Assessment of attachment disorder symptoms in foster children: comparing diagnostic assessment tools

Josephine D Kliewer-Neumann,Janin Zimmermann,Ina Bovenschen,Katja Nowacki,Sandra Gabler,Katrin Lang,Gottfried Spangler

doi:10.1186/s13034-018-0250-3

Abstract

BackgroundStandardized methods for assessing attachment disorders are scarce but needed for research and practice.MethodsIn the current study, several assessments for attachment disorder symptoms are used within a German sample of foster children after being exposed to neglect and maltreatment in their biological families. The symptoms were assessed with four established assessment methods based on both parents’ report and behavioral observation: The Rating for Infant Stranger Engagement, the Stranger at the Door, the Disturbances of Attachment Interview and the Reactive Attachment Disorder Questionnaire.ResultsThe foster care sample showed symptoms of both the inhibited and the disinhibited attachment disorder. The degree of symptoms is comparable to previous findings. The results of the different tools investigating the disinhibited type of attachment disorder are correlated to each other, but do not overlap.ConclusionsAlthough all approaches are based on the clinical criteria of the DSM-IV, the assessments do not coincide. Each tool provides a different point of view on the symptoms, so a multi methodical approach for assessing attachment disorder symptoms should be implemented. Furthermore, the inhibited and the disinhibited symptoms represent separate categories, as reflected in the DSM-5, requiring separate assessment.

Highlights

Standardized methods for assessing attachment disorders are scarce but needed for research and practice
Hall and Geher [11] describe positive caregiver child interaction leading to bonding and attachment, whereas the absence may lead to attachment disorder symptoms
We found no significant correlation between the duration of placement and the disinhibited attachment disorder symptoms in the Disturbance of Attachment Interview (DAI) (r = − .11, ns.), the Rating for Infant‐Stranger Engagement (RISE) (r = − .02, ns.), the SatD (r = − .23, ns) or

Summary

Introduction

Standardized methods for assessing attachment disorders are scarce but needed for research and practice. Minnis et al [8] found a prevalence of 1.4% in a deprived population of school-aged children and Gleason et al [9] reported 4.11% of RAD and 20% of DSED in a population of previously institutionalized children Both DSM and ICD describe poor caregiving as the core factor for the development of attachment disorder symptoms [10]. Children in foster care have a higher risk of showing attachment disorder symptoms [14] This is mainly because of earlier experiences of abuse or neglect in their biological families, experiences of inadequate care in institutions, and or the separation from primary caregivers [13, 15]

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