Attachment theory is one of the core theories proposed for child and family social work, but concerns have been raised regarding misunderstandings and misapplications. Misinformation about attachment is widespread, and texts and teaching on attachment theory often emphasize aspects of the theory that have limited value for applied practice while other elements with greater practice value are often overlooked. As an international group of social work and clinical educators, practitioners, and attachment researchers, we propose an updating of the core social work curriculum on attachment. We present eight core concepts from attachment theory and research. These concepts support thinking about children’s relational needs and behavior, caregiving characteristics, and broader contextual factors. We argue that these concepts are particularly relevant for social work with children and families and should form the basis of teaching on attachment. We also address prevalent myths about attachment, to help protect students from misinformation and simplistic accounts, and support them to challenge misuses of attachment theory. Our recommended curriculum update aims to help trainee social workers appreciate the value of attachment theory for their practice and use the theory in helpful and appropriate ways.

Mary Main played a key role for this study, in which we used an idiographic approach to examine discourse about abuse, trauma, and maltreatment (ATM) among eight mothers with a mild intellectual disability (ID), whose children had been assigned a secure (the “B-group”) or disorganized (the “D-group”) attachment classification. Thematic analysis yielded six ATM discourse themes: openness; coherence; presence of trauma in consciousness; support; agency in response to crisis; and self-concept and caregiving self-efficacy. Mothers in the B-group provided coherent narratives, were open with the interviewer, had memories of seeking and receiving support, and reflected freely and autonomously on their experiences. Contrastingly, the mothers in the D-group expressed a guarded, closed-off stance towards ATM, difficulties seeking support, helplessness in response to crisis, and poor self-concept and -efficacy. Their adverse experiences were nonetheless highly present in consciousness, albeit in unintegrated forms. Our findings suggest that the D-group mothers may be unresolved with respect to loss/abuse

Research has suggested highly elevated levels of interpersonal trauma (IPT) among parents with intellectual disabilities (ID), and that such experiences may contribute to the caregiving and child developmental problems often seen in this population. Conflicting results have however been reported, and there is no systematic review on this matter. This study therefore systematically reviewed the empirical evidence concerning (a) prevalence of IPT among parents with ID, and links with (b) caregiving-relevant and (c) child developmental outcomes, in accordance with the PRISMA 2020 guidelines. Searches were conducted in MEDLINE, CINAHL, PsycINFO, and PTSDpubs. Peer-reviewed empirical articles reporting exposure to any form of systematically assessed IPT (unspecified IPT, physical, sexual, and emotional abuse, neglect, prolonged childhood separations from caregivers, witnessing abuse in the family) among parents with ID were included, yielding a final selection of 20 studies. Findings consistently indicated markedly elevated levels of IPT among parents with ID, with a majority (>50%) having experienced some form of IPT. Estimates for both unspecified and specific forms were typically higher than corresponding estimates in other groups at elevated risk, and than meta-analytical general population estimates in comparable countries. Findings regarding caregiving-relevant outcomes were mixed but indicated links with adverse outcomes, particularly regarding parental mental health. Reports pertaining to child developmental outcomes were scant and inconsistent. We highlight important limitations in the extant literature and provide directions for future research and clinical practice. 

Research on the general parent population has established that parental exposure to interpersonal trauma and psychosocial stressors may negatively influence caregiving and children’s development. Research also suggests that parents with intellectual disability (ID) are disproportionally exposed to interpersonal trauma and psychosocial stressors, and that such exposure may contribute to the elevated risk for caregiving and child developmental problems in this population. Conflicting findings have, however, also been reported, and there is no synthesized picture of the prevalence of interpersonal trauma among these parents, or of associated caregiving-related and child developmental outcomes. There is also a scarcity of research addressing these parents’ exposure to interpersonal trauma and psychosocial stressors, in relation to developmentally informed aspects of caregiving and child development. 

