Criticism of Attachment Theory

Criticism of Attachment Theory, 2020 Professor Michael Fitzgerald Department of Psychiatry, Trinity College, Dublin 2. Ireland. www.professormichaelfitzgerald.eu 16th January 2020  Attachment Theory 2020 Attachment theory has a complex history, both positive and negative. This paper focuses on both. ̔An attachment is a tie based on the need for safety, security and protection. This need is paramount in infancy and childhood, when the developing individual is immature and vulnerable. The infants instinctively attach to their carers̕, (Prior and Glaser, 2006). Bowlby’s contribution: Attachment theory was formulated by John Bowlby and was one of the most important, guiding, persuasive theories of the twentieth century and indeed, until today. It shaped child psychiatry, psychology, child care and our understanding of various problems of children and adolescents. Wells, (2014) pointed out that, ̔attachment theory has been the cornerstone of child and adolescent psychiatry for more than fifty years̕. This is correct. Understanding the attachment system became an essential to understanding a core component of being a human being. Slater, (2007) noted that Cortina and Marrone (2003) stated that, ̔attachment theory provides a coherent and empirically supported view of normal and pathological developmental processes and clinical phenomena̕. It overlaps with psychoanalysis and Fonagy (2001) in particular, has incorporated it into psychoanalysis, although for a very long time, psychoanalysts were very critical of attachment theory. Fonagy, (2001) points out that, ̔attachment theory is almost unique among psychoanalytic theories in bridging the gap between general psychology and clinical psychodynamic theory̕. Lai and Carr, (2018) state that, ̔attachment theory has been labelled one of the last, “grand theories”, not to have been completely dismissed, replaced or extensively revised̕. Sroufe et al, (2005) stated that attachment can be considered, ̔perhaps the most important developmental construct investigated̕. John Bowlby played a critical role in the reform and care of children in institutions and hospitals and the placement of children in adopted or fostering situations. This activity was enormously beneficial to children and remains so. Finally, according to Barth et al, (2005), attachment theory is, ̔the most popular theory for explaining parent/child behaviour by professionals and clinicians̕. Of course, the idea of focusing on the attachment system does make sense to everyone and is an important part of human interactions. Criticisms of Attachment Theory: Nevertheless, there has been a more critical view, particularly since the WHO report, Ainsworth et al, (1962) to the present time. Prugh et al, (1962) points out that the idea of gross maternal deprivation and, ̔affectionless characters̕ is not supported. In 1938 and 1944 Hans Asperger described autistic psychopathy where many of Bowlby’s, ̔affectionless characters̕, really belong. Bowlby (Audry, 1962, WHO), used the phrase, ̔partial deprivation̕, which meant an, ̔unsatisfying relationship with the child’s mother̕. This was Bowlby’s most serious error because when he wrote about partial deprivation, which opened the, ̔flood gates̕ to any kind of parent/child interaction problems and allowed his original work to be misinterpreted and grossly over-expanded. Audry, (1962) criticises the, ̔single factor̕, maternal deprivation and describes this correctly as a, ̔crude̕ factor and the ̔condition of maternal deprivation may be only among several others perhaps more important aspects of mother/child relationships̕. Audry, (1962) goes on to ask about, ̔what of stimulating institutions such as the Kibbutzim, where maternally deprived children do not seem to become delinquents?̕. Audry, (1962) notes that Bowlby, (1952), ̔accepts that hereditary factors can in all probability, be ruled out as the major responsible factor, thus exposing the maternal deprivation factor as vitally important̕. This was a serious error as well as about 50% of the variants in personality is heritable (Plomin, 2018). Dr. Hilda Lewis, (1954) in her study of 500 children at a reception centre, was unable to demonstrate a clear connection between a child’s separation from his mother and a particular pattern of child’s behaviour. This was a serious and a very early criticism of Bowlby’s theories. The most severe criticism ever was by Allen, (2016) in Evidence Based Child & Adolescent Psychiatry, where he wrote, ̔a radical idea: a call to eliminate attachment disorder from the clinical lexicon̕. Indeed, Allen goes on to point out that, ̔there is a lack of professional consensus on what exactly these terms mean, (attachment) and the manner in which they should be used̕. Bollen, (2000) notes that, ̔support for attachment theory remains equivocal, and the limits of the theory are not clearly defined … professionals must be aware of these limitations̕. Perring, (2014) is