Assessment of disturbances of attachment in children with intellectual or multiple (visual and intellectual) disabilities: Model, prevalence and comorbidity with psychopathology

Children with visual, intellectual or multiple disabilities are at greater risk
for maladaptive development of social relatedness and development of
psychopathology. The disturbed development of attachment may be at the root of
many of these problems. There is a lack of evidence-based instruments for the
assessment of disturbed attachment, particularly for this group of children.
Because of the overlapping behavioral signs, distinctions between disturbances
and disorders are often hard to make, for instance between disturbed attachment
and psychiatric disorders like pervasive developmental disorder (PDD).
Furthermore, without diagnostic instruments it is difficult to make the right
(therapeutic) decisions for these children and to determine treatment effects.

The primary aim of the project is to establish the prevalence of symptoms of
disturbed attachmend in children with intellectual or multiple disabilities
(referred for psychiatric consultation and aged 5 till 11). Also to establish
the reliability and validity of the Disturbances of Attachment Interview (DAI)
as a diagnostic interview for screening disturbed attachment, determined on the
basis of the guidelines for assessment by the AACAP (2005) and to investigate
the associated factors of disturbed attachment. Secondary aims of this project
are: to investigate the overlap of symptoms of disturbed attachment and
symptoms of PDD in these group of children; to introduce and implement the DAI
and Clinical Observation of Attachment (COA) as instruments for screening and
assessment disturbed attachment in at least ten centres for psychological and
psychiatric assessment of children with intellectual or multiple disabilities.

Observational study

This project investigates common, everyday interactions between children and
their primary caregivers. The observations in the research(playing)room (COA)
differ hardly from observations in regular psychological or psychiatric
assesments, altough challenging situations are included (brief separations from
caregiver; difficult tasks) which also occur in daily situations. The
optometric screening includes a visual assesment (visual aquity, visual field,
movement detection) and will be excecuted by experienced, qualified
ophthalmologists. The used instruments and methods are worldwide wellknown and
accepted; there will be no use of eye drops.
The project includes children with intellectual or multiple disabilities,
referred for psychiatric consultation. Instruments are tested in this group
that will improve the making psychosocial assessments in this population. The
participating children may profit of their participation in the study, because
the test outcomes (including the standardized as well as the nonstandardized
tests) may provided to the diagnostic centre, if caregivers and clients so
desire. The instruments, administred to the primary caregivers (such as the
DAI) will not burden the child. In the Clinical Observation of Attachment
procedure the children will be confronted with short moments of separation of
their parents/primary caregivers. In the presence of the primary caregiver the
child will be confronted with a short, unexpected loud sound. The (mild)
stress, that may be evoked, is necessary to observe (disturbed) attachment
behavior.