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An Exploration of the Internal Working Models of Caregiver Attachment

during Middle Childhood in Children with High-functioning Autistic Disorder.

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486205
2013
AUT18510.1177/1362361313486205AutismChandler and Dissanayake

Article
Autism

An investigation of the security of 2014, Vol. 18(5) 485­–492

© The Author(s) 2013
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DOI: 10.1177/1362361313486205
childhood in children with high- aut.sagepub.com

functioning autistic disorder

Felicity Chandler and Cheryl Dissanayake

Abstract
Previous research has investigated caregiver attachment relationships in children with autism during early childhood,
with few differences found from matched control groups. However, little is known of this relationship during middle
childhood (ages 8–12 years). In this study, the aim was to establish whether there are differences in the security of
attachment in children with high-functioning autism compared to typically developing children. A secondary aim was
to establish whether caregivers’ perceptions of their child’s attachment to them accorded with the children’s own
reports. Twenty-one children with high-functioning autism and 17 typically developing children were administered the
Kerns Security Scale and the Inventory of Parent and Peer Attachment–Revised, and caregivers completed the same
questionnaires from the viewpoint of their child. There were no differences between the groups in the children’s and
parents’ reports of attachment security. Parents’ and children’s reports were moderately correlated on the Kerns
Security Scale but were not correlated on the Inventory of Parent and Peer Attachment–Revised. The results indicate
that levels of attachment security in children with high-functioning autism are not different from those in typically
developing children.

