Attachment & Human Development Taylor&Francis Vol 5 No 3 (September 2003) 223 —244 1111 healthsciences Attachment disorders: Assessment strategies and treatment approaches THOMAS G. O'CONNOR and CHARLES H. ZEANAH ABSTRACT The aim of this special issue is to examine methods for assessing and treating attachment disorders. This target article outlines existing strategies for assess- ment and considers which aspects of severe attachment disturbances and disorders may be core features of the disturbance(s). The usefulness of alternative methodolo- gies for assessment are discussed, with particular emphasis on the need for the devel- opment of clinical protocol. The applications and implications for treatment are then discussed, with particular emphasis on the nature of the underlying disturbances that should be a focus for intervention. An absence of established treatment guidelines or consensus regarding the mechanisms of change are highlighted as barriers to further progress. KEYWORDS: attachment disorder — assessment — intervention Interest in the conceptual foundations and clinical implications of attachment disorders has increased substantially in recent years. This is attributable to a greater understanding of the particular needs of children who experienced very adverse early care, especially those children in the foster care system and children who were adopted following institutional deprivation from abroad. Unfortunately, the growing appreciation of the high level of needs of these children and families has not been matched by an accumulation of knowledge about the nature of the attachment-related disturbances they exhibit or strategies for intervention. Thus, there are, for example, more review papers and chapters on the topic of attachment disorders than there are empirical papers. Moreover, extant clinical investigations of attachment disorders expose substantial differences among professionals in how the phenomena are defined and what clinical interventions might be useful. This state of affairs is confusing to parents and professionals and has severely hampered progress in understanding attachment disorders. Although many features of attachment disorders remain unresolved, it is in the area of assessment and intervention that there is the greatest uncertainty and controversy. Accordingly, these areas are the focus of this special issue. The aims of this target article are to review the current state of knowledge in the areas of assessment and intervention and to propose recommendations to guide further work. Several general reviews of attachment disorder are available elsewhere (O'Connor, 2002; Zeanah, Boris, & Lieberman, 2000). Given the inconsistencies in terminology used to date, some clarifications are needed at the outset of this paper. We use 'attachment disorder' when referring to a Correspondence to: Thomas G. O'Connor, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642, USA. Email: tom_oconnor@urmc.rochester.edu Attachment & Human Development ISSN 1461-6734 print/1469-2988 online 2003 Taylor & Francis Ltd http://www.tandf.co.uk/journals DOI: 10.1080/14616730310001593974