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Chapter 6
Disorders of Attachment
MULTIPLE CHOICE
1. The authors of the text would likely endorse which of the following statements?
a. Attachment must be established immediately after birth in order for children to develop
healthy adult relationships.
b. Attachment is a multi-dimensional and dynamic process which can and does change over
time.
c. Attachment involves multiple relationships and develops over a long period of time.
d. The authors would agree with all of these statements.
2. Tyler is a typically developing 11-month-old. According to research, by his first birthday he should
have accomplished all of the following tasks related to attachment EXCEPT:
a. a sense of self.
b. a basic understanding of himself and the world.
c. use of reciprocal communication.
d. an attachment relationship.
3. According to the authors of the text, attachment is based on which of the following factors?
a. parental variables
b. child variables
c. a cumulative effect of multiple factors
d. all of these factors
4. Andrea, a 9-month-old infant, has experienced significant physical abuse at the hands of her mother’s
live-in boyfriend. Which of the following statements is likely to be true of Andrea?
a. She will develop disinhibited social engagement disorder.
b. She will develop reactive attachment disorder.
c. She is at risk for developing reactive attachment disorder.
d. She is at risk for developing depression as an adult.
5. All of the following are caregiving factors related to the development of attachment disorders
EXCEPT:
a. inadequate care.
b. inattentive caregiving.
c. intuitive caregiving.
d. intrusive care.
7. One of the reasons it is difficult to diagnosis attachment disorders in adolescents is that behaviors:
a. exhibited by adolescents may be related to multiple factors both related and unrelated to
attachment issues.
b. exhibited by adolescents might be a result of drug use.
c. identified in adolescence are complicated by hormones and brain development.
d. identified in adolescence are fairly well set and not amenable to change.
8. Which of the following can be assumed from the discussion in the text?
a. Treatment of attachment disorders is straightforward and usually successful.
b. Prevention of attachment disorders is more effective than treatment.
c. Prevention of attachment disorders is unlikely since most families seclude themselves
from those who can help.
d. Treatment of attachment disorders most often involves removing the child from the
disordered home environment.
TRUE/FALSE
1. According to the authors of the text, the development of an attachment relationship is second only to
the ability to communicate in terms of a psychological achievement during late infancy.
2. Maggie’s mother has been hospitalized for several months to treat her drug addiction. Because of her
unavailability for parenting, young Maggie has been in day care environments in which she was
maltreated by caregivers and older children. Maggie now engages in stereotyped movements and often
looks afraid and apprehensive, which might be signs of disorganized attachment.
4. Reactive attachment disorder is the most common type of attachment problem seen in young children.
5. Children with disordered patterns of attachment are more likely to be bullies than to be victims of
bullying.
6. The authors of the text would support the fact that human attachments are especially fragile and easily
broken through a variety of parent, child, and caregiving factors.
8. Researchers have identified a specific and effective way to treat attachment disorders in young
children.
1. Children who are securely attached to a caregiver use that person as a source of security from which
they can explore their world. This is known as a/n __________.
2. Researchers at the state university are conducting research designed to create situations in which they
can directly observe attachment patterns in young children. They may be basing their research on the
__________ originally developed by Mary Ainsworth.
3. The fact that infants in a variety of cultures demonstrate similar attachment patterns would support the
__________ of attachment processes and behaviors.
4. Children who are diagnosed with __________ have almost always been in very adverse situations
(e.g., abusive homes or institutions).
6. According to the authors of this text, the most salient aspect of disordered attachments is the ________
relationship.
ANS: mental illness (maternal depression, bipolar disorder, anxiety, substance abuse, schizophrenia)
DIF: 2
REF: Etiology TYPE: F
9. A team of professionals consisting of nurses, speech pathologists, early childhood educators, and
school psychologists work with young families who have been referred by their primary care
physicians as being at risk for the development of disordered attachments. This is an example of
________ measures.
1. Describe how the development of a basic understanding of others and the world can either increase
risk for psychopathology or serve as a protective factor.
ANS:
• Earliest set of cognitions and emotions which focus on the child as a separate entity, separate
from caregivers
• Beginning of a basic understanding of the world and of others
• Optional responses – beginning of “mind-reading skills” or “mentalizing” others –
understanding others in terms of the child’s own mental states
2. Discuss the following statement as it relates to the development of attachment disorders: Difficulties in
early relationships can be considered a “marker of a beginning pathological process.”
ANS:
• Answer should include an emphasis on the fact that attachment disorders themselves are not
considered a pathological disorder; however, they could be considered a risk factor that might
lead to pathology if unrecognized or untreated.
3. Compare and contrast the DSM-V classification of attachment disorders with the Zero to Three
classification.