Keywords
attachment, high-functioning autism, security

The current study focused on the child-to-caregiver
attachment relationship in children with high-functioning
autistic disorder (HFA) during their middle childhood
years. To date, the research on attachment in children
with autism is largely limited to young preschool-aged
children. Current evidence that the attachment relation-
ship is important for other areas of psychosocial adjust-
ment in middle childhood and beyond, such as emotional
regulation, self-esteem, scholastic performance and
social adjustment, calls for a better understanding of the
attachments evidenced by school-aged children with
autism.
The attachment relationship is a differential, affectional
tie formed with the primary caregiver. In infancy and early
childhood, the attachment figure is a ‘secure base’ for
exploration and a ‘safe haven’ when the child is distressed
(Ainsworth et al., 1978). Attachment in early development
is expressed through marker behaviours that attract the car-
egiver’s attention, such as smiling and vocalising, and those
that engage the caregiver in interaction, such as crying and
clinging, which elicit care and protection by increasing
proximity to the caregiver (Bowlby, 1969).
While all children develop caregiver attachments, these
may differ in quality. The ‘Strange Situation’ laboratory pro-
cedure was developed to assess attachment security, using
behavioural observations of young toddlers (12–20 months
of age) upon separation and reunion with their caregiver
(Ainsworth et al., 1978). Three attachment classifications
were identified – ‘secure’ (B), ‘insecure-avoidant’ (A), and
‘insecure-ambivalent’ or ‘resistant’ (C). Main and Solomon
(1990) identified a fourth classification, ‘disorganised’ or
‘disoriented’ attachment. In typical development, the major-
ity of children (65%) display attachment security (Van
La Trobe University, Australia
Corresponding author:
Cheryl Dissanayake, Olga Tennison Autism Research Centre, School of
Psychological Science, La Trobe University, Bundoora, Melbourne, VIC
3086, Australia.
Email: c.dissanayake@latrobe.edu.au
486
IJzendoorn et al., 1992), which is theoretically and empiri-
cally linked to parental sensitivity (De Wolff and Van
IJzendoorn, 1997).
As children develop, changes in cognitive abilities ena-
ble the attachment relationship to become internalised
(Ammaniti et al., 2000). Bowlby (1969) referred to chil-
dren’s cognitive or representational models of themselves
in relation to their caregiver as ‘internal working models’ of
attachment, which develop and become more elaborate
from the second through the sixth year of life (Marvin and
Britner, 2008). The internalisation of the attachment rela-
tionship reduces the requirement for physical proximity
and contact (Marvin and Britner, 2008), and emotional
availability takes over the focus from physical availability
(Kerns et al., 2006).
Internal working models of attachment are schemas,
which summarise prior attachment experiences (positive
and negative) and inform future behaviour (Bretherton,
1985) and which guide the child’s perceptions of appropri-
ate behaviour, his or her own self-worth and expectations of
the caregiver’s and others’ behaviours (Thompson and
Raikes, 2003). These internal working models also incor-
porate implicit decision rules about how to relate to others,
which then influence the development of new relationships
(Bretherton and Munholland, 1999). As Thompson and
Raikes (2003) explain, ‘these models become interpretive
filters through which children (and adults) reconstruct their
understanding of new experiences and relationships in
ways that are consistent with past experiences and expecta-
tions’ (p. 696). Thus, internal working models of attach-
ment not only reflect the reality of the child’s relationships
but also create the reality of future relationships (Bretherton,
2005).
At around 4 years of age, most children are able to cor-
rectly distinguish between their own and others’ mental per-
spectives and are able to consider these simultaneously.
With the onset of this theory of mind ability, children
become able to simultaneously consider their own goals and
plans and their caregiver’s goals and plans, which facilitates
a ‘goal-corrected partnership’ whereby the caregiver and
child negotiate to reach a common goal (Bowlby, 1973).
However, children with autism are characteristically
impaired in theory of mind (Baron-Cohen et al., 1985).
Attachments are further influenced by the developmental
changes that occur during middle childhood (at age 7–12
years), such as, cognitive developments that include
improvements in metacognition, memory and cognitive
flexibility; social developments including the increased sali-
ence of peers, a shift from parental control to parent–child
co-regulation and an enhanced understanding of others; and
psychological developments, which include increased emo-
tional regulation and self-awareness and a greater under-
standing of psychological traits (Kerns, 2008). These
developments, most of which are problematic among those
with autism, allow children’s internal working models to
Autism 18(5)
become both more elaborate and organised (Mayseless,
2005).
Although early observations suggested that children
with autism may not develop attachments to their caregiv-
ers (e.g. Kanner, 1943; Rutter, 1978), there is now substan-
tial empirical evidence that children with autism do develop
these attachments (e.g. Dissanayake and Crossley, 1996;
Sigman and Ungerer, 1984). In a review of attachment
studies in children from 2 to 6 years, Buitelaar (1995) con-
cluded that children with autism do form attachment rela-
tionships as evidenced by preferential proximity seeking
and reunion behaviour after separation. Rutgers et al.
(2004) conducted a meta-analysis on 10 studies focused on
attachments in children with autism with age ranging from
2 to 5 years. The children with autism did develop caregiver
attachments with 40%–63% being secure attachments,
which was less than that achieved in various comparison
groups (e.g. typically developing (TD) children, children
with developmental language disorder and children with
Down Syndrome). However, no differences in attachment
security were found between the groups when only children
with HFA (those with IQ within the normal range of intel-
lectual functioning) were compared to the TD children. The
authors concluded that it is not autism alone but the combi-
nation of autism and intellectual impairment that contrib-
utes to attachment insecurity. This conclusion was supported
by Willemsen-Swinkels et al. (2000) and Naber et al. (2007)
who found higher rates of disorganised attachment in chil-
dren who had both autism and an intellectual impairment
compared to control children. Similarly, Rogers et al.
