Using the adult attachment interview to understand reactive attachment disorder: findings from a 10-case adolescent...

A feasibility study was conducted to examine the usability of the Adult Attachment Interview (AAI) and its coding system with 10 adolescents presenting with Reactive Attachment Disorder (RAD). Given that the measure was deemed usable with all 10 participants, the study then sought to identify the attachment status of the sample. Three transcripts were subjected to inter-rater reliability checks. All transcripts indicated a high level of insecurity, with five participants classified as organized-insecure and five assigned to the cannot classify category. However, a number of issues were raised in the administration and coding of the transcripts concerning participant distress, coding of inferred carer behaviour and experiences of unresolved loss or trauma. We also identified two new phenomena, namely extreme derogation and extreme detachment, and discuss possible development of the existing classification system. Our data indicates that cannot classify attachment status in this population may represent a transitional stage to becoming organized, and that organized insecurity may offer a route to future security. Further minimal adaptations to the AAI may promote the validity of its use with this population.