Revue de littérature sur la qualité d’attachement des enfants avec un trouble du spectre de l’autisme avec ou sans une déficience intellectuelle associée

Objectives

The purpose of this study is to conduct a systematic review of studies conducted on autism spectrum disorder (ASD) and attachment. We explore the possibility for children with ASD to establish a secure attachment relationship with their caregiver compared to neurotypical children. Given the current knowledge on ASD and attachment, we expect that ASD is a vulnerability factor in the construction of secure attachment. We also hypothesize that the presence of an associated intellectual disability potentiates the risks for children with ASD to develop insecure attachment compared to children with ASD without associated intellectual disability.

Method

We identified on the following databases, PsycInfo, Pubmed, Francis, and Pascal, studies on attachment types in individuals with ASD. Twenty-three articles were selected for our analysis.

Results

Their analysis shows that, overall, children with ASD seem to be more likely to develop an insecure type of attachment. There is an over-representation of the disorganized/disoriented type reinforced by the presence of an intellectual disability. However, the risk of developing an insecure attachment is not verified in the whole corpus and these observations are not always scientifically valid (sometimes, there are no inferential statistics because too few subjects; sometimes the results are not statistically significant). Furthermore, we were able to highlight a strong heterogeneity in the indices used in the studies (e.g., characteristics of the population included or measures of attachment), which may bias the interpretation of these studies or at least make them impossible to generalize.

Conclusion

Further research is needed to define the study population more rigorously in order to minimize bias in the research (language level, intellectual efficiency, theory of mind, presence or absence of comorbidities, etc.). Future work should allow us to better understand the links between ASD and attachment fragility, which seem to us to be more complex and multifactorial than what the first studies were able to put forward.