(1991, 1993) reported that developmental level, as meas-
ured by mental age (MA), predicted attachment security in
children with autism more strongly than the severity of
autism symptoms.
In recent years, attachment research in this area has
extended into young children at risk of an autism spectrum
disorder (ASD) as well as older, school-aged children with
high-functioning ASD. Haltigan et al. (2011) reported that
15-month-old siblings of older children with an ASD
(autism, Asperger’s disorder or pervasive developmental
disorder–not otherwise specified) were no more or less
likely than siblings of children without an ASD to form
secure attachment relationships with their caregiver. In
relation to older children, a study investigating the impact
of social relationship variables (attachment security and
mother–child relationship qualities) and social-cognitive
abilities (theory of mind) on friendships in 8- to 12-year-old
children with high-functioning ASD (autistic disorder or
Asperger’s disorder) reported that 54.5% of these children
reported secure attachments to their mothers, compared to
71% of TD children (Bauminger et al., 2010). However,
this difference was not significant, which is consistent with
research findings for younger children with autism. Further
research is required to establish whether these results can
be replicated in this age group.
Chandler and Dissanayake
Extending into adulthood, Taylor et al. (2008) reported
on attachment in 20 adults aged 19–60 years with high-
functioning ASD. Based on the Adult Attachment Interview
(George et al., 1996), 3 of the 20 adults were classified as
securely attached – markedly less than what would be
expected based on studies of younger children (e.g. Rutgers
et al., 2004). The authors note, however, that many of the
participants had additional psychiatric diagnoses, and
the rate of secure attachments found is in accordance with
the rate expected in a general clinical sample.
Kraemer (1992) proposed two forms of attachment:
first, an innate, psychobiological form, and second, a
more cognitive form that incorporates internal working
models of attachment (Dissanayake and Sigman, 2001).
While previous research suggests that the psychobiologi-
cal form of attachment might not differ in children with
autism, Rogers et al. (1993) suggest that children with
autism may experience difficulty in the development of
the cognitive form.
The primary aim in this study was to establish whether
there are differences in the security of the attachment
relationship in school-aged children with HFA compared
to TD children, both in terms of overall attachment secu-
rity and individual components of this relationship. The
secondary aim was to establish whether caregivers’ per-
ceptions of their children’s attachment to them are con-
sistent with their children’s own reports in an effort to
validate the children’s reports. On the basis of previous
findings on early childhood attachments in autism, one
may hypothesise that the security of the attachment rela-
tionship in middle childhood will be similar to those of
TD children. However, on the basis of their established
impairments in social cognition and peer relationships,
which are important in the further development of the
internal working model, it may be expected that attach-
ment security will be lower in those with HFA relative to
TD children.
Method
Participants
Participants included 38 boys aged between 8 and 12
years, accompanied by either their mother or both parents,
and in one case, a grandmother who had been the child’s
legal guardian since he was 2 months of age. Girls were
not recruited due to the higher incidence of autistic disor-
der in boys compared to girls (Fombonne, 2003). The HFA
group comprised 21 children with a clinical diagnosis of
autistic disorder (according to Diagnostic and Statistical
Manual of Mental Disorders (4th ed.; DSM-IV) criteria,
American Psychiatric Association (APA), 1994) without
intellectual disability (full scale IQ, verbal IQ and perfor-
mance IQ exceeding 70). The control group comprised 17
TD children.
487
The Autism Diagnostic Observation Schedule (ADOS,
Module 3; Lord et al., 2002) was administered to the chil-
dren in the HFA group to confirm diagnosis. In all, 17
children met criteria for autistic disorder and four met cri-
teria for ASD. The TD children were screened for symp-
toms of autism using the Social Communication
Questionnaire (SCQ; Rutter et al., 2003), completed by
parents. A score of 15 or greater on the SCQ indicates
further assessment for autism is recommended, with the
TD children receiving scores ranging from 0 to 9.
Sample characteristics
All children attended mainstream primary schools, enhanc-
ing comparability across the HFA and TD groups in terms of
their academic and social learning opportunities. They were
each administered the Wechsler Abbreviated Scale of
Intelligence (WASI; Wechsler, 1999). Verbal MA was calcu-
lated as the mean MA of the vocabulary and similarities sub-
tests; performance MA was calculated as the mean MA of
the block design and matrix reasoning subtests. Overall MA
was calculated as the mean MA of these four subtests.
Sample characteristics are presented in Table 1. The two
groups were matched on chronological age (CA), t(28.63)
= −.072, p = .943, and performance MA, t(36) = 1.73, p =
.091, but the TD children had a significantly higher overall
MA and verbal MA, t(36) = 2.54, p = .016 and t(36) = 3.12,
p = .004, respectively. These variables were, therefore, con-
sidered as covariates in any analyses where they were cor-
related with the dependent variable of interest.
The groups did not differ in relation to maternal age
(HFA: M = 39.24 years, TD: M = 41.47 years) or paternal
age (HFA: M = 41.30 years, TD: M = 43.13 years), paren-
tal employment (HFA: 19% of mothers and 86% of fathers
employed full time, TD: 6% of mothers and 77% of fathers
employed full time), parental education (HFA: 62% of
mothers and 57% of fathers with a tertiary degree, TD:
65% of mothers and 59% of fathers with a tertiary degree)
or household income (both groups had average income
range from AU$60,000 to AU$70,000 per annum).
As the focus of the current study was on children’s
attachment to their caregiver, the child’s primary car-
egiver was of interest. The majority of parents of TD chil-
dren (71%) shared the care between mother and father,
whereas more children with HFA (52%) were primarily
cared for by their mothers. Although more mothers were
the primary caregivers in the HFA group, the Chi-square
test for independence (with Yates Continuity Correction)
indicated no significant differences between the groups
(p > .05).
Measures
The Kerns Security Scale (KSS; Kerns et al., 1996, 2001) is
a 15-item child report questionnaire designed to measure
488 Autism 18(5)

