Attachment and Young Children Involved with the Child Welfare System
Julie A. Larrieu, Ph.D. Institute of Infant and Early Childhood Mental Health Tulane University School of Medicine
Acknowledgements
Charles H. Zeanah, M.D. Mary Margaret Gleason, M.D. The Tulane Infant Team The many families who share their lives with us
Questions
What is attachment? How does it develop? Why does attachment matter? How does attachment relate to psychopathology? How do we assess attachment? How do we intervene in cases of disturbed attachment?
What is Attachment?
Attachment Bond Attachment Behavior Attachment Behavior System Attachment Relationship
Behavior Control Systems Attachment Exploration Affiliation Fear/Wariness
Attachment Exploration Balance activated
attachment exploration
deactivated
Development of Attachment
Are infants born attached to their mothers/fathers/caregivers?
If not, when do they become attached?
Are mothers/fathers attached to their infants at birth?
If not, when do they become attached?
Parents’ Affiliative Feelings for Baby
For most women, attachment grows as pregnancy progresses For a substantial minority (~ 20%), strong attachment in the first trimester By one month after birth, most have experienced feelings of love for baby Mothers’ attachment is greater than fathers’ throughout pregnancy
Attachment: Birth to 2 months
Physical characteristics of babyishness attracts caregivers Discrimination limited by cognitive immaturity Preferences limited to olfactory and auditory realm
Attachment: 2 to 7 months
Differentiates among interactive partners May seem more comfortable with primary caregiver Social with everyone and preferences not strongly expressed
Attachment: 7 to 12 months
Stranger wariness apparent Separation protest begins Hierarchy of preferred caregivers Focused (preferred attachment) develops
Attachment: 12 to 24 months
Use of attachment figure as a secure base from which to venture out and explore Use of attachment figure as a safe haven to which to return if distressed or frightened Proximity to caregiver promotes an internal feeling of security in infant
Attachment: Early Childhood and Beyond
Goal-corrected partnership Increased appreciation of conflicting goals and of the need to negotiate Balance between autonomous functioning and healthy dependence Cooperation is hallmark
Attachment: Points to Remember
Infants are strongly biologically predisposed to form attachments to caregiving adults Preferred attachment apparent by 7-9 months of age Secure base and safe haven behaviors apparent by a year of age (balance between attachment and exploration)
Attachment: Points to Remember (cont.)
Relationship construct rather than a trait
different with different caregivers
Consistency and emotional availability from attachment figures are critical Child develops expectations about the dependability of attachment figures to provide comfort, support and nurturance in times of need
Why Does Attachment Matter?
Infant develops expectations about availability and dependability of others in intimate relationships Infant’s quality of attachment to primary caregiver is one of the strongest predictors of psychological and social outcomes in middle childhood and adolescence
Attachment
Organization of behaviors Biologically rooted Emerges during first several years Qualitative changes in latter part of first year Qualitative differences predictive
Circle of Security
Parent Attending to the Child’s Needs
(Powell, Cooper, Hoffman, & Marvin, 2009) I need you to
I need you to
Support My Exploration
I need you to
Protect me Comfort me Delight in me Organize my feelings
Welcome My Coming To You
I need you to
Watch over me Help me Enjoy with me Delight in me
Circle of Security: Hands
(Powell, Cooper, Hoffman, & Marvin, 2009)
Top of the Circle: Facilitating Exploration
Watch over me Help me Enjoy with me Delight in me
(Powell, Cooper, Hoffman, & Marvin, 2009)
Bottom of the Circle: Facilitating Contact/Proximity Seeking
Protect me Comfort me Delight in me Organize my feelings
(Powell, Cooper, Hoffman, & Marvin, 2009)
Circle of Security
Parent Attending to the Child’s Needs
(Powell, Cooper, Hoffman, & Marvin, 2009) I need you to
I need you to
Support My Exploration
I need you to
Protect me Comfort me Delight in me Organize my feelings
Welcome My Coming To You
I need you to
Watch over me Help me Enjoy with me Delight in me
Strange Situation Procedure
Standardized, laboratory (playroom) procedure involving series of episodes Infant, caregiver and an unfamiliar adult (Stranger) Designed to examine balance between infant’s attachment (proximity seeking) and exploration Lasts between 20-25 minutes
Infant Attachment Classifications Secure Avoidant Resistant/Ambivalent Disorganized
Secure Attachment
Distressed by separation Direct expression of negative affect Clear approach and expectation of comfort Settled by caregiver’s attempts to soothe 55-65% in low risk samples
Avoidant Attachment
Minimal response to separation Either minimal reaction during reunion or active avoidance of caregiver during reunion; attention focused on toys Implicit claim of strength, independence, normalcy Hypoactivation of attachment system Physiologic arousal 15-20% in low risk samples
Circle of Limited Security Child Anxious about the Parent’s Needs
(Powell, Cooper, Hoffman, & Marvin, 2009)
Resistant/Ambivalent Attachment
Distressed by separation Unable to be soothed by caregiver Either passively overwhelmed or angrily preoccupied Hyperactivation of attachment system 5-10% in low risk samples
Circle of Limited Security Child Anxious about the Parent’s Needs
(Powell, Cooper, Hoffman, & Marvin, 2009)
Disorganized Attachment
Derived from aberrant organization of child’s attachment behavior in presence of caregiver
contradictory attachment behaviors behaviors lacking goal orientation direct indices of fear/apprehension
Underlying pattern (secure, avoidant, or resistant) usually evident
CIRCLE OF DISORGANIZATION
(Powell, Cooper, Hoffman, & Marvin, 2009)
I need you but you are so frightened or frightening that I have no one to turn to and I don’t know what to do.
