[acb-hsp] The relationship between attachment, psycholopathology and childhood disability

Tue Nov 13 13:19:24 EST 2012

The relationship between attachment, psychopathology, and childhood disability.

Author: Huebner, Ruth A. 1 ; Thomas, Kenneth R. 1 U Wisconsin, Dept of Rehabilitation

Psychology, Madison, US

Publication info: Rehabilitation Psychology 40. 2 (1995): 111-124.

https://login.libproxy.edmc.edu/login?url=http://search.proquest.com/docview/614319132?accountid=34899

Abstract: Analyzes the literature on 3 aspects of attachment-neurobiological influences,

interpersonal and intrapersonal factors, and societal factors-in the psychological

development of chronically disabled children. Evidence suggests that neurochemical

substances such as cortisol and brain biogenic amine systems reciprocally interact

with psychological and psychosocial factors to influence attachment. Interpersonal

and intrapersonal factors such as temperamental characteristics of children, severity

and type of disability, and family influences interact in the process of attachment.

Social perceptions and prejudices about the disabled individual increase parental

stress, and diminish parental involvement and resources, which are necessary for

attachment. These 3 processes are powerful and interrelated forces in child development,

with potential to modify social competence, neurological development, and psychosocial

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Full Text: Contents - Abstract

ATTACHMENTTHEORY

NEUROBIOLOGICAL INFLUENCES AND CONSEQUENCES Cortisol

Biogenic Amine Systems

NEUROBIOLOGICAL CONSEQUENCES

INTERPERSONAL AND INTRAPERSONAL FACTORS Temperamental Characteristics of Children

Disability Characteristics

Within Family Influences on Attachment

SOCIAL FACTORS

IMPLICATIONS

Show less Abstract The literature concerning three aspects of attachment (neurobiological

influences, interpersonal and intrapersonal factors, and societal factors) in the

psychological development of children with chronic disease and disability is reviewed.

The literature suggests that these three attachment processes are reciprocally interactive,

complicated by aspects of childhood disability, and potentially related to the development

of emotional maladjustment. An understanding of attachment processes may have important

implications for facilitating adjustment in the young child and ameliorating psychopathology

in the adolescent and adult with a disability.

Historically, the study of childhood psychological dysfunction has been complicated

by inadequate diagnostic criteria for children and an insufficient understanding

of psychological development between infancy and adulthood ( Kazdin, 1988 , 1993

). Determining the relationship between chronic physical disorders in children and

the subsequent risk for psychopathology is additionally hampered by multiple methodological

problems in defining and measuring these two constructs ( Breslau, 1985 ; Pless &

Nolan, 1991 ). Pless and Nolan (1991) summarized the literature in this area and

concluded that nearly 10% of children have some form of chronic physical illness

with twice the risk of psychopathology. Other authors ( Breslau, 1985 ; Cadman, Boyle,

Szatmari, & Offord, 1987 ; Rutter, 1981 ; Seidel, Chadwick, & Rutter, 1975 ) concluded

that the risk of psychopathology increases threefold for children with a physical

disability, and fourfold in children who have a brain injury. An overall elevation

in emotional or behavioral difficulties is typically described in studies on children

with chronic disease and disabilities, without delineation or specific diagnostic

criteria ( Breslau, 1985 ). In one attempt to delineate emotional disorders, Cadman

and his colleagues (1987) randomly sampled 1,869 families, including the children

and their teachers, and found an overall increase in neurotic disorders, attentional

disorders, conduct disorders, social maladjustment, and multiple psychiatric disorders

among children with chronic diseases or disabilities; however, there was no preponderance

of any specific emotional disorder.