Table 1. Sample characteristics for the HFA and TD groups.

Variable Group

HFA (n = 21) TD (n = 17)

Mean CA in years and months (SD in months) 9 years, 2 months (15.64)
Range (years, months) 8 years, 0 months to 11
years, 10 months
Mean overall MA in years and months (SD in months)* 9 years, 3 months (27.11)
Range (years, months) 6 years, 4 months to 14
years, 7 months
Mean verbal MA in years and months (SD in months)** 8 years, 9 months (27.90)
Range (years, months) 6 years, 2 months to 16
years, 0 months
Mean performance MA in years and months (SD in months) 9 years, 8 months (31.50)
Range (years, months) 6 years, 2 months to 15
years, 6 months
9 years, 2 months (6.87)
8 years, 1 month to 10
years, 2 months
11 years, 3 months (31.62)
6 years, 3 months to 15
years, 1 month
11 years, 2 months (29.30)
6 years, 2 months to 15
years, 0 months
11 years, 4 months (37.26)
6 years, 4 months to 15
years, 8 months

HFA: high-functioning autism; TD: typically developing; CA: chronological age; SD: standard deviation; MA: mental age.
*p < .05; **p < .01.

children’s perceptions of attachment security in the car-
egiver relationship during middle childhood. Items are
grouped into the subscales of ‘dependency’ (e.g. whether a
child finds it easy to trust his or her parent) and ‘availabil-
ity’ (e.g. whether a child worries that a parent will not be
there when needed) (Lieberman et al., 1999).
The scale presents pairs of statements based on the
Harter scale (1982) in which children are presented with
two possible response types (e.g. ‘Some kids wish they
were closer to their Mum’ but ‘Other kids are happy with
how close they are to their Mum’) and are asked to indicate
which group of kids they are most like. This method of
identifying with either one or the other groups of kids
decreases the child’s likelihood of responding in a sociably
desirable manner (Harter, 1982). Items on the KSS are
scored between 1 and 4 (range: 15 to 60), with a higher
score indicative of a more secure attachment. Internal con-
sistency has been demonstrated with Cronbach’s alphas
around .80 or higher (Kerns et al., 2005), and 2-week test–
retest reliability is also adequate (r = .75; Kerns et al.,
1996). Positive correlation with a secure attachment proto-
type based on the Doll Story Completion Task, (r = .38,
p <.001), and negative correlation with an avoidant attach-
ment prototype, (r = −.30, p <.001), are given as evidence
of construct validity (Granot and Mayseless, 2001).
The Inventory of Parent and Peer Attachment–Revised
(IPPA-R; Armsden and Greenberg, 1987; Gullone and
Robinson, 2005) is a 28-item child report questionnaire
measuring the quality of attachment to parents (and peers)
and how well they serve as a source of psychological secu-
rity. Only the parent–child scale was used in the current
study. The original IPPA (Armsden and Greenberg, 1987)
was designed to assess attachment in 16- to 20-year-olds
and was later adapted by Gullone and Robinson (2005) to
measure attachment in 9- to 15-year-old children. While the
content of the 28 items remained the same, the wording of
some items was simplified for the younger age group (e.g.
‘I feel my parents are successful as parents’ was modified
to read ‘My parents are good parents’). This measure has
also been used successfully with 8-year-old children (e.g.
Bauminger et al., 2010).
While the IPPA-R uses a more simplistic 3-point
response scale (‘never true’, ‘sometimes true’ and ‘always
true’) for the younger age group, a 5-point response scale
was employed in the current study (‘almost never or never
true’, ‘rarely’, ‘sometimes’, ‘often’, ‘almost always or
always true’), as is used in the original IPPA (Armsden and
Greenberg, 1987). The decision to use the original 5-point
scale was to ensure variability in the data, as the extreme
options of ‘never’ and ‘always’ could potentially lead to
over-reporting of the only other response: ‘sometimes’.
The use of Likert scales has been recommended for chil-
dren aged 6 to 18 years, and 5-point scales have been used
successfully with this age group (Van Laerhoven et al.,
2004). Possible total scores ranged from 28 to 140 on this
measure.
Items in the IPPA are grouped into the subscales of
‘trust’ (i.e. the degree of mutual understanding and respect
in the attachment relationship), ‘communication’ (i.e. the
extent and quality of spoken communication) and ‘aliena-
tion’ (i.e. feelings of anger and interpersonal alienation). A
total score is obtained by calculating the sum of these three
subscales (Armsden and Greenberg, 1987; Gullone and
Robinson, 2005) with higher total scores indicating greater
attachment security.
Internal consistency of the three subscales of the IPPA-R
is reported to range from .76 to .83 (Gullone and Robinson,
2005), and the average test–retest reliability over a 3-week
period for the original IPPA is reported as .93 (Armsden
and Greenberg, 1987). Positive correlations with children’s
Chandler and Dissanayake 489

Table 2. Adjusted mean (standard deviation (SD)) child and Table 3. Adjusted mean (standard deviation (SD)) child and
parent ratings on the KSS. parent ratings on the IPPA-R.

Variable Group Variable Group

HFA (n = 21) TD (n = 17) HFA (n = 21) TD (n = 17)