critical of the, ̔putative and amorphous relational disorders̕. This, ̔broad brush̕, amorphous diagnosis of relationship disorder, attachment disorder is most unhelpful. It led to vague thinking, (Keil et al, 2017). Chaffin et al, (2006) makes similar criticism that the terms, ̔attachment disorder, attachment problems and attachment therapy have no clear, specific or consensus definitions̕, and that the, ̔omnibus term attachment disorders … (can) refer to a broad selection of children̕, with relationship difficulties. This is rather vague and unsatisfactory. Chaffin et al, (2006) and colleagues at the American Professional Society on the Abuse of Children noted that, ̔attachment disorders is an ambiguous term and the term attachment disorder has no broadly agreed or precise meaning. The term is not part of any accepted standard nosology or system for classifying behavioural mental disorders. Officially, there is no such disorder̕, but reactive attachment disorder is a better accepted diagnosis and is in DSM 5 and ICD 11 draft, (2019). Woolgar and Scott, (2013) also highlighted the clinical confusion that occurs between, ̔attachment disorder, attachment patterns, disorganised attachments and attachment difficulties̕. O’Connor and Zeanah, (2003) suggest that, ̔the definition of attachment disorder might be expanded to include problems in social relationships with peers and social cognitive problems indexed by a difficulty in understanding the thoughts and feelings of self and other̕ . This would only confuse the attachment literature more and would lead to even further expansion into the neurodevelopmental disorders including ASD and ADHD. Indeed, this is where many of the so-called attachment disorder diagnosis belonged. Woolgar and Scott, (2013) state that the attachment construct, ̔ refers to accessing protection and safety̕, which is different from relationships disorders, but these concerns are often confused in clinical situations, leading to misdiagnosis. Specificity: The controversy over the definition of attachment does somewhat undermine the attachment concept as a specific phenomenon. It is very non-specific and involves so many elements. The following is an example of this, maternal sensitivity, is discussed a lot in attachment literature but van der Boom states that the concept of sensitivity is, ̔too abstract and too coarse to capture the subtle nuances of parental behaviour̕ (Prior and Glaser, 2014). Indeed, Rutter et al, (2009) pointed out that, ̔parental sensitivity on its own is only a minor influence̕, on patients’ social relationships. Most of the issues in the etiology of psychiatric disorder are non-specific and overlap with other disorders. Bowlby’s idea of the, ̔specificity̕ (Bowlby, 1979), of the mother/child bond is not sustained and the problems in the mother/child relationship leading to specific attachment disorder is not supported. Breuer, (1999) noted that, ̔research on attachment has not been able to identify specific parental behaviours that lead to secure attachment between infant and caregiver. This lack of specificity is part of the reason why you sense that the brain and early childhood do not tell you specifically what to do̕. Upadhyauada, (2019) also notes the, ̔non-specificity of early childhood adversity and subsequent childhood psychopathology̕ (Jokiranta-Olkoniemi et al, 2016). Of course, drug and alcohol abuse during pregnancy is a significant factor and can give the features of attachment problems in offspring. This is a serious etiological factor, not mentioned by Bowlby and would occur in families where there is a serious deprivation, both antenatally and the parents make continue the drug alcohol abuse postnatally, interfering with their ability to parent. It is not surprising that Cowan et al, (2007) stated that the evidence for a, ̔single working model of attachment is weak̕. Cowan et al, (2007) goes on to point out that there is a necessity to, ̔integrate notions of generality and specificity̕. Genes and environment: Kendler et al, (2006) stated that in studies of genes and environment, ̔non-specificity was more common than was specificity. It was rare to find a set of genetic risk factors or particular environmental risk factors that affected only one disorder̕. Bakermans-Kranenburg et al, (2007) stated that there is evidence for ̔gene: environmental interactions explaining individual differences in attachment security and disorganisation and that genes are responsible for differential susceptibility̕, but Kendler et al, (2006) state that their research do not indicate that, ̔DSM got it right̕, in their classification suggesting that there are specific sets of genetic factors for each disorder. Further criticisms of attachment disorder: Berghaus, (2011) points out that the, ̔proponents of attachment theory have lost their way. As they try to make attachment related to everything that comes after, and major component of psychopathology, they