Attachment security in children with autism

Development and Psychopathology, 6 (1994), 249-261 Copyright © 1994 Cambridge University Press Printed in the United States of America

Attachment security in children with autism

LISA CAPPS," MARIAN SIGMAN," AND PETER MUNDY* "University of California, Los Angeles; and bUniversity of Miami

Abstract Nineteen autistic children were examined in a modified version of Ainsworth's Strange Situation. The attachment security of 15 children could be classified. Each of these children displayed disorganized attachment patterns, but almost half (40%) of them were subclassified as securely attached. To assess the validity of the attachment classifications, children and their mothers were observed in a separate interaction. Mothers of children who were subclassified as securely attached displayed greater sensitivity than mothers of children who were subclassified as insecurely attached. Children who were subclassified as securely attached more frequently initiated social interaction with their mothers than did children who were subclassified as insecurely attached. Children with secure and insecure subclassifications were compared to investigate correlations between attachment organization and representational ability and social-emotional understanding. Although children with underlying secure attachments were no more likely to initiate joint attention, they were more responsive to bids for joint attention, made requests more frequently, and demonstrated greater receptive language ability than children subclassified as insecurely attached. Discussion focuses on dynamics that may contribute to individual differences in the attachment organization of autistic children and on the reciprocal relationship between advances in our understanding of normal and pathological development.

Since the initial description of the syndrome (Kanner, 1943), attachment has been central to discussion of autism. Psychoanalytic accounts have conceptualized autism as a disorder of attachment. Mahler (1968) suggested that autistic children's development was arrested prior to forming an attachment relationship such that concepts of self and other fail to develop. Similarly, Rutter (1978, p. 9) described autistic children's "lack of attachment behavior and relative failure of bonding." More recently, Cohen, Paul, and Volkmar (1987, p. 29) have written that "autistic social impairment results in the child's failure to demonstrate differ-

ential attachment to familiar people in contrast with unfamiliar adults or objects." Contrary to previous accounts, which have viewed attachment from various perspectives, empirical evidence suggests that autistic children do form attachments, even though their social behaviors are very different from those of normally developing children. Studies consistently show that autistic children react to their caregiver's departure, that they direct more social behavior to the caregiver than to a stranger, and that a majority increase their proximity seeking behavior after separation from the caregiver (Rogers, Ozonoff, & MaslinCole, 1991; Shapiro, Sherman, Calamari, & Koch, 1987; Sigman & Mundy, 1989; SigThis research was supported by grants NS25243 from NINDS and HD17662 from NICHD to Marian Sig- man &Ungerer, 1984). man. We are very grateful to Mary Main for coding the Attachment theory as originated by John tapes. In addition, we thank Larry Epstein, Holly Bowlby (1969) is a broad construct—"open Flesh, Mellissa Fond, and Angie Pena. Address correspondence and reprint requests to: to extension, revision, and refinement Marian Sigman, UCLA Medical School, 68-237B NPI, through research" (Ainsworth, 1990, p. 760 Westwood Plaza, Los Angeles, CA 90024. 464). In 1969, Ainsworth and Wittig ex249

250

tended Bowlby's (1969) theoretical work on attachment, emphasizing the importance of security or insecurity in the attachment relationship, and developed a methodology for assessing these differences — the Strange Situation procedure (Ainsworth, Blehar, Waters, & Wall, 1978) - which is widely used as the index of attachment security in infants. To date, only two studies (Rogers et al., 1991; Shapiro et al., 1987) have classified attachment security in children with autism.1 In the first study, Shapiro et al. (1987) modified2 Ainsworth's original system (Ainsworth et al., 1978) to compare the attachment organization of children with autism, Developmental Language Disorder, Atypical Pervasive Developmental Disorder, or mental retardation. Children were matched on chronological age (M = 44 months, SD = 17) and developmental quotients (DQs; M = 65, SD = 24). Based onitheir behavior during reunion episodes, approximately half (47%) of the children in each diagnostic group were classified as securely attached, while the remainder were deemed insecurely attached. Similarly, groups did not differ in response to separation. The majority (64%) of children showed some change in behavior at separation, and almost half (44%) displayed negative mood. In the second study, comparing autistic children and children with other developmental and psychiatric disabilities, matched on chronological age (M = 46, SD = 12), mental age (M = 34, SD = 13), and IQ (Af = 72, SD = 21), Rogers et al. (1991) found that the majority of autistic children appeared securely attached. Concerned that autistic children's attachment behaviors "often appear too weak or fragmented to assign to traditional categories" (Rogers et al., 1991, p. 485), they examined attachment security using a continuous rating system (Lamb, Thompson, Gardner, Charnov, & Estes, 1984) that is based on Ainsworth's subscales (proximity and contact seeking, 1. Readers who wish to know more about autism are referred to Frith (1989). 2. The authors did not specify the modifications made.