Child ratings
Total score (SD) 48.83 (7.42) 48.03 (7.46)
Dependency score (SD) 29.30 (5.41) 27.28 (5.52)
Availability score (SD) 20.01 (3.76) 19.99 (3.83)
Parent ratings
Total score (SD) 47.14 (5.91) 48.53 (5.98)
Dependency score (SD) 27.83 (4.21) 28.45 (4.25)
Availability score (SD) 19.42 (2.70) 19.90 (2.72)
KSS: Kerns Security Scale; HFA: high-functioning autism; TD: typically
developing.
scores on the Self-Esteem Inventory (r = .51, p < .001) and
the Care subscale of the Parental Bonding Instrument (PBI)
(r = .73, p < .001) and a negative correlation with the
Overprotection subscale of the PBI (r = −.51, p < .01) are
given as evidence of construct validity (Gullone and
Robinson, 2005).
Procedure
Children and at least one caregiver, usually the child’s
mother, attended the Olga Tennison Autism Research
Centre at La Trobe University. Caregivers completed a
demographic and background information questionnaire,
and the KSS and IPPA-R to ascertain whether their percep-
tion of the child’s attachment to them matched their chil-
dren’s reports. At the same time, the children were
administered the WASI, KSS and IPPA-R by one of the
two female experimenters. The caregivers of TD children
also completed the SCQ, and children with HFA were
administered the ADOS.
Results
Child-to-caregiver attachment
KSS. Descriptive statistics for children’s total score,
dependency and availability attachment ratings on the
KSS are presented in Table 2, and as is evident from this
table, there were no differences between the children with
HFA and TD children. A one-way analysis of covariance
(ANCOVA) on the total score confirmed this, F(1, 35) =
0.10, p = .75, ηp2 = .003. There was an effect of the covari-
ate of overall MA, F(1, 35) = 4.44, p = .04. Similarly, the
multivariate analysis of covariance (MANCOVA) on the
dependent variables child dependency and availability
was not significant, F(2, 34) = 0.68, p = .51, ηp2 = .04.
There was no effect of the verbal MA covariate, F(2, 34)
= 1.92, p = .16.
Child ratings
Total score (SD) 50.98 (12.79) 53.03 (12.91)
Trust score (SD) 41.71 (5.18) 42.89 (5.24)
Alienation score (SD) 23.18 (5.22) 22.19 (5.28)
Communication score (SD) 32.26 (5.50) 32.26 (5.57)
Parent ratings
Total score (SD) 40.00 (16.57) 49.00 (11.42)
Trust score (SD) 36.90 (6.34) 39.76 (4.78)
Alienation score (SD) 26.76 (5.53) 23.00 (4.20)
Communication score (SD) 30.05 (5.27) 31.76 (4.59)
IPPA-R: Inventory of Parent and Peer Attachment–Revised; HFA: high-
functioning autism; TD: typically developing.
Descriptive statistics for parents’ total score, depend-
ency and availability ratings on the KSS are also pre-
sented in Table 2. An ANCOVA indicated no difference
between parental reports of the groups on total attach-
ment ratings, F(1, 35) = 0.47, p = .50, ηp2 = .01. There
was no effect of the overall MA covariate, F(1, 35) =
2.65, p = .11. Again, the MANCOVA indicated no group
differences between parental reports on the dependent
variables, F(2, 34) = 0.14, p = .87, ηp2 = 01. The covari-
ate of overall MA was not significant, F(2, 34) = 1.64,
p = .21.
IPPA-R. Descriptive statistics for children’s total score
and trust, alienation and communication ratings on the
IPPA-R are presented in Table 3. In keeping with the
findings on the KSS, the ANCOVA on the total attach-
ment security score indicated no difference between the
groups, F(1, 35) = 0.22, p = .64, ηp2 = .006. There was an
effect of the overall MA covariate, F(1, 35) = 10.79, p =
.002. The MANCOVA with the dependent variables of
child trust, alienation and communication also indicated
no differences between the ratings of children with HFA
and TD children, F(3, 33) = .38, p = .77, ηp2 =.03. The
covariate of overall MA was significant, F(3, 33) = 5.89,
p = .002.
Descriptive statistics for parents’ scores on the IPPA-R
are also presented in Table 3. The independent-samples
t-test conducted to compare the parents’ total scores showed
no significant difference between the groups, t(36) = 1.90,
p = .065. The magnitude of the differences in the means
(mean difference = 9.00, 95% confidence interval (CI):
−0.60 to 18.60) was moderate (η2=.09). As the subscales
were multi-collinear with each other and with the total
score (all subscales were correlated with each other at r =
.78 and above), no further analyses were undertaken on the
subscales.
490
Parent–child agreement
KSS. The correlations between children’s and parents’ rat-
ings of attachment security on the KSS were investigated
using Pearson’s product–moment correlation coefficients.
For children with HFA, parent and child total scores were
moderately positively correlated, r = .39, p = .08, as were
the dependency scores, r = .49, p = .03. However, parent
and child availability scores were not correlated, r = .07, p
= .77. For TD children, the relationships between children’s
and parents’ ratings of attachment on the KSS were inves-
tigated using partial correlations, as overall MA was related
to both parent and child ratings. Moderate, positive correla-
tions were present between child and parent total scores,
partial r = .46, p = .08, and dependency scores, partial r =
.46, p = .07. Once again, there was no relationship between
parent and child availability scores, r = .11, p = .70.
IPPA-R. The correlations between children’s and parents’
ratings of attachment security on the IPPA-R indicated that
the agreement between children and their parents in each