ignore much of the scientific evidence̕. Slater, (2007) points out that, ̔definitions of reactive attachment disorder are not helpful in meeting the needs of young people since they draw insufficiently on developmental research in this field and perhaps consequently, lack an understanding of a range of appropriate interventions̕. Romanian orphanage children, ̔were able to form attachment relationships with their adoptive parents̕, (Chisholm, 1998). Attachment disorder is used throughout this paper with its various meanings as used in the peer reviewed scientific literature. Attachment disorder and ASD: Woolgar and Scott, (2014) note that Prior and Glaser, (2006) state that, ̔there needs to be evidence that the attachment system has failed and that no discriminated attachment figure has been achieved̕. Unfortunately, this does not help and does not make a differentiation from ASD. O’Connor and Zeanah, (2003) point out that, ̔the central concern is whether or not a selective or discriminating attachment relationship exists between the child and his/her caretaker. This has been posed as a distinction between disorders of attachment versus disorders of non-attachment̕. The problem is that ASD, which is a wide spectrum of children have some who are attached and others who are not attached. This is characteristic of the massive variability of children on the spectrum and indeed, in most child psychiatric conditions. Disorganised attachment is seen in children with ASD and ADHD. Like many features in psychiatry, it is a relatively non-specific feature. ASD is common at 1/59 CDC; ADHD 6.9% and RAD is very rare. Spectrum diagnosis: O’Connor and Zeanah, (2003) point out that, ̔we simply do not have the necessary information in how attachment disorders connect with individual differences in attachment quality – and indeed, if a direct connection can be made̕. They also point out that, ̔several features of the diagnostic formulation of attachment disorder are incompatible with the research and theoretical tradition developed by Bowlby̕. There is no clear reason why attachment disorder cannot be on a spectrum like so many other disorders in child psychiatry and indeed most psychiatric conditions are on a spectrum. Woolgar and Scott, (2014) point out that the construct attachment disorder is often used in the, ̔absence of effective terms to describe something bizarre and atypical presentations in children̕. This is an important point, but most of the children with, ̔bizarre and atypical presentations̕ have ASD. A missed diagnosis of ASD is a very major problem as it deprives the children of ASD treatments and commonly happens in clinical practice. Indeed, going back to an older classification, pervasive developmental disorders, (DSM 4/TR) which is an over-arching category, many of the so-called attachment disorder diagnosis in the past could have been fitted in under this category for example PDD NOS. In DSM 5, (APA, 2013), ̔RAD is essentially the absence of a preferred attachment to anyone̕ , Lyons-Ruth et al, (2014). This feature is not uncommonly associated with ASD and is not specific to RAD. DSM 5 states that, ̔RAD occurs in less than 10% of severely neglected children and a diagnosis is rarely seen in general clinical practice̕, (Allen, 2016). Zeanah et al, (1993) stated that in relation to DSM IV (1994) the criteria in relation to the attachment area were, ̔inadequate to describe children who had seriously disturbed attachment relationships̕. DSM III-R (APA, 1987), RAD, ̔was marked by distinctive social relatedness in most contexts̕. Of course, this is also typical of ASD. This DSM in relation to RAD, also stated that, ̔a persistent failure to initiate a response to most social situations̕. This is classically seen in ASD. It also stated that what separated this diagnosis from ASD was, ̔grossly pathogenic care̕. The problem here was that in a busy clinical practice almost any form of poor care, ̔very partial deprivation̕ was used instead of grossly pathogenic care. Richter and Volkmar, (1994) concluded that, ̔RAD, as defined in DSM III-R was not compatible with developmentally derived conceptualisation of attachment disorder̕, (Allen, 2016). Boris et al, (2004) suggested that both DSM and ICD 10 criteria for RAD … ̔may be too restrictive, making underdiagnosis possible̕. The opposite is actually much more correct. There’s no evidence of underdiagnosis of RAD, but the problem is overdiagnosis of a rare disorder called RAD. Alternative criteria for attachment disorder were suggested by Zeanah et al, (2000) has a list of criteria, all of which can be seen commonly in ASD. Validity: Slater, (2007) points out that, ̔the validity of the diagnosis, (attachment disorder) has remained largely untested̕, (Zeanah and Emde, 1994). Zeanah, (1996) has argued that, ̔the conditions are actually more maltreatment disorders than attachment disorders̕ . The complexity and confusion of the attachment concept