L. Cappsetal. contact maintenance, contact resistance, and proximity avoidance; Ainsworth et al., 1978). The system yields scores ranging from 1 to 5, with 1 representing clear signs of insecurity and no sign of security, and 5 clear signs of security and no sign of insecurity. The autistic children appeared as securely attached as comparison children; across groups the mean score was 3. In the autistic group, however, there was a significant positive relationship between attachment security scores and cognitive, language, and gross motor level. Attachment security was not related to severity of autism, as measured by the Child Autism Rating Scale (Schopler, Reichler, & Renner, 1986). Beginning with the classic work of Hermelin and O'Connor (1970), studies of autism have been guided by normal developmental theory and research. Because "all pathology can be conceived of as disturbance, distortion, or degeneration of normal functioning, it follows that to better understand pathology, one must better understand normal functioning, against which pathology is defined" (Cicchetti, in press). Increases in our knowledge of the organization of attentional, cognitive, neurobiological, and socioemotional domains in autistic children are tied to concomitant advances in our understanding of normal development (see, e.g., Baron-Cohen, Leslie, & Frith, 1985; Dawson, 1989; Frith, 1989; Sigman& Mundy, 1989; Rutter & Garmezy, 1983). Ainsworth's original system for classifying individual differences in response to the Strange Situation included three attachment categories: secure ("B"), insecureavoidant ("A"), and insecure-resistant ("C"). Yet as investigators assessed infants in the Strange Situation, particularly infants at risk, they discovered that the attachment behavior of a significant percentage did not fit any of Ainsworth's categories (Crittenden, 1985, 1988; Lyons-Ruth, Connel, Zoll, & Stahl, 1987; Main & Solomon, 1986; Main & Weston, 1981). After reviewing a group of "unclassifiable" infants on tapes from laboratories throughout the country, Main and Solomon (1986, 1990) developed

Attachment security in autistic children

a fourth classification: disorganized/disoriented ("D"). They identified seven thematic characteristics of disorganized/disoriented attachment behavior: (a) simultaneous display of contradictory behavior patterns, such as approaching with head averted, gazing strongly away while in contact; (b) sequential display of contradictory behavior patterns, as is the case when a child clearly greets the parent and then turns away; (c) undirected, misdirected, incomplete, and interrupted movements and expressions; (d) stereotypies, asymmetrical and mistimed movements, and anomalous posture; (e) freezing, stilling, and slowed movements and expressions, including dazed behavior with indices of depressed affect, such as an unfocused "dead" stare, limp mouth, still body; (f) direct indices of apprehension regarding the parent; and (g) direct indices of disorganization or disorientation. Subsequent investigations of high-risk populations have associated disorganized attachment with biological and social risk, such as parental psychopathology (Cummings & Cicchetti, 1990; O'Connor, Sigman, &Kasari, 1992; Radke-Yarrow, Cummings, Kuczynski, & Chapman, 1985; Spieker & Booth, 1988) and parental maltreatment (Carlson, Cicchetti, Barnett, & Braunwald, 1989a, 1989b; Crittenden & Ainsworth, 1989). Infant's attachment disorganization has also been related to a variety of forms of parental distress, including unresolved attachment-related traumas (Main & Hesse, 1990; Main & Solomon, 1990). Finally, Main and Hesse (1990, p. 177) have asserted that "in all probability other factors are operating in a substantial minority of D cases: for example, neurological difficulties, confusion regarding parental signaling or some other aspect of the experimental procedure, and temporary stresses of other kinds." To date, disorganization in attachment has not been investigated in autistic children. The first objective of this study was to determine whether or not the attachment security of autistic children could be coded using Ainsworth's original classification system and the disorganized/disoriented "D"

251

classification. The rationale behind our attempt to apply the system that is used most widely in studies of normal children is rooted in the goals of developmental psychopathology: to understand autism from a developmental perspective and, simultaneously, to contribute precision to normal developmental theory and methodology (Cicchetti, 1984; Sigman, 1989). Since it was developed for normal 12and 18-month-old infants, the applicability of the infant attachment classification system to 3-5-year-old autistic children warrants discussion. While the average mental age of children in the present study was 23 months, slightly older than the age desirable for infant assessment, the mean language age was 18.5 months. Thus, the autistic children seem to lack the representational abilities tapped by recently designed measures of preschool attachment (Cassidy & Marvin, 1991). Given autistic children's specific deficits in emotion perception and expression, and limited awareness of others' subjective or internal experiences (e.g., emotion, intention, motivation, focus of attention), Rogers et al. (1991) have suggested that the construction of a working model of attachment figures is a more demanding task for autistic children than for normally developing or nonautistic developmentally handicapped children. In light of this, and because the autistic children in our sample appear to have the verbal and interpersonal skills of children in the second year of life, we chose Ainsworth's Strange Situation procedure and classification system, with the additional disorganized/disoriented "D" classification (Main & Solomon, 1990) rather than a preschool-level classification system. Ainsworth's classification system derives its strength from its tie to independent observations of mothers and infants in interaction. Mothers of infants judged secure on the basis of Strange Situation behavior have repeatedly been found more sensitive to the infant's signals and/or more responsive than mothers of infants judged insecureavoidant or insecure-ambivalent (Ainsworth, Bell, &Stayton, 1971,1974; Egeland

