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Autism spectrum disorder (ASD) is an exclusion criterion for one of the two attachment disorders in the DSM 5. However, previous findings indicate that ASD and attachment disorder are unrelated conditions and may co-occur. The purpose of this paper is to explore the diagnostic assessment of an adolescent male with ASD, intellectual disability (ID), severe challenging behaviour and a suspected attachment disorder.

Case study methodology was chosen because of its suitability in the exploration of complex clinical phenomena where prior knowledge is sparse.

It was possible to identify symptoms of attachment disorder in a case involving ASD, ID, anxiety and severe challenging behaviour. The Disturbances of Attachment Interview was particularly useful in this assessment, as was assessment of ASD symptoms and developmental history. Differentiating the two attachment disorders proved challenging.

There is a need for further research in ASD and attachment disorders not limited by current diagnostic categories.

Co-occurring symptoms of attachment disorder may be identified in individuals with ASD and ID, and exploration of these symptoms in assessments of children and adolescents with ASD/ID and challenging behaviour may be beneficial.

The study adds to previous findings on attachment disorder in ASD, demonstrating that identification of attachment disorder is possible even in the presence of a highly complex clinical picture involving severe challenging behaviour. It may also assist other clinicians in identifying and making more accurate assessment of attachment disorder in ASD and ID.

This study examined an individual's drug use in relation to their coping styles, personality traits and attachment style. A total of 98 participants (46 females and 52 males) took part in the study. Analysis did not show a significant difference in insecure/ambivalent attachment in the drug‐using group. Yet, there was evidence to suggest that the drug‐using group exhibited higher levels of personality disorder traits, based only on self‐report. Individuals with more personality disorder traits had a more insecure attachment style. Participants who use drugs had a more avoidant coping style. The results are discussed with reference to previous research and the implications of the current research on attachment theory and personality disorder etiology, as well as implications for drug treatment.

The purpose of this paper is to describe the mental and intellectual developmental status of children with combined intellectual disabilities, reactive attachment disorder (RAD), and/or disinhibited social engagement disorder (DSED), and to describe the presence of comorbid diagnoses.

The study included 55 children that were referred for psychiatric consultation due to low intellectual functioning (borderline or mild; IQ 50-84). Attachment diagnoses were based on the Clinical Observation of Attachment (COA) procedure. Development was measured with the Dutch version of the Vineland Adaptive Behaviour Scales. Psychopathology was measured with the DISC-IV and AUTI-R. Emotional and behavioural problems were measured with the Dutch version of the Developmental Behaviour Checklist.

Children with and without attachment diagnoses had similar IQs. However, children with disturbed attachment, RAD, and/or DSED had lower levels of adaptive behaviour than those without attachment diagnoses. No comorbidity was associated with autism or ADHD. However, 80 per cent of children with RAD and/or DSED were also diagnosed with ADHD. Parents of children with DSED often reported disruptive anti-social behaviour.

Children with RAD and/or DSED may have unused developmental potential. Disturbed attachment should be considered in some cases of ADHD.

Findings suggested that diagnostic expertise provided added value for distinguishing disordered attachment in young clients with intellectual disability.

The therapeutic community (TC) is a widely used intervention program in treating substance use disorders. Despite its documented utility, researchers and practitioners are still perplexed on how it exactly works. The purpose of this paper is to suggest the role of attachment styles and treatment motivation in the TC process.

Applying an explanatory correlational research, this notion was tested by examining the responses of 200 patients with substance use disorder in a TC using mediation analysis.

The results revealed that attachment styles indirectly affect client’s clinical progress by the path of treatment motivation. Although the current study cannot conclude causality, the results provide empirical evidence suggesting that attachment activates motivation in treatment within the social dynamics of the TC, thus influencing clinical progress.

From these findings, recommendations for the modification of TCs along with considerations for further research, and socio-political implications are discussed.

To evaluate the effectiveness of an adaptation of Interpersonal Group Psychotherapy (IPT-G), in facilitating short- and longer-term improvements in eating disorder symptomology, psychosocial impairment, anxiety, depression and attachment difficulties among adults living with overweight and diagnosed with binge eating disorder (BED).

In total, 24 participants completed measures at the start of IPT-G, mid-treatment, discharge and six-month follow-up. Quantitative outcomes were analysed utilising one-way repeated measures analysis of variance.

Treatment retention was 100%. Significant improvements in binge-eating frequency, psychosocial impairment and depression were achieved at mid-treatment and maintained at post-treatment and six-month follow-up, and with large effect sizes. Attachment anxiety had reduced significantly at post-treatment and was maintained at six-month review. Body mass index (BMI) had stabilised by mid-treatment and was maintained at post-treatment and six-month follow-up. All hypotheses were supported, with the exception that attachment avoidance did not improve significantly and following a post-treatment reduction, anxiety symptoms deteriorated slightly by six-month follow-up, such that they were no longer significantly different from pre-treatment levels.

Despite being the most prevalent of the eating disorders (compared to anorexia nervosa and bulimia nervosa), BED is under-recognised and under-treated in clinical settings. Results indicate the sustained effectiveness of IPT-G in improving eating disorder and comorbid symptomology associated with BED.

This is the first UK study to investigate the effectiveness of IPT-G at treating BED. Unlike previous studies in the field, this study did not exclude participants based on age, BMI or psychiatric comorbidity.

