One of the problems the Tuning members encountered in discussing approaches to teaching, learning and assessment on a European-wide scale was that every country, and even institution, has its own peculiarities and features deeply grounded in its national and regional culture.
Each has its own written and unwritten rules about how to prepare students best for society. On commencement of a mapping exercise on the approaches currently in use or planned in different national systems or individual universities, it became clear that each has developed its own mix of techniques and kinds of learning environments, all of which are well founded, but which need to be mutually understood.
It may be the case that the same name is given to different methods e. Tuning has seen it as one of its tasks to create more clarity with regard to the issue of definitions and their understanding in practice. A comprehensive list of terms and their translations into to all European languages is being developed and this glossary will be published on the Tuning website at the end of A wide range of teaching techniques is used in universities.
The set of teaching techniques strongly depends on the instructional form of education face to face education, education by correspondence or distance education. Apart from the ubiquitous lecture, the consultation revealed the following list which is far from exhaustive. Such lists are indicative only, and are really a list of categories of teaching activity, since how each is undertaken may vary widely not only between academics but within the everyday practice of any one academic, depending on the focus of the teaching and the intended learning outcomes for the students.
The lecture itself can vary immensely in format and function. At another extreme, the students will have read the notes before the lecture on the intranet, and will participate in a presentation that fleshes out the notes supplemented by interesting examples provided by both lecturer and possibly also by students from their reading. The scope or function can also be quite different.
A lecture introducing a new topic may provide an overview so that students can quickly become aware of who are the key players in this aspect of a field, how it has developed, and where current concerns are focussed. But not all lectures deal with broad scopes: one might, for example, use a lecture to fully explicate some key but complex concept, engaging students in some small group or individual problems at different points. Thus it is with all of the teaching techniques. The mere label is handy, but it does not tell exactly what the lecturer does. One way of gaining some insights into the teaching techniques used is to look at what learning activities students are also required to do in a programme or part of a programme of study.
As with teaching, learning activities called by the same name can differ quite widely. Apart from attending lectures participating in lectures or reading books and journals, the following inevitably partial list of commonly used learning activities gives some idea of the richness that is possible in aligned teaching and learning. To complete the cycle of learning one must also look at how students' achievement of learning outcomes is assessed. Assessment is not just the rounding off of the teaching and learning period but to a large extent a central steering element in those processes, and directly linked to learning outcomes.
At one time, in some countries the oral examination was the most used method of assessment, while in others it was the essay. In a number of countries even today the essay remains a commonly used mode s of assessment. There is nothing wrong with essays as such, as long as the task set is appropriate to the unit of study and to its intended learning outcomes, and the lecturer has the time to mark them promptly and provide written feedback which is constructive and focussed.
Nevertheless, the long written paper is only one of the options that the busy lecturer has at his or her disposal, and the main competence assessed is the ability to research and write such papers in the appropriate genre: useful academic skills, but not the only ones students need to develop and demonstrate the ability to perform. Most programmes described in Tuning use a range of modes of assessment at different points in the programme. Coursework assignments, which may be formally assessed and graded - or not - assess student performance as the programme or part of it progresses.
These may include the following, but again this is not an exhaustive list, merely that which arose from the Tuning work. Central to all of these ways of assessing student work during a programme is feedback. The assessment is said to be formative , because the students learn by doing the work and then having the lecturer comment on how well they have achieved it, where they have done less well, how to improve, and what steps might be taken to do this.
To further enable students to achieve the task successfully it is increasingly the case that students are given the criteria for success at the outset: a specification of what they have to do in order to complete the task satisfactorily. Of course, in any programme of study, or parts of it, there is a need for summative assessment. Sometimes the coursework discussed above performs both a formative and a summative function. The grade given is the summation of the student's achievement in that element, and the feedback from lecturer — and sometimes peers as well — is the formative part.
Traditionally, however, and still commonly used for a variety of reasons, there are some forms of assessment which are usually only summative: they assess achievement at the end of a programme or part of it, and students may receive only their mark or grade which does have its formative aspect! If the examination has a follow-up seminar or tutorial to discuss the results it then contains a greater amount of the formative function. Some form of invigilated examination is the usual format for summative assessment; this may be written or oral. Written examinations have the virtue of cheapness and security: a large cohort can be examined at the same time, while oral examinations can probe a student's learning in ways that a written format normally does not allow.
