# Standardised tools for assessing attachment difficulties

Canonical: https://pinnacleblooms.org/ask/which-standardised-tools-are-used-to-assess-attachment-difficulties-in-early-childhood
Publisher: Pinnacle Blooms Network / Bharath Healthcare Laboratories Private Limited

Attachment difficulties in early childhood (ICD-11 6B44) are assessed by combining structured observation and caregiver interview — the Strange Situation Procedure, Attachment Q-Sort, Disturbances of Attachment Interview, Crowell Procedure and story-stem narratives — never a single test. Developmental measurement supports care planning; diagnosis requires an appropriately qualified healthcare professional.

*A pattern of disturbed attachment behaviour is best mapped, never inferred — standardised observation and structured history are what turn a clinical hunch into a measured profile.*

## In short
Attachment difficulties in early childhood (ICD-11 **6B44**) are assessed through a convergence of structured observation, caregiver interview and developmental screening — not a single test. The reference paradigm remains the **Strange Situation Procedure (SSP)** for classifying attachment patterns in 12–20 month olds, complemented by the **Attachment Q-Sort (AQS)** for naturalistic home observation. Clinically, relationship and caregiving context must be captured alongside the child.

## The instruments in practice
- **Strange Situation Procedure (Ainsworth):** the validated laboratory paradigm for classifying secure/insecure and disorganised patterns in infancy.
- **Attachment Q-Sort (Waters):** observer-rated, ecologically valid, suited to home or naturalistic settings up to ~4 years.
- **Disturbances of Attachment Interview (DAI):** semi-structured caregiver interview screening for reactive attachment and disinhibited social engagement features.
- **Crowell Procedure / parent–child interaction assessments:** structured dyadic observation of caregiving and child response.
- **Manchester Child Attachment Story Task / story-stem narratives:** representational measures for preschoolers (~3–8 years).

These map to ICD-11 differentiation between reactive attachment disorder and disinhibited social engagement disorder; sensory, communication and developmental screening should run in parallel to exclude alternative explanations.

## The Pinnacle way
A clinical **AbilityScore®** and any diagnosis are formed only at a Pinnacle Blooms Network centre, under qualified clinician care — these tools inform, never replace, that clinician-administered structured assessment. Explore [Attachment Difficulties](/attachment-difficulties), our [child psychology and behavioural therapy](/child-psychology-therapy) pathway, and [how the AbilityScore is established](/ask/what-is-the-abilityscore-and-how-is-it-calculated).

## Trusted sources
WHO ICD-11 (6B44); AAP and ASHA developmental guidance on early relational health; NICE guidance on children's attachment.

**Next step —** Partner with a Pinnacle clinician to combine these tools into one measured baseline. [Begin the assessment pathway](https://www.pinnacleblooms.org/enroll-autism-speech-aba-therapies-india).

This is general information, not a diagnosis — individual assessment and diagnosis require an appropriately qualified healthcare professional.

## Sources
- WHO ICD-11 — Attachment difficulties: https://icd.who.int/
- NICE — children's attachment guidance: https://www.nice.org.uk/
- AAP — early relational health: https://www.aap.org/

## Connected topics and perspectives
- Conditions: https://pinnacleblooms.org/ask/conditions
- Therapist: https://pinnacleblooms.org/ask/lens/stakeholder/therapist
- Emotional: https://pinnacleblooms.org/ask/lens/domain/emotional
- Assessment: https://pinnacleblooms.org/ask/lens/intent/assessment
- Measure: https://pinnacleblooms.org/ask/lens/lifecycle/measure
- Special Education: https://pinnacleblooms.org/ask/lens/route/special-education
- Early Clarity: https://pinnacleblooms.org/ask/lens/empowerment/early_clarity