Attachment Theory can be regarded as central to the concept of relational security. There is a paucity of research examining the coherence of this construct for ward-based staff. The paper aims to discuss these issues.

Five female nurses from the acute admission and assessment ward of a UK medium secure unit acted as participants. Semi-structured interviews were conducted, and inductive thematic analysis was applied.

Six themes; “staff-service user relationships”, “staff diversities”, “service user backgrounds”, “variability in service users’ presentations”, “service users with personality disorder are problematic” and “nurses do not use attachment” emerged from the data. The nurses used heuristic models of attachment-related behaviour and they lacked knowledge of constructs associated with Attachment Theory.

Acute admissions may not be representative of all treatment contexts. Traditional models of attachment style may have only limited relevance in forensic services.

Limited knowledge and confidence in the nurses regarding how Attachment Theory might apply to service users is interesting because it may limit the extent to which care, treatment and risk management might be informed by an understanding of service user representations of therapeutic relationships. Training and educational interventions for nurses that enhance understanding of personality development and attachment styles are warranted.

The importance of nurses for achieving relational security is emphasised and the adequacy of their training is questioned.

Case formulation has gained increasing prominence as a guide to intervention across a range of clinical problems. It offers a contrasting orientation to diagnosis and its value is considered in the context of clinical work with autistic spectrum disorders (ASD). The purpose of this paper is to argue that case formulation integrating attachment, systemic and narrative perspectives offers a valuable way forward in assisting people with the diagnosis and their families.

The literature on ASD and related conditions is reviewed to examine levels of co-morbidity, consider the role of parental mental health difficulties and explore the issues inherent with current approaches to diagnosis.

ASD is found to have a high level of co-morbidity with other difficulties, such as anxiety and insecure attachment. Research findings, alongside the authors own clinical experience, are developed to suggest that formulation can allow the possibility of early intervention based on a holistic appraisal of the array of difficulties present prior to a diagnosis.

It is argued that the use of this systemic-attachment formulation approach could offset the exacerbation in ASD and related conditions, and deterioration in families’ mental health, whilst they face long waiting times for a diagnosis.

The purpose of this paper is to present an annotated bibliography of books and journal titles to assist researchers, clinicians, educators and parents in need of information on child and adolescent psychopathology.

Resources that include a wide range child and adolescent mental disorders were selected. Criteria for book selection was based on those that include evidence-based therapies. Journal titles were selected based on impact factor according to Journal Citation Reports.

The scholarship on child and adolescent psychopathology is immense. After a review of the literature, 15 books and eight journal titles that reflect the diverse nature of child and adolescent mental health disorders are included.

This is an original bibliography that will be helpful to librarians assisting patrons with information needs about child and adolescent mental health disorders.

Secure Children’s Homes are safe environments where many of the most troubled children in British society are resident. These children are from either a criminal background or referred for protection of themselves and others from harm. There is often a history of drug use and diagnoses of mental health problems before admission. The purpose of this paper is to examine one Secure Children’s Home to determine the level of drug use prior to admission compared to surveys of children not in this environment and to examine the veracity of the mental health diagnoses.

This paper is a retrospective examination of case notes for admissions from 2014 to 2015.

The study found much higher levels of drug use than in the general population at similar age and a wide diagnosis of mental health problems prior to admission.

Levels of harm from traumatic childhood events need to be recognised by referrers as maybe leading to attachment disorders and not mental health problems. More research is needed into the outcomes form Secure Children’s Homes in the long term.

The children in these homes do have as anticipated much higher levels of drug use than in the general population and high levels of mental health diagnoses which are not always borne out during their admission to the children’s home.

This is an examination of a special population of young people indicating high levels of drug use and mental health problems.

The purpose of this paper is to investigate whether early maladaptive schema (EMS) and autobiographical memory specificity mediate the relationship between abuse and attachment in childhood with Borderline Personality Disorder (BPD) characteristics among forensic inpatients.

The study adopted a quantitative cross-sectional design. In total, 34 male adults residing in medium secure facilities completed self-report measures. Data were analysed using bootstrapped mediation procedures.

The study’s hypotheses received partial support. The EMS of “entitlement/grandiosity” and autobiographical memory specificity differentially mediated the relationship between emotional and physical abuse and neglect, and parental care and overprotection with BPD characteristics, including trait anger and the frequent expression of anger. In line with attachment theory and the functional avoidance mechanism (Williams et al., 2007), the proposed mediators are conceptualised as adaptive responses to early adversity with potential maladaptive consequences for later interpersonal functioning.

These provisional findings will require further exploration with specific investigation of the relationship between EMS and autobiographical memory specificity. It is recommended that future research replicates the study’s design with a larger sample and investigate the role of other mediators and moderators in this complex relationship. Examples of these are mentalisation, social problem-solving capabilities, social support and adult attachment styles.

Clinical implications encourage the incorporation of these mediators into clinical formulation, intervention and ward practices.

For forensic inpatients with a history of adversity, interventions working directly with EMS and specificity of autobiographical memory, e.g. schema therapy (Young, 1999), mentalisation and mindfulness may be useful. Furthermore, the relationship between EMS and specificity of autobiographical memory with interpersonal experience and functioning can be incorporated into clinical formulation.