Normal Attachment and Attachment Disorders in the Early Years

1. Normal Attachment and Attachment Disorders in the Early Years Dawn Viers, PhD, Prevention Supervisor Susan Lindsey, BS, Family Resource Specialist Mary Talbert, BS, Family Resource Specialist New River Valley Community Services Blacksburg, VA

3. Attachment Definition Attachment is a profound, reciprocal, physical and emotional relationship between a parent and a child that endures and sets the stage for all future intimate and trusting relationships.

4. Attachment Behavior Definition “Any form of behavior that results in a person attaining or maintaining proximity to some other clearly defined individual who is conceived as better able to cope with the world”

5. Why Is Attachment Important? • Early infant-caregiver attachment sets the stage for the infant’s future intimate and trusting relationships • Development of ability to regulate emotions linked to attachment relationship • Child develops a set of beliefs (“Working Model”) about whether: 1. The attachment figure is capable of respond helpfully in time of need 2. The child is the sort of person to whom the figure might respond

6. It begins early... Center for Evidence Based Practice: Young Children with Challenging Behavior www.challengingbehavior.org

7. Children who are identified as hard to manage at ages 3 and 4 have a high probability (50:50) of continuing to have difficulties into adolescence (Campbell & Ewing, 1990; Egeland et al., 1990; Fischer, Rolf, Hasazi, & Cummings, 1984). Center for Evidence Based Practice: Young Children with Challenging Behavior www.challengingbehavior.org

8. Early Predictors • Temperamental Difficulties • Early Aggression • Language Difficulties • Noncompliance Center for Evidence Based Practice: Young Children with Challenging Behavior www.challengingbehavior.org

9. Family Factors • Maternal Depression • Harsh Parenting • Stressful Family Life Events • Low Social Support • Family Instability Center for Evidence Based Practice: Young Children with Challenging Behavior www.challengingbehavior.org

10. WHAT PREDICTS THE MALADAPTED CHILD? Insecure Attachment + High Family Adversity (maybe) + Ineffective Parenting + Atypical Child Characteristics (temperament, activity level, intelligence, etc)

11. Early appearing aggressive behaviors are the best predictor of juvenile gang membership and violence. (Reid, 1993) Center for Evidence Based Practice: Young Children with Challenging Behavior www.challengingbehavior.org

12. Young Children with Challenging Behavior: • Are rejected by peers • Receive less positive feedback • Do worse in school • Are less likely to be successful in kindergarten Center for Evidence Based Practice: Young Children with Challenging Behavior www.challengingbehavior.org

13. Of the young children who show early signs of problem behavior, it has been estimated that fewer than 10% receive services for these difficulties. (Kazdin & Kendall, 1998) Center for Evidence Based Practice: Young Children with Challenging Behavior www.challengingbehavior.org

14. Child’s Contribution to Attachment • Proximity promoting 0-6 months • Snuggle, mold to body • Smile- very powerful • Cry if leave • Eye contact • “Being” a baby

15. Child’s Contribution to Attachment • Proximity seeking 6-12 months • Cling • Crawl toward • Reach to be picked up • Receive comfort when upset

16. What Parents Do to Promote a Secure Attachment • Adaptations, e.g. child with colic • Behavioral adaptations, e.g. pick up child • Affective state, e.g. diaper change

17. The Concept of Affective Attunement, Mirroring, Matching • Babies are more active and show more proximity promoting behaviors when parents imitate rather than initiate • A dance, the baby leads

18. Cross Modal Nature of Attunement Smile s s e s e s s e s y Mother Says s

19. Affective Attunement Communicates “Yes, I know what your experience was like, and by my response, I’m confirming your experience of it, and thus, I confirm you. This helps you to develop a sense of your self as separate from me and yet attached”

20. Steps in Attachment • Indiscriminate 0-3 months • Preference for the familiar 3-6 months • Selective attachment 6-8 months • Multiple attachments, thereafter

21. Estimated Time for Ability To keep one as a psychological parent 0-2 years - a few days 2-3 years - weeks 3-5 years - months 5-12 years - years or more 12+ years - a few years

22. Strange Situation • Reflect strategies to manage anxiety • Not a quality of the child or the parent, but a quality of the relationship • E.g. can look different with different parents

23. Strange SituationSecure Attachment • Past experiences of available, responsive caregiver, so infant believes caregiver will be available • Explores, checking back with caregiver • Distressed when separated, less play • On reunion seeks out caregiver, is comforted and goes back to play • May be comforted by stranger, but more so by caregiver • 65% of cases

24. Strange Situation – Insecure Attachments • Avoidant- child suppresses the attachment, dismisses the parent, and explores without security concerns – 21% of cases • Ambivalent- child preoccupied with the attachment. Much less exploration even when the parent is present – 14% of cases

25. Strange Situation • Disorganized attachment- No coherent strategy for coping • Seen most often in children of abuse and neglect

26. Resilience Secure attachment helps protect children, so that when adversity comes they can cope!

27. Attachment • All attachment behaviors reflect an attempt to modulate emotions, specifically anxiety • Attachment types or styles do not reflect specific personality traits, but styles of engaging in relationships