## Related question paths

### Understand the subject
- Attachment Difficulties: ICD-11 Features in Early Childhood: https://pinnacleblooms.org/ask/what-is-attachment-difficulties-and-what-are-its-icd-11-features-in-early-childhood
- ICF Functioning Domains Affected by Attachment Difficulties in Early Childhood: https://pinnacleblooms.org/ask/which-icf-functioning-domains-does-attachment-difficulties-affect-in-early-childhood
- How does Attachment Difficulties affect a child's daily life?: https://pinnacleblooms.org/ask/how-does-attachment-difficulties-affect-a-child-s-daily-life
- Is Attachment Difficulties considered a disability?: https://pinnacleblooms.org/ask/is-attachment-difficulties-considered-a-disability
- Is Attachment Difficulties genetic or hereditary?: https://pinnacleblooms.org/ask/is-attachment-difficulties-genetic-or-hereditary
- Common Myths About Attachment Difficulties: https://pinnacleblooms.org/ask/what-are-common-myths-about-attachment-difficulties
- What are the types or levels of Attachment Difficulties?: https://pinnacleblooms.org/ask/what-are-the-types-or-levels-of-attachment-difficulties
- What Causes Attachment Difficulties in Children?: https://pinnacleblooms.org/ask/what-causes-attachment-difficulties-in-children
- Early intervention outcomes for Attachment Difficulties under 7: https://pinnacleblooms.org/ask/what-does-current-research-show-about-early-intervention-outcomes-for-attachment-difficulties-in-children-under-7
- What is Attachment Difficulties?: https://pinnacleblooms.org/ask/what-is-attachment-difficulties
- What Are Attachment Difficulties in Early Childhood?: https://pinnacleblooms.org/ask/what-is-attachment-difficulties-and-what-does-it-look-like-in-early-childhood
- ICD-11 Classification for Attachment Difficulties (6B44): https://pinnacleblooms.org/ask/what-is-the-icd-11-classification-for-attachment-difficulties

### Recognise signs & concerns
- Can Attachment Difficulties be cured?: https://pinnacleblooms.org/ask/can-attachment-difficulties-be-cured
- Can Attachment Difficulties Be Prevented?: https://pinnacleblooms.org/ask/can-attachment-difficulties-be-prevented
- Do boys show attachment difficulties differently?: https://pinnacleblooms.org/ask/do-boys-show-attachment-difficulties-differently
- Do girls show Attachment Difficulties differently?: https://pinnacleblooms.org/ask/do-girls-show-attachment-difficulties-differently
- How a frontline health worker can spot possible attachment difficulties early: https://pinnacleblooms.org/ask/how-can-a-frontline-health-worker-spot-a-child-with-possible-attachment-difficulties-early
- Should I Be Worried About Attachment Difficulties?: https://pinnacleblooms.org/ask/should-i-be-worried-my-child-might-have-attachment-difficulties
- What are the early signs of Attachment Difficulties?: https://pinnacleblooms.org/ask/what-are-the-early-signs-of-attachment-difficulties
- Early Signs of Attachment Difficulties in a 1-Year-Old Boy: https://pinnacleblooms.org/ask/what-are-the-early-signs-of-attachment-difficulties-in-a-1-year-old-boy
- Early Signs of Attachment Difficulties in a 1-Year-Old Girl: https://pinnacleblooms.org/ask/what-are-the-early-signs-of-attachment-difficulties-in-a-1-year-old-girl
- Early Signs of Attachment Difficulties (12–18 Months): https://pinnacleblooms.org/ask/what-are-the-early-signs-of-attachment-difficulties-in-a-12-to-18-month-old
- Early Signs of Attachment Difficulties in an 18–24-Month-Old: https://pinnacleblooms.org/ask/what-are-the-early-signs-of-attachment-difficulties-in-a-18-to-24-month-old
- Early Signs of Attachment Difficulties in a 2-Year-Old: https://pinnacleblooms.org/ask/what-are-the-early-signs-of-attachment-difficulties-in-a-2-year-old

### Explore causes & influences
- Are boys more likely to have attachment difficulties?: https://pinnacleblooms.org/ask/are-boys-more-likely-to-have-attachment-difficulties
- Are girls more likely to have attachment difficulties?: https://pinnacleblooms.org/ask/are-girls-more-likely-to-have-attachment-difficulties
- Early Intervention for Attachment Difficulties & UN Child Rights: https://pinnacleblooms.org/ask/how-does-early-intervention-for-attachment-difficulties-advance-un-child-rights-uncrpd-and-the-sdgs
- Contributing Factors for Attachment Difficulties: https://pinnacleblooms.org/ask/what-are-the-known-contributing-factors-for-attachment-difficulties-in-early-childhood
- What causes Attachment Difficulties in young children?: https://pinnacleblooms.org/ask/what-causes-attachment-difficulties-in-young-children
- Cost-effectiveness of early therapy for attachment difficulties: https://pinnacleblooms.org/ask/what-is-the-cost-effectiveness-of-early-therapy-for-attachment-difficulties-in-young-children
- Attachment Difficulties in India: prevalence and public-health burden: https://pinnacleblooms.org/ask/what-is-the-prevalence-and-public-health-burden-of-attachment-difficulties-among-young-children-in-india