ANS:
• Zero to Three – identified as disorders of relationships; focuses on three types – never had a
health attachment, child has experienced inadequate or abusive care, or child has lost a
significant relationship; focuses more on relationship rather than pathology of either caregiver or
child
• DSM-V – two categories of attachment; reactive attachment disorder and disinhibited social
engagement disorder; focuses on pathology of child
4. The Zero to Three (2005) classification scheme identifies atypical attachment related to three
situations. Identify, describe, and give examples of each of these.
ANS:
• The child has never had a specific or special attachment to a caregiver; example – orphaned or
institutionalized
• The child has experienced inadequate or abusive care; example – in drug-addicted home or
home with abuse
• The child has lost an already-established attachment; example – death of a caregiver
5. Describe the two terms “mentalizing” and “mind-reading skills” and how deficits in these two skills
might lead to psychopathology in children.
ANS:
• Mentalizing – understanding others in terms of own mental states and concepts
• Mind-reading skills – the ability to accept personality responsibility, lack of appreciation of
others, and less concern about distress of others
• Possible outcomes (not directly addressed in text) – both could lead to detachment from others;
lack of empathy could lead to sociopathic acts, could lead to withdrawal from social interactions,
etc.
6. Identify two factors that may contribute to the development of disordered attachment.
ANS:
• Caregiving factors – inadequate, inattentive, inconsistent and intrusive care; neglectful or
abusive caregivers; maltreatment; poor foster care
• Parent factors – personality and psychopathology; maternal depression; bipolar disorder;
anxiety; substance abuse and schizophrenia
• Child factors – difficult temperaments; development/neurological difficulties; special medical
needs; prematurity
• Overall environmental factors – atypical environments such as institutions; frequent change of
caregivers; neglectful or abusive caregivers
REF: Etiology
7. Discuss the difficulties with diagnosing disorders of attachment in older children and adolescents.
ANS:
• Symptoms and behaviors exhibited by older children and adolescents could be a reflection of
many types of disorders other than disorders of attachment; could also be typical fluctuations in
mood and relationships
• Some of these behaviors include aggression, anxiety, and depression
• Difficult to diagnosis between cause of these behaviors (which could be attachment issues) or a
result of other disorders (which cause disruptions in relationships with others)
8. Describe infant-parent psychotherapy and provide two examples of how it may be useful in treating
disorders of attachment. What recommendations have come out of the research related to infant-parent
psychotherapy?
ANS:
• Description – collaborative relationship between therapist and parent; must not pathologize or
blame the child or the parent; must give positive regard to parent as well as empathy; model
positive ways to relate and nurture
• Useful – has been shown to be somewhat useful in treating disordered relationships between
child and caregiver; on the other hand, results of psychotherapy are mixed
• Recommendations – there is still not a specific and effective treatment for disordered
relationships; no clear professional consensus related to treatment (as well as assessment and
diagnosis); more research is needed
REF: Intervention
1. Describe and discuss the three different types of insecure attachment patterns as it relates to short-term
and long-term attachment.
ANS:
• Resistant (or anxious/ambivalent) attachment – related to inconsistency or unpredictability; on-
again, off-again parenting;
o Short-term – may or may not settle into a routine or be comfortable around caregivers; may or
may not reconnect with mother when she returns
o Long-term – most research would not predict long-term consequences of any type of
attachment pattern; there are too many intervening variables that can change the course of
development. A cumulative or additive (both positive and negative) effect determines the
outcome.
• Avoidant (or anxious/avoidant) attachment – related to inadequate care; less competent,
overwhelmed, or resentful caregivers
o Short-term – emotionally constricted and distant; feelings of not being worthy of care; may
avoid overstimulating interactions; blunted emotions; take care of themselves and look to
others for play and comfort
o Long-term – most research would not predict long-term consequences of any type of
attachment pattern; there are too many intervening variables that can change the course of
development. A cumulative or additive (both positive and negative) effect determines the
outcome.
• Disorganized attachment – caregiver is seen as frightening, frightened, or malicious; a result of
long separations or repeated separations from a caregiver; can occur in situations where
caregiver is sensitive
o Short-term – can result in a set of attention, emotion, and behavioral strategies; undirected or
misdirected behavior; behavioral “freezing” or stereotyped movements; expression of fear
o Long-term – most research would not predict long-term consequences of any type of
attachment pattern; there are too many intervening variables that can change the course of
development. A cumulative or additive (both positive and negative) effect determines the
outcome.
2. Describe and discuss the impact of early psychological deprivation as evidenced in the children in
Romanian orphanages. How has this information led to interventions used with children today?
ANS:
• Orphans in Romania were in overcrowded and sterile settings where they had their basic
physiological needs met, but little of their psychological and social/emotional needs met.
• Children in these settings have been followed through longitudinal studies that monitor their
physical, psychological, and social/emotional adjustment.
