Attachment and Young Children Involved with the Child Welfare System

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1 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

2 Acknowledgements Charles H. Zeanah, M.D. Mary Margaret Gleason, M.D. The Tulane Infant Team The many families who share their lives with us

3 What is attachment? How does it develop? Questions Why does attachment matter? How does attachment relate to psychopathology? How do we assess attachment? How do we intervene in cases of disturbed attachment?

4 What is Attachment? Attachment Bond Attachment Behavior Attachment Behavior System Attachment Relationship

5 Behavior Control Systems Attachment Exploration Affiliation Fear/Wariness

6 Attachment Exploration Balance activated attachment exploration deactivated

7 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?

8 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

9 Attachment: Birth to 2 months Physical characteristics of babyishness attracts caregivers Discrimination limited by cognitive immaturity Preferences limited to olfactory and auditory realm

10 Attachment: 2 to 7 months Differentiates among interactive partners May seem more comfortable with primary caregiver Social with everyone and preferences not strongly expressed

11 Attachment: 7 to 12 months Stranger wariness apparent Separation protest begins Hierarchy of preferred caregivers Focused (preferred attachment) develops

12 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

13 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

14 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)

15 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

16 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

17 Attachment Organization of behaviors Biologically rooted Emerges during first several years Qualitative changes in latter part of first year Qualitative differences predictive

18 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 Watch over me Help me Enjoy with me Delight in me I need you to Protect me Comfort me Delight in me Organize my feelings Welcome My Coming To You

19 Circle of Security: Hands (Powell, Cooper, Hoffman, & Marvin, 2009)

20 Top of the Circle: Facilitating Exploration Watch over me Help me Enjoy with me Delight in me (Powell, Cooper, Hoffman, & Marvin, 2009)

21 Bottom of the Circle: Facilitating Contact/Proximity Seeking Protect me Comfort me Delight in me Organize my feelings (Powell, Cooper, Hoffman, & Marvin, 2009)

22 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 Watch over me Help me Enjoy with me Delight in me I need you to Protect me Comfort me Delight in me Organize my feelings Welcome My Coming To You

23 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 minutes

24 Infant Attachment Classifications Secure Avoidant Resistant/Ambivalent Disorganized

25 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

26 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

27 Circle of Limited Security Child Anxious about the Parent s Needs (Powell, Cooper, Hoffman, & Marvin, 2009)

28 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

29 Circle of Limited Security Child Anxious about the Parent s Needs (Powell, Cooper, Hoffman, & Marvin, 2009)

30 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

31 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.

32 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

33 Sequelae of Early Attachment Secure attachment predicts positive parent-child relationships better peer relationships positive child-teacher relationships higher self-esteem greater resiliency

34 Sequelae of Early Attachment Insecure attachment predicts problematic parent-child relationships poor peer relations aggression anxiety conflicted relationships with teachers

35 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

36 Spectrum of Attachment Secure Insecure Disorganized Secure Base Distortions Non-attachment/RAD

37 Secure Base Distortions Disordered Attachment with Self- Endangerment Disordered Attachment with Vigilance/hypercompliance Disordered Attachment with Role- Reversal

38 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

39 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

40 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

41 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

42 Reactive Attachment Disorder Two patterns are apparent: Emotionally withdrawn/inhibited pattern Indiscriminately social/disinhibited pattern evidence suggests this may be a different disorder

43 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

44 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

45 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

46 Reactive Attachment Disorder Indiscriminately social/disinhibited pattern: lack of selectivity in seeking comfort, support and nurturance; child seems overly friendly, superficially attached

47 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

48 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

49 Sequelae of Early Attachment Lack of attachment predicts increased levels of psychopathology serious peer relationship problems others unknown

50 Intervention

51 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

52 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

53 Adult Barriers to Facilitating Secure Attachment in Young Children Psychological ownership Here and now crises Attachment relationship histories Unresolved losses and traumas

54 A Model of Child Centered Healthy Foster Parenting Sensitive Caregiving Psychological Ownership/ Commitment Valuing Child as An Individual Placing Needs of Child First Physically and emotionally safe Securely attached Socially competent Emotionally well-regulated Parent Behaviors Child Outcomes

55 Circle of Change PARENT PRIORITIZING THE CHILD (Powell, Cooper, Hoffman, & Marvin, 2009) I need you to Challenge Your Old Ways I need you to 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 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

56 Thank You! Questions?