AboutKidsHealth

 

 

Attachment part five: Attachment under adversityAAttachment part five: Attachment under adversityAttachment part five: Attachment under adversityEnglishDevelopmentalChild (0-12 years);Teen (13-18 years)NANAHealthy living and preventionCaregivers Adult (19+)NA2010-05-13T04:00:00ZSusan Goldberg, PhDDiane Benoit, MD, FRCPCSheri Madigan, PhD, C.Psych000Flat ContentHealth A-Z<p>Adversity has a massive impact on attachment security. When children are abused or parents cannot provide adequate care, attachment can suffer.</p><p>In <a href="/Article?contentid=742&language=English">Attachment part four: Caregiver and child influences on attachment </a> we described how infant and caregiver factors contribute to the attachment relationship. In this article we discuss the development of attachment under conditions of adversity.</p><h2>Key points</h2><ul><li>Sometimes an infant's care-seeking behaviours or a parent’s caregiving behaviours are impaired, overridden or suppressed. When this happens, the attachment relationship can suffer.</li><li>Adversity comes in many forms and can originate in the infant, the caregiver or from circumstances outside of the relationship. Adversities can include: premature birth; infant maltreatment; caregiver depression; and social disadvantage.</li><li>Babies raised under conditions of maltreatment may require more than good care to establish secure attachments. They may need therapeutic intervention and their caregivers need adequate support and guidance.</li> </ul><p>Benoit, D. Modified Interaction Guidance. <i>Newsletter of the Infant Mental Health Promotion Project.</i> Winter 2001-2002;32:61-65.</p> <p>Goldberg S. <i>Attachment and Development</i>. Hillsdale, NJ: The Analytic Press; 2000.</p> <p>Goldberg S, Muir R, Kerr J, eds. <i>Attachment Theory</i>. Hillsdale, NJ:The Analytic Press;1995.</p>
Attachement – cinquième partie : l’attachement dans l’adversitéAAttachement – cinquième partie : l’attachement dans l’adversitéAttachment part five: Attachment under adversityFrenchDevelopmentalChild (0-12 years);Teen (13-18 years)NANAHealthy living and preventionCaregivers Adult (19+)NA2010-05-13T04:00:00ZSusan Goldberg, PhDDiane Benoit, MD, FRCPCSheri Madigan, PhD, C.Psych000Flat ContentHealth A-Z<p>L’adversité a d'énormes conséquences sur la sécurité de l’attachement. Lorsque les enfants sont maltraités ou que les parents ne peuvent offrir des soins adéquats, l’attachement peut en souffrir.</p><p>La quatrième partie de notre série sur l’attachement décrit la façon dont certains facteurs liés à l’enfant et au fournisseur de soins influencent le lien d’attachement. Dans ce cinquième article, nous examinons la création du lien d’attachement dans des conditions adverses.</p><h2>À retenir</h2><ul><li>Parfois, les comportements d’un bébé qui sollicite des soins ou ceux d’un parent qui cherche à en prodiguer sont contrariés, contournés ou supprimés. Quand cela se produit, la relation d’attachement peut être compromise.</li><li>L’adversité prend plusieurs formes et peut venir du nourrisson, du pourvoyeur de soins ou de circonstances en dehors de la relation. Ces adversités peuvent inclure une naissance prématurée, la maltraitance du nourrisson, de la dépression chez le pourvoyeur de soins et un handicap social.</li><li>Les bébés élevés dans des conditions de maltraitance peuvent nécessiter un soutien allant au-delà de simples bons soins pour tisser des liens d’attachement sécurisants. Ils auront peut-être besoin d’une intervention thérapeutique et leurs pourvoyeurs de soins auront peut-être besoin d’un soutien et de conseils adéquats.</li></ul><p>Benoit, D. Modified Interaction Guidance. <i>Newsletter of the Infant Mental Health Promotion Project.</i> Winter 2001-2002;32:61-65.</p> <p>Goldberg S. <i>Attachment and Development</i>. Hillsdale, NJ: The Analytic Press; 2000.</p> <p>Goldberg S, Muir R, Kerr J, eds. <i>Attachment Theory</i>. Hillsdale, NJ:The Analytic Press;1995.</p>

 

 