Finding evidence of increased psychopathology is, of course, an easier task than

explaining why that pathology may exist. Kazdin (1993) noted that psychological research

has neglected children with chronic diseases and physical handicaps; he argued for

exploring both risk and protective factors to understand childhood psychological

dysfunction and treatment. Attachment processes may be such a risk or protective

factor. Securely attached children are more likely to achieve social competence,

trust, a strong sense of self, and resilience against stress; in contrast, insecurely

attached children are more likely to develop psychopathology (e.g., see Ainsworth,

1978 ; Cox & Lambrenos, 1992 ).

Attachment is variously defined by authors from different perspectives as mother-infant

interaction patterns ( Ainsworth, Blehar, Waters, & Wall, 1978 ), as mother-infant

interaction patterns with related neurobiological system development ( Bowlby, 1969

), and/or as a socialization process ( Kraemer, 1992 ). The purpose of this paper

is to elucidate the relationships among these three components of attachment: (a)

neurobiological influences and consequences, (b) interpersonal and intrapersonal

factors, and (c) social forces affecting the child and caregiver. The literature

search and review included publications on attachment in typical and atypical development,

and publications on childhood chronic illness or congenital disability. Disorders

such as asthma, cleft palate, cerebral palsy, and congenital anomalies are typically

mentioned in the literature, usually without differentiation. Other authors (e.g.,

see Kraemer, 1992 ; Wasserman & Allen, 1985 ) have elaborated on the relationship

between neurological development and attachment, but no author has specifically integrated

the literature on attachment as described in this paper.

ATTACHMENTTHEORY Classic attachment theory emphasizes the intrapersonal drive for

social relatedness and the interpersonal relationships necessary to satisfy that

drive. Attachment and loss theory grew out of a psychoanalytic framework with an

emphasis on object relations; it is based on the work of John Bowlby (1973 , 1979

, 1982) , who argued that the mother-infant relationship was fundamental to emotional

stability rather than mere physical survival. Ainsworth and her associates ( Ainsworth,

1978 , 1985 ; Ainsworth & Bell, 1970 ; Ainsworth et al., 1978 ) developed a widely

used system of classifying attachment behavior into three groups: avoidant/insecurely

attached (Group A), securely attached (Group B), and ambivalent/insecurely attached

(Group C). Although the names of Bowlby and Ainsworth are often considered synonymous

with attachment theory, other psychoanalytic scholars have also contributed significantly

to an understanding of attachment (e.g., Eagle, 1984 ; Fairbairn, 1952 ; Greenberg

& Mitchell, 1983 ; Mahler, 1968 ; Mahler, Pine, & Bergman, 1975 ; Sullivan, 1953

; Winnicott, 1960 ) with the common belief that attachment is fundamental to emotional

health and social relationships.

Recently, authors such as Baldwin (1992) , Liotti (1984) , Safran and Segal (1990)

, and Westen (1991) have formalized a link between attachment and interpersonal theory

and cognitive therapy. According to these authors, fundamental interpersonal schema

with expectations and rules for maintaining interpersonal relatedness are formed

in early attachment relationships. For example, complex social schema with a hierarchy

of representations are found in children at age three ( Bretherton, 1985 ).

NEUROBIOLOGICAL INFLUENCES AND CONSEQUENCES The strong link between brain injury

and psychopathology suggests that one component in the development of psychopathology

is altered brain function. However, the literature indicates that neurobiological

mechanisms are reciprocally interactive. That is, failures in infant and child attachment

may compromise neurobiological development and consequently psychological well-being.

Moreover, neurobiological differences may exist as a direct result of brain dysfunction,

which may affect relatedness directly with subsequent secondary social deficits.

Although it is not clear which specific neurobiological deficits result from inadequate

attachment or interfere with normal attachment and social interaction, research is

beginning to illuminate these relationships. For example, deficits in neurotransmission

processes and neurochemicals, abnormalities in neural responses, and site-specific

neurological lesions are being identified in people with severe developmental disorders

such as autistic disorder and mental retardation (e.g., see Hooper, Boyd, Hynd, &

Rubin, 1993 ; Huebner, 1992 , for reviews of this literature), but neither the etiology

nor the developmental implications of these neurological alterations has been established.

