Children with disrupted attachment histories : Interventions and psychophysiological indices of effects

Diagnosis and treatment of children affected by disruptions of attachment (out of home placement, multiple changes of primary caregiver) is an area of considerable controversy. The possible contribution of psychobiological theories is discussed in three parts. The first part relates the attachment theoretical perspective to major psychobiological theories on the developmental associations of parent-child relationships and emotional response. The second part reviews studies of autonomic reactivity and HPA-axis activity with foster children, showing that foster children show more reactivity within physiological systems facilitating fight or flight behaviours rather than social engagement, especially foster children with atypical attachment behaviour. The third part is focused on treatment of children suffering from the consequences of disrupted attachment, based on a psychotherapy study with psychophysiological outcome measures. Implications are discussed for theory, diagnosis, and intervention. Review In severe and systematic cases of abuse and neglect, out of home care is often used as intervention to stop abuse and neglect. Being placed out of home, children may experience more physical security but not necessarily more emotional security. Young children in particular, who may not yet have had the opportunity to develop secondary attachment relationships, may lose the only source of security and comfort that they had, however fallible or limited it was. Experiments with primates [1,2] and experiments of nature with orphanage children [3,4] suggest that the risks of severe disruptions of attachment are profound. Fortunately, these and other studies also suggest that these risks may be partially offset by a positive and stable caregiving environment. This has led to an interest in the processes that might mediate the impact of attachment disruptions and compensatory attachment experiences on socioemotional development, in particular the pivotal role of attachment relationships with caregivers in the psychophysiological regulation of affect [5-8]. In this contribution, we discuss psychobiological propositions that may complement attachment theory in order to understand the effects of attachment disruptions. Against this background, we discuss studies on children with disrupted attachment in which the quality of their current caregiving experience was related to psychophysiological parameters, using cross-sectional as well as experimental study designs. The findings are discussed with respect to the value of integrating psychobiological theory in the design and evaluation of psychological and behavioural interventions for children with disrupted attachment. Published: 4 September 2009 Child and Adolescent Psychiatry and Mental Health 2009, 3:26 doi:10.1186/1753-2000-3-26 Received: 3 March 2009 Accepted: 4 September 2009 This article is available from: http://www.capmh. com/content/3/1/26 © 2009 Schuengel et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.