L. Capps et al.

252

& Farber, 1984; Goldberg, Perrotta, Minde, & Corter, 1986; Grossmann, Grossmann, Spangler, Suess, & Unzner, 1985; Isabella, 1993; Pederson et al., 1990; Smith & Pederson, 1988). Previous studies of attachment security in autistic children have not examined concurrent relationships. The second purpose of this study was to investigate associations between attachment security and mothers' and children's behavior in a separate interaction, providing a measure of the validity of the attachment classifications. In addition, we were interested in the relationship between representational abilities and attachment security in children with autism. Although previous findings are not conclusive (Sigman & Mundy, 1989), there is empirical support for an association between attachment and representational ability in children with autism (Sigman & Ungerer, 1984). Studies of nonautistic children suggest that there may be a relationship between cognitive and linguistic abilities and attachment security, particularly among high-risk families (Cicchetti, 1990; Cicchetti & Beeghly, 1987; Coster, Gersten, Beeghly, & Cicchetti, 1989; Gersten, Coster, Schneider-Rosen, Carlson, & Cicchetti; Morisset, Barnard, Greenberg, Booth, & Spieker, 1990). In line with these findings, Rogers et al. (1991) identified a correlation among mental age, language abilities, and attachment security (based on a continuous rating scale) in a sample of autistic children. Thus, the third objective of this study was to investigate the correlates of secure attachment in the current sample of autistic children. Finally, because our research on autism has identified pivotal deficits in joint attention and social referencing (Mundy, Sigman, Ungerer, & Sherman, 1986; Sigman, Kasari, Kwon, & Yirmiya, 1991; Sigman, Mundy, Sherman, & Ungerer, 1986), we wondered whether or not these behaviors might relate to security of attachment. To address this question, we examined whether or not children who appeared more securely attached displayed more looking, pointing, showing, and giving than children who ap-

peared less securely attached, while interacting both with their mothers and with an experimenter. In sum, the purpose of this study was to see whether or not attachment security could be classified in children with autism using Ainsworth's original categories and the "D" classification. To assess the validity of the attachment classifications, we also examined associations between attachment organization and mothers' and children's behavior in a separate interaction. The third objective was to investigate possible correlations among children's attachment security, their expressive and comprehensive language abilities, and their joint attention behaviors with a caregiver and experimenter. Method

Subjects This sample consists of 19 children with autism, 16 boys and 3 girls, ranging between 3 and 6 years of age. Although the sample size in this study is relatively small, these children are representative of autistic children at this age and developmental level. Based on the Cattell Scale of Infant Intelligence (Cattell, 1960), the mean DQ of the group was 45.5 (SD = 10.22) and the mean mental age was 23.95 (SD = 9.33). All children who participated in this investigation were subjects in the Clinical Research Center for the Study of Childhood Psychosis at UCLA. Their diagnoses were determined by two independent psychiatrists who are very experienced in the field of autism, neither of whom were involved in the research project. Because the sample was recruited between 1982 and 1987, diagnoses were based on DSM-III criteria for autism (American Psychiatric Association, 1980). These consist of the following criteria: (a) onset before 30 months of age; (b) pervasive lack of responsiveness to other people; (c) gross deficits in language development; (d) if speech is present, peculiar speech patterns such as immediate and delayed echolalia, metaphorical language pronominal rever-


sal; (e) bizarre responses to various aspects of the environment, such as resistance to change or peculiar interest in or attachments to animate or inanimate objects; and (f) absence of delusions, hallucinations, loosening of associations, and incoherence as in schizophrenia. In the second part of the study, two groups of children were compared on the basis of attachment organization. As will be described in detail, the first group consisted of six children whose secondary attachment classification was secure. The second group included nine children who were subclassified as insecure. With respect to the 15 children who could be classified, the mean chronological age was 48.6 months (SD = 12.4), the mean mental age was 24.1 (SD = 9.9), and the mean DQ, as indicated on the Cattell Scale of Infant Intelligence, was 47 (SD = 10.8). Groups did not differ on the basis of chronological age, mental age, or DQ. For the more securely attached group, mean chronological age was 48.2 months (SD = 14.6), the mean mental age was 26 (SD = 13.7), and the mean DQ was 49.5 (SD = 14.7). For the less securely attached group, mean chronological age was 48.8 (SD = 11.6), the mean mental age was 22.8 (SD = 7.1), and the mean DQ was 45.3 (SD = 7.7) (see Table 1).

253

Table 1. Cognitive and language abilities Characteristics

Secure (n = 6)

Insecure (n = 9)

48.17 14.63

48.79 11.56

49.50 14.73

45.33 7.71

26.00 13.73

22.78 7.11

23.33 11.06

15.22 4.58

26.83 10.82

16.33* 6.75

Chronological age (months) M SD

Developmental quotient M SD

Mental age (months) M SD

Language age (months) Expressive M SD

Receptive M SD *p < .05.

uation was modified such that the caregiver remained in the room with the child during the stranger separation, and the stranger remained with the child during the caregiver separation because the investigators were uncomfortable leaving the autistic children alone. Thus, the play situation was followed by two 2-min separations of the caregiver and child and subsequent 2-min reunions, and a 2-min separation and reunion of a stranger and the child. The role of Procedures stranger was not played by the experimenter Each child was assessed individually in but by someone entirely unfamiliar to the three sessions. During these sessions, inde- child. The order of the stranger and the first pendent testers administered the Cattell caregiver separation and reunion was varied Scale of Infant Intelligence, the Reynell randomly across subjects. Separation situaLanguage Scales (Reynell, 1983), and a tions were terminated early if a child nonverbal social communication measure showed 20 s of continuous distress. The ses(Early Social Communication Scales [ESCS]; sions were videotaped. see Mundy et al., 1986, for a detailed deUsing these videotapes, an expert in the scription). In addition, children and their area of attachment, Mary Main, classified mothers participated in separation-reunion children's attachment organization accordexperiences and a social interaction. ing to Ainsworth's system. Because it was our original intention to study nonautistic Separation and reunion episodes. Separa- mentally retarded children as well as the tion and reunion episodes took place after a current sample, she was told that the tapes play situation in a room containing two showed mentally retarded children, some of chairs in diagonal corners. The Strange Sit- whom were autistic.