Several neurochemical substances which relate to issues of attachment have also been

studied in human and nonhuman primate research. These substances are cortisol and

the brain biogenic amine systems, including the norepinephrine (NE) system, dopamine

(DA) system, and serotonin (5HT) system.

Cortisol Stress has been shown to be associated with alterations in the immune system,

sleep cycle, circadian rhythms, and possibly some aspects of learning ( Reite, 1990

). Consequently, children with disabilities who are subjected to increased stress

due to medical procedures, separation from mothers, and other complications such

as cardiopulmonary insufficiency are more likely to suffer stress-related secondary

disabilities.

Cortisol is the primary hormone produced by the adrenocortical system in humans;

it increases the level of energy available to respond to stress, suppresses inflammation,

and facilitates learning ( Gunnar, 1989 ). Too much cortisol secretion may be associated

with being overwhelmed by stress, especially novel stress. Since cortisol levels

can be measured by tests on saliva, the research in this area is growing, but the

findings are preliminary. Gunnar, in several studies, discovered that both behavioral

distress and sleeping were associated with excessive elevation of cortisol levels

during medical procedures such as circumcision, suggesting that observation alone

is insufficient to measure stress in an infant. According to Gunnar, experience with

a stressful event tended to attenuate cortisol secretion, but infants showed substantial

variability in their responses to stress. Similarly, Fox (1989) found that infants'

and young children's responses to stress fell on two continua of reactivity or arousal

and the ability to regulate autonomic nervous system responses. For example, children

with high reactivity and high regulation were expressive and social, but those with

high reactivity and low regulation were more hyperactive and uncontrollable. These

highly reactive infants with low regulation of autonomic nervous system responses

were more vulnerable to stress.

>From another perspective, Coe, Lubach, and Ershler (1989) found in numerous related

studies that psychological distress (in non-human primates) can alter the immune

system with potentially long-lasting effects on susceptibility to illness. Conversely,

touch, when given by a individual with an attached relationship to the child, may

reduce the biological disorders that occur secondary to stress and separation ( Reite,

1990 ). Although preliminary, these research findings may facilitate more precise

identification of children who manifest signs of being overwhelmed by stress.

Biogenic Amine Systems A great deal of research on the neurobiological aspects of

attachment has grown from the work of Harry Harlow with non-human primates. Kraemer,

Ebert, Schmidt, and McKinney (1989) reared infant monkeys from birth in several attachment

conditions (i.e., without any objects; with cloth, stationary wire, or moving wire

surrogate mothers; with peers; or with their mothers). They measured the levels of

NE over 21 months. Although monkeys raised with peers had higher levels of NE than

those raised without objects or with inanimate surrogate mothers, the monkeys raised

by their mothers had nearly twice the levels of NE. Low levels of NE are thought

to be associated with poor overall adaptation, attention disorders, increased vulnerability

to stress, and decreased problem-solving ability. In addition, primates raised in

social isolation were noted to have eating disorders; lack aggression-impulse control;

and demonstrate hypervigilance, body rocking, self-injurious behavior, and a variety

of cognitive deficits. Kraemer (1992) integrated the results of many studies on brain

biogenic amine systems and concluded that deficits produced by isolation include

disregulation of all three biogenic amine systems (NE, DA, and 5HT), changes in brain

cytoarchitecture such as reduction in dendritic branching, and failure to organize

an emotional response to stressors.

NEUROBIOLOGICAL CONSEQUENCES Perhaps in no other disorder is the link between neurobiology

and attachment as intriguing as in autistic disorder. Sigman and Mundy (1988) defined

a continuum of attachment behaviors in children with autistic disorder and found

that these children were attached to their parents, but were more vulnerable to separation

from parents than other children. The autistic children's social deficits were related

to difficulty with comprehending and sharing emotional reactions rather than to lack

of responsiveness. One possible explanation for these findings may be that the neuromechanisms

for attachment are altered prior to birth in children with autistic disorder; consequently,

the social contacts of parents may be ineffective in developing social responsiveness,

with a resulting cascade of impairment in many systems as described in the work of

Kraemer et al. (1989) and Kraemer (1992) .

