Attachment measures

Psychological technique
Attachment measures, or attachment assessments, are the various procedures used to assess the attachment system in children and adults. These procedures can assess patterns of attachment and individual self protective strategies. Some assessments work across the several models of attachment and some are model specific. Many assessments allow children and adults' attachment strategies to be classified into three primary attachment pattern groups: B pattern (balanced, secure), A pattern (avoidant, dismissive, cognitive), C pattern (anxious ambivalent, preoccupied, affective). In most models, each pattern group is further broken down into several sub patterns. Some assessments are capable of finding additional information about an individual, such as unresolved trauma, depression, history of family triangulation, and lifespan changes in the attachment pattern. Some assessments specifically or additionally look for caregiving behaviors, as caregiving and attachment are widely considered two separate systems for organizing thoughts, feelings, and behavior. Other models, such as the Dynamic Maturational Model of Attachment and Adaptation (DMM), describe virtually all attachment behavior and patterns within (or in a combination of) the three primary A, B, C patterns. The DMM considers all attachment behavior to be an organized effort to adapt within a given caregiving environment to optimize available caregiver protection and maximize survival.

Attachment measures for infants rely on observing the infant with a caregiver, typically videotaped, either in a natural or contrived environment. Measures for older children, including toddlers, are listed in subsequent sections.

The Infant CARE Index (ICI) is procedure that assesses risk in parent/infant relationships. It was developed by Patricia Crittenden early in the development of the Dynamic Maturational Model of Attachment and Adaptation (DMM) and can be used from birth, that is before infant's attachment strategies are established, and up to 15 months of age. The ICI involves a 3 minute  video recording of a typical play interaction between a caregiver and infant, without requiring a separation or other stressor. The focus is on the dyadic synchrony, that is the extent to which adult sensitivity to infant signals result in infant cooperation in play. The ICI does not conclude attachment strategies but it is highly correlated to the maternal scales in the infant Strange Situation assessment patterns of attachment. It can be used in screening, to identify levels of risk, and as a tool for clinical intervention and evaluation and has been used in numerous research projects. The ICI is a statistically valid and reliable assessment, and trained reliable coders can typically code an interaction in 15–20 minutes. (Tryphonopoulos, 2014)

The ICI is often used within the context of child welfare in Britain and the wider UK. It is also used as a developmental screening tool as a way to identify parents who may benefit from more support or specific interventions that support their ability to sensitively attune to their infant.

As the SSP is not suitable beyond 18 months of age, other measures have been developed for older ages groups, which include observational measures (in a controlled or naturalistic environment), representational methods and interview methods. Some are developed for research purposes whereas others have been developed for clinical use. Effective training of evaluators is essential, as some items to be assessed require interpretation reliability (e. g., child is "suddenly aggressive toward mother for no reason").

Although originally designed for 1 year old children, Ainsworth’s strange situation has been adapted to measure the attachment and exploratory behavior of children between the ages of 2 4½ years old. A fundamental feature of the strange situation is that the situation the child is placed in must elicit stress. If the strange situation fails to stress the child, it cannot serve as an adequate environment for the measurement of attachment. The preschool strange situation features several alterations to facilitate the creation of stress in older children. These modifications include a slightly longer separation, changes in the role and/or gender of the stranger, and changes in the instructions to the caregiver. Some versions of the preschool strange situations omit the stranger altogether, thus leaving the child alone in the room throughout both separations. The coding system used to interpret the attachment style expressed by the child has also been modified. Rather than focusing entirely on the expression of specific behaviors and emotions, the revised coding system assesses ways in which a variety of behaviors, such as talking, are organized to maintain and negotiate proximity and contact. Cassidy, Marvin and the MacArthur Working group published a version of the Strange Situation procedure designed for children within the age group of 3 to 4 years old. In addition to categorizing a child’s attachment as secure, insecure/avoidant, insecure/ambivalent, and insecure/disorganized, the measure includes a seven point avoidance scale and nine point security scale.

