Autism and attachment

Dr. Bram Sizoo (The Netherlands)

Autism spectrum disorders (ASD) are developmental conditions that are diagnosed in childhood with presenting problems in areas of social communication and social interaction, and restricted, repetitive patterns of behavior, interests, or activities. Despite the prevalence of 1% of ASD, little is known of the origins. It is clear however, that a multi-genetic component underlies the high heritability of ASD. This hereditary vulnerability for ASD interacts with environmental influences, and can become manifest as a clinically significant problem, One of the early signs of ASD is that young children seem less attracted to biological movement, compared to children without ASD. This lack of innate interest in ‘the other’ has a negative influence on the development of inter subjectivity, like joint attention. This, in turn, causes delays in learning processes in different modalities (verbal, motor, sensory, etc.). In other words, children born with a proneness for ASD seem impaired in how they relate to their environment. Despite the expected attachment problems, it appears that 53% of the children with ASD develops secure attachment, although to a lesser extend than children without ASD (Rutgers et al. , 2004). A lack of responsiveness of parents can also contribute to children (with or without ASD) developing an  insecure attachment style. This can be the case when parents have ASD, are insecurely attached, or have other psychopathological impairments.

In this presentation, the literature on ASD and attachment will be reviewed, as well as a hypothetical etiological model in which both attachment and ASD are involved. The relevance of bonding in people with ASD fort the developmental path will  be illustrated with case histories and video material.

Bram Sizoo was born in 1961. He followed secondary school in London and Hilversum. Hetworked from 1979 for 10 years as a naval officer in the submarine service of the royal Netherlands navy. Between 1989 and 1994 he obtained master degrees in law and medicine at the Free University in Amsterdam. From 1999 to 2003 he was director of Mulanje Mission Hospital in Malawi, where he worked as a tropical doctor with his wife. In 2008 he completed his training as a psychiatrist in Zwolle. In 2010 he obtained his PhD on the thesis “Developmental Disorders and Substance Use Disorder; a phenotypical, endophenotypicaland genetic exploration”. Bram Sizoo is board member of CASS18+, a national organization for clinicians in the field of autism in adults. He is head of the specialist Center for Developmental Disorders within Dimence, a mental health institution in the East of the Netherlands. Apart from clinical work, he is active in several scientific research projects. BramSizoo is married and has three sons.