Links Between Early Attachment and Later Development/Psychopathology
Secure attachment is a protective factor among high-risk infants Insecure/organized attachment is a risk factor, but primarily in high-risk samples Disorganized attachment is most predictive of subsequent psychopathology
Sequelae of Early Attachment
Secure attachment predicts positive parent-child relationships better peer relationships positive child-teacher relationships higher self-esteem greater resiliency
Sequelae of Early Attachment
Insecure attachment predicts
problematic parent-child relationships poor peer relations aggression anxiety conflicted relationships with teachers
Sequelae of Early Attachment
Disorganized attachment predicts role inappropriate parent child relationships serious aggression and externalizing disorders dissociative phenomena in children dissociative disorders in adolescence internalizing disorders
Spectrum of Attachment Secure Insecure Disorganized Secure Base Distortions Non-attachment/RAD
Secure Base Distortions
Disordered Attachment with SelfEndangerment Disordered Attachment with Vigilance/hypercompliance Disordered Attachment with RoleReversal
Disordered Attachment with Self-Endangerment
Recklessness, accident proneness and/or risk-taking in presence of the attachment figure Aggression directed towards self or others (including attachment figure) in place of comfort seeking
Disordered Attachment with Vigilance/Hypercompliance
Absence of age-appropriate, spontaneous exploratory behavior in presence of attachment figure Emotional constriction, vigilance, and hypercompliance in the presence of attachment figure Absence of these behaviors with other caregivers
Disordered Attachment with Role-Reversal
Child may be oversolicitous or bossy and controlling towards attachment figure To a developmentally inappropriate degree, the attachment figure’s emotional well-being is the concern of the child
Reactive Attachment Disorder
Markedly disturbed and developmentally inappropriate social relatedness in most contexts Must begin before 5 years of age Due to pathogenic care Not due solely to developmental delay or pervasive developmental disorder
Reactive Attachment Disorder
Two patterns are apparent: Emotionally withdrawn/inhibited pattern Indiscriminately social/disinhibited pattern – evidence suggests this may be a different disorder
Reactive Attachment Disorder
Emotionally withdrawn/inhibited pattern: Absence of expectable tendency to initiate or respond appropriately to social interactions Exhibits instead excessively inhibited, hypervigilant, or highly ambivalent reactions
Emotionally Withdrawn/Inhibited Pattern of RAD
Indicative of young children who lack a discriminated attachment figure Phenomenologically characterized by: absence of organized attachment behaviors impaired social engagement and reciprocity emotion regulation difficulties
Emotionally Withdrawn/Inhibited Pattern of RAD
Readily identifiable in samples of maltreated and currently institutionalized children Resolves after improvements in caregiving environment, but subsequent attachments more likely to be disturbed Identified in children only without preferred attachment figures
Correlates course and sequelae are not yet clear , but some relationship to depressive symptoms
Reactive Attachment Disorder
Indiscriminately social/disinhibited pattern: lack of selectivity in seeking comfort, support and nurturance; child seems overly friendly, superficially attached
Indiscriminate/Disinhibited Pattern of RAD
Lack of expectable reticence about engaging with unfamiliar adults Willingness to approach, interact with, and “go off” with a stranger Failure to check back with caregiver in unfamiliar settings
Indiscriminate/Disinhibited Pattern of RAD ?
Readily identifiable in samples of maltreated and institutionalized children Persistent even after improvements in caregiving environment Predictive of later social relationship difficulties, but not necessarily disturbed attachments Identified in children with and without preferred attachment figures
Correlates, course and sequelae are not yet clear
Sequelae of Early Attachment
Lack of attachment predicts increased levels of psychopathology serious peer relationship problems others unknown
Intervention
Levels of discrimination between infants and caregivers It’s not just attached or not attached:
Recognition/familiarity Familiarity/comfort Comfort/pleasure Pleasure/reliance Reliance/preference
Intervention for Disturbances and Disorders of Attachment
Does the child have an attachment figure? Characteristics of attachment figures who foster secure attachments:
warm, nurturing, emotionally available sensitive and responsive to child’s needs values child as a unique individual responds to comfort seeking provides physical and psychological protection
Adult Barriers to Facilitating Secure Attachment in Young Children
Psychological ownership Here and now crises Attachment relationship histories Unresolved losses and traumas
A Model of Child Centered Healthy Foster Parenting Sensitive Caregiving Psychological Ownership/ Commitment
Valuing Child as An Individual
Physically and emotionally safe Securely attached Socially competent Emotionally well-regulated
Placing Needs of Child First Parent Behaviors
Child Outcomes
Circle of Change
PARENT PRIORITIZING THE CHILD
(Powell, Cooper, Hoffman, & Marvin, 2009) I need you to
Challenge Your Old Ways
I need you to
Recognize my needs Accept & respond to my feelings Be willing to stand back and observe how you parent Be bigger, stronger, wiser, and kind
Prioritize My Needs
Take ownership of your part in the problem Be more protective of me Believe you can change Get the help you need to make changes Stabilize your life
Thank You!
Questions?