is commented on by Chisholm, (1998), that, ̔even Romanian orphanage children (classified) as secure display indiscriminate friendship, I cannot agree that their indiscriminate friendships should be equated with attachment disorder̕. Prevalence of RAD: Sroufe et al, (2005) found in his follow-up of high risk samples study, ̔only two or three out of one hundred and eighty children studied̕, fitted categories of attachment disorders. Upadhyaya et al, (2019) stated that RAD was rare at 6.38 per 10,000/10,000. For Gleason et al, (2011), the incidence of RAD cases treated in specialised healthcare services for severely neglected children in Eastern European orphanages only, ̔4.6% of their children showed inhibited RAD and 31.8% disinhibited RAD̕. There is certainly no one-to-one relationship between severe neglected and RAD. At follow-up, Allen, (2016) stated that, RAD …̔is not related to the child’s concurrent attachment behaviour and therefore is not a sign of disordered attachment̕. Further discussion of attachment disorder: Partial deprivation: Bowlby, (1951) noted that, ̔a child is deprived even if living at home if his mother is unable to give him the loving care all children need̕ , and he went on to elaborate this when he wrote about, ̔(a) an unconsciously rejecting attitude underlying a loving one; (b) an excessive demand for love and reassurance on the part of the parent and, (c) the parent obtaining unconscious satisfaction from the child’s behaviour, despite conscious condemnation of it̕. This is all very psychoanalytic and speculative. He doesn’t provide data for what was written here. Eyer, (1992) pointed out that maternal deprivation included, ̔effects of institutionalisation, stimulus deprivation, neglect, separation from mother, multiple and discontinuous caretakers, distortions in the qualities of caretaking – rejection, overprotection, ambivalence and complete social isolation̕. Maternal deprivation came to encompass a vast array of different ideas and almost became the theory of, ̔all causality̕, in relation to psychopathology. Sluckin and Sluckin, (1982) state that, ̔it is said that foolish or reprehensible child rearing practices, particularly on the part of the mother, and distortions on the formation of the mother’s attachment to her offspring are responsible for the various unsatisfactory aspects of the child’s physical and psychological development … and for the exclusive role for the mother in the formation of a bond̕, and the chargers of separation have been modified in the face of empirical evidence̕. Holmes, (1993) pointed out that Bowlby claimed that, ̔maternal deprivation produced physical, intellectual, behavioural and emotional damage̕, and that, ̔even brief separations from the mother in the first five years of life had lasting consequences̕. Day care: Slater, (2007) notes that Belsky and Vine, (1988) stated that separation due to day care, ̔may interfere with the construction of secure attachment relationships̕. A large scale study, (N equals 1357) by the National Institute of Child Health and Human Development found that, ̔child care by itself constituted neither a risk nor benefit for the development of the mother/child attachment̕. Prior and Glaser, (2006) noted that Chisholm, (1998) stated that, ̔although the children’s experiences in the orphanages constituted a risk factor, early institutional care alone did not foretell later attachment security, other stressors were required̕. Angles, (1980) stated that, ̔evidence of the absence, weakness or distortion of the usual affectional bond between parent and child can be found in virtually every case of child abuse̕. This is not proven. This is going way beyond the evidence and an example of attachment theory trying to, ̔explain everything̕. Aetiology: O’Connor et al, (2000) pointed out that approximately, ̔70% of the children exposed to profound deprivation of more than two years did not exhibit marked/severe attachment disorder indicates that grossly pathogenic care is not a sufficient condition for attachment disorder to occur̕. O’Connor et al, (2000) pointed out that approximately, ̔70% of the children exposed to profound deprivation of more than two years did not exhibit marked/severe attachment disorder indicates that grossly pathogenic care is not a sufficient condition for attachment disorder behaviour to occur̕. This seriously undermines attachment theory. Breuer, (1999) noted that Ross Thomson, (1998) concluded that the evidence, ̔indicates that except in extreme circumstances, early influences are not deterministic but rather predispositional, with the strength of their effects on later behaviour moderated by a variety of factors that may subsequently enhance, undermine or alter their relation to hypothesized consequences̕. Thompson, (1998) also stated that, ̔developmental theorists have for so long regarded early experience as foundational for later development that the emergence of voices questioning