Services include evaluations of attachment-caregiving patterns for intervention planning, consultation, and help with decisions about placement and custody regarding the best interests of children.

Evaluation of Attachment-Caregiving Patterns

Results from an evaluation of attachment-caregiving patterns can be effectively used for intervention planning, and for help in making decisions related to placement questions, custody, visitation, foster care, and adoption.

Purpose of the Evaluation

In general, the evaluation is designed to provide evidence-based results regarding:

1. The health and quality of a child’s attachment patterns with a parent (including secure base and safe haven behavior, emotion coregulation, rhythms of soothing, and partnership behavior, all known in research to be associated with developmental outcomes).
2. The health and quality of a parent’s caregiving patterns with a child (including abilities to accurately read the child’s emotional behavior, identify the child’s thoughts, feelings, and relationship needs, and provide a sensitive caregiving response that helps the child).
3. A parent’s thoughts, feelings, and reflective functioning about a child’s needs (which is found in clinical research to be associated with child outcomes).
4. A parent’s thoughts, feelings, and perspective about relationships with their caregivers in childhood, and the degree of resolution regarding the impact of losses, neglect, conflict or abuse they may have experienced (also found in clinical research to be associated with child outcomes).
5. Risks to the child if the relationships were to be disrupted or lost.
6. Level of risk, if any, associated with current attachment-caregiving patterns.
7. Intervention services necessary to reduce risks.
8. The likelihood of success of intervention over a specific time frame.

Evaluation Procedures

Standardized Observations and classification of attachment-caregiving patterns: the Still Face Procedure; Infant Strange Situation; Preschool Strange Situation; Separation-Reunion Procedure for school-age children and adolescents.

Parent Development Interview (PDI) is standardized assessment of a caregiver’s thoughts and feelings about their relationship with the child and their ability to reflect on the child’s attachment needs.

Adult Attachment Interview (AAI) is a standardized assessment of a person’s way of making sense of childhood relationships with caregivers, and of the affects of loss and trauma.

Adolescent Clinical Interview

Attachment-based Story Stem Completion (projective doll stories)

Child Attachment Interview (CAI)

Clinical interviews with parents or other caregivers

Friends and Family Interview (FFI)

Parenting Stress Index (PSI-4)

Achenbach Child Behavior Checklist (CBCL)

Brief Symptom Index 18 (BSI-18)

Child Sexual Behavior Inventory (CSBI)

Childhood Autism Rating Scale (CARS)

Post-Strange Situation Ratings (PSSR)

Attachment-Caregiving Scale (ACS)

Review of available records.

Description of The Evaluation and Procedures

This evaluation includes assessment of a child’s emotional, behavioral, and relationship functioning, the parent’s patterns of caregiving, and the quality of their attachment-caregiving patterns in terms of meeting the child’s relationship and regulatory needs.  The evaluation follows the American Psychological Association (APA) guidelines, including the current standards of practice for psychologists conducting evaluations, by using standardized observational and coding procedures and relying on scientific methodology.

The attachment-caregiving component of the evaluation is based on standardized procedures developed over the past 50 years in research. The attachment-caregiving bond is the foundational relationship between a child and parent (or parent-figure).   The existing research indicates that organized, average (especially secure) attachment patterns are associated with healthy outcomes for children, especially in terms of acquiring healthy automatic patterns of coregulation, self-regulation, resilience, partnership behavior, hope and optimism, peer relationships, competence and achievement.  The existing research also demonstrates a strong association between non-secure attachment patterns (especially Disorganized patterns) and moderate to high risks for current and future difficulties in terms of self-regulation, aggression, academics and learning, peer relationship problems, and legal and psychiatric problems.

It is important to note that predictions of risk and resilience for various developmental outcomes reflect levels of probability, rather than certainty, for any particular child and caregiver evaluated.

Attachment-Caregiving Assessment (Observation of child-parent interactions). 

These standardized, observational procedures assess the organization of the child’s attachment to a particular caregiver, ability to use that caregiver as a secure base from which to explore and learn about the physical and social environment, and as a safe base for protection, refueling, coregulation of emotions and thinking, and for connection, joy and forgiveness. The strange situation procedure is currently the best laboratory procedure for assessing a child’s attachment to caregivers, the results of which are associated with current and future child outcomes related to emotional and behavior functioning, degree of risk in relationships with adults and peers, and degree of risk for future academic and legal problems.  These observations are also used to assess the health and organization of the parent’s caregiving patterns with the child, and the fit of those patterns with the child’s needs.  In the case of young infants, observations may include the still face procedure.

The results of this evaluation include findings about the quality of a child’s relationship with caregivers and, in particular, the quality of attachment-caregiving patterns since they tends to be predictive of development outcomes.  The healthiest kind of attachment is a Secure one in that it reflects the best relationship and emotional functioning and predicts the best developmental outcomes for children.

Other patterns of attachment (e.g., Anxious-Avoidant and Anxious-Ambivalent) are broadly in the Average range (except in their extreme forms) although are associated with less healthy outcomes, and reflect moderate to high risk for poor outcomes under circumstances of high stress, including a history of maltreatment, trauma, neglect, loss, and/or multiple placements.

There are also other relationship patterns (Disorganized, Indiscriminately Sociable, Role-Reversed Controlling, Apprehensive, Aversive, Fearful, Emotionally Dysregulated, etc.) that are outside of the Average range and Disordered in that they reflect significant deficits in emotional and behavioral functioning, and are associated with high levels of current and future risk for emotional and behavioral problems in children.

Description of the Standardized Interviews with Caregivers.

The Adult Attachment Interview (AAI), provides results about the quality of an adult’s early relationship history, current patterns of thinking and feeling about attachment relationships, and evidence about the degree of healing (resolution) of the affects of relationship conflict, losses, rejection, injury, neglect, or abuse they may have experienced.  Resolution of the affects of relationship problems and trauma is important since it is associated with healthy caregiving and better outcomes for children. The Parent Development Interview (PDI) provides results about the parent’s abilities to reflect upon, and make sense of, the child’s emotions and behavior, as well as the impact of the parent’s emotions and behavior on the child.  In the research literature, these abilities are associated with healing in children and their developmental outcomes.