Attachment disorder draws closer look

Children who spend their first few years in institutions without affectionate care, sensory stimulation, or other bare necessities often can’t form close relationships. Known as attachment disorder, this condition has attracted intense interest as more people adopt institutionalized youngsters from around the world.

Despite some highly publicized cases in which violent acts were attributed to attachment disorder, its features and causes remain controversial.

An ongoing study of children adopted from Romanian orphanages by British parents outlines a set of behaviors typical of the disorder. Neither defiance nor violence characterizes the group. The work confirms that severe deprivation lies at the core of attachment disorder but doesn’t inevitably undermine social functioning, reports a team headed by psychologist Thomas G. O’Connor of the Institute of Psychiatry in London.

Kids between ages 4 and 6 who have attachment disorder disregard their adoptive parents and eagerly approach strangers, and they don’t look for their parents in new or scary situations. Such kids also often misinterpret social cues and find it difficult to generate more than superficial interest in others. Published diagnostic criteria for attachment disorder only partially describe this overall clinical picture, O’Connor’s group says.

“Our observations of children [with attachment disorder] and interviews with parents attest to the clinical concerns raised about the children’s safety and difficulties in establishing relationships with others,” the researchers conclude in the June Journal of the American Academy of Child and Adolescent Psychiatry.

However, nobody knows whether the youngsters’ condition will improve as they spend more time in adoptive families, the scientists say. No established treatment exists for attachment disorder.

The researchers conducted home evaluations on 111 Romanian children at ages 4 and 6 who were adopted by 2 years of age and 52 British children adopted by 6 months of age.

Another 48 Romanian children who entered adoptive families between ages 2 and 3½ were evaluated at age 6. At the time of adoption, the Romanian kids had shown malnourishment and other physical signs of severe deprivation.

Children exposed to the most deprivation had the highest rates of attachment disorder. O’Connor’s team diagnosed the condition in 4 percent of the British children, 7 percent of Romanian kids adopted by age 6 months, 21 percent of Romanian youngsters adopted between ages 6 months and 2 years, and 31 percent of Romanian children adopted between ages 2 and 3½ years. Attachment disorder, or its absence, usually stayed stable from ages 4 to 6.

Other data suggest that indiscriminate friendliness is the most persistent symptom linked to attachment disorder, remarks psychiatrist Charles H. Zeanah of Tulane University School of Medicine in New Orleans. His research indicates that among formerly deprived children, unchecked sociability can still affect those who manage to develop close relationships.