the formative significance of infancy for later socio personality functioning sounds jarring̕. Breuer (1999) notes that, ̔what matters is early experience plus whatever happens afterwards. If later experiences do matter and if later experiences do moderate early experiences, then the first years do not last forever, in any simple sense of that expression̕. Lamb, (1984) stated that research, ̔suggest that early experiences per se may not be the crucial determinants and that future attempts to study the effects of early experiences must also consider the occurrence of intervening events which may ameliorate, accentuate, or maintain the, “effects” of early experiences̕. Breuer (1999) stated that, ̔in a recent book, the developmental psychologist, Jerome Kagan characterises infant determinism as one of the three seductive ideas that influence how we think about human development and behaviour in both our folk theories and scientific theories̕. Attachment theory could be described as seductive for the past fifty years. Wilson, (2019) notes that Plomin points out that in terms of, ̔systematic sources of environmental influences, we haven’t been successful̕, in finding them and what we are left with is, ̔random chance events̕, in understanding behaviour. Wilson, (2019) quotes Plomin as pointing out in an interview that the idea that, ̔environment dictates everything has done worse damage than genetic determinism̕. This criticism certainly applies to attachment theories. Genetics and attachment theory: Kendler et al, (2006) pointed out that, ̔what is inherited is a vulnerability or liability … and that heritability estimates were typically less than 50%̓, and later Plomin, (2018) points out that, ̔inherited DNA differences account for 30-60% of the variance for most psychological traits̕. Attachment theory (Scott et al, 2011) references Bowlby’s, (1969) conception that attachment theory was a, ̔model for understanding how, (early) experiences with the caregiver shapes social and personality development in the child̕. This requires massive explanatory power which attachment theory doesn’t have and particularly when genetic variance in psychological traits is around 50%. Evolutionary psychology: The psychobiologist, Henry Plotkin, (2004) noted that, ̔an idea first put forward by the psychoanalyst John Bowlby … (relied) upon the notion of the mind as a bundle of adaptations̕. Plotkin (2004) is very critical of this and states that, ̔the weakness of the evolutionary adaptedness concept is tied to the problems encountered by adaptationist accounts of the mind of every kind … (and) the insistence that the adaptations are to past environments and hence that their explanation, “lies completely in the past”, makes them empirically inaccessible which in effect takes them out of the realm of science and imprisons them within speculative narrative̕. This is ironic because Bowlby was very much against speculations and was very critical of psychoanalysts for their speculations. In terms of evolutionary psychology, Plotkin (2004) pointed out that, ̔explanations of adaptations based on past events are not part of science̕. This is another serious criticism of Bowlby’s scientific thinking, but Plotkin is going much too far in his criticism of adaptation accounts which in a way are Darwinian. Also, Perring (2014) points out that, ̔attachment theory is not a promising candidate for providing a universal basis for evolutionary designed relationships between mothers and infants̕. Fonagy (2001) is correct to point out that Egle’s critique of attachment theory exaggerated claim to objectivity is well taken. Nevertheless, when the author, (M.F.), met Bowlby, Bowlby told him that his only interest was in the science of attachment theory. Dr. Jerome Kagan pointed out that this was an, ̔unreasonable idea̕, (Vinopal, 2019), i.e., that what happens, ̔in the first year of life influences in a significant way, how you’ll be for the rest of your life̕. Kagan is here going too far but he is giving a warning about excessive attention and weight being given to early experience. In most cities, most of the prisoners in prison come from certain geographical areas and one can’t explain all that on maternal deprivation. Social class is also critical, or not so much social class, but negative influences that occur on children in deprived social classes. Holmes, (1993) is correct to be critical of these, ̔simplistic event pathology models̕. It was simplistic for Bowlby to write about, ̔anti-social behaviour … (being) specifically linked to the loss of the mother̕, (Holmes, 1993). Bowlby grossly overstated his case. Eleanor Macoby and John Martin, (1983) reviewed the literature and concluded that there is, ̔very little impact of the physical environment that the parents provide for children and very little impact of parental characteristics that must be essentially the same for all children in the family̕. Nevertheless, Gervai, (2009) notes