Written examinations can take a wide range of formats, including the following short list of common ones. Oral examinations can also have a wide range of formats, within the following two categories. It goes without saying that almost any form of assessment can have a diagnostic function for both student and lecturer. By seeing what has not been achieved, what has been achieved with little effort, what is excellent, and so on, both the teacher and the learner know where more work is needed or where effort can be diverted.
So far, the project based dissertation or thesis has not been mentioned. This is an example of a complex mode of assessment, widely used across Europe in every subject area, and in all degree cycles in varying levels of complexity, and with different purposes at each level. The thesis is a summative assessment of a programme or substantial part of a programme, demanding the demonstration of a range of competences and understanding.
It is also strongly formative in that it is normally prepared under the supervision of a lecturer, who advises the student on the work, and certainly provides feedback at different stages of its development. The summative examination may be oral or written i. At doctoral level the final examination of the thesis is always by an oral examination the defence of the thesis , although the format of this may vary quite widely from country to country, but in the lower two cycles assessment of projects and dissertations may be based on the student's written document alone.
In many institutions guidelines and requirements have been developed for the assessment of learning at different programme levels, as well as for preparing final theses. In particular, it is becoming the norm to publish the criteria for success in assignments, something which should be universal. Many Tuning members reported that their departments were instituting procedures for fair assessment. European wide guidelines 1 are now emerging, which say, for example,. Finally, when discussing assessment issues across different cultures, it is important to probe the different ideas about what should be taken into account in assessment vary.
For example some systems prize hard work, others high achievement, others high potential. The Tuning II consultation. Each academic involved in the project was asked to reflect on a given number of subject-specific and generic competences and to identify ideas and best practices to develop these competences in a degree programme in terms of learning activities, teaching, and assessment.
They were asked to find answers to the following five questions:. Tuning members followed different strategies to find reliable answers, including consultation with colleagues in their home institutions.
Most subject groups identified possible strategies either based on ideas or real experience. While some reported actual practices, others described how current good practices could be linked to new concepts of competences, and so reported on future possibilities rather than on present practice. Across Europe , it is clear that there are two main ways of teaching or enhancing generic competences. In this respect one could think of, for example, academic writing and oral skills and ICT-competences.
The second way is for generic competences to be developed as part of or integrated into subject programmes and modules. Through the consultation process it became clear that it is possible to foster generic competences while teaching normal subject area material if there is awareness of the need to do so and if teaching strategies are designed taking generic competences into account. In general, since different approaches to learning, teaching and assessment tend to form or enhance different generic competences, Tuning members underlined the requirement that each student experience a variety of methods.
The consultation process on generic competences. Further aims are to see how they are perceived by or, possibly, what their importance is for students and to investigate whether there are teaching learning methods used in some disciplinary areas, or in some countries or in some institutions which can usefully be proposed as models of good practice or which can be of interest more generally in developing new insights into competence-based curriculum design and delivery.
It is striking to see how differently some generic competences have been understood in the context of the various subject area groups. Sometimes strong differences can be noted between different national traditions within a single subject area; however it is more common to observe strong differences in perception and methods between different subject areas. It seems clear from an examination of the answers gathered that generic competences are always interpreted in the light of the disciplinary area. Even in cases in which the graduates or a relevant number of them will almost certainly be expected to work in areas not directly related to the subject in which they will receive a degree, the academics' perception of the generic competences remains quite tightly tied to the subject area disciplines themselves.
The first consequence of this observation is that in practice the generic competences do not appear to be rigidly separate from the subject specific competences. Rather they appear as further variations to be considered within the range of the subject specific competences. An additional consequence is that for each generic competence a distinction must be made between disciplinary areas in which the competence is considered important or even fundamental, a priority for the discipline, and those in which its connection with the subject area is less clear.
The consultation focussed on a selection of the thirty generic competences identified by the Tuning project. From these eight were selected for discussion in this paper:. No clear-cut definition of the capacity emerged from the consultation but it was evident that the Subject Area Groups SAGs defined analysis and synthesis in a very wide sense. The Business Studies SAG listed among others the elements of identifying the right research question or problem, the ability to describe as well as to conclude and formulate recommendations as indicators.
The Education SAG also took into account the reflective ability of a student and the ways in which this demonstrates the capacity for description, analysis and synthesis. If not, students should find out what they could use from past experience and start there to develop new approaches to solving the problem. Other SAGs defined analysis in a way which seems to comprise all these indicators as activities, i. It demands logical thinking, using the key assumptions of the relevant subject area and even the development of this area further by research.
