Autistic and peudo-autistic traits in ongoing complex trauma

AimsTo compare the neurodevelopmental profiles of Albanian street children to those predicted by the Coventry grid.BackgroundA street children's centre had requested help to meet children's emotional needs. No program exists for children experiencing ongoing complex trauma. With input from widely-experienced consultant psychiatrist and consultant psychologist, a very low-intensity program of coping skills was piloted. Extensive anonymised notes were taken as part of the piloting.The Coventry grid is a clinical tool comparing patterns of difficulties typically seen in autistic spectrum disorder (ASD) versus attachment difficulties. It's based on clinical experience and invites ongoing feedback.Method12 Children aged 5–12 years completed the two-week program. The notes were examined for their relevance to areas of the Coventry Grid.ResultThe children showed both traits typical of ASD and of attachment problems. Identifying emotions was impossible for the youngest group (5–7 years); while the older groups could say whether someone was likely to feel “good” or “bad” but struggled to differentiate further.Fantasy and symbolic play were hard for the younger children. If asked to imagine a situation, they replied “but that's not happening”. One child constantly hugged a stuffed doll, but couldn't use it for play. Both younger groups found it hard to imagine a safe-place, though they could say what they wanted in it (chocolate and a working lightbulb). The oldest group all chose a real place related to the centre.Generalising was difficult for all the children. The older children could say whether a story character was a good friend, but not apply this to real life. The youngest children were told a story about a dangerous stranger. Afterwards, the children said they would still go away with strangers as only the man in the story had said he wanted to harm children.The younger children were diffusely attached, but the boys’ eye contact, gesturing, and language were normal in all age groups. All children formed friendships easily, played in a group and were intensely loyal to siblings. They didn't show restricted interests, distress at changes to routine or sensory difficulties. They showed good awareness of the widely divergent social rules at the centre and at home.ConclusionThe children showed a mix of traits usually associated with attachment difficulties and those usually associated with ASD. They may be different from UK clinic samples as they continued to experience severe trauma.

Development and use of the Early Attachment Observation tool for infant mental health

The Early Attachment Observation (EAO) is a simple assessment tool that has been developed by the Leeds Infant Mental Health service in collaboration with Leeds Health Visiting Service for use by health visitors to identify emerging attachment difficulties. The EAO is delivered as part of the universal offer at the routine 6–8-week health visitor contact. The EAO protocol requires the health visitor to ask the primary caregiver three questions about the emerging relationship between themselves and their infant: Describe your relationship with your baby in three words; What is the best thing about your relationship with your baby?; and What is your biggest fear about your relationship with your baby? The health visitor completes a 2-minute observation of the interactions between the infant and parent. The purpose of the EAO is to screen for emerging attachment difficulties, in line with the WAVE report Conception to Age 2: The Age of Opportunity. The EAO is now a crucial element of the Leeds Early Start infant mental health pathway. The purpose of this article is to outline the development, pilot, implementation and evaluation of the use of the EAO in Leeds.

Differentiating 'attachment difficulties' from autism spectrum disorders and attention deficit hyperactivity disorder: Qualitative interviews with experienced health care professionals

Objectives: Attachment difficulties is an umbrella term often used to describe various forms of non-secure attachment. Differentiating ‘attachment difficulties’ from autism spectrum disorder (hereafter autism) and attention deficit hyperactivity disorder (hereafter ADHD) has been characterised as challenging. Few studies have explored how this happens in practice, from the perspective of the professionals. Design: Qualitative study. Method: We conducted in-depth semi-structured interviews with (n=17) healthcare professionals from five NHS Foundation Trusts in the United Kingdom. Participants were recruited using a combination of snowballing, convenience and purposive sampling. Data were analysed using a thematic approach. Results: We identified six interrelated themes that might reflect difficulties with differential conceptualisation. These include: a clinical lexicon of attachment; approaching attachment with caution; contextual factors; perceived characteristic behaviours; assessing attachment and adjacent supports; spotlighting intervention and dual conceptualisation. Conclusion: Our results indicate some of the ways suspicions around attachment are raised in practice. We advocate for more dialogue between research and practice communities on issues of differential conceptualisation. We call for collaboration between a panel of experts consisting of attachment and neurodevelopmental orientated practitioners and researchers, to clarify issues around differentiating between attachment difficulties, ASD and ADHD.

Dealing with Post-Catastrophe—Resilience

This final chapter discusses the complex phenomenon of resilience: how some people weather the storm of crisis. It also describes the limitations of resilience and the importance of treating individuals who lack or lose it. A discussion of attachment as a factor relevant to IPT and to resilience suggests one mechanism through which IPT may benefit patients and impart resilience. Brief IPT may actually repair long-standing attachment difficulties, thus improving interpersonal comfort and functioning. The chapter also reviews the concept of post-traumatic growth in the context of the pandemic. Finally, it documents the uncertain situation in which we find ourselves at this juncture in the pandemic.

Are people with an intellectual disability at increased risk of attachment difficulties? A critical review

Attachment difficulties are associated with a range of adverse outcomes in mental health, and people with intellectual disabilities (IDs) may be at greater risk of experiencing difficulties in their attachment relationships. This review critically evaluated recent research measuring the prevalence of attachment difficulties in people with ID. Eight studies met the inclusion criteria, and a higher prevalence of insecure and disorganized attachment classifications, and symptoms of attachment disorder, was found across a number of subgroups of people with diagnoses of ID. However, the validity and reliability of measures of attachment have not been empirically established in this population, and control groups were not always appropriate. These findings indicate the need to (1) develop reliable and standardized assessments of attachment for people with ID and (2) evaluate the efficacy of attachment-based interventions in relation to reducing psychological distress, mental health problems and expression of behaviours experienced by others as challenging.