that, ̔meta-analysis have shown that parenting behaviour accounts for about one third of the variance in attachment security or disorganisation̕. In terms of the impact of early experience, Mitchell (2018) points out correctly that studies in this area, ̔suggest that early life experiences causes differences in later behaviour. They don’t actually show that early, however – all they show is a correlation between early experience and later behaviour̕. Of course, there are an enormous number of possible explanations of this correlation. Parenting: Plomin, (2018) states that, ̔differences in parenting correlate with differences in children’s outcomes, the correlation is mostly carried by genetics. These correlates are caused by the nature of nurture rather than nurture̕, and, ̔there is no evidence that parenting practices make a difference in children’s development after controlling for genetics̕. This is clearly going too far and says nothing about, for example, parenting by severely drug and alcohol addictive parents etc. Nevertheless, attachment theory has not taken genetic factors sufficiently into account. Plomin is not dealing with outliers which are children with moderate and severe problems, but with the general population of children. Indeed, Scott et al, (2011) showed that, ̔adolescence representational models of attachment are related to but distinct from parenting quality̕. Eyer, (1992) claimed that in relation to war orphans in Europe after the Second World War, there was a view that, ̔the problems were due to loss of mothers, the devastating experience of war was not withstanding̕. Eyer, (1992, page 7) noted that, ̔assessment of the maternal deprivation research reveals that research claims were exaggerated in the service of reform – in fact, some of Spitz’s data appeared to have been fabricated̕. Of course, smoking and alcohol during pregnancy can have effects, and were missed by early separation studies. Eyer, (1992) pointed out that, ̔Bowlby’s argument went beyond the data on institutionalised infants̕. It probably does stand up in relation to the effects of gross neglect, for example, in Eastern European orphanages in the past. Allen, (2016), points out that in terms of RAD, ̔any form of emotional or behavioural problems could be conceptualised as, “reactive” to the problems in the primary relationship̕. DSM 5, (2003) stated that RAD was rarely seen in clinical practice; by that would be meant, CAMHS, (Child and Adolescent Mental Health). Attachment disorder was seriously over diagnosed in this setting and indeed, there are doubts whether RAD will survive in DSM 6. Adoption and fostering: Allen, (2016) concluded that, ̔adopted and fostered children … are frequently diagnosed with attachment problems̕. This happens often without a comprehensive psychiatric diagnosis and attachment disorder of one form or another becomes an automatic clinical response. Woolgar and Baldcock, (2015) noticed that attachment problems were mentioned very frequently and often not sustained in assessment in one hundred referrals to a specialised adoption and fostering programme. The referrals were confusing attachment problems with ADHD, oppositional defiant disorder, conduct disorder or indeed, ASD. Strange Situation Test: Mary Ainsworth, (1970) devised the Strange Situation Test to describe the relationship between the child and caretaker and she described major styles of attachment – secure, insecure avoidant, insecure ambivalent and a fourth type was added by Maine and Solomon, (1990) called disorganised. Breuer, (1999) states that, ̔careful review of the evidence also suggests that the attachment classifications infants receive in the Strange Situation Test are not highly stable over time. One would think that when, or shortly after, the twig is bent into a type B baby, the infant would tend to remain a type B baby. Recent studies of even middle class infants, however, do not show high stability in infants attachment classification over time. What the evidence seems to suggest is that the classification remains stable as long as the life circumstances for mother and infant and the caring relationship between mother and infant remains stable̕. Breuer concludes that is really, ̔as the wind blows̕, rather than, ̔as the twig is bent̕. Later experience it seems can straighten a bent twig or bend a straight one. Culture and SST: Breuer, (1999) stated that, ̔there is considerable variation across cultures, between countries, and within countries on the percentage of babies that fall into these categories. Among Northern German babies, 50% were insecure avoidant, 30% were secure, and 7% insecure – resistant̕. Breuer, (1999) also noted that among, ̔Japanese infants, one study reported no insecure avoidant infants, 68% securely attached, and 32% insecure – resistant. Among low-income, high risk US infants, 22% were found to be insecure - avoidant, 56% securely attached, and 22% insecure – resistant̕. Rothbaum et