254

Mother-child interaction. Social behaviors were videotaped during a 12-min motherchild play situation. As described by Sigman et al. (1986), the session took place in a carpeted room, with a set of toys including a plastic puzzle, a doll, a small wooden bed, a bottle, a car, blocks, a cup, and a rattle. Mothers were given a list of onesentence directions, requesting that they play with their child first using any of the toys, then with the doll, bottle, and bed, and next with the puzzle, and then that they play a social game (i.e., hide and seek, pata-cake, or song). Mothers were then instructed to help their children clean up and finally to engage in another social game. These sessions were videotaped.

L. Capps et al.

frequency scores based on paired ratings of eight children exceeded .82 (M = .88).

Joint attention and requesting with experimenter. Children's nonverbal communication with an experimenter was assessed using a form of the ESCS (Seibert & Hogan, 1982), as described by Mundy et al. (1986). In this procedure, the child and experimenter sat facing each other at a small table. A set of toys were in view but out of reach of the child. The experimenter presented and activated the toys one at a time, pointed and looked at posters on the wall, made simple requests of the child such as "give it to me," and presented the child with social games and turntaking opportunities. Three categories of nonverbal communication skill were identified. The first, social Coding- Using a scale developed by Susan interaction, involved using eye contact, Crawley and Donna Spiker (1983; see ERIC reaching, or object exchange. The second, document No. ED 221 978 for details), an indicating, measured the child's ability to observer naive to group status coded materrespond when the adult pointed to a target, nal sensitivity (kappa reliability based on 10 saying "look," and the child's ability to use tapes = .83) and children's social initiative eye contact and gestures to direct the experi(K = .82) and social responsiveness (K = menter's attention. The third category, re.81) during the 12-min session. questing, measured the child's ability to respond to simple commands such as "give it to me" and the child's ability to use acts, Correlates of attachment gestures, and eye contact to request objects Language. Groups were compared in terms that were out of reach, or to activate meof expressive and comprehensive language, chanical toys. Within each category, the as indicated by performance on the Reynell child was rated in the role of both initiator and responder. The behaviors observed Language Scales. within each category of nonverbal communication skill have been ranked according to Joint attention and requesting with moth- three ascending developmental levels (Seiber. Using videotapes of the mother-child ert & Hogan, 1982; see Table 1). The validinteraction, an observer who was blind to ity of these developmental levels has been group status coded children's communica- confirmed empirically (Mundy, Seibert, & tion behaviors that served either to indicate Hogan, 1984). or to request. Indicating behaviors were The ESCS was videotaped and coded by measured by the frequency with which the child either looked at, pointed to, showed, two trained observers. Based on 10 tapes, inor gave an object to his or her mother in or- terobserver generalizability coefficients for der to engage or share with her. Requesting frequency scores exceeded .65 (M = .84). or help-seeking behaviors were measured by the frequency with which the child pointed Results to, showed, or handed an object to his or her mother to obtain assistance. The video- Attachment organization tapes were coded by two trained observers. Separation and reunion episodes. Four Interrater generalizability coefficients for children were unclassifiable on the basis of


their own or their mothers' behavior, although they did show some signs of attachment. Two of these children spent much of the time running around the room, falling and freezing in stereotyped ways, and directing unusual, indecipherable facial expressions toward the mother and stranger. A third child was described as "one of the rare cases who show too little real patterning to be classifiable." This child seemed to miss his mother and appeared glad of her return but did not appear connected to her when she was in the room. In the fourth case, the mother's persistent efforts to embrace the child throughout the procedure made it impossible to assess his attachment organization. Thus, 15 children, 3 girls and 12 boys, were deemed classifiable. Moreover, all of these children showed signs of attachment to their mothers. Each of them was given a primary classification of "D," disorganized/disoriented . As is always the case when a child's attachment organization is judged disorganized/disoriented, subjects were given secondary or subclassifications. With respect to subclassifications, six of the children were subclassified as securely attached. Each of these children appeared distressed at separation and showed pleasure and contact-seeking behavior at reunion. In addition, three of the six showed increased distress during the second separation and increased proximity seeking during the final reunion—behavior that is consistent with the pattern of attachment security seen in infants. This group of six was also distinct in that they showed no signs of attachment disorganization apart from stereotypies that are attributable to autism, such as repetitive hand and eye movements, odd facial movements, particularly with the mouth and tongue, rocking from side to side, and repetitious circling behavior. Although these behaviors meet the third criteria for disorganized/disoriented attachment behavior, namely, "incomplete or undirected movements or expressions . . . including stereotypies" (Main & Solomon, 1986, p. 114), they were not judged to be

255

representative of the attachment relationship. For example, one child responded to the first reunion with his mother by looking up at her, opening and closing his mouth several times while blinking, shaking his head, and then dashing toward her, leaning into her body. Another child responded to reunion with his mother by looking up and moving toward her, yet did so by hopping around the room, swinging his arms with his chin protruding. In this case autistic stereotypies were virtually absent by the final reunion, at which time he joined his mother on her chair, leaning back into her, before resuming active play with objects. Nine of the children were classified secondarily as insecure. Three of them were judged to be "true Ds," indicating the presence of disorganized/disoriented behaviors other than stereotypies characteristic of autism. These children fretted at separation and responded to reunions with their mothers. In addition to hand clapping, head rocking, and strange facial movements, they showed behavioral stilling, wandering, nervous gestures, and incongruous affect at significant points in the Strange Situation. One child, for example, backed away when his mother returned, whereas another displayed strained smiles that were out of context. Two children were given subclassifications of insecure-ambivalent. In addition to autistic stereotypies, these children displayed incomplete, undirected movements, odd posture and mouth movements, and indices of confusion and nervousness, suggesting disorganization and disorientation. Yet while they showed signs of attachment, their contact-seeking behavior included aggression and apprehension. One child approached her mother during reunion, appearing pleased, unexpectedly slapped her mother's face, hugged her, and jerked backward abruptly. The behavior of the second child was characterized by signs of confusion and apprehension, such as approach and withdrawal. One child was given a subclassification of insecure-avoidant. In addition to stereotypic hand flapping and incomplete move-