28. Most Children Attach • Most children who are adopted out of orphanages attach to adopted parents • Most children who are abused attach to their abusive parents • Attachment disorders usually atypical, insecure, disorganized

29. Insecure Attachment = Increased Risk for Behavioral/Emotional Problems Minimize distress shut off feelings/deny parents’ wrong-doing more likely to be aggressive and oppositional Maximum focus on distress desperate not to lose caregiver increased risk for depression and anxiety

30. Securely Attached Infants in the 6th Grade • Cheerful • Cooperative • Popular • Resilient • Resourceful • Confident • Hopeful

31. Avoidant Attached Infants in 6th Grade • Emotionally insulated • Hostile • Antisocial • Unduly seeking attention

32. Ambivalent Attached Infants in 6th Grade • Tense • Impulsive • Easily frustrated • Passive • Helpless

33. “Use it or Lose it” • The Brain is over wired and prepared for a lot of environmental contingencies! • Concept of Pruning - new synapses form as the result of stimulation; however others weaken or remain the same. Weaker cells die off and are lost forever.

34. Neglect/Abuse Changes Brains • CIVITAS Child Trauma Programs • Brains are 20-30 % smaller • Romanian Orphans • Speech Delays • Hearing Problems • Gross and Fine Motor Problems • SOCIAL DEFICITS

35. Normal Brain

36. Brain of Child that was severely neglected in the first three years of life

37. Symptoms and Behaviors Associated with Problematic Attachment • Superficially engaging and charming • Indiscriminately affectionate with strangers • Lack of eye contact and affection on parent’s terms • Inappropriately demanding and clingy • Compulsive, often crazy, lying • Poor impulse controls • Learning and speech lags • Lack of cause and effect thinking • Abnormal eating patterns • Poor peer relationships • Nonsense questions and chatter • Destructive to self, materials things, others • Stealing • Cruel to animals • Preoccupation with fire, blood, gore, etc.

38. Multiple Transitions: A Young Child’s Point of view on Foster Care and Adoption Written and Produced by Michael Trout, Director of the Infant-Parent Institute, Champlaign, Ill

39. Problems with Diagnosing • Criteria focuses on individual behavior instead of attachment relationship • Comorbid and differential diagnoses • Misses attachment disorders that develop in stable, unhealthy relationships where there is not severe maltreatment • No description of how attachment behaviors change with development • Not clear how much of symptoms are actually trauma-related

40. A Continuum of Interventions Intense RX Social/Emotional Learning Strategies Prevention Practices in Home Classroom Settings & Courts Building Positive Relationships with Children and Families Positive relationships form the foundation of the triangle

41. Level 1 Practices • Relationships between practitioners and parents play an important role in children’s development. • Time to know families • Welcoming parents to observe • Consulting parents about child’s abilities • Sharing information with parents • Valuing parent’s concerns • Conducting home visits

42. Level 2 Practices • Clear rules and consistent consequences • Help with transitions • Spaces to allow for interactions and for quiet times • Giving good directions (how to later)

43. Anxiety precipitates problematic behaviors; recognize anxiety, help prevent it • Recognize that anxiety triggers are different in traumatized children (e.g. unexpected schedule change, intruder alert) • Relationships are more important than learning • Get help • Persist

44. Response to the perceived trauma can be fear, aggression, sexual acting out, splitting, avoidance, uncontrolled emotional reaction • In the child’s past such behaviors were the only way they knew to cope with frightening events

45. Understand that traumatized children likely to experience anything novel (including rules and protective interventions) as punishments • Tend to regard teachers, foster care parents, and therapists who try to establish safety as perpetrators • Don’t take it personally - Avoid passion

46. Level 3 Practices • Use good behavioral principles • Ignoring the ignorable • Reward the desired behavior • If you say it, mean it and follow through • Intermittent re-enforcement is most powerful

47. Find opportunities to develop intimacy, eye contact, asking about them in social terms • Expect regression • Have long term goals • Get your self esteem needs met in other ways • Avoid punitive practices (expelling, denying recess, arguing ) • Promote feelings of belonging to the larger culture

48. YOUR VALUE! • Regular caregivers (teachers, foster parents, day care workers, therapists, etc.) are the “active ingredients” of any treatment. • The relationship is what allows a child to grow and thrive. • Without at least one such relationship, development is disrupted and the consequences can be severe. • A sensitive, caring relationship can foster remarkable recovery

49. We are guilty of many errors and many faultsbut our worst crime is abandoning the childrenneglecting the fountain of life.Many of the things we needcan wait. The child cannot.Right now is the time his bones are being formed, his blood is being made, and his senses are being developed.To him we cannot answer‘Tomorrow.’His name is ‘Today.’Gabriela MistralNobel Prize-winning poet from Chile

50. The best of these slides were designed by Dr. Otto Kaak, professor of psychiatry, pediatrics and social work at the University of Kentucky Center for Study of Violence Against Children (formerly known as CATS clinic) and Dr. Circe Cooke, NRVCS Child Psychiatrist. Thanks