• Some have found a distinctive pattern of development, called deprivation-specific psychological
patterns, which result in behavioral patterns known as “quasi-autism,” “disinhibited attachment,”
“cognitive impairment,” and “intervention/overactivity.”
• Children who were adopted were able to show gains in cognitive skills and positive attachments.
• Research continues, but most effective intervention includes placement in a high-quality
environment.
3. Zennah and Smyke (2009) assert that “only in highly unusual and maladaptive caregiving
environments do attachments fail to develop.” Discuss this statement in terms of what types of
environments might lead to disordered attachment and how this information might be used to prevent
and/or treat attachment disorders.
ANS:
• Environments – abusive homes, mentally ill parents, institutions, etc.
• Prevention – universal prevention through education; targeted intervention for at-risk families
• Intervention – working with caregivers to change the home environment; removal from highly
dysfunctional environments
• Emphasizes the resiliency of children even when subjected to adverse situations
REF: Etiology
4. A 3-month-old infant is referred to your clinic by their primary care physician. Presenting problems
include lack of eye contact, difficulty sleeping, restricted eating patterns, resistance to touch by
caregivers and weight loss. Develop an assessment protocol (justify your approach) and provide a
tentative diagnosis.
ANS:
• Assessment – history provided by caregivers, doctor, etc.; interviews with caregivers and others;
questionnaires and structured tasks; observations
• Justification – gather as much data from multiple sources as to create a well-rounded view of the
child
• Tentative diagnosis – any plausible suggestion related to disordered attachment or the possibility
of no diagnosis
5. Develop and describe a comprehensive program that would include prevention and intervention for
attachment disorders. Build on research-based programs discussed in your text.
ANS:
• Prevention – universal screening/measures for general population provided in schools, hospitals,
etc.; selective measures – groups at above average risk such as teen parents, mentally ill parents,
etc.; indicated measures for groups with specific risk factors
• Intervention – treat child and caregiver; psychotherapy for infant-child; use empathy and
understanding, not blame
• Programs – STEEP (Steps Toward Effective, Enjoyable Parenting); The Attachment and
Biobehavioral Catch-up Program (ABC); etc.
REF: Intervention
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Ráleltek a régi utakra és mámorosan, szinte öntudatlanul lebegve
járták őket keresztül-kasul. A Dunaparton erős szélroham jött
szembe velük.
– A gallérját, Viksi, föl kell hajtani.
Az asszony gépies engedelmességgel gyürte föl a puha prémet
és mosolygott. Így mentek soká, együtt, mint régen.
Csak mikor a csendes, előkelő belvárosi utczába értek, a
keskeny átjáróba, ahol a néni lakott, akkor néztek egymásra hirtelen,
megrettenve, csodálkozón.
A néni lakása, az öt elsőemeleti ablak világosságban úszott, a
villamos lámpafény kisugárzott a nyitott erkélyajtón is, megvilágította
a tömött, szürke kőkorlátot. Felülről zongoraszó hallatszott és
néhány karcsú árnyék járt-kelt a libbenő függönyök megett.
– Hát még most is fogad a néni? – csodálkozott a férfi.
– Újra négy húga nőtt fel – magyarázta suttogva az asszony.
Csendesen, elszomorodva ballagtak a kapuig. A férfi szorongva
kérdezte:
– Nem megyünk föl, úgy-e?
Már a küszöbön voltak és valami szomorú józanság most már
egészen hatalmába kerítette az asszonyt.
– Én fölmegyek, Gábor – mondta most a keresztnevén szólítva őt
– de maga ne jöjjön fel. Tudom, így nem is lehetne, de később se
jöjjön, átöltözve sem. Lássa, elfelejtettem mondani az előbb, a néni
egészen új bútorokat szerzett megint és az almaszagú kis szobából
is szalont csináltak most. Lányszalont, mert a mostani húgai közt
gazdag lányok is vannak. Általában nagyon megváltozott a néni, én
is megváltoztam, maga is. Jobb lesz…
– Mikor jön megint Pestre?
– Nem tudom, éppenséggel nem tudom.
– Viktorin! Nem lehet!
– De. Az jobb lesz úgy, Gábor. Én már olyan jól megszoktam az
életet, én már nem is tudnám máskép, nem is bírnám.
– Mi lett belőlünk, Viksi.
– Jobb így. Azért jó, hogy találkoztunk… Az is jó, hogy minden
így történt, úgyis elromlott volna lassankint minden, ami valaha szép
volt. Isten vele, Gábor, kivánom, hogy hamar egészséges legyen a
felesége.
Gyorsan megfordult és sietve iramlott föl a lépcsőn. Még látni
lehetett a puha, finom köntöse egy-egy redőjét és egyszer
megcsillant a hófehér arcbőre is a lépcsőház lámpája mellett. Aztán
sietve csengetett be a kivilágított lakásba.
A halál meséje.
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