The evidence linking increased physical or cognitive disability as secondary to disruption

of attachment is sparse, but this potential relationship is an important consideration

when examining the effects of interrupted attachment. Magid and McKelvey (1987) described

the worst-case scenario for children with attachment disorders as including some

sensory abnormalities with decreased ability to feel pain or affectionate touch,

phoniness, learning disabilities, abnormalities in eye contact, speech pathology,

and many other severe psychopathic behaviors. Similarly, Steinhauer (1991) discussed

children with disorganized and disoriented attachment (Group D Attachment response)

as exhibiting whining, petulant behavior, huddling, rocking, and wetting in response

to stress. Some of these insecure attachment-related behaviors could be perceived

as intensifying existing symptoms of physical disabilities or in some cases mimicking

a physical disorder.

Attachment may also influence intellectual and motor development. Wasserman and Allen

(1985) studied 12 children with disabilities compared to 14 "at-risk" premature children

and 9 normal children at 9, 12, 18, and 24 months; they found that children who were

ignored at 12 months (50% of those with a disability; none of the normal sample)

showed a 30-point drop in IQ by 24 months as measured on a variety of developmental

scales. Sorting out the cause of this diminished IQ is difficult since IQ tends to

be unstable in young children, and lower cognitive levels could be associated with

diminished social reciprocity and maternal fatigue over time. However, Egeland and

Farber (1984) studied over 200 mother/infant dyads and also found that those children

with more anxious resistant attachment had significantly lower scores on both the

mental and motor sections of the Bayley Scales of Infant Development at 9 months.

Psychopathology, possibly stemming from insecure attachment, may also be associated

with increased vulnerability to the onset of physical disabilities. Rutter (1981)

, for example, found in a follow-up study after head trauma that children with mild

head injuries ( n = 29) were more impulsive, disturbed, and overactive before their

head injury than a control group, suggesting that behavioral disturbances may increase

vulnerability to head trauma.

INTERPERSONAL AND INTRAPERSONAL FACTORS To understand the context of attachment for

children with disabilities, it is necessary to examine both infant characteristics

and caregiver responses because it is within this context that interpersonal and

intrapersonal characteristics interact in the process of attachment. When considering

the influence of infant and child characteristics, researchers view the child as

an active participant in the social relationship with caregivers; that is, the child

both influences and is influenced by the interaction (e.g., see Rogers, 1988 ).

Temperamental Characteristics of Children Overall, children with disabilities are

more likely to be born prematurely with low birthweight ( Cox & Lambrenos, 1992 ),

and they may require long-term hospitalization. Plunkett, Meisels, Stiefel, Pasick,

and Roloff (1986) compared 33 premature infants, at ages 12 and 18 months, who required

hospitalization for more than one month to preterm infants who were hospitalized

for less than one month. Although 55% of the long-term hospitalized infants were

judged to be securely attached, 36% (compared to 9% of infants with shorter hospital

stays) were found to exhibit patterns of insecurity with anxious and resistant behaviors.

This study was particularly significant since the authors excluded infants who showed

signs of central nervous system disorders, or whose mothers were addicted to drugs

or alcohol, were less than 17 at the time of birth, or who had severe mental disorders.

Thus, the sample of premature infants was likely to be showing the effects of long-term

separation after birth rather than increased biological vulnerability to attachment

disorders.

Premature babies are also likely to be more irritable and immature ( Cox & Lambrenos,

1992 ). Crockenberg (1981) found that irritable and unresponsive babies, those with

motor immaturity, or babies with poor physiological regulation were more stressful

to mothers and more vulnerable to other maternal or family stressors; conversely,

easy temperament babies were more likely to develop secure attachments even in discordant

homes.