Attachment part five: Attachment under adversity743.000000000000Attachment part five: Attachment under adversityAttachment part five: Attachment under adversityAEnglishDevelopmentalChild (0-12 years);Teen (13-18 years)NANAHealthy living and preventionCaregivers Adult (19+)NA2010-05-13T04:00:00ZSusan Goldberg, PhDDiane Benoit, MD, FRCPCSheri Madigan, PhD, C.Psych000Flat ContentHealth A-Z<p>Adversity has a massive impact on attachment security. When children are abused or parents cannot provide adequate care, attachment can suffer.</p><p>In <a href="/Article?contentid=742&language=English">Attachment part four: Caregiver and child influences on attachment </a> we described how infant and caregiver factors contribute to the attachment relationship. In this article we discuss the development of attachment under conditions of adversity.</p><h2>Key points</h2><ul><li>Sometimes an infant's care-seeking behaviours or a parent’s caregiving behaviours are impaired, overridden or suppressed. When this happens, the attachment relationship can suffer.</li><li>Adversity comes in many forms and can originate in the infant, the caregiver or from circumstances outside of the relationship. Adversities can include: premature birth; infant maltreatment; caregiver depression; and social disadvantage.</li><li>Babies raised under conditions of maltreatment may require more than good care to establish secure attachments. They may need therapeutic intervention and their caregivers need adequate support and guidance.</li> </ul><p>Infants depend on caregivers for their survival and well-being. Fortunately infants are predisposed to solicit care from caregivers and caregivers are predisposed to provide such care. But sometimes an infant's care-seeking behaviours or a parent’s caregiving behaviours are impaired, overridden or suppressed. When this happens, the attachment relationship can suffer.</p> <p>Adversity comes in many forms and can originate in the infant, the caregiver or from circumstances outside of the relationship. Most often, adversity involves multiple interacting factors. </p> <h2>Premature birth</h2> <p>Some infants are limited in their capacity to solicit care from caregivers due to medical or biological conditions. Premature babies are one example. Pre-term infants are less alert and less responsive than full-term babies. A number of behaviours used to achieve and maintain contact with caregivers such as smiling, clinging, reaching and following are slow to develop. Premature infants are also more likely to spend extended time in hospital and have limited time with caregivers compared to full-term babies.</p> <p>Attachment researchers have studied premature infants to see whether these challenges adversely affect the infant-caregiver relationship. They have found that despite pre-term infants’ limitations, the majority are securely attached by 12 to 18 months of age. In general, if other adversities do not arise, caregivers of premature babies are able to compensate for their children’s difficulties in communicating attachment behaviours. </p> <h2>Infant maltreatment</h2> <p>Caregivers are able to compensate for infant limitations but the same cannot be said for most babies facing neglect or abuse. An infant's attachment security is seriously jeopardized by maltreatment. Maltreatment can be either abusive or neglectful. In cases of abuse, care is provided but is accompanied by excessive anger, harshness or hostility. Neglect involves a lack of normal and necessary care. The two forms of maltreatment often co-exist. </p> <p>The majority of infants who are maltreated are insecurely attached and many display disorganized attachment patterns. Recall from the first feature in this series that a disorganized attachment pattern involves either a lack of an organized behaviour pattern or existing strategies that repeatedly break down. When stressed, in the presence of their caregiver, infants in disorganized attachment relationships appear disoriented, displaying unusual behaviours such as approaching the caregiver with their head averted, trance-like freezing or strange postures. These behaviours have been interpreted as evidence of fear or confusion with respect to the caregiver. Disorganization is considered an extreme form of insecurity.</p> <p>Infants who have suffered from maltreated and are classified as disorganized tend to remain so and those who are rated as secure often do not maintain their secure status throughout development.</p> <h2>Caregiver depression</h2> <p>There are other circumstances which leave caregivers unable to provide adequate care for their infants. Maternal depression can interfere with normal caregiving by limiting a mother’s emotional availability. To the infant, a depressed caregiver is perceived as inaccessible and unresponsive. There is evidence that severe and chronic maternal depression increases the likelihood that an infant will develop insecure attachment with that depressed caregiver. </p> <h2>Social disadvantage</h2> <p>One difficulty in studying the impact of social adversity on attachment is that different types of disadvantage often occur together. For example, extreme poverty is often associated with poor nutrition, poor medical care and inadequate housing. These conditions in turn adversely affect a caregiver's ability to care for children.