The divergence between evidence-based attachment work and an alternative discourse which "…makes passing reference to Bowlby and the academic literature, and then proceeds to make claims which have no basis in attachment theory and for which there is no empirical evidence" has been going on now for many years.
That quote is from Understanding Attachment and Attachment Disorders: Theory, Evidence and Practice (2006) by Vivien Prior and Danya Glaser. Glaser was also consulted in the preparation of the psychiatric report by Dr J.C. Sturge giving a child and adolescent opinion, under the instruction of the Official Solicitor, with regard to appeal cases Re L, Re V, Re M, and Re H (2000), which defined the state of the evidence regarding the implications of domestic violence for contact. Glaser is an eminent expert in the area of child welfare and development.
Also in 2006, the American Professional Society on the Abuse of Children (APSAC) published their report on Attachment Therapy, Reactive Attachment Disorder, and Attachment Problems, which was endorsed by the APA's Society for Child and Family Policy and Practice. It makes damning reading for the same reasons delineated by Prior and Glaser. In particular, it recommended:
Assessment for attachment problems requires considerable diagnostic knowledge and skill, to accurately recognize attachment problems and to rule out competing diagnoses. Consequently, attachment problems should be diagnosed only by a trained, licensed mental health professional with considerable expertise in child development and differential diagnosis…
Assessment should first consider more common disorders, conditions, and explanations for behaviour before considering rarer ones. Assessors and caseworkers should be vigilant about the allure of rare disorders in the child maltreatment field and should be alert to the possibility of misdiagnosis…
Care should be taken to rule out conditions such as autism spectrum disorders, pervasive developmental disorder, childhood schizophrenia, genetic syndromes, or other conditions before making a diagnosis of attachment disorder. If necessary, specialized assessment by professionals familiar with these disorders or syndromes should be considered.
Diagnosis of attachment disorder should never be made simply based on a child’s status as maltreated, as having experienced trauma, as growing up in an institution, as being a foster or adoptive child, or simply because the child has experienced pathogenic care. Assessment should respect the fact that resiliency is common, even in the face of great adversity.
For clarity, the 'more common disorders' being referred to are mental health and, in particular, neurodevelopmental problems. You might now think: But that was back in 2006 - surely we now have a better understanding of the nature and importance of attachment problems? Well, we do to some extent. But, in terms of the actual science and research relating to attachment, there has not been some sort of fundamental change. These same problems and mistakes were shown to be ongoing in the UK in 2014 (Woolgar & Baldock). And David Shemmings, Professor of Child Protection Research at the University of Kent, advocates that practitioners don't use the word 'attachment' at all for related reasons. In fact, what seems to have happened is that the 'alternative discourse' that Prior and Glaser said '... is found in some clinical practice, non-academic literature and on the Internet' has become mainstream clinical practice: it is what you see and hear trained professionals in health, education and social care routinely using even in Court reports that will form part of the evidence relating to whether a child will be removed from their family.
In parallel to all this is the key point, which is in no way controversial, that child maltreatment will generally have an effect on the brain. We knew this before we even starting studying the specific effects it has on the brain: "There is an undoubted immediate equivalence between every mind function – emotion, cognition, behaviour and brain activity" (Glaser, 2014) - so things that we know to impact on functioning, as maltreatment does, will have an effect on the brain.
But the questions are: What sort of maltreatment? And what effects?
The answers are, in short: Quite a lot of maltreatment. And the effects that we know maltreatment causes - that we generally knew it caused before we started looking at the brain in any real detail.
Furthermore, we also know from a variety of quite specific research that maltreatment does not have a causal role in any neurodevelopmental disorder apart from ADHD. And it still requires a lot of maltreatment to be causally implicated there.
The errors that are made in relation to this fall into two main areas:
- Misunderstanding population research that shows that relatively small differences in parenting can have effects on outcomes i.e. thinking that because there is clear evidence of an effect, that effect might be substantial even in the absence of evident deprivation
- Misidentifying bio-genetic neurodevelopmental symptoms, which can often be quite significant, as having a deprivation-related cause - and therefore also wrongly deducing that any deprivation must have also been significant
There is a more complex issue in relation to ADHD, which is that environmental effects are routinely given too much weighting when thinking about causes. Bio-genetics is likely to be main explanation unless and until it is clear that a child has been evidently abused, neglected and/or exposed to multiple changes in caregiver: that is the clear finding from the research.
There is a further, related problem concerning the misunderstanding of other causes of problem behaviour: "It is also possible that some of these children’s behaviours belong in a very different domain, unconnected to attachment. Some children have been found to show an absence of pro-social behaviour and to be ‘callous unemotional’ at the age of 7 years. These aspects appear, from a twin study (Viding et al. 2005), to be highly heritable and therefore point to a genetic vulnerability in these children." (Prior & Glaser 2006).
So, there are attachment disorders related to significant maltreatment and a variety of attachment styles within the core paradigm that are unrelated to such experiences. But these constructs are routinely misused to describe and explain a variety of problems entirely unrelated to attachment - and to ascribe problems in child development to environmental factors when there is simply no evidence of this either in the specific case or the general research.
An additional point is that it is essential to understand the terms used in genetics research. This includes 'shared environmental influences' - which does not generally mean things that are done to a child but things that impact on both twins involved in a study. In twin studies of autism, this has been described as "dangerous terminology":
Dangerous terminology: “The conclusions of an important effect for the environment should be tempered, especially given how they can be misinterpreted and misrepresented. The fact that monozygotic twins are not always concordant for the disorder suggests there are some non-genetic factors that contribute to whether individuals develop the disorder or not. In the analytical models used here, these sources of variance are bundled into a statistical term called the ‘non-shared environment.’ This term is used here in a technical sense that does not correspond to the colloquial meaning. In particular, it should not be taken as evidence of effects of some causal factors out in the environment.
From <https://www.spectrumnews.org/opinion/cross-talk/what-constitutes-environmental-risk-for-autism/>
In summary, what has been going on in the UK with ASD, ADHD and similar problems over the past decade or two is most likely going to have repercussions far greater than the negligence relating to dyslexia in previous decades. That resulted in a large number of education negligence claims. The failures in training and practice in relation to complex neurodevelopmental disorders are resulting in clinical and medical negligence, education negligence, disability discrimination, personal injury through mental health disorders, and human rights abuses. If the regulatory, government and other agencies do not move to address these issues, the legal professionals and system almost certainly will. The failures are not only significant, they are extreme. And they are hiding in plain sight.
