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News — An accurate diagnosis is essential to providing the right psychiatric care to young children, say Tulane University child psychiatrists, but children often are misdiagnosed and may be subjected to ineffective or dangerous treatments. Tulane researchers have published results from the first study to intensively examine high-risk young children and to look at how reliable and valid diagnosis of an attachment disorder might be. The study is in the May issue of Journal of the American Academy of Child & Adolescent Psychiatry.

"There have been ahandful deaths of young children nationally who were allegedly being treated for what were thought to be attachment disorders. This terrible outcome is because there is little research on how early disruptions in high-risk preschool children's lives impact their behavior over time, so the diagnosis and resulting treatment plan may not be correct," says child psychiatrist Neil Boris of the Tulane Institute for Infant and Early Childhood Mental Health.

Attachment disorders are thought to occur when an infant or young toddler does not receive appropriate emotional and physical care from a primary caretaker. Failing to create a secure attachment as an infant may result in later problems with psychological development and relationships. According to Boris, attachment disorders are diagnosed in small children by mental health professionals despite little research on this type of mental health condition. In rare cases, treatments are then recommended that may harm children.

In order to assess the effectiveness of the way in which children are diagnosed, Boris and his research colleagues observed the diagnosis of 20 or more children aged 18 to 48 months and their primary caregivers from a treatment team for maltreated young children (20), a homeless shelter (25), and Head Start centers (24).

According to the researchers, all but one type of attachment disorder could be identified reliably using current standards. Children from the maltreatment group were significantly more likely to meet criteria for one or more attachment disorders than children from the other groups. Children classified as having disorganized attachment were not more likely to receive an attachment disorder diagnosis.

"We are good at diagnosing the extremes," says Boris, "it's the kids who fall into the grey middle ground of attachment disorders who may not be diagnosed accurately. We need to do more research to better understand attachment disorders and create appropriate interventions."