Clarification of Specialist Attachment Assessment: Science not guesswork

The assessment of psychological states in all ages requires extensive training in both clinical interviewing and psychological assessment tools that are evidence based. This takes at least 6 years, it cannot be circumvented. It should be reliant on evidenced based ‘clinical’ formulation. The unstructured approaches of former years have attracted a great deal of criticism because they lack any evidence bases, transparency, reliability, and utility. Over the last decade we have seen the failures of assessment in the deaths of Victoria Climbie, Baby P and Daniel Pelka (and many more) due to specifically the inability to understand and recognise that children can falsify their outward behaviour and emotional demeanour according to how they have adapted to their environment within their attachment relationships.

Assessment of any kind should reflect current empirical, theoretical, and clinical knowledge (this is completely understood and expected in ‘forensic’ assessment of risk for example). It is not acceptable to be able to make judgements based on ‘opinion’, as we have an enormous body of research which supports the in-depth, psychological understanding of how and why individuals act the way they do. Therefore attachment assessment is of particular significance for making decisions about children involved in court proceedings as a result of maltreatment or parental conflict.

Further, attachment is an interpersonal construct; it is no good simply saying a child has ‘insecure’ attachment when we have scientific-based knowledge to both measure the parent’s motivations and adaption in terms of their attachment to their child; and a child’s attachment adaption to their individual parent. Without knowledge of both there is simply no accuracy in understanding about the relationship that exists between a child and their parent/s. It is not a stand-alone process and there are only certain evidence-based assessments that can measure child and adult attachment. If someone does not have training in the assessment of adult attachment using such methods, they unfortunately will only have half the picture; that is assuming they are able to accurately (with a solid theoretical base and strong statistical validity which can be explained) measure the child’s attachment, not simply relegate it to a category that describes their opinion of the ‘behaviour’ that is presented. Such assessments must be peer reviewed and validated in that they actually do what they say they do, for example the Child Parent Game and the Marschak Interaction Method are not evidence based assessments of attachment or risk.

By using direct observation, interpreted systematically, assessment of attachment can address both the immediate state of relationships and also the historical experiences that have shaped parents’ and children’s strategies for staying safe and eliciting care. From this, the likely effects of maintaining things as they are, or of possible interventions, can be estimated. Early assessment of parent and child attachment relationships can (1) promote the selection of appropriate interventions, (2) avoid the inadvertent use of interventions that amplify family problems, (3) identify family members’ resources and vulnerabilities (especially those that are not often or easily discerned through social work assessment or psychiatric diagnosis), (4) address issues of how family members function together (e.g., parent-child relationships, couple functioning, and family patterns), and (5) indicate which family members are central in changing family functioning.

This information can potentially prevent escalation of problems. There are three primary limitations to current family forensic practice regarding attachment: 1) defining attachment, 2) authorizing experts, and 3) provision of evidence that can be reviewed by other experts. Although ‘attachment’ is now a commonly used term, in reality there are many different meanings ascribed to the concept, and courts are rarely told which meaning is being applied. This often leads to confusion in instructions from the court. The most universal distinction is between secure and insecure attachment, with the latter usually used to imply dysfunction that requires intervention.

Although almost everyone agrees that families coming to court attention are characterized by insecure attachment as previously stated, simply describing it as ‘insecure’, ‘disorganised’, ‘anxious’, ‘avoidant’ or a child having an ‘attachment disorder’ actually means nothing. Evidenced based attachment categories should differentiate among children and adults with troubled patterns of attachment, whereas reactive attachment disorder and disorganized put highly heterogeneous cases together in one category. Attachment is tied to both information-processing and behaviour; non evidence-based approaches (i.e. simply describing what appears to be seen visually) only assess behavioural aspects. Information processing underlying the evidence-based assessments indicates that opposite neuropsychological processes may be used by individuals with different types of attachment (Strathearn, Fonagy, Amico & Montague, 2009).

This means different interventions may be needed: inappropriate interventions may amplify psychological distortions and maladaptive behaviour. The understanding of the science of attachment and the use of associated assessments provide the needed specificity. Evidence based assessments of attachment are also developmentally attuned, with suitable and interrelated assessments across the lifespan. One of the most troubling aspects of current reports on attachment is the lack of evidence regarding how experts’ conclusions were derived. Unlike medical evidence or photographic evidence of home conditions, conclusions regarding attachment often depend on descriptions of observed interactions, which are difficult for others to review independently unless they are videotaped. Standardized assessments that both generate a permanent record that others can view, and have peer reviewed published studies that address validity and reliability of the means for drawing conclusions from the observation, help to redress this.

When such assessments are used, other qualified experts can evaluate the same evidence independently and render an informed opinion. This approach helps to reduce multiple assessments of the same family by different professionals. Evidence based approaches to children’s attachment emphasises the adaptive function of children’s behaviour in increasing their safety in dangerous contexts. That is, rather than focusing on what children lack (a deficit approach) or their troublesome behaviours (a symptom-based approach) accurate attachment assessment addresses the protective function of the organisation of children’s behaviour.

In summary ‘evidence based’ means an action or decision was guided by, based on, or made, after reviewing relevant information in the form of observation, research, statistics and well validated theory that underpins the method of assessment used. There is a vast body of current and growing research that indicates unaided or unstructured clinical judgement(in respect of those trained in psychological science) and unaided and unstructured professional judgement (in terms of other professionals within the family law system) are not only inferior in both accuracy and limited in what can actually be explained, but also the cost of inaccuracy can be highly detrimental to children and families; this is purely because it is based on incomplete knowledge.