Does disorganised attachment mean a child has been abused? Research update.

Child protection and family support social workers really need to have it all: a strong political analysis, an understanding of organisations and a decent handle on relevant micro theories. In service of the latter, a rather obscure recent announcement was made about attachment theory. This is of interest to the child protection and family support communities due to the dominance of the theory in education and practise, and its usefulness in understanding some aspects of adult-child relationships.[1]

Without getting too much into the basic premises of attachment theory and its critiques (see footnote caveats!), this announcement was interesting for several reasons. It was made by around forty academics who have worked in the area for many years, and who have historically disagreed about the nature of a particular type of attachment: a disorganised attachment. The announcement, and excellent accompanying academic paper, conclude that the common view that disorganised attachment was always an indicator of child abuse is not, well, true (Granqvist et al., 2017).

Just what is a disorganised attachment? At first, it was a bit of a ‘dumping ground’ category for those children who clearly had some kind of attachment problem, but couldn’t be classified in one of the other categories: insecure – anxious/avoidant, or insecure – ambivalent. They tended to freeze in the strange situation test, and literally had no ‘organised’ or patterned response to ordinary situations where attachment behaviours might be expected – when caregivers leave or arrive, or where the child is upset or frightened. It was deduced that where children had no discernible reaction and seemed to be paralysed, caught between their own fear and fear of the caregiver, that this was always related to the fact that the parental response had been so frightening or unpredictable, that the child was paralysed by conflicting emotions. This was often called the third ‘f’ of attachment categories, with an avoidant style equating to ‘flight’, ambivalent as ‘fight’ and disorganised as ‘freeze’. Increasing levels of careful research into disorganised attachment styles have concluded that the reverse inferential process often used (this child has a disorganised attachment, therefore they have been abused) doesn’t always hold true. The joint statement is this:

There has been a growth in recent years of social workers and clinicians using assessment of disorganised attachment to screen for child abuse. Disorganised attachment in young children does not necessarily indicate abuse of the child; and many children who have been abused do not show signs of disorganised attachment. Social workers and clinical psychologists must not rely on a classification of disorganised attachment alone to decide whether to initiate child protection proceedings. In fact disorganised attachment is as likely to be caused by compounded family adversity. (Professor Granqvist, 2017)

Attachment Infographic
Attachment Infographic

Instead, as the research highlights, all sorts of things can contribute to a disorganized attachment (not in and of itself a diagnosis of a specific child, but of aspecific relationship). In a seminal study by Chantal Cyr and colleagues, (Cyr, Euser, Bakermans-Kranenburg, & Van Ijzendoorn, 2010) it was found that where families had five or more socio-economic risk factors, they had rates of disorganized attachment as high as children in families where abuse had occurred. These included things like poverty, drug abuse or not graduating high school. She proposes that such circumstances can affect the parent child relationship due to the level of dangers or stressors faced in parent’s own lives, rather than due to direct abuse. Other studies confirm that several pathways can result in disorganised attachment relationships, not just abuse – offering other primarily social factors such as mental health difficulties, domestic violence and poor housing (see the neat infographic to the left and click it to download).

Of extra interest was the classification of domestic violence (DV) as a socio-economic or contextual factor, rather than a type of abuse. This reflects the much more European view of DV as a family or parental issue related to social conditions as much as anything else, while we have adopted the US and increasingly UK view that it should count as a type of direct child abuse with limited connection to social context. It’s a big debate. Perhaps we can agree that exposure to DV harms children, but responding to it in a traditional ‘child abuse’ paradigm doesn’t tend to work out well for anyone, and reinforces the criminalisation of oppressed groups (see Hester, 2011 and Kim, 2013 on this).

Another study informing this announcement examined the surprisingly high rate of disorganized attachment behaviours among a low-risk sample (39% compared to an expected 15 – 18%). They concluded that participation in previous strange situation tests and heightened stress on the day of the test were pushing up findings of disorganised attachment, even with experienced coders: another reason not to assume that disorganized behaviours necessarily indicate abuse (Granqvist et al., 2016). This study highlights another reason to critically examine attachment theory and its categories: there are clear tensions between realistic, everyday experiences of children’s behaviour and efforts to interpret and categorise it within the attachment theory paradigm (Keddell, 2017). Most parents or people who have worked with children would immediately understand that a young child who had an earlier ‘strange situation’ test (where they were left with a stranger) might be more distressed the second time around because they knew what was coming. It’s disturbing to imagine that an expert ‘coder’ might come to a conclusion that was so wrong, because they allowed the theory and what they thought they were seeing, to lead to a conclusion of child abuse. While attachment theory does have insights to offer, an understanding of the everyday reactions of specific children requires a contextualisation of the theory to particular people and their cultural and personal contexts. As humans we don’t always fit neatly into theories, and in this area we should make sure that the theory is used to inform and understand, rather than dictate an assessment of specific children and their carers. Theories are always culturally-specific ways of understanding human behavior, and should be used with the tentativeness this realization demands (Rothbaum et al., 2000).