group was negligible. For the HFA group, parents’ and chil-
dren’s total scores were not correlated, r = .02, p = .92, nor
were their trust scores, r = .05, p = .84, communication
scores, r = .02, p = .94, or alienation scores, r = .11, p = .62.
The findings for the TD group were similar: total scores: r
= −.01, p = .99; trust: r = −.09, p = .75; alienation: r = .17,
p = .51; and communication: r = .14, p = .60.
Discussion
Overall, the security of attachment between children with
HFA and TD children were largely similar, as reported by
themselves and their parents. Despite their well-known dif-
ficulties in the social realm, including their social cognition
and peer relationships, the middle-school-aged children
and their parents from both groups reported similar levels
of total attachment security and perceptions of dependency
and availability on the KSS. Likewise, children from both
groups reported similar levels of total attachment security
and perceptions of trust, alienation and communication on
the IPPA-R, and parents from both groups also reported
similar levels of total attachment security on this measure.
The findings from this study are in accordance with
those from previous research on attachments in younger
children with autism as well as children of a similar age
group. Consistent with the findings of Rutgers et al. (2004)
and Bauminger et al. (2010), there were no differences
between these children and TD children in the security of
their attachments to their caregivers.
Correlations between parents’ and children’s
reports of attachment
Correlations between parents’ and children’s reports on
the attachment measures also revealed comparable
Autism 18(5)
patterns across the two groups. Parents’ and children’s
total scores on the KSS were moderately, positively cor-
related, for both the HFA and TD groups. The dependency
ratings showed the highest correlations for both groups,
with no correlation between availability scores, indicating
that children and parents from both groups may either
have interpreted the meaning of ‘availability’ differently
or that the children simply disagreed with their parent’s
reports of their availability for their child. In contrast to
the KSS, there were no correlations between parents’ and
children’s total scores on the IPPA-R for either group.
Thus, parents and children from both groups did not agree
at all on attachment security as measured by the IPPA-R,
whereas moderate agreement was achieved on the KSS.
As a result, findings on the IPPA-R must be interpreted
with caution as the questions on this measure may be dif-
ferentially interpreted by parents and middle-school-aged
children with and without ASD.
Possible explanations for the discrepancy between
parents’ and children’s ratings on the IPPA-R include
social desirability and normalising relating to the
response formats of the attachment measures. The KSS
presents pairs of statements based on the Harter scale
(1982), ‘some kids/other kids’ format, in which children
are presented with two possible response types and are
asked to indicate which group of kids they are most like.
This response format decreases the child’s likelihood of
responding in a sociably desirable manner (Harter,
1982) and also serves to normalise both response
options. In contrast, the IPPA-R requests that children
respond to statements such as ‘my parents are good par-
ents’ with a frequency (‘never or almost never’ through
to ‘always or almost always’). There is potential, using
this response format, for children to answer these ques-
tions in a more socially desirable manner as they are
more personalised, which may have resulted in the low
levels of agreement between parent and child reports on
this measure.
Study limitations
The inclusion of only boys in the current study limits the
generalisability of the results to the female population. Due
to the much higher incidence of autism in boys than girls,
there is comparatively little research specifically address-
ing the presentation of autism in girls. However, gender dif-
ferences in autism have been noted in developmental
functioning, autism symptoms and severity and behavioural
problems (see Hartley and Sikora, 2009, for a review).
Given the disagreement in the field regarding gender differ-
ences in attachment during middle childhood in the typical
population, even less is known about the effect of gender on
attachment in children with HFA (Bakermans-Kranenburg
and Van IJzendoorn, 2009a, 2009b; Del Giudice and
Belsky, 2010; Kerns et al., 2007; Van IJzendoorn and
Bakermans-Kranenburg, 2010).
Chandler and Dissanayake
Clinical implications: facilitating attachment
security
Facilitating the development of attachment security is clini-
cally important given the established relationship between
the security of attachment and psychosocial outcomes
throughout development. A secure attachment has been
associated with higher positive mood, increased construc-
tive coping, emotional and behavioural regulation,
increased global self-worth and perceived competencies,
improved friendship quality and social competence (Granot
and Mayseless, 2001; Kerns et al., 2006, 2007). In contrast,
an insecure-ambivalent attachment has been associated
with social anxiety, and insecure-avoidant and insecure-
ambivalent attachments have been associated with internal-
ising and externalising behaviour problems (Brumariu and
