Change in caregiver can only be contemplated if there is near certainty that it is not possible to enhance the original caregiver's sensitivity sufficiently to meet the child's needs, within the timescale of the child. As O'Connor and Zeanah state, 'there is no intervention more radical than adoption' (2003, p.225).
The review of studies by Rushton and Mayes presents evidence from a number of studies concerning the efficacy of a change in caregiver.
childhood: a research update'
In this paper, Rushton and Mayes review research concerning the development of the relationship between older, later-placed maltreated children and their new parents. In their introduction, the authors caution against the overuse of the diagnosis of reactive attachment disorder in explaining the difficulties of these children. 'However, we need to be careful that a wide range of adjustment difficulties are not carelessly ascribed to the attachment process when they could be the result of numerous other experiences and adversities' (p.121). The authors point out that they found no published studies of older children where attachment was assessed directly through interviews, observation or testing of the child. Thus, all the studies reviewed examined attachment through indirect assessment.
Ten studies were reviewed. From the early 1970s to the mid-1980s only four follow-up studies examined attachment relationships. All reported high rates of successful adoption as indicated by (1) a high rate of parental satisfac-