Coming back to the declaration that disorganized attachment is not necessarily a sign of abuse, on the other side of the bad inference equation, about a third of children who have been abused don’t show signs of disorganized attachment. In brief, concluding a child has a disorganized attachment shouldn’t be used as a shorthand for abuse. This means that attention to the adversity facing parents in their social environments is just as important as working on parent- child relationships. Turns out even in the most intimate of relationships, we need to understand both the individual and the social context. Who knew.

PS Those looking for good micro interventions to support the parent-child relationship should also check out the NICE guidelines, the developments in video feedback techniques and see Dr Chantal Cyr on the use of attachment-based video feedback as an assessment and intervention 

PPS Those looking for good macro interventions for the social stressors on family life should work on supporting the new government to follow through on its commitment to reduce child poverty and improve housing and mental health services – all key to improving child-adult relationships and mental health.

Image credit: Wyncliffe

Footnote

[1] But for some excellent alternatives to attachment theory see Smith et al., 2017 on Honneth’s ‘recognition’ (Smith, Cameron, & Reimer, 2017) which I love for its strong claim on everyday understandings of parenting and care, its point that attachment theory can be used to support conservative family and gender arrangements, and the totalising dominance attachment theory has assumed, noting, for example, that “The reification of attachment theory in policy and practice betrays a greater certainty about the concept than Bowlby himself ever claimed for it. By 1956, he acknowledged that he and others had overstated the inevitable deleterious consequences of poor early attachment” (p.1608).  It can be used to mean all sorts of things in an uncritical and far too universal manner (ie every conceivable problem anyone has is all about attachment), it can be used to pathologise women and their children, and it requires an interpretive process that is often unstated and tied up with the ‘interpreter’s’ own values, culture and beliefs – see for eg Rothbaum, Weisz, Pott, Miyake, & Morelli, 2000.

References

Cyr, C., Euser, E. M., Bakermans-Kranenburg, M. J., & Van Ijzendoorn, M. H. (2010). Attachment security and disorganization in maltreating and high-risk families: A series of meta-analyses. Development and Psychopathology, 22(1), 87-108. doi: 10.1017/S0954579409990289

Granqvist, P., Hesse, E., Fransson, M., Main, M., Hagekull, B., & Bohlin, G. (2016). Prior participation in the strange situation and overstress jointly facilitate disorganized behaviours: Implications for theory, research and practice. Attachment & Human Development, 18(3), 235-249. doi: 10.1080/14616734.2016.1151061

Granqvist, P., Sroufe, L. A., Dozier, M., Hesse, E., Steele, M., van Ijzendoorn, M., . . . Duschinsky, R. (2017). Disorganized attachment in infancy: A review of the phenomenon and its implications for clinicians and policy-makers. Attachment & Human Development, 19(6), 534-558. doi: 10.1080/14616734.2017.1354040

Hester, M. (2011). The three planet model: Towards an understanding of contradictions in approaches to women and children’s safety in contexts of domestic violence. British Journal of Social Work, 41(5), 837-853. doi: 10.1093/bjsw/bcr095

Keddell, E. (2017). Interpreting children’s best interests: Needs, attachment and decision-making. Journal of Social Work, 17(3), 324 – 342. doi: 10.1177/1468017316644694

Kim, M. E. (2013). Challenging the pursuit of criminalisation in an era of mass incarceration: The limitations of social work responses to domestic violence in the USA. British Journal of Social Work, 43(7), 1276-1293. doi: 10.1093/bjsw/bcs060

Rothbaum, F., Weisz, J., Pott, M., Miyake, K., & Morelli, G. (2000). Attachment and culture: Security in the united states and japan. American Psychologist, 55(10), 1093-1104. doi: 10.1037/0003-066X.55.10.1093

Smith, M., Cameron, C., & Reimer, D. (2017). From attachment to recognition for children in care. The British Journal of Social Work, 47(6), 1606-1623. doi: 10.1093/bjsw/bcx096  free to read

3 thoughts on “Does disorganised attachment mean a child has been abused? Research update.

