Comparing criteria for attachment disorders: establishing reliability and validity in high-risk samples.
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.


METHODS
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.
Boris
Neil W
NW
Tulane University, Department of Community Health Sciences, USA. nboris@tulane.edu
Hinshaw-Fuselier
Sarah S
SS
Smyke
Anna T
AT
Scheeringa
Michael S
MS
Heller
Sherryl S
SS
Zeanah
Charles H
CH
D002675:Child, Preschool; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007223:Infant; D038801:International Classification of Diseases; D008297:Male; D019962:Reactive Attachment Disorder / Q000175:diagnosis*; D015203:Reproducibility of Results