Disorganised, insecure avoidant, and resistant attachment patterns in both boys and girls are associated with later poor social competence with peers.
As many as 80% of children who have experienced maltreatment have a disorganised attachment, according to Carlson et al. (1989) and Cyr et al. (2010).
The cost of identifying disorganized attachment in the expected annual cohort of 3,237 newborns in an average UK Clinical Commissioning Group is £93,873, with an average subsequent treatment cost of £219,987.
Disorganised attachment is associated with a cluster of parenting behaviours including frightening or frightened behaviour, extreme intrusiveness, unmarked frightening facial expressions, unusual vocal tone, and dissociative behaviour.
As many as 80% of children in maltreated populations are thought to have a disorganised attachment.
Disorganised attachment and attachment disorder are distinct phenomena that largely do not overlap, as noted by Boris et al. in 2004.
Children classified as disorganised appear to lack an organised strategy for achieving closeness with their attachment figure when distressed.
The economic estimates for screening and treating disorganised attachment assume a cost of £29 per case for the Strange Situation Procedure (SSP), an average treatment cost of £2,265 per case, and an expected prevalence of 3%.
Infants under 20 months can be rated for disorganised attachment using the Main and Solomon (1990) indices of disorganisation and disorientation, which measure the extent to which observable behaviour suggests a disruption at the level of the attachment system.
Disorganised attachment is assessed using the Strange Situation Procedure (SSP) administered by a trained, reliable coder, whereas an attachment disorder is diagnosed through a psychiatric assessment.
The Main and Solomon indices and the classification of disorganised attachment in the Strange Situation Procedure (SSP) cannot be used to assess a child for maltreatment, as maltreatment cannot be inferred from infant disorganised attachment.
Standard assessments of parental sensitivity do not reliably predict disorganised attachment in children, according to studies by van IJzendoorn et al. (1999).
Between 15% and 19% of children in population samples are thought to have a disorganised attachment.
Children may show disorganised attachment when they are frightened for their carer, such as when a parent is terminally ill or experiencing domestic abuse.
The authors assessed the budget impact of screening and treating disorganised attachment across various target populations, including the general population, middle-class children, children born into poverty, children with alternative caregivers (adopted or fostered), and maltreated children.
Children on the autistic spectrum can exhibit disorganised attachment in the absence of maltreatment.
Insecure or disorganised attachment patterns can be clearly observed at 1 year of age, although parent-infant interaction patterns that give rise to these attachments are present and measurable earlier.
As children with disorganised attachment age, their behavioural patterns may evolve into compulsive caregiving or coercive controlling behaviours towards their primary carers.
Behaviours associated with disorganised attachment include the infant approaching with the head averted, fearful expressions, oblique approaches, dazed or trance-like expressions, or freezing of all movement, as documented by Lyons-Ruth and Jacobvitz (2008).
Behaviours reflecting disorganised attachment are typically observed during assessments like the separation-reunion procedure (SSP) and may not be displayed by the child in their home, unlike insecure attachment behaviours.
Children who are on the edge of care, looked after, or adopted from care are at high risk of both insecure and disorganised attachment.
A review of 69 studies by Fearson et al. (2010) found that insecure or disorganised attachment is significantly associated with increased risk for externalising problems, with effect sizes of d = 0.31 for insecure attachment and d = 0.34 for disorganised attachment.
The term 'attachment difficulties' refers to insecure or disorganised attachment or diagnosed attachment disorders.
Up to 40% of children in disadvantaged populations are thought to have a disorganised attachment.
Atypical parenting behaviours associated with disorganised attachment include affective communication errors, role or boundary confusion, and withdrawal, as indicated by research from Jacobvitz et al. (2006) and Out et al. (2009).
Disorganised attachment represents an infant's inability to resolve distress within the context of their relationship by either signalling their anxiety to their caregiver or by directing their attention away from the caregiver.
The total annual cost to screen the general population and treat disorganised attachment in an average UK Clinical Commissioning Group (CCG) is approximately £313,860.
In the context of the provided guideline, the term 'attachment difficulties' encompasses children who have received a diagnosis of an attachment disorder or who have been classified as having disorganised attachment by a reliable coder.
Disorganised attachment may be short-lived and can be resolved once the child is reunited and in a stable relationship with their primary caregiver.
Disorganised attachment, and to a lesser extent avoidant and resistant attachment patterns, are associated with externalising problems such as anger and aggression, particularly in boys.
A meta-analysis found that avoidant and ambivalent attachment patterns show no increase or only a modest increase in the prevalence of mental health problems, whereas disorganised attachment is associated with significant and greater increases in mental health problems, particularly externalising problems.
Meta-analyses suggest that approximately 30% of children with oppositional defiant disorder or conduct disorder have a disorganised attachment pattern, compared to 15% in control groups.
Children who are abused may not show disorganised attachment, particularly if the abuse is less severe or less frequent.
Insecure attachment patterns in children are associated with a higher prevalence of mental health problems, particularly among children with disorganised attachment.
In children with oppositional defiant disorder or conduct disorder, the odds ratio of having a disorganised attachment pattern is nearly 4-fold.
Children with earlier disorganised attachment frequently develop coercive controlling or compulsive caregiving behaviour.
High rates of disorganised attachment have been observed in infants and young children exposed to maltreatment, as reported by Cyr et al. (2010) and van IJzendoorn et al. (1999a), and to a lesser extent among children in foster care or who have been adopted.
Attachment patterns, including disorganised attachment, do not represent a disorder, although they may indicate a risk for later problems.
Children who develop insecure or disorganised attachments, potentially due to neglect or placement in multiple foster care homes, are more likely to experience emotional and behavioural difficulties and struggle with emotional regulation and mentalisation.
There are four defined attachment behavioural patterns in young children: secure, insecure avoidant, insecure resistant (also called ambivalent), and disorganised.
Wright et al. (unpublished) estimated the expected budget impact of screening strategies and treatment for disorganised attachment within the context of a clinical commissioning group (CCG) in a Health Technology Assessment (HTA) report.