Table 3.
Reactive Attachment Disorder and Disinhibited Social Behavior
| Study | Country of origin | Severity of deprivation | Age at assessment | N | Construct measured | Outcome measure | Age at adoption: Distribution | Age at adoption: Measurement | Statistical test | Significant effect of age at adoption? | Form of the relationship? | Relationship with other variables? |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Positive Results | ||||||||||||
| Bruce, Tarullo, & Gunnar (2009) | Eastern Europe, China1 | Socially-emotionally depriving | 6–7y | 40 | disinhibited social behavior | observational measure; parent interview2 | < 36m | continuous | correlation | yes | — | mediated by inhibitory control |
| O’Connor, Bredenkamp, Rutter, & The ERA Study Team (1999) | Romania | Globally depriving | 4y | 111 | disinhibited or inhibited attachment behavior | 3-item parent interview3; additional items for inhibited attachment | < 24m | continuous and < 6m, 7–24m | correlation | yes | linear | not mediated by nutritional deprivation or cognitive impairment |
| O’Connor, Rutter, & The ERA Study Team (2000) | Romania | Globally depriving | 4y, 6y | 165 | disinhibited or inhibited attachment behavior | 3-item parent interview3; additional items for inhibited attachment | 58 < 6m, 59 6–24m, 48 > 24m | continuous and < 6m, 6–24m, > 24m | correlation, chi-squared | yes | linear | not accounted for by other behavioral or emotional problems, or by cognitive ability; stable from 4y to 6y |
| Rutter, Kreppner, & O’Connor (2001) | Romania | Globally depriving | 6y | 165 | disinhibited or inhibited attachment behavior | 3-item parent interview3; additional items for inhibited attachment | 58 < 6m, 59 6–24m, 48 > 24m | < 6m, 6–24m, > 24m | chi-square trends | yes | — | — |
| Rutter, O’Connor, and the ERA Study Team (2004) | Romania | Globally depriving | 4y, 6y | 144 | disinhibited attachment | 3-item parent interview3 | 45 < 6m, 54 6–24m, 45 > 24m | < 6m, 6–24m, > 24m | chi-square; correlation | yes | — | — |
| Rutter, Sonuga-Barke, Beckett, Castle, Kreppner, Kumsta, Schlotz, Stevens, & Bell (2010) | Romania | Globally depriving | 6y, 11y, 15y | 144 | disinhibited attachment | 3-item parent interview3 | 58 < 6m, 59 6–24m, 48 > 24m | < 6m (combined with non-PI), > 6m | Fisher’s exact test | yes | — | partial mediation by head circumference (20% of total effect) |
| Sonuga-Barke, Beckett, Kreppner, Castle, Colvert, Stevens, Hawkins, & Rutter (2008) | Romania | Globally depriving | 11y | 138 | disinhibited attachment | 3-item parent interview3 | .5–3y7m | < 6m, > 6m | ANOVA; regression | yes | — | overall sample: not mediated by head circumference; sub-nourished subgroup: possibly mediated by head circumference |
| Mixed Results | ||||||||||||
| Rutter, Colvert, Kreppner, Beckett, Castle, Groothues, Hawkins, O’Connor, Stevens, & Sonuga-Barke (2007) | Romania | Globally depriving | 4y, 6y, 11y | 111 | disinhibited attachment | 3-item parent interview3 | 44 < 6m, 88 6–42m | continuous and < 6m, 6–42m | chi-square; phicoefficient (contrast); t-test | yes, for persistence of DA over time, and for correlation among 6–42m at adoption group, but ns for correlation of whole sample | — | — |
| Smyke, Zeanah, Gleason, Drury, Fox, Nelson, & Guthrie (2012) | Romania | Globally depriving4 | 6m–8y | 68 | disinhibited attachment disorder | Disturbances of Attachment Interview (first 5 items) 5 (parent-report) | Md = 24m6 | < 24m, > 24m6 | repeated-measures ANOVA | yes | — | interaction with age at assessment |
| Romania | Globally depriving4 | 6m–8y | 68 | inhibited attachment disorder | Disturbances of Attachment Interview (last 3 items) 7 (parent-report) | Md = 24m6 | < 24m, > 24m6 | repeated-measures ANOVA | no | — | — | |
| Null Results | ||||||||||||
| Ames (1997) | Romania | Globally depriving | most 4.5y; some 5.5–9y | 46 | indiscriminate friendliness | 5-item parent interview8 | 8–68m; Md = 18.5m9 | continuous9 | — | no | — | — |
| Chisholm (1998) | Romania | Globally depriving | 1y5m–9y2m | 46 | indiscriminate friendliness | 5-item parent interview8 | 8–68m; Md = 18.5m9 | —9 | — | no | — | — |
| Chisholm, Carter, Ames, & Morison (1995) | Romania | Globally depriving4 | 1y5m–6y4m | 46 | indiscriminate friendliness | 5-item parent interview8 | 8–68m; Md = 18.5m | continuous | correlation | no | — | — |
| Nielsen, Coleman, Guinn, & Robb (2004) | Ug and a | Various levels of deprivation | 1–3y | 33 | discriminating social behavior | observation of free play | 3m–3y; M = 1.5y, SD = .67y10 | < 1y, 1–2y, 2–3y10 | ANCOVA | no | — | — |
| Tizard & Hodges (1978) | UK | Adequate | 8y | 25 | “over-friendliness” | parent interview or observations | 2y–7.5y | — | — | no | — | — |
| Tizard & Rees (1975) | UK | Adequate | 4.5y | 24 | “over-friendliness” or “indiscriminately affectionate” | observations | M = 3.11y; SD = .69 | — | — | no | — | — |
| Age at admission: Distribution | Age at admission: Measurement | Significant effect of age at admission | ||||||||||
| Oliveira, Soares, Martins, Silva, Marques, Baptista, & Lyons-Ruth (2012) | Portugal | — | 11–30m | 74 | indiscriminate behavior | RISE (observational measure based on SSP) | 26% at birth, 24% < 5m, 23% 5–12m, 16.2% 12–18m, 10.8% 18–24m | continuous and various cutoff points | correlation, other tests not listed | no | — | — |
DA = disinhibited attachment, RISE = Rating of Infant and Stranger Engagement, SSP = Strange Situation Procedure, m = months, y = years, M = mean, Md = median, SD = standard deviation
The vast majority of children adopted from China are female
Items were: child too eager to approach, made personal comments to adults, initiated physical contact with unfamiliar adults
Items were: definite lack of differentiation among adults with respect to the child’s social response to them, clear indication that the child would readily go off with a stranger, definite lack of checking back with parent in anxiety-provoking situations
This article did not provide information about the conditions of these institutions, but other studies from the same authors on the same sample did describe the severity of the deprivation.
Items were: whether the child has developed a preference for a specific caregiver, approaches the caregiver for comfort, responds to comfort when offered, engages in reciprocal social interaction, regulates emotions well
In this study, children moved from an institution to foster care (not an adoptive home) at this age
Items were: whether the child checks back with the caregiver when exploring, shows age-appropriate reticence around strangers, demonstrates willingess to “go off” with a stranger
Items were: child wandered without distress, child would be willing to go home with a stranger, child was friendly to strangers, child was ever shy, what a child typically did upon meeting new adults
This study used time in the orphanage instead of age at adoption; these two variables were correlated at r = .97