The PAA was devised by Patricia Crittenden for the purpose of assessing patterns of attachment in 18 month to 5 year old children. It uses the coding method developed with the Dynamic Maturational Model of Attachment and Adaptation (DMM). Like the SSP it involves an 8 segment 21 minute procedure which is video recorded and then coded. The classifications include all the SSP patterns plus patterns that begin to develop during the second year of life, A3 A4 and C3 C4. The DMM maintains Ainsworth's ABC labeling scheme, but renames the three basic strategies for negotiating interpersonal relationships. Balanced for B patterns, cognitive for A patterns, and affective for C patterns. It is also intended to be able to distinguish the unendangered from the endangered compulsive and obsessive subpatterns that may have implications for emotional and behavioral development. It has been determined scientifically validated and reliable.

The MIM is a structured observation of the interaction between parent and child. The MIM was created by Marianne Marschak in the 1960s at the Yale Child Study Center. Salo & Makela (2006) of Finland have standardized and published a rating scale for the MIM for research purposes. Anne Stewart has developed the MIM Behavior Rating Scale (MIMBRS).

This method, devised by Waters and Deane in 1985, utilizes Q Sort methodology. It is based on a set period of observation of children aged 1 – 5 in a number of environments. It consists of nearly 100 items intended to cover the spectrum of attachment related behaviors including secure base and exploratory behaviors, affective response and social cognition. The observer sorts the cards corresponding to the degree to which the child exhibits the item, which is then scored. The overall score for each child will result in a variable ranging from +1.0 (i. e., very secure) to 1.0 (i. e., very insecure). Despite its ability to classify secure attachment, the score derived from the Q set measure does not classify the type of insecure attachment. The Interviewer prompts the child to complete each story by saying "show me, or tell me what happens next." The information derived from the interview is later coded according to the organization and content of the story completion. Avoidant attachment, for example, can be disclosed by a child refusing to acknowledge the attachment issue presented in the story stem (through claiming that the event did not take place). A child may also avoid addressing attachment by focusing solely on minor details, such as how the protagonist is dressed. Secure attachment, alternately, is indicated when a child provides coherent and constructive resolutions to the stories.

The ADPA was developed by Judith Solomon and Carol George (Solomon et al., 1995) as a variation of the ACST. The measure, unlike some of the doll play measures was validated from concurrent mother child Strange Situation patterns at ages 5 7 years. The assessment identified five attachment groups secure, avoidant, ambivalent, and the punitive and caregiving patterns of middle childhood disorganization. The ADPA has two unique features not found in other doll play assessments. One is the instruction to the child to select their own family, as compared with other assessments that create a standard family set of dolls. This variation was found important for children in the D group because they frequently do not select a mother figure or they select an adult doll to represent the self. Another is a coding system that is based on defensive processes rather than content or rating scales. The focus on defense is unique to Solomon and George's work and served as the foundation for assessing defenses in the Adult Attachment Projective Picture adult attachment assessment. The ADPA has been used cross culturally in Japan and with French speakers in Canada.

The MCAST is a semi structured doll play 'story stem' methodology, developed by Jonathan Green, Charlie Stanley, Ruth Goldwyn and Vicky Smith, to evaluate and understand the internal (mental) representations of their attachment relationship with a specific primary caregiver in children of 4 to 8.5 years. The concepts and procedures used have a basis in the Strange Situation Procedure and Adult Attachment Interview, and involves 4 story stem vignettes involving two dolls representing the caregiver child dyad of interest and a dolls house, presented with affective arousal to mobilise attachment representations in a way that children of this age range find accessible and engaging. Responses are usually videotaped in order to reliably rate aspects of the child's represented narrative content and behaviour, and the child's own behaviour, to ascertain an attachment classification, with a particular focus on disorganised attachment, as well as providing other supporting ratings. Clinical development of the MCAST started in 1992, validation was published in 2000, and it has been since used in a range of cultural contexts and clinical and at risk groups. Training is required for its use.

Like the stem stories, these techniques are designed to access the child's internal working models of attachment relationships. The child is shown attachment related pictures and asked to respond. Methods include the Separation Anxiety Test (SAT) developed in 1972 for children aged between 11 and 17. Revised versions have been produced for 4 7 year olds. The SAT was doctored.