This thesis aims to counter these knowledge gaps. Study I systematically reviewed extant empirical reports on interpersonal trauma among parents with ID, and links with caregiving-related and child developmental outcomes. The review indicated that > 50% of these parents have been exposed to interpersonal trauma. Findings regarding caregiving-related outcomes overall indicated that interpersonal trauma increases caregiving-related risks. Reports on links with child developmental outcomes were scant and inconsistent. Studies II and III present empirical works, focused on parental social-cognitive capacities among mothers with ID. Study II involved a sample of mothers with ID (n = 30), and comparison mothers with ADHD (n = 61), and examined the mothers’ exposure to interpersonal trauma and psychosocial adversity in relation to their capacity for parental mentalizing. Mothers with ID had a heightened risk for mentalizing difficulties, in the form of prementalizing modes of relating to their children. Cumulative interpersonal trauma uniquely predicted prementalizing across groups, whereas psychosocial adversity added to the risk for prementalizing specifically among mothers with ID. Study III involved a second sample of mothers with ID (n = 23) and their children, and socioeconomically matched mothers without ID (n = 25) and their children. This study examined the mothers’ capacity for interpreting infants’ emotions, in relation to the mothers’ exposure to interpersonal trauma, and their children’s attachment. Mothers with ID had a heightened proclivity to misinterpret infants’ emotional expressions as expressions of anger and shame. Shame misinterpretations were also linked with these mothers’ cumulative interpersonal trauma, and with child attachment insecurity and disorganization. An addendum to Study III also addressed the mothers’ psychosocial situation, in relation to maternal sensitivity and the children’s attachment. In both study groups, psychosocial adversity was linked with lower maternal sensitivity. The analysis also suggested that psychosocial adversity contributed to child attachment disorganization specifically among children of mothers with ID. Overall, the thesis points to the importance of acknowledging the parents’ relational history and psychosocial situation, when attempting to understand caregiving-related and child developmental difficulties in families headed by parents with ID. The thesis also outlines important steps for future research, and discusses implications of the findings for practitioners and policy-makers.

Background: Parental mentalising difficulties are robustly linked to caregiving problems. Mothers with intellectual disability are at risk for caregiving problems, but knowledge on their parental mentalising abilities is lacking. The present study aimed to fill this gap.

Method: Thirty mothers with mild intellectual disability, and 61 comparison mothers with ADHD, were assessed for parental mentalising using the Parental Reflective Functioning Questionnaire. Contributions of intellectual disability, maternal exposure to childhood abuse/neglect and psychosocial risk to parental mentalising were examined through hierarchical regression analysis.

Results: Mothers with intellectual disability had a heightened risk for parental mentalising difficulties, in the form of elevated prementalising. Intellectual disability and cumulative childhood abuse/neglect uniquely predicted prementalising among the mothers, whereas cumulative psychosocial risk added to the risk for prementalising specifically among mothers with intellectual disability.

Conclusions: Our findings support contextual models of caregiving, and suggest a need for mentalisation-based support for parents with mild intellectual disability.

Synen på föräldraskap och intellektuell funktionsnedsättning (IF) har förändrats över tid, vilket medfört behov av ny kunskap om bemötande och utformning av stöd. Mödra- och barnhälsovården (MBHV) ska ge ett förstärkt stöd, men det saknas kunskap om hur stödet upplevs av föräldrarna, och hur det bör utformas för att vara gynnsamt för både föräldrar och barn. Inom ramen för ett specialistarbete, som är en delstudie inom ett projekt vid Stockholms universitet, intervjuades tio mammor med lindrig IF om hur de upplevt föräldraskapsstöd från MBHV. Resultaten visade att det fanns en rädsla för att uttrycka behov av föräldraskapsstöd, grundad i en förväntan om dåligt bemötande och diskriminering. Mammorna beskrev olika strategier för att hantera detta, relaterade till om de skulle berätta om sin diagnos för barnmorska och BHV-sjuksköterska, samt i så fall när och hur. För att nå fram och hjälpa mammor med IF, och deras barn, behöver MBHV utforma bemötande och stöd som i större utsträckning än i dag gör att mammor med IF kan känna sig trygga i kontakten med vården.

Attachment theory and research are drawn upon in many applied settings, including family courts, but misunderstandings are widespread and sometimes result in misapplications. The aim of this consensus statement is, therefore, to enhance understanding, counter misinformation, and steer family-court utilisation of attachment theory in a supportive, evidence-based direction, especially with regard to child protection and child custody decision-making. The article is divided into two parts. In the first, we address problems related to the use of attachment theory and research in family courts, and discuss reasons for these problems. To this end, we examine family court applications of attachment theory in the current context of the best-interest-of-the-child standard, discuss misunderstandings regarding attachment theory, and identify factors that have hindered accurate implementation. In the second part, we provide recommendations for the application of attachment theory and research. To this end, we set out three attachment principles: the child’s need for familiar, non-abusive caregivers; the value of continuity of good-enough care; and the benefits of networks of attachment relationships. We also discuss the suitability of assessments of attachment quality and caregiving behaviour to inform family court decision-making. We conclude that assessments of caregiver behaviour should take center stage. Although there is dissensus among us regarding the use of assessments of attachment quality to inform child custody and child-protection decisions, such assessments are currently most suitable for targeting and directing supportive interventions. Finally, we provide directions to guide future interdisciplinary research collaboration.

