MEQ: Attachment theory — Strange Situation, AAI, RAD/DSED, and clinical application

(i) Definition and dual functions (3). Attachment is an evolved biobehavioural system organising proximity-seeking to a stronger/wiser figure under threat. The attachment figure provides a secure base (platform for exploration when safe enough) and a safe haven (comfort and co-regulation when distressed). Repeated interactions build internal working models of self and other.^[1]

(ii) SSP patterns and AAI (5). Strange Situation coding is reunion-focused; AAI coding is discourse-focused.^[2][3]

Strange Situation (Ainsworth): reunion-focused laboratory procedure. B secure — seeks comfort, settles, returns to play. A avoidant — minimises distress/contact. C resistant/ambivalent — intense distress, clingy/angry, hard to soothe. D disorganised — collapse/contradiction of strategy (freezing, simultaneous approach–avoidance, apprehension).^[2][3]

AAI: adult states of mind coded from discourse coherence — autonomous (F), dismissing (Ds), preoccupied (E), unresolved/disorganised (U/d; lapses around loss/trauma), cannot classify. Not identical to current romantic self-report style.^[3]

(iii) Styles vs disorders; application (6). Attachment styles/patterns are organised (or disorganised) strategies and mental models along a common continuum. RAD and DSED are clinical disorders requiring a history of insufficient care plus specific phenotypes: RAD = emotionally withdrawn/inhibited (rarely seeks/responds to comfort, limited positive affect); DSED = indiscriminate social engagement (over-familiarity, reduced checking back, willingness to go with strangers).^[4]

This child: early neglect/institutional care supplies pathogenic care. Withdrawn limited comfort-seeking suggests RAD features; indiscriminate approach to unfamiliar adults suggests DSED features (can co-occur or sequential patterns after deprivation). This is not proof the current carer is “bad,” and insecure style alone would be insufficient for disorder diagnosis without care history and structured multi-setting assessment.^[4][6]

(iv) Assessment, management, evidence (6). Prioritise caregiving history, multi-setting observation, comorbidity screens, and stable sensitive care; refuse coercive therapies.^[4][5][6]

Assessment: detailed caregiving/placement history; multi-informant observation; screen ASD, ADHD, language/cognitive delay, PTSD; safeguarding review; carer mental health and support needs.^[4]

Management: first priority is a stable, sensitive caregiving environment; support carer sensitivity; treat comorbidity; school/social boundary coaching for DSED traits; multi-agency placement stability. Refuse coercive holding/rebirthing/rage-reduction therapies (APSAC: associated with harm).^[4][5]

Evidence anchor: BEIP tradition shows earlier high-quality foster care improves attachment/developmental outcomes versus prolonged institutional care; AACAP practice parameter structures RAD/DSED care principles.^[6][4]