L. Capps et al.

256

ments, this child watched his mother leave and looked up briefly during the reunion episodes but appeared indifferent to her presence or absence, continuing to spin his toy. Finally, subclassifications could not be determined for three children. In addition to autistic stereotypies, these children manifested puzzling combinations of secure and insecure attachment behaviors. In one case, the child seemed indifferent to separation from the mother but responded to the mother's initiation of contact. Similarly, a second child fretted momentarily at separation but did not respond during reunion. The third child did not seek proximity in either reunion and appeared listless until picked up by his mother but protested at being put down. Mother-child interaction. Children were divided into two groups based on security of attachment. The first group consisted of the six children who were subclassified as securely attached. The second group included the nine children who were subclassified as insecure: three had been deemed "true Ds," two were insecure-ambivalent, one was insecure-avoidant, and three were mixed and could not be given secondary classifications. T tests showed that mothers of children in the securely attached group appeared more sensitive (/ = 3.33, df = 13, p < .01) and that the more securely attached children more often initiated social interaction with their mothers than did less securely attached children (t = 2.52, df = 8.36,p < .02). Groups did not differ with respect to children's social responsiveness (see Table 2). Correlates of attachment in children Language. Language comprehension was significantly higher among children with more secure attachment classifications (/ = 2.33, df = 13, p < .03) and group differences in expressive language approached significance (/ = 1.99, df = 13, p = .06). Children did not differ with respect to measures of intelligence. The mean

Table 2. Maternal sensitivity and child sociability

Maternal sensitivity M SD Child initiates social interaction M SD Child responds to social interaction M SD

Secure (n = 6)

Insecure (n = 9)

4.50 0.55

3.11* 1.05

3.17 1.17

1.78* 0.83

3.00 1.10

2.44 0.88

•p < .03.

DQs for the secure and insecure groups were 49.5 (SD = 14.7) and 45.3 (SD = 7.7), respectively (see Table 1). Joint attention and requesting with mother. Group differences in indicating and requesting behaviors were examined by summing the frequency scores for looking, pointing, showing, and giving over the entire 12-min observation period. T tests yielded a significant group effect for requesting behaviors, suggesting that children in the securely attached group more frequently used looking, pointing, and giving to obtain assistance from their mothers than did less securely attached children, t = 2.57, df = 6.79, p = .05 (see Table 3). Joint attention and requesting with experimenter. Between-group comparison of the six categories of social communication yielded two significant differences. Children in the securely attached group displayed greater responsiveness to the experimenter's bids for joint attention, t = 2.08, df = 12.70, p = .05. Consistent with our observations of children interacting with their mothers, secure children displayed more requesting behavior. That is, they more frequently used gestures and eye contact to request objects that were out of reach than did children who were less securely attached, f = 2.12, df = 12.31,p = .05.


Table 3. Requesting and joint attention behavior Secure (n = 6)

Insecure (« = 9)

6.83 4.70

2.11* 2.42

1.67 1.51

2.22 1.99

2.33 1.03

1.78* 0.97

2.50 0.55

2.20 1.19

1.67 1.03

1.56 1.01

2.50 0.55

1.66* 1.00

With mother (mean frequencies) Initiates request M SD

Initiates joint attention M SD

With experimenter (mean developmental level) Initiates request M SD

Responds to request M SD

Initiates joint attention M SD

Responds to joint attention M SD *p < .05.

Conclusions

This investigation corroborates a growing body of empirical evidence countering the notion that autistic children are unable to form attachment relationships. In striking contrast to the view that autistic children fail to form emotional bonds, almost half (40%) of the children appeared securely attached. The distribution of attachment security in this study is consistent with that found in previous studies (Rogers et al., 1991; Shapiro etal., 1987). This study is unique, however, in that it included the disorganized or "D" classification, which was of critical importance. AH of the children displayed signs of behavioral disorganization. However, some (six) of them were distinct in that their "D" behavior was attributable to autistic stereotypies, such as repetitive hand and eye movements,

257

odd facial expressions, rocking, and circling. These children did not manifest behavioral indices of disorganized attachment other than stereotypies associated with autism and showed strong signs of underlying attachment security. Alternatively, other children displayed behavioral manifestations of underlying disorganized/disoriented attachment, including stilling, wandering, and incongruous affect. These behaviors were classified as "true D" attachment behavior because they occurred at significant points during the Strange Situation procedure and could not be attributable to autistic stereotypies. Clearly, distinguishing between disorganized behavior that seems to be a function of autism and that which seems to represent the attachment relationship requires sensitivity. Yet the ability to do so does not hinge upon being an expert in autism; the rater in this study had limited experience with autistic children. Nonetheless, a less experienced coder may have had difficulty making the classifications. The finding that all children showed behavioral disorganization, but only some manifested underlying attachment security, raises questions about the extent to which people who interact with autistic children discern attachment behaviors and about the basis and consequences of such sensitivity. Further studies of attachment security in autistic children should aim to define more precisely the bases for differentiating disorganized attachment behaviors from autistic stereotypies that are not related to attachment security. An additional issue concerns the children who could not be classified. In one case, the reason is clear: The child's parent interfered with the procedure. We are less clear with respect to the behavior of the other three children. These children were not deemed unattached; rather, their behavior was "too bizarre to classify." Revision and extension of Ainsworth's original attachment classification and Main and Solomon's (1990) additions have been, and will continue to be, informed by a dialectic between biological and social history and appearance. Distinguishing important aspects of a dyad's history or