By three weeks of age, mothers and infants have established a cycle of rhythmic interaction

in which the mother and child match levels of vocalization and cuddling ( Brooks-Gunn

& Luciano, 1985 ); responsive infants who vocalize and cuddle elicit the same level

of interaction from their caregivers. Between 9 and 12 weeks, a typical child develops

the ability to change head position and visual gaze, smile, and vocalize ( van Wulfften

Palthe & Hopkins, 1993 ). Van Wulfften Palthe and Hopkins theorized that these typical

abilities enable a child's first control of and competence in social interactions.

Premature or disabled children may have poor ability to interact and focus attention,

with decreased visual tracking and reaching, and impaired sensory responses and ability

to cuddle ( Bendell, 1984 ). Infants (2-7 months) with a physical disability made

less eye contact and fewer protests toward the mother when compared with typical

infants ( Barrera & Vella, 1987 ). Consequently, children with disabilities may be

less able to steady their head, focus their gaze, smile, and vocalize in response

to others; these limited social abilities may elicit less reciprocal interaction

by the mother ( Rogers, 1988 ), and afford a diminished experience of social competence

and control for the child.

Disability Characteristics Although the evidence is not conclusive, severity of disability

tends to have a concave, curvilinear relationship with psychological adjustment (

Breslau, 1985 ). That is, individuals with mild or severe disabilities tend to present

more psychopathology ( Pless & Nolan, 1991 ). However, the reasons for psychopathology

may be different in the mild and severe groups. Children with severe disabilities

are more likely to have brain injury and difficulties with cognition and mentatation

that may mimic psychopathology ( Breslau, 1985 ). Children who have hidden or mild

handicaps, on the other hand, may have an ambiguous identity or difficulty in acknowledgment

of limitations with subsequent maladjustment ( Pless & Nolan, 1991 ).

The type of disability also seems to make a difference in both security of attachment

and overall psychological well being. Children with facial deformities ( Wasserman

& Allen, 1985 ), abnormal genitalia, or sensory abnormalities ( Collins-Moore, 1984

) are more likely to be ignored by their mothers.

Although infants' interactions have been studied extensively, the process of lifespan

adaptation to disability has received less attention ( Eisner, 1990 ). However, Breslau

(1985) studied 304 children (ages 3-18 years) grouped into four congenital conditions

and found that chronicity, with or without neurological injury, was consistently

associated with increased amounts of social isolation, conflicts with parents, and

repressive anxiety.

Within Family Influences on Attachment For parents who have a child with a disability,

the celebration of birth may be replaced with shock, disbelief, and grief. The family

is faced with the high cost of treatment, questions regarding the future, separations

from the infant, and sometimes even decisions about rights to life and death ( Bendell,

1984 ). Some parents disengage from their infant in anticipation of a death ( Plunkett

et al., 1986 ). Although little is actually known about parent-coping processes,

some parental responses may include shock and protective denial, hope for a cure,

grieving for the child with vastly different mourning reactions, grieving for themselves

and their other existing or planned children, feelings of inadequacy, anger towards

many others, and depression ( Eisner, 1990 ). These emotions may divert energy from

the attachment process and require professional intervention.

Adjustment to having a child with a disability is a dynamic process which changes

over time. Barrera and Vella (1987) found that mothers of infants (2-7 months) with

disabilities were very similar to controls in responsiveness to their infants; however,

these mothers were significantly more commanding and controlling during social interactions

with their infants. Over time, the interactional differences may increase; Wasserman

and Allen (1985) , for example, found low rates of maternal ignoring before 18 months,

but by two years of age 50% of mothers with handicapped toddlers ignored their child,

even when being watched by research teams. Long-term ignoring may be associated with

differences in perception, with mothers being less able to judge and respond to the

stress experienced by their children. Tackett, Kerr, and Helmstadter (1990) found

in their study of 20 mother/child dyads (8-15-year-old children with physical disabilities

and average intelligence) that mothers and their children differed in perceptions

of stress and acceptance of the disability. Although the children were keenly aware

of stressors such as school, medical procedures, family strife, and peer reactions,

the mothers were more stressed about the physical limitations and their own feelings

of being different and inadequate. Similarly, Gilbride (1993) found that parents

who perceived their child's disability as more severe, whether this was objectively

true, held lower expectations and gave less encouragement to their child with a disability.

