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Cited by 128Attachment and Relationship DynamicsChild and Adolescent Psychosocial and Emotional DevelopmentPsychoanalysis and Psychopathology Research

Comparing Criteria for Attachment Disorders: Establishing Reliability and Validity in High-Risk Samples

Boris, Neil W., Hinshaw-Fuselier, Sarah S., Smyke, Anna T., Scheeringa, Michael S., Heller, Sherryl S., Zeanah, Charles H.·2004·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1097/00004583-200405000-00010
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Abstract

Objective To determine whether published subtypes of attachment disorder can be reliably identified by trained clinicians reviewing data from high-risk populations and to investigate the relationship between disorder classification and standardized measures of attachment behavior.Method Twenty or more children aged 18 to 48 months and their primary caregivers were recruited from three sites: a treatment team for maltreated young children (n = 20), a homeless shelter (n = 25), and Head Start centers (n = 24). All dyads completed a semistructured clinical assessment and laboratory and home-based attachment measures.Results All but one type of attachment disorder could be identified reliably by clinician raters (kappa range = 0.62-0.74, depending on subtype). Children from the maltreatment sample were significantly more likely to meet criteria for one or more attachment disorders than children from the other groups (p <.001). As predicted, children without an attachment disorder were more likely to be classified as securely attached than those with an attachment disorder (p =.03); however, children classified as having disorganized attachment were not more likely to receive an attachment disorder diagnosis.Conclusions Attachment disorders can be reliably diagnosed in young children, though research on refining disorder criteria should precede intervention trials.

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  • The validity and relevance of the criteria for the diagnosis of Reactive Attachment Disorder (RAD) have been controversial, especially regarding how these features should be characterised and assessed after the age of 5 years old.

    “In contrast to the general agreement regarding the diagnostic criteria and methods of assessment for most mental disorders in children, the validity and relevance of the criteria for the diagnosis of Reactive Attachment Disorder (RAD) have been more controversial, especially regarding how these features should be characterised and assessed after the age of 5 years old [17,18].”

    From Mental disorders in foster children: a study of prevalence, comorbidity and risk factors (2013) · cites this paper as [17]

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Authors
Boris, N. W., Hinshaw-Fuselier, S. S., Smyke, A. T., Scheeringa, M. S., Heller, S. S., & Zeanah, C. H.
Affiliations
Tulane University (US)
Corresponding author
Boris, Neil W.
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2004-05
Volume
43
Issue
5
Pages
568-577
ISSN
0890-8567 (ISSN-L)
DOI
10.1097/00004583-200405000-00010
OpenAlex
W2013978218
Cited by
128
References
40
Citations by year
2026: 3 · 2025: 5 · 2024: 4 · 2023: 3 · 2022: 3 · 2021: 1 · 2020: 3 · 2019: 4 · 2018: 11 · 2017: 6 · 2016: 5 · 2015: 6 · 2014: 6 · 2013: 5 · 2012: 8
FWCI
8.36
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • NIMH/AACAP K-12 ((MH-009991-03))
  • NIMH R03 ((MH55531-01))
Topics
  • Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords
attachment disorders, diagnostic reliability, inter-rater reliability, diagnostic validity, child abuse, homeless children, early childhood attachment, disorganized attachment, secure attachment, caregiver-child dyads
MeSH terms
Child, Preschool, Female, Humans, Infant, Male, Reproducibility of Results, Reactive Attachment Disorder, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders

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