Normal Attachment and Attachment Disorders in the Early Years Dawn Viers, PhD, Prevention Supervisor Susan Lindsey, BS, Family Resource Specialist Mary

Normal Attachment and Normal Attachment and Attachment Disorders in the Attachment Disorders in the

Early YearsEarly YearsDawn Viers, PhD, Prevention Supervisor

Susan Lindsey, BS, Family Resource Specialist Mary Talbert, BS, Family Resource Specialist

New River Valley Community Services

Blacksburg, VA

Attachment DefinitionAttachment 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.

Attachment Behavior DefinitionAttachment 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”

Why Is Attachment Important?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 need2. The child is the sort of person to whom the figure might respond

Center for Evidence Based Practice: Young Children with Challenging Behavior

www.challengingbehavior.org

Children who are identified as hard to Children who are identified as hard to manage at ages 3 and 4 have a high manage at ages 3 and 4 have a high probability (50:50) of continuing to have probability (50:50) of continuing to have difficulties into adolescence (Campbell & difficulties into adolescence (Campbell & Ewing, 1990; Egeland et al., 1990; Fischer, Ewing, 1990; Egeland et al., 1990; Fischer, Rolf, Hasazi, & Cummings, 1984).Rolf, Hasazi, & Cummings, 1984).

Center for Evidence Based Practice: Young Children with Challenging Behavior www.challengingbehavior.org

Early Predictors

•Temperamental Difficulties

•Early Aggression

•Language Difficulties

•NoncomplianceCenter for Evidence Based Practice: Young Children with Challenging Behavior

www.challengingbehavior.org

Family Factors

•Maternal Depression

•Harsh Parenting

•Stressful Family Life Events

•Low Social Support

•Family Instability


WHAT PREDICTS THE WHAT PREDICTS THE MALADAPTED CHILD?MALADAPTED CHILD?

Insecure Attachment

+

High Family Adversity (maybe)

+

Ineffective Parenting

+

Atypical Child Characteristics (temperament, activity level, intelligence, etc)

Early appearing Early appearing aggressive behaviors are aggressive behaviors are

the best predictor of the best predictor of juvenile gang juvenile gang membership membership and violence.and violence.

(Reid, 1993)(Reid, 1993)


Young Children with Young Children with Challenging Behavior:Challenging Behavior:

Are rejected by peersAre rejected by peersReceive less positive Receive less positive

feedbackfeedbackDo worse in schoolDo worse in schoolAre less likely to be Are less likely to be

successful in successful in kindergartenkindergarten


Of the young children who show Of the young children who show early signs of problem behavior, it early signs of problem behavior, it has been estimated that fewer has been estimated that fewer than 10% receive services for than 10% receive services for these difficulties. these difficulties.

(Kazdin & Kendall, 1998) (Kazdin & Kendall, 1998) Center for Evidence Based Practice: Young Children with Challenging Behavior www.challengingbehavior.org

Child’s Contribution to Child’s Contribution to AttachmentAttachment

Proximity promoting 0-6 months

Snuggle, mold to body

Smile- very powerful

Cry if leave

Eye contact

“Being” a baby

Child’s Contribution to Child’s Contribution to AttachmentAttachment

Proximity seeking 6-12 months

Cling

Crawl toward

Reach to be picked up

Receive comfort when upset

What Parents Do to Promote What Parents Do to Promote a Secure Attachmenta Secure Attachment

Adaptations, e.g. child with colic

Behavioral adaptations, e.g. pick up child

Affective state, e.g. diaper change

The Concept of Affective The Concept of Affective Attunement, Mirroring, Attunement, Mirroring,

MatchingMatching Babies are more active and show more

proximity promoting behaviors when parents imitate rather than initiate

A dance, the baby leads

Cross Modal Nature of Cross Modal Nature of AttunementAttunement

Smile

MotherSays

ye

e se ss

ss

ss

Affective Attunement Affective Attunement CommunicatesCommunicates

“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”