As children move into late adolescence and adulthood, Crittenden (1990) proposed,

but did not investigate, the hypothesis that autonomy will be facilitated by family

cohesion and adaptability, which are marked by open communication, support, and the

emerging of adult attachment styles.

Several authors ( Eisner, 1990 ; Pless & Nolan, 1991 ; Rutter, 1981 ; Seidel et al.,

1975 ) have postulated that a physical disability may create increased vulnerability

to psychopathology, but that vulnerability is exacerbated and manifested when paired

with family dysfunction. Although a causal or directional relationship was not implied,

Rutter (1981) found that the rate of psychiatric disorder in children was 20-25%

in families with adversity, such as marital discord or parental psychopathology,

but less than 7% in families without such adversity.

Lastly, families and their children with chronic disease or physical disabilities

are often separated for medical procedures. Steinhauer (1991) reviewed the effects

of separation and found that children were most susceptible if separation occurred

between the ages of 6 months and 4 years; the longer the separation the greater the

negative impact. Separation anxiety and suffering was attenuated in those children

who were securely attached prior to separation, in those with some prior experience

with separation, and when the post-separation environment supported a process of

mourning and provided tender support.

SOCIAL FACTORS Social forces may present both additional risks for psychopathology

and/or provide a buffer and support for children with disabilities and their families.

The act of labeling a disability is itself fraught with problems since accurate diagnosis

and identification of risks and problems are necessary for intervention, but the

labels may become part of a self-fulfilling prophecy ( Pless & Nolan, 1991 ). People

with chronic diseases or disabilities may be perceived as "damaged goods" ( Phillips,

1990 ) or categorized as devalued people ( Wolfensberger & Tullman, 1991 ). Regrettably,

professionals may unwittingly reinforce or act upon limited or stereotyped expectations

and facilitate the process of stigmatization ( Rubenfeld, 1988 ; Sigelman, 1991 ).

Parents are sometimes characterized as overprotective, shopping for treatments, depressed,

hostile, overcompensating, and poorly adjusted to their child's disability ( MacKinnon

& Marlett, 1984 ).

Both parents and their children with disabilities are vulnerable to prejudice secondary

to these stereotypical beliefs. These social pressures are likely to create parental

stress and diminish parental resources necessary for nurturance and attachment (

Westman, 1991 ).

Although mothers may feel the most pressure, Tavecchio and van IJzendoorn (1987)

challenged the belief that mothers must bear the burden and guilt. These authors

proposed that a stable network of caregivers may be optimal to reduce maternal stress

and minimize the effects of neglect or overprotection of a child. In support of this

proposal, they studied 166 families and found that 70% of the children with working

mothers (as compared to nonworking mothers) exhibited equal attachment intensity

with both the mother and father.

IMPLICATIONS When considering this literature on attachment, it is evident that the

three fundamental components of attachment processes are powerful and interrelated

forces in child development, with potential to modify social competence, neurological

development, and psychological adjustment. An appreciation of the dynamics of attachment

has important implications for treatment and research.