Kerns, 2008; Granot and Mayseless, 2001). While a diag-
nosis of autism may increase a child’s risk of developing
emotional, social and behavioural problems, a secure
attachment relationship may represent a protective factor
for these children, and its development should be fostered.
Future directions
To date, no research has investigated the outcomes of devel-
oping a secure attachment in ASD, and this empirical gap
needs to be addressed in order to argue that the child–
caregiver attachment relationship in ASD functions in the
same way as in children without an ASD. Given the assumed
clinical implications of developing a secure attachment rela-
tionship and the deficits in social-emotional and social-
cognitive skills that often characterise ASDs, it is important
that future research investigate the role that these skills play
in the development of attachment in this population. Social-
emotional and social-cognitive skills that may impact this
development include self-perception, empathy, theory of
mind and memory. Understanding which of these skills con-
tribute uniquely to the development of a secure attachment
may allow for specific interventions to target these areas to
facilitate positive outcomes.
Declaration of conflicting interests
The authors declare that there is no conflict of interest.
Funding
This research received no specific grant from any funding agency
in the public, commercial, or not-for-profit sectors.
References
Ainsworth MDS, Blehar M, Waters E, et al. (1978) Patterns of
Attachment: A Psychological Study of the Strange Situation.
Hillsdale, NJ: Erlbaum.
American Psychiatric Association (APA) (1994) Diagnostic
and Statistical Manual of Mental Health Disorders. 4th ed.
Washington, DC: APA.
491
Ammaniti M, van IJzendoorn MH, Speranza AM, et al. (2000)
Internal working models of attachment during late childhood
and early adolescence: an exploration of stability and change.
Attachment & Human Development 2: 328–346.
Armsden GC and Greenberg MT (1987) The Inventory of Parent
and Peer Attachment: individual differences and their rela-
tionship to psychological well-being in adolescence. Journal
of Youth and Adolescence 16: 427–454.
Bakermans-Kranenburg MJ and Van IJzendoorn MH (2009a)
The first 10,000 Adult Attachment Interviews: distributions
of adult attachment representations in clinical and non-clinical
groups. Attachment & Human Development 11: 223–263.
Bakermans-Kranenburg MJ and Van IJzendoorn MH (2009b) No
reliable gender differences in attachment. The Behavioral and
Brain Sciences 32: 22–23.
Baron-Cohen S, Leslie AM and Frith U (1985) Does the autistic
child have a ‘theory of mind’? Cognition 21: 37–46.
Bauminger N, Solomon M and Rogers SJ (2010) Predicting
friendship quality in autism spectrum disorders and typi-
cal development. Journal of Autism and Developmental
Disorders 40: 751–761.
Bowlby J (1969) Attachment and Loss: Attachment, vol. 1.
New York: Basic Books.
Bowlby J (1973) Attachment and Loss: Separation, Anxiety and
Anger, vol. 2. London: Hogarth.
Bretherton I (1985) Attachment theory: retrospect and prospect.
In: Bretherton I and Waters E (eds) Monographs of the Society
for Research in Child Development, vol. 50. New Jersey:
Blackwell Publishing, pp. 3–35.
Bretherton I (2005) In pursuit of the internal working model
construct and its relevance to attachment relationships. In:
Grossmann KE, Grossmann K and Waters E (eds) Attachment
from Infancy to Adulthood. New York: Guilford Press, pp.
13–47.
Bretherton I and Munholland KA (1999) Internal working models
in attachment relationships. In: Cassidy J and Shaver PR (eds)
Handbook of Attachment: Theory, Research and Clinical
Applications. New York: Guilford Press, pp. 89–111.
Brumariu LE and Kerns KA (2008) Mother-child attachment
and social anxiety symptoms in middle childhood. Journal of
Applied Developmental Psychology 29: 393–402.
Buitelaar JK (1995) Attachment and social withdrawal in autism:
hypotheses and findings. Behaviour 132: 319–350.
Del Giudice M and Belsky J (2010) Sex differences in attachment
emerge in middle childhood: an evolutionary hypothesis.
Child Development Perspectives 4: 97–105.
De Wolff MS and Van IJzendoorn MH (1997) Sensitivity and
attachment: a meta-analysis on parental antecedents of infant
attachment. Child Development 68: 571–591.
Dissanayake C and Crossley SA (1996) Proximity and sociable
behaviours in autism: evidence for attachment. Journal of
Child Psychology and Psychiatry, and Allied Disciplines 37:
149–156.
Dissanayake C and Sigman M (2001) Attachment and emotional
responsiveness in children with autism. In: Glidden LM (ed.)
International Review of Research in Mental Retardation:
Autism, vol. 23. San Diego, CA: Academic Press, pp. 239–264.
Fombonne E (2003) Epidemiological surveys of autism and other
pervasive developmental disorders: an update. Journal of
Autism and Developmental Disorders 33: 365–382.
492
George C, Kaplan N and Main M (1996) Adult Attachment
Interview (Unpublished manuscript). 3rd ed. Berkeley, CA:
University of California.
Granot D and Mayseless O (2001) Attachment security and adjust-
ment to school in middle childhood. International Journal of
Behavioral Development 25: 530–541.
Gullone E and Robinson K (2005) The Inventory of Parent and
Peer Attachment–Revised (IPPA-R) for children: a psycho-
metric investigation. Clinical Psychology & Psychotherapy