258

particular vulnerabilities may lead the search for corresponding distinctions in the infant's behavior patterns under circumstances such as the Strange Situation. At the same time, recognition of as yet unclassified infant behavior patterns may lead to further discoveries regarding the history, experiences, or particular vulnerabilities of the dyad. In terms of the second component of this study, we found consistent relationships between attachment security and mothers' and children's behavior in a separate social interaction. Children who were subclassified as securely attached more frequently initiated social interaction with their mothers than did children who were subclassified as insecurely attached, and mothers of more securely attached children displayed greater sensitivity than did mothers of less securely attached children. These results both validate the attachment classifications and support the use of Ainsworth's system with autistic children. The association among attachment security, maternal sensitivity, and children's social responsiveness also raises the issue of causality. Parental sensitivity is likely to promote secure attachment, which fosters developmental gains in socioemotional and cognitive domains. At the same time, children with greater socioemotional and cognitive abilities may be easier to parent with sensitivity. Further research is needed to address questions concerning the basis for individual differences in attachment organization and to delineate the reciprocal interactions that are likely to be involved. This introduces the third set of questions, regarding the correlates of attachment security among autistic children. In the normal developmental literature, behavioral manifestations of felt security are linked to representational systems. Just as the infant's relationship with the caregiver promotes the process of differentiating between self and others (Lewis & BrooksGunn, 1979), the attachment relationship is thought to undergo transformations in concert with cognitive and social accomplishments. In the present study, the correlation be-

L. Capps et al.

tween underlying attachment security and receptive language ability supports the link between attachment and representational ability in autistic children. The association between attachment security and joint attention behavior, however, was equivocal. Although securely attached children were no more likely to initiate joint attention, they were more responsive to bids for joint attention, made requests more frequently, and initiated social interaction with their mothers more often than less securely attached children. It is also possible that groups did not differ in terms of initiating joint attention because the behaviors so rarely occurred in either group. These findings offer important insights into attachment theory, specifically with respect to models that posit a psychobiological or basic adjustment that exist somewhat separately from the individual's working models of attachment (Kraemer, 1992; see also Sigman & Siegel, 1991). While the autistic children in this study display the "first" form of attachment, it is not clear whether or not any autistic individual — even those who initiate joint attention—develop more than very simple working models of relationships. These findings extend the notion that there are two forms or levels of attachment. They suggest that the psychobiological form is not sufficient for the development of working models. The latter seems to require a sophisticated form of perspective taking that does not seem available to most autistic individuals. This is not obvious from studies of normally developing children. The normal child's psychobiological form of attachment is continuously enriched as the child becomes aware of the intentions and emotional experiences of others. By disrupting the seamless integration of new abilities that occurs when attachment develops normally, autism reveals separable elements of the developmental process. Finally, classifications of attachment organization in infancy have been found predictive of the child's social and emotional behavior in that "secure" infants appear more cooperative, empathic, and compe-


tent later on (see Bretherton & Waters, 1985, for review). Following children over time who have received attachment classifications will allow us to address important questions about the implications of attachment security for later adjustment. Investigation of individual differences in attach-

259

ment organization and their manifestation throughout the years might also increase our understanding of the emotional and cognitive underpinnings of critical socialcognitive abilities such as empathy, thus informing intervention with autistic children.

