Attachment security in children with disability or developmental delay: Systematic review of quality and interventions

Secure attachment has broad and long-lasting benefits for the development and wellbeing of a child. Conversely, disorganized attachment is associated with social, emotional, and behavioral problems in children, and later psychopathology. Children with a developmental delay or disability (DD) may be at greater risk of insecure or disorganized attachment than children without DD. This systematic review aims to (1) synthesize the available evidence worldwide regarding attachment and children with DD and (2) to examine the effectiveness of interventions employed to prevent or address attachment insecurity for this population. Peer reviewed articles with four-fold attachment classification data or attachment interventions for children with DD were included in the review. Seventeen databases were searched for studies published in English from January 1980 to January 2019. The systematic review protocol was registered a priori with PROSPERO (CRD42018117574). Twenty-three articles met the inclusion criteria, nine containing strange situation procedure (SSP) data and 14 relating to interventions. Meta-analysis was conducted with data from six of the SSP articles (n = 215). The remaining articles were reviewed narratively. Results indicate that children with DD are significantly less likely to develop a secure attachment and significantly more likely to develop a disorganized attachment than children without DD. Emerging research indicates promise that early intervention may be effective in improving attachment security.