In no SAG was the acquisition of this skill taught in a separate element or module, i. This view was also supported by the perceptions of students. Data collected from students showed that they attached great importance to this competence as it enabled them to relate theory and practice, evaluate findings logically and use instruments to find out alternative ways; they perceived it as being highly pertinent to their future professional career.
For the description of the competence a large number of expressions were used: to interpret, to find the main points, to understand, to evaluate, to deal with information, to evaluate critically, to marry theory and practice, to organise information, to understand, to place in context, to develop objectivity, to combine, to research, to formulate, not just reproduce, to apply, to describe, to conclude, to think, to compare, to select, to differentiate, to contrast, to break down, to summarise, to argue, to relate, to generalise, to think logically, to think rationally, to appreciate, to consider, to predict, to provide, to solve.
This wide definition is essential as it relates directly to the teaching and learning activities which enable students to achieve this competence. It is highlighted that the competence is directly related to the ability to solve problems, another highly ranked generic competence. It was reported that students develop the capacity for analysis and synthesis through. Assessment of the extent to which this competence has been achieved varies according to the way in which it has been developed.
In some SAGs this was done partly through group meetings and discussion sessions. The assessment can also be based on how students analysed material or information. In the Education SAG a variety of modes of assessment were identified: discussion, questioning, observation, evidence of personal and professional engagement, supervision of reports, active participation in placements, essays, assignments, projects, examinations, theses. Students may also contribute to their assessment by submitting or presenting a "self-evaluation" at the end of the semester.
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Feedback is organised through group discussions or individually, whether in writing or face-to-face. SAGs also highlight that students identified a number of ways by which they would know if they had achieved this competence, such as. In most cases, however, it is described as the ability to perform specific academic tasks, which may vary according to the discipline. In initial teacher education there is a clear projection into the future teaching profession. In the second cycle this competence is often described in more professional terms, and may be more closely associated with activities to be performed in the workplace such as collecting information from diverse sources and writing a report on a complex issue.
The different teaching methods used to help the students achieve this competence reflect different approaches to practice. Accordingly, the opportunities for practice provided inside and outside the institution are described differently in the various disciplines, as exercises of various types, practical classes, lecture sessions, seminars, field classes, laboratory sessions, industrial projects, industrial placements, study visits, field excursions, student teaching practice.
Some disciplines suggest that this competence can be best developed by doing a project or writing a thesis. Others, like Business Studies, Chemistry, Mathematics and Education emphasise the need to provide appropriate tools and methods as well as opportunities for problem solving. The Education group emphasises the importance of reflection on work done. Earth Science Geology reported the centrality of this competence to the development of subject knowledge. Sometimes the learning activities intended to develop this competence are carried out in connection with the world of work. In Physics, Chemistry, Business Studies among other subjects final year projects can be carried out partially or totally in an industrial environment, and in Nursing and Education there is a substantial practical component.
Learning activities for this competence may also be carried out within the academic learning environment, performed by whole classes, small groups and individual students. I t is traditional in Earth Science to have students undertake a mapping thesis involving some six weeks applying their knowledge in the field working either autonomously or in a small group, usually with limited supervision. The resultant report on this independent work can comprise a significant component of the final exam and is considered extremely important by employers. Continuous assessment of progress is based on seminars, exercises of increasing complexity, laboratory work, short oral presentations, teaching practice, assignments, regular meetings with the teacher for evaluation and feedback on the project.
For some courses, only a part of the marks are given for coursework, in other cases coursework completely replaces the traditional examination. This may be particularly true in the second cycle.
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This competence can be assessed through the essay format provided that the task set is clear and well constructed. A three part model for a task might include a requirement to outline the theoretical bases of the issue; a requirement to outline relevant issues to do with implementation in practice; and illustrations of how this is done, or would be done, in the working context of the candidate. It would not examine content knowledge very efficiently, since the topic would be too large to deal with, and there might even be a danger of plagiarism, or at least over reliance on the source materials.
Generally students understand whether or to what degree they have achieved this competence from the feedback they get from the teachers, either on progress made during the course or on their final products and exams. This general competence is the one most obviously linked to the single subject areas. Hence in the abstract one might expect that the ways of forming this competence would be different for each area, tightly linked to the specificities of the subject. In practice this is not entirely the case. Basic general knowledge is perceived as having three aspects: the first, the basic facts ; and second the basic attitude considered specific to the subject area.