### Understand assessment
- Validated outcome measures for Attachment Difficulties in early childhood: https://pinnacleblooms.org/ask/which-validated-outcome-measures-are-used-to-study-attachment-difficulties-in-early-childhood
- How to Assess and Track Attachment Response: https://pinnacleblooms.org/ask/how-can-a-clinician-assess-and-track-a-child-s-progress-in-learning-to-attachment-response
- How Attachment Is Defined and Measured in Early Childhood Research: https://pinnacleblooms.org/ask/how-is-attachment-defined-and-measured-as-a-developmental-construct-in-early-childhood-research
- How Attachment Difficulties Is Assessed in a Young Child: https://pinnacleblooms.org/ask/how-is-attachment-difficulties-assessed-in-a-young-child
- How AbilityScore Tracks Progress in Attachment Difficulties: https://pinnacleblooms.org/ask/how-does-abilityscore-track-progress-in-a-child-with-attachment-difficulties
- How is Attachment Difficulties assessed in children under 7?: https://pinnacleblooms.org/ask/how-is-attachment-difficulties-assessed-in-children-under-7
- What an AbilityScore of 0–100 Means for Attachment Difficulties: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-0-100-mean-for-a-child-with-attachment-difficulties
- What an AbilityScore of 100–200 Means for Attachment Difficulties: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-100-200-mean-for-a-child-with-attachment-difficulties
- What does an AbilityScore of 200–300 mean for a child with Attachment Difficulties?: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-200-300-mean-for-a-child-with-attachment-difficulties
- AbilityScore 300–400 for Attachment Difficulties: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-300-400-mean-for-a-child-with-attachment-difficulties
- AbilityScore 400–500 in Attachment Difficulties: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-400-500-mean-for-a-child-with-attachment-difficulties
- What an AbilityScore of 500–600 Means for Attachment Difficulties: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-500-600-mean-for-a-child-with-attachment-difficulties

### Explore therapy & support
- How is Attachment Difficulties diagnosed in a child?: https://pinnacleblooms.org/ask/how-is-attachment-difficulties-diagnosed-in-a-child
- How therapy helps a child with attachment difficulties make progress: https://pinnacleblooms.org/ask/how-does-therapy-help-a-child-with-attachment-difficulties-make-progress
- Evidence-Based Therapy Plan for Attachment Difficulties: https://pinnacleblooms.org/ask/what-does-an-evidence-based-therapy-plan-for-a-young-child-with-attachment-difficulties-include
- What therapy goals matter most for a child with Attachment Difficulties?: https://pinnacleblooms.org/ask/what-therapy-goals-matter-most-for-a-child-with-attachment-difficulties
- Which ICHI Interventions Apply to Attachment Difficulties?: https://pinnacleblooms.org/ask/which-ichi-health-interventions-apply-to-attachment-difficulties-in-young-children
- Supporting a Child with Attachment Difficulties Day to Day: https://pinnacleblooms.org/ask/as-a-grandparent-or-caregiver-how-can-i-support-a-child-with-attachment-difficulties-day-to-day
- Can a child with Attachment Difficulties attend a mainstream school?: https://pinnacleblooms.org/ask/can-a-child-with-attachment-difficulties-attend-a-mainstream-school
- Can a Child with Attachment Difficulties Attend a Regular School?: https://pinnacleblooms.org/ask/can-a-child-with-attachment-difficulties-attend-a-regular-school
- Can a Child with Attachment Difficulties Live Independently?: https://pinnacleblooms.org/ask/can-a-child-with-attachment-difficulties-grow-up-to-live-independently
- How a Teacher Can Help a Child with Attachment Difficulties Learn: https://pinnacleblooms.org/ask/how-can-a-classroom-teacher-help-a-child-with-attachment-difficulties-take-part-and-learn
- Identifying and Supporting Under-7s with Attachment Difficulties: https://pinnacleblooms.org/ask/how-can-a-district-early-intervention-programme-identify-and-support-children-under-7-with-attachment-difficulties
- Supporting a Child with Attachment Difficulties in a Mainstream Classroom: https://pinnacleblooms.org/ask/how-can-a-teacher-include-and-support-a-young-child-with-attachment-difficulties-in-a-mainstream-classroom

### At home & in everyday life
- How can I support my child with Attachment Difficulties at home?: https://pinnacleblooms.org/ask/how-can-i-support-my-child-with-attachment-difficulties-at-home