References of the John D. and Catherine T. MacArthur FounAinsworth, M. D. S. (1990). Some considerations redation on the Transition from Infancy to Early garding theory and assessment relevant to attachChildhood. (1991). Attachment organization in ments beyond infancy. In M. Greenberg, D. Cicthree- and four-year olds: Coding guidelines. Unchetti, & M. Cummings (Eds.), Attachment in the published manuscript, University of Virginia, preschool years (pp. 463-489). Chicago: University Charlottesville. of Chicago Press. Ainsworth, M. D. S., Bell, S. M., & Stayton, D. J. Cattell, P. (1960). The measurement of intelligence of infants and young children. New York: The Psy(1971). Individual differences in Strange Situation chological Corporation. of one-year-olds. In H. R. Schaffer (Ed.), The origins of human social relations (pp. 17-57). New Cicchetti, D. (1984). The emergence of developmental York: Academic Press. psychopathology. Child Development, 55, 1-7. Ainsworth, M. D. S., Bell, S. M. & Stayton, D. J. Cicchetti, D. (1990). The organization and coherence (1974). Infant-mother attachment and social develof socioemotional, cognitive and representational opment: Socialization as a product of reciprocal redevelopment: Illustrations through a developsponsiveness to signals. In M. P. M. Richards mental psychopathology perspective on Down syn(Ed.), The integration of a child into asocial world drome and child maltreatment. In R. Thompson (pp. 99-135). London: Cambridge University (Ed.), Nebraska Symposium on Motivation: Vol. Press. 36. Socioemotional development (pp. 259-366). Lincoln: University of Nebraska Press. Ainsworth, M. D. S., Blehar, M. D., Waters, E., & Wall, S. (1978). Patterns of attachment. Hillsdale, Cicchetti, D. (in press). Developmental theory: Lessons NJ: Erlbaum. from the study of risk and psychopathology. In S. Matthysse, D. Levy, J. Kagan, & F. Benes (Eds.), Ainsworth, M. D. S. & Wittig, B. (1969). Attachment Psychopathology: The evolving science of mental and exploratory behavior of one-year-olds in a disorder. New York: Cambridge University Press. Strange Situation. In B. M. Foss (Ed.), Definitions Cicchetti, D., & Beeghly, M. (1987). Symbolic develof infant behavior (Vol. IV). London: Methuen. opment in maltreated youngsters: An organizaAmerican Psychiatric Association. (1980). Diagnostic tional perspective. In D. Cicchetti & M. Beeghly and statistical manual of mental disorders (3rd (Eds.), Symbolic development in atypical children ed.). Washington, DC: Author. (pp. 47-68). San Francisco: Jossey-Bass. Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a "theory of mind"? Cohen, D. J., Paul, M. R., & Volkmar, F. R. (1987). Cognition, 21, 37-46. Issues in the classification of pervasive developmental disorders and associated conditions. In D. Blehar, M. C , Liebermann, A. F., Ainsworth, M. D. J. Cohen, A. M. Donnellan, & R. Paul (Eds.), S. (1977). Early face-to-face interaction and its reHandbook of autism and pervasive developmental lation to later infant-mother attachment. Child disorders (pp. 221-243). New York: Wiley. Development, 48, 182-194. Bowlby, J. (1969). Attachment and loss: Vol. 1. At- Coster, W. J., Gersten, M. S., Beeghly, M., & Cictachment. New York: Basic Books. chetti, D. (1989). Communicative functioning in maltreated toddlers. Developmental Psychology, Bretherton, I., & Waters, E. (1985). Growing points of 25, 1020-1029. attachment theory and research. Monographs of the Society for Research in Child Development, Crawley, S. B., & Spiker, D. (1983). Mother-child in50(1-2, Serial No. 209). teractions involving two-year-olds with Down syndrome: A look at individual differences. Child DeCarlson, V., Cicchetti, D., Barnett, D., & Braunwald, velopment, 54, 1312-1323. K. (1989a). Disorganized/disoriented attachment relationships in maltreated infants. Developmental Crittenden, P. M. (1985). Maltreated infants: VulneraPsychology, 25, 525-531. bility and resilience. Journal of Child Psychology Carlson, V., Cicchetti, D., Barnett, D., & Braunwald, and Psychiatry, 26, 85-96. K. (1989b). Finding order in disorganization: Les- Crittenden, P. M. (1988). Relationships at risk. In J. sons from research in maltreated infants' attachBelsky & T. Nezworski (Eds.), Clinical implicaments to their caregivers. In D. Cicchetti & V. Carltions of attachment theory (pp. 136-174). Hillsson (Eds.), Child maltreatment: Theory and dale, NJ: Erlbaum. research on the causes and consequences of child Crittenden, P., & Ainsworth, M. (1989). Attachment abuse and neglect (pp. 494-528). New York: Camand child abuse. In D. Cicchetti & V. Carlson bridge University Press. (Eds.), Child maltreatment: Theory and research Cassidy, J., & Marvin, R. S., with the Working Group and consequences of child abuse and neglect (pp.

260 432-463). New York: Cambridge University Press. Cummings, M., & Cicchetti, D. (1990). Toward a transactional model of relations between attachment and depression. In M. Greenberg, D. Cicchetti, & M. Cummings (Eds.), Attachment in the preschool years (pp. 339-375). Chicago: University of Chicago Press. Dawson, G. (Ed.). (1989). Autism: Nature, diagnosis, and treatment. New York: Guilford Press. Egeland, B., & Farber, E. A. (1984). Infant-mother attachment: Factors related to its development and changes over time. Child Development, 55, 753-771. Frith, U. (1989). Autism: Explaining the enigma. Oxford: Blackwell. Gersten, M., Coster, W., Schneider-Rosen, K., Carlson, V., & Cicchetti, D. (1986). The socioemotional bases of communicative functioning: Quality of attachment, language development, and early maltreatment. In M. Lamb, A. L. Brown, & B. Rogoff (Eds.), Advances in developmental psychology (Vol. 4, pp. 105-151). Hillsdale, NJ: Erlbaum. Goldberg, S., Perrotta, M., Minde, K., & Corter, C. (1986). Maternal behavior and attachment in lowbirth-weight twins and singletons. Child Development, 57, 34-46. Grossmann, K. Grossmann, K. E., Spangler, G., Suess, G., & Unzner, L. (1985). Maternal sensitivity and newborns' orientation responses as related to quality of attachment in northern Germany. In I. Bretherton & E. Waters (Eds.), Growing points of attachment theory and research. Monographs of the Society for Research in Child Development, 50(1-2, Serial No. 209), 233-256. Hermelin, B., & O'Connor, N. (1970). Psychological experiments with autistic children. New York: Pergamon Press. Isabella, R. A. (1993). Origins of attachment: Maternal interactive behavior across the first year. Child Development, 64, 605-621. Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217-250. Kraemer, G. W. (1992). A psychobiological theory of attachment. Behavioral and Brain Sciences, 15, 493-511. Lamb, M. E., Thompson, R. A., Gardner, W. P., Charnov, E. L., & Estes, D. (1984). Security of infantile attachment in the "Strange Situation": Its study and biological interpretation. Behavioral and Brain Sciences, 7, 127-147. Lewis, M., & Brooks-Gunn, J. (1979). Social cognition and the acquisition of self. New York: Plenum Press. Lyons-Ruth, K., Connel, D., Zoll, D., & Stahl, J. (1987). Infants at social risk: Relationships among infant maltreatment, maternal behavior, and infant attachment behavior. Developmental Psychology, 23, 223-232. Mahler, M. S. (1968). On human symbiosis and the vicissitudes of individuation: I. Infant psychosis. New York: International Universities Press. Main, M., & Hesse, P. (1990). Lack of resolution of mourning in adulthood and its relationship to infant disorganization: Some speculations regarding causal mechanisms. In M. Greenberg, D. Cicchetti, & E. M. Cummings (Eds.), Attachment in the preschool years {pp. 161-182). Chicago: University of Chicago Press.