Scholarly discussion suggests prevalent, overconfident use of attachment classifications in child protection (CP) investigations but no systematic research has examined actual prevalence, the methods used to derive such classifications, or their interpretations. We aimed to cover this gap using survey data from a nationally representative sample of Swedish CP workers (N = 191). Three key findings emerged. First, the vast majority formed an opinion about young children's attachment quality in all or most investigations. Second, most did not employ systematic assessments, and none employed well-validated attachment methods. Third, there was overconfidence in the perceived implications of attachment classifications. For example, many believed that insecure attachment is a valid indicator of insufficient care. Our findings illustrate a wide researcher-practitioner gap. This gap is presumably due to inherent difficulties translating group-based research to the level of the individual, poor dissemination of attachment theory and research, and infrastructural pressures adversely influencing the quality of CP investigations.

La théorie et les recherches sur l’attachement sont utilisées dans de nombreux cadres d’application, y compris dans les tribunaux compétents en matière familiale [1], mais les incompréhensions sont fréquentes et sources d’erreurs lorsqu’il s’agit de les mettre en pratique. L’objectif de cet article de consensus est donc d’accroître la compréhension, de lutter contre la désinformation et d’améliorer l’utilisation de la théorie de l’attachement dans les tribunaux compétents en matière familiale sur la base des données probantes, en particulier concernant la protection de l’enfance et les décisions relatives au mode de résidence des enfants de parents séparés. L’article est divisé en deux parties. Dans la première, nous abordons les problèmes liés à l’utilisation de la théorie et de la recherche sur l’attachement dans les tribunaux compétents en matière familiale, et nous évoquons les raisons qui en sont à l’origine. Pour cela, nous examinons les applications de la théorie de l’attachement dans les tribunaux compétents en matière familiale dans le contexte actuel de la norme relative à l’intérêt supérieur de l’enfant ; nous discutons des incompréhensions concernant la théorie de l’attachement et nous identifions les facteurs qui ont pu entraver sa bonne utilisation. Dans la deuxième partie, nous formulons des recommandations pour une meilleure application de la théorie et de la recherche sur l’attachement. Dans ce but, nous énonçons trois principes fondamentaux à propos de l’attachement : le besoin de l’enfant d’avoir des caregivers [2]familiers et non abusifs ; la valeur de la continuité des soins suffisamment bons ; et les avantages inhérents à la construction d’un réseau de relations d’attachement. Nous discutons également de la pertinence des outils d’évaluation de la qualité de l’attachement et des comportements de caregiving [3] pour éclairer les décisions des tribunaux compétents en matière familiale. Nous concluons que l’évaluation des comportements de soin des parents ou de toute personne en position de donneur de soins à l’enfant (caregivers) devrait être au centre des préoccupations. Bien qu’il existe un désaccord entre nous concernant l’utilisation des outils d’évaluation de la qualité de l’attachement pour éclairer les décisions relatives à la résidence et à la protection des enfants, ces outils apparaissent actuellement comme les plus appropriés pour cibler et mettre en place des programmes de soutien à la parentalité. Pour conclure, nous fournissons quelques orientations afin de guider les chercheurs dans le développement de futures collaborations au niveau interdisciplinaire.

Attachment theory and research are drawn upon in many applied settings, including family courts, but misunderstandings are widespread and sometimes result in misapplications. The aim of this consensus statement is, therefore, to enhance understanding, counter misinformation, and steer family-court utilization of attachment theory in a supportive, evidence-based direction, especially with regard to child protection and child custody decision-making. The article is divided into two parts. In the first, we address problems related to the use of attachment theory and research in family courts, and discuss reasons for these problems. To this end, we examine family court applications of attachment theory in the current context of the best-interest-of-the-child standard, discuss misunderstandings regarding attachment theory, and identify factors that have hindered accurate implementation. In the second part, we provide recommendations for the application of attachment theory and research. To this end, we set out three attachment principles: the child’s need for familiar, non-abusive caregivers; the value of continuity of good-enough care; and the benefits of networks of attachment relationships. We also discuss the suitability of assessments of attachment quality and caregiving behavior to inform family court decision-making. We conclude that assessments of caregiver behavior should take center stage. Although there is dissensus among us regarding the use of assessments of attachment quality to inform child custody and child-protection decisions, such assessments are currently most suitable for targeting and directing supportive interventions. Finally, we provide directions to guide future interdisciplinary research collaboration.

Attachment theory, research, and assessments have become increasingly applied to settle child custody cases. We discuss such applications in relation to admissibility criteria for scientific evidence and testimony proposed by Faigman et al. (2014). We argue that attachment theory and research can provide valid “framework evidence”; group-based attachment research has yielded general principles suitable as a frame of reference for pertinent court decisions. In particular, child custody decision-making should generally be guided by research indicating that children benefit from attachment networks. In contrast, assessments of attachment quality fall short of providing valid “diagnostic evidence”; information that a specific individual/dyad is a “true” instance of a general group-level principle. In particular, such assessments do not yield valid information about whether a particular caregiver has better caregiving skills than another caregiver and will better support child development. We conclude that attachment theory and research should be admissible for framework but not for diagnostic testimony.