Awhile back, Pat Johnston mentioned the “big issue” unfolding with the organization ATTACh, and their recently released Position Statement and “White Paper”. Pat wanted to know what I thought about it all. After listening to all that occurred last week, I guess now is the time to start commenting. I will do my best to be a reporter of what I heard and saw last week, and interject as little as possible about my views, at least in the beginning.


To understand what the buzz is about, you must first understand the APSAC report.


APSAC is the American Professional Society on the Abuse of Children. Within the last year, they released a report that was an indictment of attachment therapy. One of the ATTACh board members participated on the committee that wrote the report. It is the opinion of ATTACh that the report, while not a document favorable to the attachment community, would have been far more deleterious if an ATTACh member had not participated.


In the report, certain people and methods were specifically named and discredited. ADN received a nod in a reference to “horses and zebras.” The following is a quote from the report:

Just as it is important not to miss the presence of an uncommon condition in a child, it also is important not to diagnose an uncommon and dramatic disorder when the diagnosis of a common but less exciting disorder is more appropriate. Although more common diagnoses, such as attention-deficit/ hyperactivity disorder (ADHD), conduct disorder, PTSD, or adjustment disorder may be less exciting, they should be considered as first-line diagnoses before contemplating any rare condition, such as RAD or an unspecified attachment disorder. The standard diagnostic aphorism that “when you hear hoof beats, think horses, not zebras” is important to bear in mind for a number of reasons. First, more prevalent conditions are less likely than rare conditions to be misdiagnosed; their criteria are better established and agreed on, sound assessment procedures are more widely available, and classification accuracy is always higher with more prevalent (i.e., higher base rate) conditions. Second, the appropriate intervention for a common disorder is likely to be different from that for an uncommon disorder. Finally, there are richer literatures and better established evidenced-based treatments for more common conditions. For example, scientifically well-supported and effective treatments exist for ADHD, oppositional-defiant disorder, and PTSD (Kazdin, 2002).

Lots more coming...