Revisão sistemática da representação e do transtorno de apego em crianças que vivenciam cuidado substituto

Abstract

Although there is a large number of studies that conduct research on attachment in institutions, little is said about how assessments are conducted in institutions. The investigation of attachment in children living in institutions is fundamental because there are studies that show the variety of consequences to the physical and psychological development resulting from the deprivation of family care. From the understanding of how these constructs are made evident in institutions, it is possible to think of public policies that benefit this population. The present study aims to investigate the literature on how attachment representations and attachment disorders are assessed in children in foster care. A systematic literature review was conducted by means of meta-synthesis. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Articles were searched in PubMed, Science direct and Scopus electronic databases. The descriptors used were: attachment and foster*, attachment and orphan*, attachment and shelter and attachment and instituti*. The papers that fit the inclusion criteria were: full-text, quantitative empirical research articles published in peer-reviewed scientific journals that work with the attachment assessment instruments for children in foster care. Articles published in Portuguese, English, and Spanish were read. The types of studies included were ethnographic, observational (cohort and case-control) and cross-sectional case studies. The studies had to have as participants: children aged zero to twelve years old residing in substitute care settings. The data were synthesized from the thematic synthesis. The 22 articles that comprised the research were worked on in two studies. Study number I used nine articles about attachment representations, and had as main results: inclusion of studies of great relevance in the investigated area, which has a topical character and a strong theoretical base; the evaluations restricted adaptations for the context of substitute care, which correspond to the modification of the term father/mother for " caregiver"; important gaps are perceived in these evaluations as to how the child's reference caregiver is delimited; there is an absence of data regarding the children's attachment representations at the moment of arrival to the institutional environment, which makes it difficult to infer that the manifested attachment representation is a consequence of the experience of substitute care; the studies respect the guidelines of the instruments used in their implementation; several factors influence children's attachment representations, from individual issues to factors of their institutionalization process; and several aspects of child development are interrelated to their attachment representations. In Study II, 13 articles about attachment disorders, which had as main results articles from studies of great relevance and representation were included in the present review; the studies have methodological strength, especially those derived from the BEIP, which present longitudinal data; few studies make use of a control group to ensure comparability; the evaluations were mostly carried out respecting the instruments' guidelines; only two instruments used report adaptation to the substitute care context; only three studies define a way to determine the reference caregiver; only three studies used more than one instrument methodology to assess the attachment disorder; many variables are associated with attachment disorders, from personal characteristics to factors associated with the institutionalization process; and many aspects of child development are associated with attachment disorders. Using the data from the present review to analyze the national context, one can notice both the need to expand the studies on attachment in substitute care environments and the relevance of working on public policies to expand foster family services in Brazil, which were pointed out as having greater developmental potential for children when compared to group institutions. We conclude that the present review adds important data, both in relation to attachment theory and in relation to attachment disorders. These are distinct concepts, but with an important aspect in common, their influence on the child's developmental aspects, especially for those who experience substitute care. It is also understood that the present review introduces important insights for the evaluation of children who experience substitute care, which is important for future research, but also for the clinical and social fields, which have a strong relationship with the theories presented here.