al, (2000) notes that in Japan, ̔sensitivity competence and secure base are viewed very differently, culminating into questioning the universality of fundamental tennents of attachment theory̕. Moullin et al, (2014) found that, ̔40% of children in the UK show signs of insecure attachment̕. Such high rates in the normal population would bring into question about what was normative. Arredondo and Edwards, (2000) noted that, ̔40 – 50% of abused and neglected children were classified as securely attached to their maltreating parent̕, (Zeanah and Emde, 1994). Critics of attachment theory: Field, (1996) notes that attachment theory has been criticised, ̔for being based on momentary stressful situations for being limited to behaviours that occur with the primary attachment figure, for only including overt behaviour in its paradigms and for failing to consider multiple alternatives at different stages of life̕. Validity: Keller et al, (2015) notes that, ̔attachment researchers claim universal validity for the attachment assessment procedures̕, but serious doubt about the dimensions have been articulated by psychologists. Rutter et al, (1979) states that it is, ̔seriously misleading to view all attachment patterns through the lens of, “security/insecurity”̓. The more serious problem is that child psychiatry for almost fifty years in the UK and Ireland tended to see children’s behavioural problems through the lens of security/insecurity and attachment theory. This problem is reduced now with the development of the neurodevelopmental paradigm, (Fitzgerald, 2017). Kagan, (1965, 1978) stated that, ̔the strange situation is not a reliable measure̕,. Kagan stated that in the 1940s and 1950s the children now called, ̔securely attached̕, were called, ̔overprotected̕. Granqvist et al, (2017) stated that disorganised attachment cannot be used as a definitive in child protective services; does not prove child maltreatment; is not a strong predictor of psychopathology; is not fixed. This should be taken as a warning in relation to an attachment diagnosis which can be very easily misused. Treatment and outcome and problems with the use of attachment theory including Courts: Lieberman, (2003) stated that, ̔there is no established treatment guidelines for institutionalised children̕, (O’Connor and Zeanah, 2003). The fact that adoption by good enough parents does not remove attachment disorder in quite a few institutionalised children is a problem because as O’Connor and Zeanah, (2003) points out, ̔there is no intervention far more radical than adoption̕. This means that this solution, ̔attachment therapy̕, is not removing attachment problems. Of course, many institutionalised children do improve in those circumstances. The reason a child with so-called attachment disorder doesn’t respond to attachment therapy is that they never had that problem, and instead had a neurodevelopmental disorder. Finally, Scott, (2003) describes attachment disorder in older children who had, ̔long standing abuse̕. Most of these had PTSD. Over the past fifty years, attachment disorder was often used instead of a PTSD diagnosis. A metanalysis of treatment studies showed that, ̔a behaviourally based direct coaching of mother skills with her infant was helpful̕, (Scott, 2003, Bakermans-Kranenburg et al, 2003). O’Connor and Zeanah, (2003), asked why, ̔some children are impervious to treatment̕ for attachment disorder. One answer is that they never had this and had a neurodevelopmental disorder instead. Allen, (2016) states that, ̔giving the immense confusion and multiple child deaths associated with purported, “attachment therapies”, and that, “attachment – related problems are poorly understood by many practising clinicians”, that, “neither of these two concepts is empirically sound, as commonly practiced̕. Holmes noted that in 1956, a paper called, “The Effects of Mother/Child Separation, a Follow-Up Study”, found that, ̔at least half of the deprived children made good social relationships̕. Holmes stated that maternal deprivation acts as a vulnerability factor which increases the likelihood of problem behaviour in children in certain circumstances. This was a rather multifactorial view which seems reasonable. Ross Thompson, (1999) concluded that, ̔two decades of enquiry into the sequelae of early attachment yields this confident conclusion: sometimes attachment in infancy predicts later follow-up psychosocial functioning and sometimes it does not̕. Child and Adolescent Mental Health, (CAMHS): Allen, (2016) points out that clinical child psychiatry coalesced around the concept of, ̔attachment disorder in spite of a complete lack of empirical validation for the purported syndrome̕. Unfortunately when clinicians were giving treatment for attachment problems, they should have been giving treatment for ASD/ADHD. Allen, (2016) states that, ̔attachment theory should be expurgated from our clinical lexicon̕, Because psychiatry is more non-specific