This is a semi structured interview designed by Target et al. (2003) for children aged 7 to 11. It is based on the Adult Attachment Interview, adapted for children by focusing on representations of relationships with parents and attachment related events. Scores are based on both verbal and non verbal communications.

Disturbances of Attachment Interview developed, by Smyke and Zeanah, (1999), is a semi structured interview designed to be administered by clinicians to caregivers. This method is designed to pick up not only reactive attachment disorder but also Zeannah et al. 's (1993) suggested new alternative categories of disorders of attachment. It covers 12 items, namely having a discriminated, preferred adult, seeking comfort when distressed, responding to comfort when offered, social and emotional reciprocity, emotional regulation, checking back after venturing away from the care giver, reticence with unfamiliar adults, willingness to go off with relative strangers, self endangering behavior, excessive clinging, vigilance/hypercompliance and role reversal.

This is a version of the Adult Attachment Interview (AAI) rendered age appropriate for adolescents. The classifications of dismissing, secure, preoccupied and unresolved are the same as under the AAI described below.

The three main ways of measuring attachment in adults include the Adult Attachment Interview (AAI), the Adult Attachment Projective Picture System (AAP), and self report questionnaires. The AAI and AAP are based on a developmental perspective, while the self report questionnaires are based on a social psychology perspective. Each assessment was created with somewhat different aims in mind. Shaver and Fraley, coming from the social psychology perspective, note:
"If you are a novice in this research area, what is most important for you to know is that self report measures of romantic attachment and the AAI were initially developed completely independently and for quite different purposes. One asks about a person's feelings and behaviors in the context of romantic or other close relationships; the other is used to make inferences about the defenses associated with an adult's current state of mind regarding childhood relationships with parents. In principle, these might have been substantially associated, but in fact they seem to be only moderately related at least as currently assessed. One kind of measure receives its construct validity mostly from studies of romantic relationships, the other from prediction of a person's child's behavior in Ainsworth's Strange Situation. Correlations of the two kinds of measures with other variables are likely to differ, although a few studies have found the AAI to be related to marital relationship quality and a few have found self report romantic attachment measures to be related to parenting." (Shaver & Fraley, 2004)
The AAI, the AAP, and the self report questionnaires offer distinct, but equally useful, perspectives on adult attachment. this is a quasi clinical semi structured interview that takes about one hour to administer. It utilizes either the ABC+D (or Berkeley) or DMM model for discourse analysis, and originally involved about twenty questions. It has since had extensive research validation to support it. The AAI Berkeley model is discussed in Chapter 25 of Attachment Theory, Research and Clinical Applications (2nd ed. ), edited by J. Cassidy and P. R. Shaver, Guilford Press, NY, 2008. The chapter title is "The Adult Attachment Interview: Historical and Current Perspectives," and is written by E. Hesse. The interview taps into adult representation of attachment (i. e. internal working models) by assessing general and specific recollections from their childhood. The interview is coded based on quality of discourse (especially coherence) and content. Categories are designed to predict parental stances on Berkeley infant data. AAI Attachment status, using the Berkeley (or ABC+D) model, originally utilized Ainsworth's patterns, A1 and A2, B1 5, and C1 and C2, and also disorganization. (Disorganization was initially considered a pattern, then seen as a status, and then determined to be not usable as a concept for adults or children over 20 months.) Four broad categories have included:
Autonomous: They value attachment relationships, describe them in a balanced way and as influential. Their discourse is coherent, internally consistent, and non defensive in nature. Dismissing: They show memory lapses. Minimize negative aspects and deny personal impact on relationships. Their positive descriptions are often contradicted or unsupported. The discourse is defensive. Preoccupied: Experience continuing preoccupation with their own parents. Incoherent discourse. Have angry or ambivalent representations of the past. Unresolved/Disorganized: Show trauma resulting from unresolved loss or abuse. Some of the strongest external validation of the measures involves its demonstrated ability to predict interviewees' children's classifications in the Strange Situation. The measure also has been shown to have some overlap with attachment constructs measured by the less time intensive measures of the peer/romantic attachment tradition (Hazan & Shaver, Bartholomew), as reported by Shaver, P. R., Belsky, J., & Brennan, K. A. (2000). However, there are important differences in what is measured by the AAI using the Berkeley model—rather than being a measure of romantic attachment, it taps primarily into a person's state of mind regarding their attachment in their family of origin. The DMM AAI uses a slightly modified set of interview questions, and uses principles and analysis techniques from attachment theory as described by Patricia Crittenden and the Dynamic Maturational Model of Attachment and Adaptation (DMM). The DMM method is more comprehensive, assessing more self protective attachment strategies, more types of trauma, and more types of memory systems. is the coding manual for the DMM AAI. This manual is published and available at any bookseller, and provides a comprehensive and detailed description of the AAI process, DMM attachment theory, and the attachment system's impact on aspects of humanity such as patterns of information processing, memory system function, and the effect of trauma. It also offers a brief comparison of the two attachment models using the AAI. The Berkeley/ABC+D model has never published a coding manual or comprehensive model of attachment. and in a 2023 book, how to implement the AAP in clinical practice for assessment, client conceptualization, treatment planning, analysis, and as a therapeutic guide. The AAP can identify three organized patterns of attachment, secure, insecure avoidant (or deactivating defenses), insecure preoccupied/ambivalent (or cognitive disconnection), and also insecure unresolved (disorganized attachment). The AAP identifies the same adult attachment groups as the early version of the AAI (Berkeley model), as described above. In addition to providing adult group classifications, the AAP is also used to code individual attachment defensive information processing patterns, experiences of attachment trauma, attachment synchrony, and personal agency.