The third aspect is constituted by related or necessary general knowledge which is not strictly subject specific: e. Little space is given in the reports to considering whether the basic general knowledge of the subject at first cycle level might in some cases and to some degree be acquired in school or previous to the higher education experience, and hence be assessed at entry and integrated or completed during the higher education experience in a selective way. Normally for first cycle study universities are very familiar with the school curriculum and have a good idea of what is covered, particularly in the pre-university period.
However, in Physics, the subject area group states that the maths knowledge and capabilities obtained in upper school are evaluated at entry in higher education. Another exception is Education, where mature students wishing to enter a teacher education programme may present a portfolio of evidence to show that their qualifications both formal and non-formal are appropriate for entry. Basic general knowledge for most subject areas is learned through lectures, reading, discussions, library and Internet searches and assessment through written or oral examination.
Discussion of papers, exam results or discussion during the oral examination is thought to make students aware of whether their basic general subject knowledge is adequate. Great effort does not seem to be put into thought and reflection about this aspect of learning; it is accepted by all concerned as necessary, largely a matter of factual and conceptual knowledge. Naturally the pan-European context of Tuning shows that in some subject areas the content of this basic general subject knowledge varies quite radically from country to country, although in others there seems to be relatively little difference.
However, in most subject areas there is general agreement about the core subject knowledge of first cycle degrees. It is more complicated to develop or foster the other component of basic general knowledge, the mindset of the discipline, its values, and its methodological or even ethical base. However here a number of strategies were mentioned by the SAGs. Some aspects rigour of analysis, ethical values and intellectual standards are discussed in lecture courses, and presumably are criteria for success in assignments.
The objective in this case is to tell students what the standards and the values of the subject area are. Students also acquire the mindset of the subject area through their reading, where they constantly see models of how their subject community thinks; they will also gradually see how the different schools within the subject community think and what their attitudes are.
In the subject areas that have discussed this general competence, we find that the mindset or attitude, intellectual and ethical values considered fundamental to the subject are also thought to be encouraged by hands-on learning experiences, such as laboratory work in physics or experience in analysis of historical documents in history, preparation of oral presentations, reports and posters in education. Information management skills ability to retrieve and analyse information from different sources. This competence is fairly uniformly understood to mean knowing how to find information in the literature, how to distinguish between primary and secondary sources or literature, how to use the library — in a traditional way or electronically — how to find information on the Internet.
One subject area, history, devotes much specific attention to the various kinds of sources of information and techniques for accessing them and interpreting them indicating archival documents, papyrus, archaeological materials, secondary sources, oral history and so forth as well as to the more usual kinds of information listed by the other subject areas.
In this particular subject area a variety of activities, lectures, workshops, site visits, group and individual work including final research dissertations are seen as connected to this general competence. In all subject areas there are specific teaching-learning activities devoted to learning library skills. Some of these activities may organised in conjunction with the library staff and have the form of visits to the library or library workshops. Retrieval of information from the Internet and its critical evaluation may be demonstrated in a lecture context with multi-medial support, followed by assignments of student tasks and evaluation of the results.
Information retrieval skills are seen as progressive: in one report it is mentioned that in the beginning of the higher education experience students are encouraged to use reference books to supplement the information they receive from lectures, whereas by the time students complete their studies, they should have brought their library and other information retrieval skills up to research level.
In history, the student is required to read and analyse documents of various kinds and to contextualise them using the bibliography and published sources. Such exercises will be more or less elaborate and more or less original according to level of study. In earth science students are asked to organise presentations, written or oral, of the material collected and to show that they have interpreted it properly using the relevant literature.
Feedback on students' efforts is perceived as particularly important for this competence, and is in the form of written or oral comments on student work. On the basis of the reports it seems that the subject areas have a clear perception of the importance of this competence and that it is developed and assessed — to varying degrees of complexity and characteristics that are determined by the subject area — in all disciplinary studies.
This competence is seen as central to three subject areas, Education, Nursing and Business Studies, all of which in one way or another provide specific activities to develop what is perceived as an important competence for the subject area as well as an important general competence. For the other subject areas, this competence is perceived as useful or necessary for survival, citizenship and employment, but not subject related — and according to some reports not even very important. In Business Studies the means mentioned for developing these skills are group work, presentations, specific lectures, training-coaching course.