than specific, it is not surprising that most non-medical (psychotherapeutic) in the broadest sense have similar positive outcomes. Of course, they can also have negative outcomes which, ̔proves̕, that they are not inert. Courts: Criticism of Bowlby: Unfortunately, misuse of attachment theory has led to many injustices in the Courts, in relation to custody and access. Legal Court experts have extrapolated way beyond the capacity of attachment theory to be useful. This has been powerfully expounded by Arredondo and Edwards, (2000) in their paper on the limitations of attachment theory in juvenile and family Courts. Arredondo and Edwards, (2000) point out that attachment theory has, ̔outlived much of their usefulness in the setting of the juvenile and family Courts̕. They are particularly critical of attachment theories because, ̔they place insufficient focus on the reciprocity of relationships between persons̕, and that, ̔the categorical nature of attachment relations is inadequate to describe the spectrum of human relatedness seen in Court̕. They also point out that, ̔attachment is too narrow to be of much use to the Court because it focuses primarily on security seeking on the part of the child̕. They go on to point out that clinical experts in Court may use the term attachment, ̔to mean something different from others. This failure to converge on a single meaning can confuse and possibly mislead the Court̕, and that the term attachment, ̔is too vague to be useful to the Court̓. They also state that attachment theory experts, ̔reduce the entire spectrum of human relatedness into a limited number of discreet categories̕. Many miscarriages of justice have occurred using these theories in custody and access without a comprehensive psychiatric assessment. Arredondo and Edwards, (2000) point out that, ̔the concept of attachment does not differentiate pathological dependency and emotional neediness from developmentally healthy human relatedness̕. They warn about, ̔the dangers of relying upon attachment, (theory) making placement decisions̕. The Court reports are often full of attachment theory and at times, it can be difficult to see how it’s related to the child before the Court. Educational Psychology & Attachment Theory: Slater, (2007) notes comments by an educational psychologist, Ian McNabb about, ̔a perceived lack of support for Bowlby’s theories with the notion that attachment theory is an, “all too often a casual attribution, which induces in professionals, a kind of hopeless fatalism that obstructs creativity about how a person who was experiencing trauma and suffering might still make a good life for themselves”, (Ian McNabb, November 2005, EPN et archives – educational psychology NET). Slater, (2007) noted that Bowlby’s original work, (1944) forty thieves, (juvenile thieves), ̔may enrage educationalists since it suggested a bad start in life is wholly predictive of poor life outcomes, leaving little scope for positive interventions throughout a child’s life in school̕. Teachers found it hard to work with children with so-called attachment disorder, but this could very well be because they hadn’t been given their proper diagnosis ADHD/ASD etc. Discussion: Many child psychiatrists were concerned about the loose and vague way that attachment disorder was diagnosed in clinics. Adoption, fostering, neglected and maltreated children led to a too often diagnosis of attachment disorder. This could have been avoided with a comprehensive child psychiatric assessment. A child psychiatric assessment always assesses for neurodevelopmental disorders including ADHD, ASD as well as anxiety and depression in a formal way. Diagnosis of attachment disorder was often too simplistic. Literature by ̔Bowlbyians̓ and attachment theorists is very defensive and sycophantic. It has an ̔excathedra feel to it̕, that has led to serious mis-disposals in Courts’ diagnosis of ASD/ADHD being missed. Paradigms that become too dominant have major problems in the history of psychiatry and these would include psychoanalysis, family systems theory and many others. Bowlby was over-ambitious, like Freud before, with the explanatory power that he claimed for his theory. His theory was much more subjective than people realise. When he travelled around, and he travelled a great deal first, when he was asked by the WHO to do the report and later, these travels were mainly looking for evidence, (like Freud before him), to support his attachment theory and for the purpose of proselytization. Attachment theory became almost Bowlby’s core identity – certainly so when I met him.  References: Ainsworth M., Audry R., Harlow R., Lebovici S., (1962): Deprivation of maternal care: A reassessment of its effects. Geneva: WHO. Ainsworth M., Bell S., (1970): Attachment, exploration and separation: Illustrated by the behaviour of one year old in Strange Situation. Child Development 41, 49-67. 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