DMM informed assessments offer a full lifespan set of assessments, many adapted from existing attachment assessments. Some assessments are validated and some are still in development or the validation process.

This validated assessment, described above, primarily assess interaction rather than attachment in a 3 minute observation.

The TCI is undergoing a 15+ year validation process. It assess the general attachment characteristics of a child 15 72 months old. The assessment is a shortened version of the Strange Situation Procedure and involves a 5 minute video recorded play interaction between a child and caregiver with a frustration task and post frustration repair attempt.

As described above, this validated assessment is a slightly modified version of the SSP to cover a wider range of ages 2 5 years old.

Similar to the Adult Attachment Projective Picture System above and the CAPA below, it invites a free response task from a child 6 13 years old after seeing a picture stimuli. It uses a DMM discourse analysis technique to assess attachment. The SAA was the subject of a special section of Clinical Child Psychology and Psychiatry in July 2017, and is a validated assessment.

The MotC uses an interview and discourse technique similar to the AAI. It assesses a parent's general pattern of caregiving, sensitivity and responsiveness to their child.

This assesses the attachment and exploration systems for children 7 11. It uses a process similar to the School Age Assessment of Attachment and Adult Attachment Projective Picture System above.

This assessment is undergoing a development and validation process. It assess attachment patterns in people 14 25 years old, and is a version of the AAI modified to be age and development appropriate.

As described above, this well validated assessment considers many aspects of the adult attachment system. Also, questionable measures of attachment in school age children have been presented. For example, a protocol for establishing attachment status was described by Sheperis and his colleagues. Unfortunately, this protocol was validated against another technique, the Randolph Attachment Disorder Questionnaire, that was itself poorly validated and that is based on a nonconventional view of attachment.

Regarding the issue of whether the breadth of infant attachment functioning can be captured by a categorical classification scheme, continuous measures of attachment security have been developed which have demonstrated adequate psychometric properties. These have been used either individually or in conjunction with discrete attachment classifications in many published reports. The original Richter’s et al. (1998) scale is strongly related to secure versus insecure classifications, correctly predicting about 90% of cases. and the rejoinders in the same issue by many prominent attachment researchers including J. Cassidy, A. Sroufe, E. Waters & T. Beauchaine, and M. Cummings.