Book: Diagnostic assessment of attachment related disorders in children with intellectual disability

This concerns a group of children for whom it was difficult to diagnose until now because there was no good diagnostic tool. In addition to the diagnostic tool, Giltaij's dissertation provides clarification in the definition of the distinction between attachment-related disorders and disorders in the autism spectrum. This definition is used in the DSM5 classification criteria.

The Research

Giltaij is a mental health coordinator at Bartiméus and works at the Psychotherapy department, specializing in research and the treatment of clients with multiple disabilities. For the past twelve years he has conducted research with children with a mild intellectual disability aged 5-11 years. These children were referred for examination to a specialized center for Child and Adolescent Psychiatry because of psychological, psychiatric or behavioral problems. This group of children often had to deal with problematic situations in the early years, which prevented good bonding. Children with a mild intellectual disability have a three to four times higher risk of developing psychological, psychiatric and/or behavioral problems than children without this disability.

The results

Research by Hans Giltaij shows that 18% of the children studied have an attachment-related disorder (HGS). A disturbed attachment can arise when a child cannot build a stable attachment relationship with one or more adults (parents, guardian or supervisors) important to the child in the first years of life. As humans, we have an innate drive to attach ourselves to someone who offers us care, support and comfort. If, due to circumstances, a child is placed at an early age in an institution where there is a lot of changing guidance, or in a children's home, or spends a lot of time in hospital due to illness, frequently changes foster or crisis families or has to deal with parents who are less available for example, due to a drug addiction or own problems, a child runs the risk of an attachment-related disorder. This group of children is also at high risk of developing other behavioral or psychiatric problems (comorbidity). These children also have a greater developmental delay than the studied children without an attachment-related disorder. This developmental delay is not related to the mild intellectual disability, but to the attachment-related disorder. Furthermore, the study provides clarification in the definition of the distinction between attachment-related disorders and autism spectrum disorders, as used in the DSM-5 classification criteria.

Application

The results and conclusions of this research should lead to a more refined approach to the guidance of children in institutions and also to more attention for people with attachment-related problems. For example, during the intake of new clients in institutions, more questions should be asked about the developmental history in the early years of the child/client. As this happens later in the client's life, it becomes more difficult to obtain the correct information and therefore more difficult to diagnose attachment-related disorders. The sooner the diagnosis can be made, the better the treatment and guidance that can be provided. Based on this research, a course has been developed for the interview method to diagnose disturbed attachment behavior. This interview method is part of the 3-phase model to arrive at a diagnosis.

The course is intended for psychologists, behavioral experts and psychiatrists who perform diagnostics and is applicable to children up to 12 years of age. In the Netherlands, the course is taught by two university lecturers from VU Amsterdam and by Hans Giltaij himself. The RINO Group in Utrecht organizes this (postgraduate) training. It is the ambition to also offer the clinical observation instrument from the research as a course within the RINO. More research is still needed to make the new protocol and tools applicable to older children and adults.