When assessing a child and his or her family, psychologists must recognize that neurological

disorders, developmental delays, or psychopathology have potential to be exacerbated

by inadequate attachment to caregivers. Furthermore, a developmental or emotional

disorder may be a secondary problem that is founded in inadequate attachment. Although

such disorders or delays will alter the interpersonal interaction between the child

and the caregivers, a securely attached child will have an innate buffer against

psychopathology. In view of these findings, psychologists and other professionals

must consider the impact on attachment when intervening within a family. For example,

parents are often asked to provide medical, educational, or therapeutic interventions

for their child at home. These interventions, although potentially beneficial, may

create guilt and stress for the caregivers and ultimately interfere with the benefits

of the attachment process. It may be more important, in some cases, to facilitate

the bond between child and caregivers than to treat the child. Rogers (1988) , for

instance, suggested helping caregivers to recognize and interpret the altered or

subtle social behavior of the infant and Westman (1991) recommended assessing and

facilitating a family's capability to form a parent-professional alliance.

Adults with lifelong chronic diseases or congenital disabilities are likely to have

experienced alterations in attachment interactions with their caregivers and continue

to have an increased risk of psychopathology. For example, Turner and McLean (1989)

found that rates of depression and anxiety were two and a half to four times higher

in adults with disabilities ( n = 967). Although Turner and McLean attributed this

psychopathology to chronic stress, another variable might be alterations in interpersonal

expectations and images stemming from alterations in interpersonal relatedness. Safran

and Segal (1990) suggested that interpersonal expectations often become self-fulfilling

prophecies in which the individual both construes reality and constructs reality

to validate the expectations. While finding employment and securing social support

are important for combating depression in adults, examining interpersonal schema

and the meaning of ambiguous attachment may enhance social competence and mastery

for the adult with a disability. Safran and Segal (1990) provided a guide for such

intervention which included using interpersonal processes to activate and explore

implicit interpersonal schema and cognitive therapy to alter these schema.

Finally, there is a critical need for research to clarify: (a) the coping processes

of families and ways to identify families who are most in need of intervention, and

(b) the dynamics of adjustment to disability across childhood and into adulthood.

A pertinent question is: If attachment processes are fundamental to mental health,

then how are attachment deficits manifested in adults and adolescents with physical

disabilities?

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Show less

Address for Correspondence: Ruth A. Huebner, Department of Rehabilitation Psychology,

University of Wisconsin, 432 N. Murray Street, Madison, WI 53706

© 1995 Division of Rehabilitation Psychology of the American Psychological Association

Subject: Attachment Behavior (major); Chronic Illness (major); Literature Review

(major); Psychological Development (major); Disorders; Interpersonal Influences;

Neurobiology; Social Influences

Classification: 3200: Psychological&Physical Disorders

Age: Childhood (birth-12 yrs)

Population: Human

Identifier (keyword): neurobiological&interpersonal&intrapersonal&societal factors

of attachment, psychological development, children with chronic disabilities, literature

review

Methodology: Literature Review

Title: The relationship between attachment, psychopathology, and childhood disability.

Publication title: Rehabilitation Psychology

Volume: 40

Issue: 2

Pages: 111-124

Publication date: 1995

Format covered: Print

Publisher: American Psychological Association

Country of publication: United States

ISSN: 0090-5550

eISSN: 1939-1544

Peer reviewed: Yes

Document type: Journal, Journal Article, Peer Reviewed Journal

Number of references: 62

DOI: <a href="

http://dx.doi.org/10.1037/0090-5550.40.2.111">http://dx.doi.org/10.1037/0090-5550.40.2.111</a

>

Release date: 01 Aug 1996 (PsycINFO); ; 10 Jul 2006 (PsycARTICLES);

Correction date: 08 Mar 2010 (PsycINFO)

Accession number: 1996-22968-001

ProQuest document ID: 614319132

Document URL:

https://login.libproxy.edmc.edu/login?url=http://search.proquest.com/docview/614319132?accountid=34899

Copyright: ©Division of Rehabilitation Psychology of the American Psychological Association

1995

Database: PsycARTICLES

____________________________________________________________

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http://www.proquest.com/go/contactsupport

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Jessie Rayl
thedogmom63 at frontier.com
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