A specific kind of activity is a computer-based Business Studies game in which groups of students must act out realistic business scenarios, working in groups and dealing with issues of group dynamics, time management, decision making and so forth. Nonetheless, it is stated that except for the actual performance in such activities, there is little knowledge of how to evaluate and assess interpersonal skills and that this competence needs further work.
In Education and Nursing, the interpersonal skills cluster of competences is at the centre of reflection. In fact, in a very meaningful sense, for many graduates of Education and Nursing their work is an entirely interpersonal activity. In Nursing particular communication aspects are key skills, such as presencing, observation, listening, asking questions, non-verbal communication, ability to have conversations with different groups of interlocutors, leading and participating in meetings.
These skills are often contextualized in written practices, including, for example, preparing written health promotion materials for different audiences. In Education, there also is a great awareness of the different aspects that this competence has. Interpersonal skills are defined as including not only the ability to work in a group, to present one's projects effectively and possibly to develop leadership skills — here emphasis is placed on the dialogic nature of interpersonal skills and of the teaching-learning process.
There was, however, no evidence of unresolved loss or trauma. It was only when her transcribed discourse was analyzed very carefully that the absence of a coherent perspective became apparent. In common language, this means that Benjamin was disoriented with a dismissed lack of resolution regarding spousal trauma to his mother, in a context of a mixed compulsive Type A and obsessive C strategy that contained developmentally incomplete elements of both an externally assembled self A8 and also a wished-for angry and self-sufficient self C5.
The mere complexity of this statement suggests the confusion with which Benjamin tried to cope. A8 is characterized by borrowed discourse e. That is, Benjamin did not have a perspective of his own in speech, thoughts, or episodic recall; all of these were borrowed from adults, usually his mother.
Neither, however, was he present in his sentences i. The episodes themselves frequently described deceit, but in an open manner. His images were sometimes somatic, both arousing Type C and unconnected to any person Type A , frequently about stomach pain and sometimes descriptive of mangled objects like bicycles that evoked fear — but only in manner that is displaced from himself possible unresolved trauma. The frequently mentioned non-specific feelings of sadness and worrying did not describe Benjamin himself, but were, instead, attributed to his mother.
Although Benjamin did not describe his feelings verbally, his voice varied dramatically from a tiny child-like voice to emphatic, emotional, and questioning. In addition, he sniffed, coughed and exhaled loudly repeatedly, all of which indicated high arousal Type C. On the other hand, he combined idealization and positive wrap-ups Type A with confusing discourse that erroneously connected unconnected events Type C. The last of these indicated that Benjamin did not understand accurately the causal relations that affected his life.
Nevertheless he made substantial logical errors and had difficulty keeping to the topic. In the end, we cannot tell whose perspective was being taken, i. The aims of this case study were to identify the attachment patterns of a child diagnosed with ADHD and of his mother and to consider their relevance to ADHD.
According to Ladnier and Massanari , children with ADHD typically have grown up in families that share three debilitating characteristics: 1 the absence of a healthy relationship between two caring adults; 2 a pattern of exposure to yelling, criticism, sarcasm, and violence; and 3 parenting that lacked respect, discipline, structure and consistency. All of this was true for Benjamin. We expected that such early experiences could lead to a self-protective strategy characterized by 1 heightened arousal, 2 quick response i.
In some cases, these might function to increase the predictable and protective response of parents, thereby, being atypical, but adaptive. This was the situation for Benjamin and his mother. This probably caused Benjamin to become anxious, behaving in symptomatic ways which, in turn, further upset his mother. Neither Benjamin nor his mother could disentangle this cycle of anxious arousal, nor could they accurately attribute feelings and actions to their proper sources. Important aspects of this interpretation are that Benjamin experienced no direct traumas, and his mother tried her best to care for him.
Nevertheless her arousal affected him, and together they created a dyadic system of escalating distress and increasing confusion regarding its cause. Confusion about the sources of information is the defining feature of disorientation in the DMM. This often results in information from incompatible sources being treated as equally self-relevant in the present. The sources include both the self and others and also present and past perspectives, all conglomerated without indication of personal or temporal specificity. Needless to say, these representations are self-relevant to attachment figures, but inappropriate to the child.