L. Capps et al. Main, M., & Solomon, J. (1986). Discovery of an insecure-disorganized/disoriented attachment pattern. In T. Brazelton& M. W. Yogman (Eds.), Affective development in infancy (pp. 95-124). Norwood, NJ: Ablex. Main, M., & Solomon, J. (1990). Procedures for identifying infants as disorganized/disoriented during the Ainsworth Strange Situation. In M. T. Greenberg, D. Cicchetti, & E. M. Cummings (Eds.), Attachment in the preschool years (pp. 121-160). Chicago: University of Chicago Press. Main, M., & Weston, D. (1981). The quality of the toddler's relationship to mother and father. Child Development, 52, 932-940. Morisset, C. E., Barnard, K. E., Greenberg, M. T., Booth, C. L., & Spieker, S. J. (1990). Environmental influences on early language development: The context of social risk. Development and Psychopathology, 2, 127-149. Mundy, P., Seibert, J. M., & Hogan, A. E. (1984). Relationships between sensorimotor and early communication abilities in developmentally delayed children. Merrill-Palmer Quarterly, 30, 33-48. Mundy, P., Sigman, M., Ungerer, J., & Sherman, T. (1986). Defining the social deficits of autism. Journal of Child Psychology and Psychiatry, 27, 657669. O'Connor, M. J., Sigman, M., & Kasari, C. (1992). Attachment behavior of infants exposed prenatally to alcohol: Mediating effects of infant affect and mother-infant interaction. Development and Psychopathology, 4, 243-246. Pederson, D. R., Moran, G. Sitki, C , Campbell, K., Chesquire, K., & Acton, H. (1990). Maternal sensitivity and the security of infant-mother attachment: A Q-sort study. Child Development, 61, 1974-1983. Radke-Yarrow, M., Cummings, E. M., Kuczynski, L., & Chapman, M. (1985). Patterns of attachment in two- and three-year-olds in normal families and families with parental depression. Child Development, 56, 884-893. Reynell, J. (1983). Reynell Developmental Language Scales manual. Windsor, UK: NFER-NELSON Publishing. Rogers, S. J., Ozonoff, S., & Maslin-Cole, C. (1991). A comparative study of attachment behavior in young children with autism or other psychiatric disorders. Journal of the American Academy of Child Adolescent Psychiatry, 30, 483-488. Rutter, M. (1978). Diagnosis and definition. In M. Rutter & E. Schopler (Eds.), Autism: A reappraisal of concepts and treatment (pp. 1-25). New York: Plenum Press. Rutter, M. & Garmezy, N. (1983). Developmental psychopathology. In P. Mussen (Ed.), Handbook of child psychology, (Vol. 4, pp. 775-911). New York: Wiley. Schopler, E., Reichler, R., & Renner, B. R. (1986). The Childhood Autism Rating Scale (CARS): For diagnostic screening and classification of autism. New York: Irvington. Seibert, J. M., & Hogan, A. E. (1982). Procedures manual for Early Social Communication Scales (ESCS). (Available from Mailman Center for Child Development, University of Miami, FL 33124.) Shapiro, R., Sherman, M., Calamari, G., & Koch, D. (1987). Attachment in autism and other develop-

Attachment security in autistic children mental disorders. Journal of the American Academy of Child Adolescent Psychiatry, 26, 485-490. Sigman, M. (1989). The application of developmental knowledge to a clinical problem: The study of childhood autism. In D. Cicchetti (Ed.), Rochester Symposium on Developmental Psychopathology: Vol. 1. The emergence of a discipline (pp. 165187). Hillsdale, NJ: Erlbaum. Sigman, M., Kasari, C , Kwon, J., & Yirmiya, N. (1992). Responses to the negative emotions of others by autistic, mentally retarded, and normal children. Child Development, 63, 796-807. Sigman, M., & Mundy, P. (1989). Social attachments in autistic children. Journal of the American Academy of Child Adolescent Psychiatry, 28, 74-81. Sigman, M., Mundy, P., Sherman, T., & Ungerer, J. (1986). Social interactions of autistic, mentally re-

261 tarded, and normal children and their caregivers. Journal of Child Psychology and Psychiatry, 27, 647-656. Sigman, M., & Siegel, D. (1992). The interface between the psychobiological and cognitive models of attachment. Behavioral and Brain Sciences, 15,

523-524. Sigman, M., & Ungerer, J. (1984). Attachment behaviors in autistic children. Journal of Autism and Developmental Disorders, 14, 231-244. Smith, P. B., & Pederson, D. R. (1988). Maternal sensitivity and patterns of infant-mother attachment. Child Development, 59, 1097-1101. Spieker, S. J., & Booth, C. (1988). Family risk typologies and patterns of insecure attachment. In J. Belsky & T. Nezworski (Eds.), Clinical implications of attachment (pp. 95-135). Hillsdale, NJ: Erlbaum.