  1. As a member of a holistic health community organization I receive posts from Health Impact News, which is an organization that investigates and supports many human rights based issues associated with health, medical practice and the law.
    ( This is not a statement of agreement with all the opinions posted by this network. I do detect some extremist elements)
    The network includes Health Freedom, (http://www.ayurvedanama.org/page/HealthFreedom ) which makes a stand on vaccination issues and more recently a publication has appeared called “Medical Kidnap News”, a publication which features issues concerning the American medical system and how they interact with the American Child Protection Service.
    Many of the articles could be viewed as having a ‘sensationalist edge’ to them – the content and volume of the reporting is deeply alarming, with wave after wave consisting of accounts of CPS and medical professionals showing gross injustice and prejudice towards parents, with implications about the use of ‘political’ ideological and ‘economic’ influences encroaching on to CPS and health professional practice. I have been receiving these posts for months and there is soooo much of it!
    Mostly however until now has been about American CPS. In consideration about CPS reform and practice I am mindful that NZ law and policy making structure is very different to America, and that the sometimes fanatical mindsets and content of many American political and religious organizations, for example ‘Creationist’ vs ‘Evolutionist’ concepts exist in a much larger population context, and as such can more easily influence the diverse rights based campaigns such as pro vs anti vaccination, abortion family values marriage issues which makes American lobby groups to having a more polarizing effect on US democratic processes, law practice and reform, and human rights practices. For me, the posts are a reminder of what could possibly happen in social justice reform in general, should the most fanatical of these ideas colonize rationality for social democratic processes.
    However this latest post from Medical Kidnap News demonstrates just how vulnerable we are to imported ideological and other forms of capture- ie commercial capture of funded services and scientific research.
    Quote;
    “The dangers of computerized racial profiling

    ProPublica reports that predictive analytics already has gone terribly wrong in criminal justice, falsely flagging Black defendants as future criminals and underestimating risk if the defendant is white. A new analysis of ProPublica’s data confirmed their findings.

    In child welfare, a New Zealand experiment in predictive analytics touted as a great success wrongly predicted child abuse more than half the time.

    In Los Angeles County, another experiment was hailed as a huge success in spite of a “false positive” rate of more than 95 percent. And that experiment was conducted by the private, for-profit software company that wanted to sell its wares to the county.

    The same company is developing a new approach in Florida. This one targets poor people. It compares birth records to three other databases: child welfare system involvement, public assistance and “mothers who had been involved in the state’s home visiting program.”
    – “Link http://medicalkidnap.com/2017/11/02/cps-using-predictive-analytics-software-to-label-parents-as-unfit-even-before-baby-is-born/