Steps in AttachmentSteps in Attachment

Indiscriminate 0-3 months

Preference for the familiar 3-6 months

Selective attachment 6-8 months

Multiple attachments, thereafter

EstimatedEstimated Time for Ability Time for Ability

To keep one as a psychological parent0-2 years - a few days2-3 years - weeks3-5 years - months5-12 years - years or more12+ years - a few years

Strange SituationStrange 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

Strange SituationStrange SituationSecure AttachmentSecure 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

Strange Situation – Insecure Strange Situation – Insecure AttachmentsAttachments

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

Strange SituationStrange Situation

Disorganized attachment- No coherent strategy for coping

Seen most often in children of abuse and neglect

ResilienceResilience

Secure attachment helps protect children, so that when adversity

comes they can cope!

AttachmentAttachment

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

Most Children AttachMost 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

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

Insecure Attachment = Increased Risk forInsecure Attachment = Increased Risk for Behavioral/Emotional ProblemsBehavioral/Emotional Problems

Securely Attached Infants in Securely Attached Infants in the 6the 6thth Grade Grade

Cheerful Cooperative Popular Resilient Resourceful Confident Hopeful

Avoidant Attached Infants in Avoidant Attached Infants in 66thth Grade Grade

Emotionally insulated

Hostile

Antisocial

Unduly seeking attention

Ambivalent Attached Infants in Ambivalent Attached Infants in 6 6thth Grade Grade

Tense

Impulsive

Easily frustrated

Passive

Helpless

““Use it or Lose it”Use it or Lose it”

•The Brain is over wired and prepared for a The Brain is over wired and prepared for a lot of environmental contingencies!lot of environmental contingencies!

•Concept of Pruning - new synapses form as Concept of Pruning - new synapses form as the result of stimulation; however others the result of stimulation; however others weaken or remain the same. Weaker cells weaken or remain the same. Weaker cells die off and are lost forever. die off and are lost forever.

Neglect/Abuse Changes Neglect/Abuse Changes BrainsBrains

• CIVITAS Child Trauma Programs– Brains are 20-30 % smaller

• Romanian Orphans– Speech Delays– Hearing Problems– Gross and Fine Motor Problems– SOCIAL DEFICITS

Normal Brain

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

Symptoms and Behaviors Symptoms and Behaviors Associated with Problematic Associated with Problematic

AttachmentAttachment 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.

Multiple Transitions: A Young Multiple Transitions: A Young Child’s Point of view on Foster Child’s Point of view on Foster

Care and AdoptionCare and Adoption

Written and Produced

by Michael Trout,

Director of the Infant-Parent Institute, Champlaign, Ill

Problems with DiagnosingProblems 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

A Continuum of InterventionsA Continuum of Interventions

Building Positive Relationships with Children and Families

Prevention Practices in Home Classroom Settings & Courts

Social/EmotionalLearning Strategies

Intense RX

Positive relationships form the foundation of the triangle

Level 1 PracticesLevel 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

Level 2 PracticesLevel 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)

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

- 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

- 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

Level 3 PracticesLevel 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

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

YOUR VALUE!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

We are guilty of many errors and many faultsWe are guilty of many errors and many faultsbut our worst crime is abandoning the childrenbut our worst crime is abandoning the children

neglecting the fountain of life.neglecting the fountain of life.Many of the things we needMany of the things we needcan wait. The child cannot.can wait. The child cannot.

Right now is the time his bones are being formed, Right now is the time his bones are being formed, his blood is being made, and his blood is being made, and

his his sensessenses are being developed. are being developed.To him we cannot answerTo him we cannot answer

‘‘Tomorrow.’Tomorrow.’His name is ‘His name is ‘TodayToday.’.’

Gabriela MistralGabriela MistralNobel Prize-winning poet from ChileNobel Prize-winning poet from Chile

ThanksThanks

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.

Documents

Normal Attachment and Attachment Disorders in the Early Years Dawn Viers, PhD, Prevention Supervisor Susan Lindsey, BS, Family Resource Specialist Mary