In the same way, self-relevant representations generated at different times and for different contexts are all treated as self-relevant in the current context. Put another way, too little is excluded as irrelevant to the self in the present. This results in diffuse, misdirected, and contradictory behavior. In SAAs and AAIs, disorientation can be seen as both disconnection across related parts of the interview and also misconnection of unrelated events and perspectives.
That is, individuals both miss relevant causal connections and also find causal connections where there are none. Similarly, there are often self-orienting intrusions requests for reorientation by the interviewer or self-talk that the individual seems both unable to control and unable to use. Attention deficit is the inability to differentiate between relevant and irrelevant stimuli and is crucial to diagnosing ADHD.
Children with ADHD easily become distracted, struggle to stay focused, and keep very few things out of awareness. Everything seems immediately relevant to them. This clearly parallels the description of disoriented attachment. The question becomes whether the notion of non-strategic disorientation in a family context adds to our understanding of ADHD and, if so, whether it offers new approaches to prevention or treatment.
A major roadblock to studying the relation of attachment to ADHD has been the lack of a fine-tuned assessment suitable for 6—12 year old children. The SAA now makes it possible to assess attachment in school-age children, thus permitting exploration of how attachment relationships and interaction with primary caregivers may contribute to the troubling symptoms.
Full validation of attachment assessments for school-aged children is sorely needed. Finding a similar attachment pattern in both mother and son was not unexpected.
This raises the question of whether the Benjamin would have had a disoriented attachment pattern even if there had been no family disruptions. Every parent intends the best for their child. Knowing the nature of that contribution is the best way to reduce its negative impact. Parents of children with ADHD often complain of power struggles and difficult parent—child relationships.
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Treatment, however, is usually focused on the child. If treatment planning were based on attachment theory, therapists would consider the functioning of all family members. Until then, medication might help more than psychotherapy. His partial A8 suggests that he is beginning to rely on professionals, rather than his mother, to organize his thinking about himself. This is an unfortunate outcome that should be avoided. These ideas are conjectures, not prescriptions. They are important because they change the focus of treatment from symptom reduction to strategic adaptation and the need for children to feel that their home is safe and comforting.
To be able to assist their children to change, parents need to understand their own concerns and strategies for coping, i. Case studies are limited to generating hypotheses that can be tested by appropriately controlled group designs. Moreover, having data at only one time period cannot address causation. It might be that biological vulnerability would have brought on the symptoms of ADHD regardless of the bonding break — or the reverse, that biological vulnerability was not necessary in the context of a boding break and a disoriented attachment figure. Moreover, only prospective, longitudinal studies can test the direction of effects and determine which factors are necessary or even sufficient to cause ADHD.
In addition, many children outgrow their ADHD symptoms when they reach adulthood. Longitudinal studies can determine whether those who improve also change attachment pattern, thus making change in strategy a possible explanation for symptom reduction. Another serious limitation to a case study design is that generalization of the results to other dyads can only be tentative.
Our case does, however, suggest directions for future research. Specifically, familial contributions to the development of ADHD should be sought, both in terms of disorientation in mothers and children, but also in terms of other possible anomalous strategies. Certainly there would be no reason to expect that one case study would define the range of familial circumstances associated with ADHD. If cross-sectional studies indicated that environmental influence was supported in a substantive proportion of cases, longitudinal studies should be undertaken.
In addition, the contribution of fathers should be considered; they could provide the moderating influence that reduced or augmented the risk brought by mothers and children. Further, the procedure used for the childhood years, the SAA, still needs validation and psychometric evaluation. But given the serious consequences of treating a considerable and rising percentage of children with psychostimulant medications, as well as the potential usefulness of attachment-informed intervention, these obstacles may be less daunting than they appear, especially if large-scale replication confirms the findings demonstrated here.
In that case, less intensive assessment may prove sufficient to confirm an already expected pattern. In this single case, we explored how a particular form of insecure attachment, disorientation, might contribute to the symptoms of ADHD. The outcome was a self-maintaining cycle of anxiety and miscommunication. Although it is generally agreed that constitutional abnormalities are important in ADHD, evidence of specific etiology is still lacking.
Instead, ADHD cannot yet be affirmed as a disease and retains it status as a disorder, with the lack of definitive diagnostic and etiological definition that that implies. In particular, inclusion of the DMM approach to attachment suggests that some of the symptoms of ADHD may serve a self-protective function in families where children feel unsafe, but cannot directly discern and organize around a specific danger. Ainsworth, M.
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