12: 67–79.
Haltigan J, Ekas N, Seifer R, et al. (2011) Attachment security
in infants at-risk for autism spectrum disorders. Journal of
Autism and Developmental Disorders 41: 962–967.
Harter S (1982) The Perceived Competence Scale for children.
Child Development 53: 87–97.
Hartley SL and Sikora DM (2009) Sex differences in autism spec-
trum disorder: an examination of developmental functioning,
autistic symptoms, and coexisting behavior problems in tod-
dlers. Journal of Autism and Developmental Disorders 39:
1715–1722.
Kanner L (1943) Autistic disturbances of affective contact. The
Nervous Child 2: 217–250.
Kerns KA (2008) Attachment in middle childhood. In: Cassidy
J and Shaver PR (eds) Handbook of Attachment: Theory,
Research and Clinical Applications. 2nd ed. New York:
Guilford Press, pp. 366–382.
Kerns KA, Abraham MM, Schlegelmilch A, et al. (2007) Mother-
child attachment in later middle childhood: assessment
approaches and associations with mood and emotion regula-
tion. Attachment & Human Development 9: 33–53.
Kerns KA, Aspelmeier JE, Gentzler AL, et al. (2001) Parent-child
attachment and monitoring in middle childhood. Journal of
Family Psychology 15: 69–81.
Kerns KA, Klepac L and Cole A (1996) Peer relationships and
preadolescents’ perceptions of security in the child-mother
relationship. Developmental Psychology 32: 457–466.
Kerns KA, Schlegelmilch A, Morgan TA, et al. (2005) Assessing
attachment in middle childhood. In: Kerns KA and Richardson
RA (eds) Attachment in Middle Childhood. New York:
Guilford Press, pp. 46–70.
Kerns KA, Tomich PL and Kim P (2006) Normative trends in
children’s perceptions of availability and utilization of attach-
ment figures in middle childhood. Social Development 15:
1–22.
Kraemer GW (1992) A psychobiological theory of attachment.
The Behavioral and Brain Sciences 15: 493–511.
Lieberman M, Doyle A and Markiewicz D (1999) Developmental
patterns in security of attachment to mother and father in late
childhood and early adolescence: associations with peer rela-
tions. Child Development 70: 202–213.
Lord C, Rutter M, DiLavore PC, et al. (2002) Autism Diagnostic
Observation Schedule. Los Angeles, CA: Western Psychological
Services.
Main M and Solomon J (1990) Procedures for identifying infants
as disorganized/disoriented during the Ainsworth Strange
Situation. In: Greenberg MT, Cicchetti D and Cummings
EM (eds) Attachment in the Preschool Years. Chicago, IL:
University of Chicago Press, pp. 121–160.
View publication stats
Autism 18(5)
Marvin RS and Britner PA (2008) Normative development: the
ontogeny of attachment. In: Cassidy J and Shaver PR (eds)
Handbook of Attachment: Theory, Research and Clinical
Applications. 2nd ed. New York: Guilford Press, pp. 44–67.
Mayseless O (2005) Ontogeny of attachment in middle child-
hood: conceptualization of normative changes. In: Kerns KA
and Richardson RA (eds) Attachment in Middle Childhood.
New York: Guilford Press, pp. 1–23.
Naber FB, Swinkels SHN, Buitelaar JK, et al. (2007) Attachment
in toddlers with autism and other developmental disor-
ders. Journal of Autism and Developmental Disorders 37:
1123–1138.
Rogers SJ, Ozonoff S and 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 and Adolescent Psychiatry 30: 483–488.
Rogers SJ, Ozonoff S and Maslin-Cole C (1993) Developmental
aspects of attachment behavior in young children with per-
vasive developmental disorders. Journal of the American
Academy of Child and Adolescent Psychiatry 32: 1274–1282.
Rutgers AH, Bakermans-Kranenburg MJ, van IJzendoorn MH,
et al. (2004) Autism and attachment: a meta-analytic review.
Journal of Child Psychology and Psychiatry, and Allied
Disciplines 45: 1123–1134.
Rutter M (1978) Diagnosis and definition. In: Rutter M and
Schopler E (eds) Autism: A Reappraisal of Concepts of
Treatment. New York: Plenum, pp. 1–25.
Rutter M, Bailey A and Lord C (2003) SCQ: The Social
Communication Questionnaire Manual. Los Angeles, CA:
Western Psychological Services.
Sigman M and Ungerer JA (1984) Attachment behaviors in autis-
tic children. Journal of Autism and Developmental Disorders
14: 231–244.
Taylor EL, Target M and Charman T (2008) Attachment in
adults with high-functioning autism. Attachment & Human
Development 10: 143–163.
Thompson RA and Raikes HA (2003) Towards the next quarter
century: conceptual and methodological challenges for attach-
ment theory. Development and Psychopathology 15: 691–718.
Van IJzendoorn MH and Bakermans-Kranenburg MJ (2010)
Stretched until it snaps: attachment and close relationships.
Child Development Perspectives 4: 109–111.
Van IJzendoorn MH, Goldberg S, Kroonenberg PM, et al. (1992)
The relative effects of maternal and child problems on the
quality of attachment: a meta-analysis of attachment in clini-
cal samples. Child Development 63: 840–858.
Van Laerhoven H, van der Zaag-Loonen HJ and Derkx BHF
(2004) A comparison of Likert Scale and Visual Analogue
Scales as response options in children’s questionnaires. Acta
Paediatrica 93: 830–835.
Wechsler D (1999) Wechsler Abbreviated Scale of Intelligence
(WASI). San Antonio, TX: Harcourt Assessment.
Willemsen-Swinkels SHN, Bakermans-Kranenburg MJ,
Buitelaar JK, et al. (2000) Insecure and disorganised attach-
ment in children with a pervasive developmental disorder:
relationship with social interaction and heart rate. Journal of
Child Psychology and Psychiatry, and Allied Disciplines 41:
759–767.