Transcript ATTACHMENT AND MATERNAL DEPRESSION

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
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.
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”
Why Is Attachment Important?
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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
Center for Evidence Based Practice: Young Children with Challenging Behavior
www.challengingbehavior.org
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
Early Predictors
•Temperamental
Difficulties
•Early Aggression
•Language
Difficulties
•Noncompliance
Center 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
Center for Evidence Based Practice: Young Children with Challenging Behavior
www.challengingbehavior.org
WHAT PREDICTS THE
MALADAPTED CHILD?
Insecure Attachment
+
High Family Adversity (maybe)
+
Ineffective Parenting
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Atypical Child Characteristics (temperament, activity
level, intelligence, etc)
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
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
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
Child’s Contribution to
Attachment
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Proximity promoting 0-6 months
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Snuggle, mold to body
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Smile- very powerful
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Cry if leave
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Eye contact
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“Being” a baby
Child’s Contribution to
Attachment
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Proximity seeking 6-12 months
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Cling
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Crawl toward
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Reach to be picked up
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Receive comfort when upset
What Parents Do to Promote
a Secure Attachment
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Adaptations, e.g. child with
colic
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Behavioral adaptations, e.g.
pick up child
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Affective state, e.g. diaper
change
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
Cross Modal Nature of
Attunement
Smile
s s s
e
e
s
Mother
Says
y
e
s
s
s
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”
Steps in Attachment
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Indiscriminate 0-3 months
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Preference for the familiar 3-6
months
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Selective attachment 6-8
months
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Multiple attachments, thereafter
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
Strange Situation
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Reflect strategies to manage
anxiety
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Not a quality of the child or the
parent, but a quality of the
relationship
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E.g. can look different with
different parents
Strange Situation
Secure Attachment
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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
Attachments
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Avoidant- child suppresses the
attachment, dismisses the
parent, and explores without
security concerns – 21% of
cases
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Ambivalent- child preoccupied
with the attachment. Much less
exploration even when the
parent is present – 14% of cases
Strange Situation
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Disorganized attachment- No
coherent strategy for coping
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Seen most often in children of
abuse and neglect
Resilience
Secure attachment helps protect
children, so that when adversity
comes they can cope!
Attachment
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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 Attach
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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
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
Securely Attached Infants in
the 6th Grade
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Cheerful
Cooperative
Popular
Resilient
Resourceful
Confident
Hopeful
Avoidant Attached Infants in
6th Grade
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Emotionally insulated
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Hostile
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Antisocial
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Unduly seeking attention
Ambivalent Attached Infants in
6th Grade
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Tense
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Impulsive
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Easily frustrated
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Passive
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Helpless
“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.
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
Normal
Brain
Brain of
Child
that was
severely
neglected in
the first
three years
of life
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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.
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
Problems with Diagnosing
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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 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
Level 1 Practices
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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 Practices
– Clear rules and consistent
consequences
– Help with transitions
– Spaces to allow for interactions and
for quiet times
– Giving good directions (how to
later)
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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
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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 Practices
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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
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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!
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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 faults
but our worst crime is abandoning the children
neglecting the fountain of life.
Many of the things we need
can 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 Mistral
Nobel Prize-winning poet from Chile
Thanks
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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.