children were studied by means of structured interviews with caregivers that were administered over several months in Bucharest, Romania, in 1999: (1) 32 toddlers living in a typical unit (standard care) in a large institution in Bucharest; (2) 29 toddlers living in the same institution on a “pilot unit” designed to reduce the number of adults caring for each child; and (3) 33 toddlers living at home who had never been institutionalized. The presence of attachment disorders and other behavioral problems was assessed by caregiver/parent report.

Results

Children on the typical unit (standard care) had significantly more signs of disordered attachment than children in the other two groups. Both the emotionally withdrawn and the indiscriminately social pattern of attachment disorder were apparent in these children, but cluster analysis suggested that mixed patterns are more typical.

Conclusions

The continuum of caretaking casualty is reflected by increasing signs of disordered attachment in toddlers living in more socially depriving environments.

Section snippets

METHOD

After obtaining institutional review board approval for the project, we interviewed caregivers regarding three groups of young children who resided in Bucharest, Romania, and who ranged in age from 11 to 70 months. Two groups of children resided in an institution for young children (a “leagan,” meaning “cradle”), and one group resided with their parents. This third group consisted of children who had never been institutionalized and whose primary caregivers were their mothers. Information about

Preliminary Analyses

Preliminary analyses of the sample revealed differences in age among the ST, PI, and NI groups (F_2,91 = 4.217, p = .02), with the children in the pilot program older than those in the other two groups. Subsequent analyses were performed with age as a covariate. Age was unrelated to the dependent variables, and results were unchanged when age was used as a covariate. The proportion of females in the three groups (ST: 46.9%; PI: 37.9%; NI: 30.3%) was not different (χ²₄ = 1.89, p = .389).

Indices of Reactive Attachment Disorder

DISCUSSION

This is the first study of disturbances of attachment in young children living in an institution that has been conducted in the past 25 years. The results clearly support the prediction that disturbances of attachment in young children are linked to the continuum of caretaking casualty. When young children were raised in environments that increasingly limited opportunities for them to form selective attachments, they were far less likely to develop preferred attachments. Children raised by

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AD symptoms describe a constellation of behaviours arising from the maltreatment in infancy, which equate to marked abnormalities under the umbrella of ‘social relatedness’ – distinct from attachment types (Minnis et al., 2009) and from other common emotional and behavioural problems in childhood (Minnis et al., 2007; Seim, Jozefiak, & Wichstrøm, 2022). Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) were classified as two discrete subtypes of AD from the findings of two seminal empirical studies of children in extremely deprived institutional contexts: The Bucharest Early Intervention Project (Smyke, Dumitrescu, & Zeanah, 2002; Zeanah, Humphreys, Fox, & Nelson, 2017) and The English and Romanian Adoptees Study (O'Connor, Bredenkamp, & Rutter, 1999; Sonuga-Barke et al., 2017). Since then, they have continued to show strong construct validity as distinct disorders (Gleason et al., 2011; Lehmann et al., 2020; Seim et al., 2022).
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This work was supported by the John D. and Catherine T. MacArthur Foundation Research Network on Early Experience and Brain Development. The authors thank Alina Codres and her staff for their cooperation and hard work, which made this project possible. Cristian Tabacaru, Adrian Gaspar, Ronald Federici, and Dana Johnson also provided invaluable assistance. Drs. Julie Larrieu and Michael Scheeringa provided helpful suggestions about an earlier version of the manuscript.

Article Plus (online only) materials for this article appear on the Journal's Web site: www.jaacap.com.

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ArticlesAttachment Disturbances in Young Children. I: The Continuum of Caretaking Casualty

ABSTRACT

Objective

Method

Results

Conclusions

Section snippets

METHOD

Preliminary Analyses

Indices of Reactive Attachment Disorder

DISCUSSION

J Am Acad Child Adolesc Psychiatry

Patterns of Attachment: A Psychological Study of the Strange Situation

Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV)

Cortisol regulation in family-reared and institutionalized Romanian children

Soc Neurosci Abstr

A three year follow-up of attachment and indiscriminate friendliness in children adopted from Romanian orphanages

Child Dev

Attachment security and indiscriminately friendly behavior in children adopted from Romanian orphanages

Dev Psychopathol

Sensitivity and attachment: a meta-analysis on parental antecedents of infant attachment

Child Dev

Reactive attachment disorder in maltreated twins

Infant Ment Health J

Medical and developmental sequelae of early childhood institutionalization in Eastern European adoptees

Determinants of behavioural problems in Romanian children adopted into Toronto

Int J Behav Dev

Articles
Attachment Disturbances in Young Children. I: The Continuum of Caretaking Casualty