The negative consequences of over-diagnosing attachment disorders in adopted children: the importance of comprehensive formulations

TY - JOUR

T1 - The negative consequences of over-diagnosing attachment disorders in adopted children

T2 - the importance of comprehensive formulations

AU - Woolgar, Matt

AU - Scott, Stephen

PY - 2014/7

Y1 - 2014/7

N2 - In many child services across health, education and social care, ‘attachment disorder’ is a popular description and explanation for complex presentations of children who have been neglected or maltreated and is frequently used to describe fostered and adopted children. Very often the use of this term bears little resemblance to the established diagnostic systems, nor indeed to attachment theory as conceptualised by Bowlby. Its misuse can lead professionals to overlook commoner and more treatable conditions, to the detriment of the children. In fact both reactive and disinhibited attachment disorders are rare, but are becoming better characterised by high quality research. Poor understanding about the attachment disorder construct can pose particular problems for clinicians working with adopted children. The current paper briefly reviews the practical difficulties with the attachment disorder diagnosis as applied to adopted children and uses four case studies taken from a specialist Adoption and Fostering Service to highlight some of the problems for services working with adopted children. Finally, we propose some provisional recommendations for the assessment and treatment of adopted children and their families, which aim to be consistent with attachment theory as well as with the existing evidence base on wider child mental health problems.

AB - In many child services across health, education and social care, ‘attachment disorder’ is a popular description and explanation for complex presentations of children who have been neglected or maltreated and is frequently used to describe fostered and adopted children. Very often the use of this term bears little resemblance to the established diagnostic systems, nor indeed to attachment theory as conceptualised by Bowlby. Its misuse can lead professionals to overlook commoner and more treatable conditions, to the detriment of the children. In fact both reactive and disinhibited attachment disorders are rare, but are becoming better characterised by high quality research. Poor understanding about the attachment disorder construct can pose particular problems for clinicians working with adopted children. The current paper briefly reviews the practical difficulties with the attachment disorder diagnosis as applied to adopted children and uses four case studies taken from a specialist Adoption and Fostering Service to highlight some of the problems for services working with adopted children. Finally, we propose some provisional recommendations for the assessment and treatment of adopted children and their families, which aim to be consistent with attachment theory as well as with the existing evidence base on wider child mental health problems.

KW - Attachment disorder

KW - adoption

KW - fostering

KW - mental health

KW - reactive attachment disorder

U2 - 10.1177/1359104513478545

DO - 10.1177/1359104513478545

M3 - Article

SN - 1359-1045

VL - 19

SP - 355

EP - 366

JO - Clinical Child Psychology and Psychiatry

JF - Clinical Child Psychology and Psychiatry

IS - 3

ER -