    The article also contained a reference to Emily Keddell’s paper
    Substantiation Decision-making and Risk Prediction in Child Protection
    Systems- Link-http://igps.victoria.ac.nz/publications/PQ/2016/PQ12-2-Preview-Keddell.pdf
    Which will be my next study project.
    Over the last 2 years I have had experience with a family whose third son was taken at birth possibly due in part to the aforementioned risk profiling. The newborn’s 2 other siblings are also in foster care. The parents as far as I could ascertain had no role in the decision making process.
    I am not qualified to judge whether CYFS action was justified. But I was shocked at the lack of compassion and insight and the assumptions which were made by those people both in decision making roles, medical care practice, and from observers outside the situation, and the way the family, particularly Mum, was treated in the community.
    The first point I would like to make about this issue is;
    Research into the NZ foster care support policies shows that Foster Families ( who are often associated with faith based NGOs) have always enjoyed an enhanced social status and support system over first parents in one form or another. Often this means that the child’s relationship to their first family is at best ignored/neglected, or worse actively discouraged, which contravenes stated NZ child welfare policy.
    It is my experience that huge prejudices, still exist particularly within some faith based social groups , against sole mothers in particular, and the advent of the DPB, rather than actually support sole mothers left without an income, entrenched this resentment among many NZ communities. This throws an ethical ambiguity component on the fact that many faith based communities also pursue contestably funded social work contracts, where service recipients may have restricted service provider choices. Where management would be bound by certain ethical commitments, these ideals may not be followed through by staff, volunteers and others connected to the service provision particularly if service provider employees are mostly recruited from members of the service provider’s faith based social networks.
    Before DPB, many women, especially within the working class held down paid jobs in manufacturing, shops and offices. Until relatively recently, occupations and pay levels were genderized, and women who had no partner were, and still are socially and economically disadvantaged. Social engagement is a significant component of employment engagement. Historically, women’s single status has been a source of resentment among their (partnered) peers. Elements of this still exist in NZ.
    DPB raised the political and value judgement profile of women parenting alone. Many women eligible for DPB were, and still are bullied in the community over their employment and marital status , and also bullied in the workplace when they attempt to engage in paid work.
    Historically, marital status played a larger role in prioritizing working role selection. For sole parents, parental responsibility still influences job applications.
    Before the advent of DPB, often, some larger business provided pre-school child care facilities on the premises or nearby. (eg the Bendon Factory New Lynn). Many of these closed when a lot of large scale manufacturers who employed many female workers shifted interests overseas or closed down.
    When welfare to work initiatives started to creep into DPB eligibility daycare options for working parents were less available. At that time, I asked a member of the employers federation why more businesses no longer provide daycare for parents, and the reply was because they had such huge numbers of applicants that providing extra services was not something they needed to do.
    Similar levels of morally justified prejudice towards sole parents persists now, but are Justified in a different way. Similar prejudices have also transferred to all parents receiving social assistance.
    Access to housing has become an equally morally contestable process as seeking employment, and applicants face similar levels of moral and economic scrutiny. It is widely acknowledged amongst women who are sole parenting that many private landlords make statements about providing accommodation for “a family” to morally justify declining applications from single women. In NZ, the realities of contesting a job or housing application declined in this way is difficult to do without organized support. The realities of the employment and housing market is that it is underresourced, and providers have copious applicant choices, and this means that providers do not justify declining any applications, and continue to get away with using social exclusion as policy.
    IF NZ social policy makers choose the public/ private partnership pathway for supplying essential goods and services, it is a responsibility to provide organized support services to ‘at risk’ families and individuals in ways which include individualized support to combat the practice of preventing access to essential goods and services by use of social exclusion.
    IF the NZ public continues to support the ‘child rescue’ pathway of child protection, it will become difficult to justify parenting for first parents in a human rights format.
    The role and social status of first parents is becoming increasingly contestable. Ethically,to meet the needs of changing social and economic environments, support is needed for the concept that services need to be in place to support and protect the respect for parenting which falls outside the home and family sphere, and the well being of relinquishing parents and their children as a vulnerable social group, and include them in social justice discourse; to manifest support for the provision of a child, first parents and foster family social support service with ongoing support to maintain healthy communicative relations about the decision making process, and the upbringing of the children. This means fulfilling a social justice human rights based commitment towards open and democratic processes in both practice and policy to ALL parties.
    NZ ( as far as I know) has only signed two components of the UN Covenant of Social Cultural and Economic Rights into domestic law. So while this may mean that certain priorities exist for protected social groups, children being one of these; social practices need to reflect at the very least respect for the child’s birthright.
    Irresponsible policy statements by NZ community and political leaders have exacerbated the manifestation of a strong ‘witch hunt’ mentality component to public opinion towards people at risk of or who fail in their attempts to climb out of poverty; and encouraged the voting public to support the development of a economic ideology which accepts the ‘necessity’ of poverty, and an increasingly parsimonious approach to poverty relief, which is at best economically disingenuous and at worst deliberately punitive. Many organizations and individuals have profited from this situation whilst advocating for tax, labor and trade practices which allow them to justify avoiding social and economic accountability to vulnerable sections of the community, and more recently threaten to commodify the state of living in poverty in profit seeking ways.
    The posts from ‘Medical Kidnap News’ give an account of the manifestation of a continuum of poverty, misery and misanthropic approaches to social justice. Does NZ have to follow this trend or can we learn from this experience and create room for concepts and practices which shine a light to show a way to positive change?

  2. Re Children’s family experience of poverty, ‘disorganized attachment’ as a marker for child abuse – In many circumstances impoverished parents are more likely to be included in the working poor and members of the ‘precariat’ , less likely to have full control of the day to day caregiving roles for their children. NZ convention relies of the assumption that if a child shows signs of being abused then the parents will be the ‘first port of call’ for investigation. Irrespective of this, and stand corrected if I am wrong, but legally – regardless of who carries out abuse ( negligent daycare service provision, or non- parent in home caregiver) the parents are held legally responsible.
    Outside factors such as parents employment conditions outside the home, access- or not to quality housing, outgoings, debt, income etc all play a part in creating a possible abusive environment for a child, whether this is intentional or a an indirect influence or not. This document should be contingent reading LINK; https://www.union.org.nz/wp-content/uploads/2016/12/CTU-Under-Pressure-Detailed-Report-2.pdf

    1. Thanks for your comment Jayne. It’s a good point that the more precarious the employment, the less control parents often have over the time they have for the everyday care of children. People end up having to make all sorts of stressful arrangements that put a lot of everyday pressure on all family members. But whoever actually abuses a child is legally responsible for it ie if a daycare worker abuses a child it is they, not the parent who would be charged and/or disciplined. Where it gets murkier is where a parent may be treated with suspicion if they have left a child with someone deemed ‘unsafe’. Perhaps due to desperate work conditions. Thanks for the link!

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