</p> <p>Research shows that children growing up under conditions of high social risk have less secure and less stable attachments than children growing up in low social risk environments. But conditions of social disadvantage do not inevitably lead to insecure attachment. Children growing up socially disadvantaged while receiving adequate care show higher levels of secure attachment than socially disadvantaged children with inadequate care. Caregiver behaviour can ameliorate the effects of other harmful circumstances. </p> <h2>Recovery from early deprivation or inadequate care</h2> <p>We know that certain conditions contribute to insecure attachment. Once an infant has been exposed to adverse circumstances, can anything be done to ensure the development of more secure attachment? Before considering the issue of intervention, it is helpful to look at the case of naturally occurring “experiments” involving infants who are removed from adverse conditions and placed in more advantageous environments. </p> <h3>Orphanage care</h3> <p>Early accounts of institution-reared infants describe babies who display unusual social behaviours, are unable to form close relationships and are often indiscriminately friendly. Even infants who received excellent physical care and adequate cognitive stimulation display these kinds of unusual behaviour patterns. A number of more recent studies have looked at the recovery of adopted children taken from the extremely deprived conditions of orphanages. In general, these studies support the findings of earlier research. Although the adopted children made substantial developmental and behavioural gains, many developed problematic attachments. </p> <h3>Foster care</h3> <p>Infants in foster homes have been removed from conditions of inadequate care. Infants who are put into care before 12 months of age usually develop a new attachment relationship with their new primary caregiver, based on how this new attachment figure reacts to them when they are emotionally upset, physically hurt or ill. But for babies placed into care after 12 months of age it can take up to two months for stable attachment relationships to emerge. These children also develop more insecure attachments than children who are placed into care earlier. </p> <p>Researchers have suggested that babies who receive inadequate care develop patterns of relating to caregivers that are designed to protect them from abuse. These behaviours, although adaptive at the time that they emerge, interfere with the development of normal and healthy attachment behaviours. For this reason, babies raised under conditions of maltreatment may require more than good care to establish secure attachments. They may need therapeutic intervention and their caregivers need adequate support and guidance. </p> <p>These adoption and foster care findings provide some insight into the potential for recovery from adversity as well as the limitations imposed by severe and prolonged disadvantage. </p> <h2>Help for victims of maltreatment </h2> <p>Children who grow up under adversity, particularly if they are maltreated, develop coping strategies that are counter to behaviours that solicit caregiver attention and contact. For example, children who have been maltreated tend to be hyper-vigilant and often interpret ambiguous stimuli as threatening. These coping strategies interfere with the development of positive relationships. Children experiencing maltreatment often must be taught to be open to new and potentially positive relationships and experiences. </p> <p>Essentially, therapeutic interventions must help the abused child overcome negative beliefs about relationships. For a child who has experienced extreme abuse or neglect, positive new experiences can be anxiety provoking rather than comforting. Maltreated children expect all situations to confirm what they have learned in their relationships with maltreating caregivers. When faced with situations that are contrary to these expectations, even though positive, disequilibrium may result and anxiety escalates. Treatment for maltreated children must focus on helping them believe that not all adults will reject or abuse them. </p> <p>Facilitating positive peer interaction is a major component of therapy with older children. Maltreated children are prone to repeat negative relationship patterns from their past. A goal of therapy is to encourage relationships that diverge from familiar negative patterns. </p> <p>Adults who suffered childhood abuse present a special challenge to therapists. Many adults who were subjected to maltreatment as children face the world expecting to be victimized. These individuals tend to be mistrusting of others and their resistance to change is often powerful. In general, prevention and early intervention are the most effective methods for minimizing the life-long effects of attachment-based problems. </p> <h2>Improving the infant-caregiver relationship</h2> <p>A number of attachment-driven therapeutic approaches focus on improving the infant-caregiver relationship. Therapy has been used successfully with high-risk groups. Some caregivers and their offspring burdened by poverty, lack of education and other life stressors, have responded well to some interventions. Some caregivers show greater empathy and interaction with their infants, following these interventions and infants show less avoidance, resistance, and anger. </p> <p>Most interventions that focus on infant-caregiver relationships focus on improving parental sensitivity to baby's cues and signals. But research has shown that while caregiver sensitivity is associated with the different patterns of organized attachment, it is not associated with disorganized attachment. Further, disorganized attachment is one of the strongest predictors of serious psychopathology and emotional or behavioural problems. </p> <p>A recent pilot study conducted by Diane Benoit and colleagues at The Hospital for Sick Children explored the efficacy of a brief, focused, caregiver-training intervention. <i>Modified Interaction Guidance</i> was designed to not only improve caregiver sensitivity but also to focus specifically on caregiver behaviours associated with disorganized attachment. The intervention involves videotaped interactions between caregiver and child followed by discussion and feedback with a trained therapist. </p> <p>Preliminary findings with Modified Interaction Guidance are promising. Caregiver behaviours associated with disorganized attachment declined after participation in the intervention. A number of studies across Canada are testing the effectiveness of this approach with high-risk families, children with clinical problems, and children of adolescent mothers, and families involved with child protection services. </p> <p>Other attachment-based programs have been offered to caregivers of infants at risk of developmental delay due to biological, medical, or psychosocial risk. <i>Right from the Start</i>, an 8-week parenting training course developed by Alison Niccols of the Infant Parent Program at Hamilton Health Sciences and McMaster University, was designed to improve caregiver-child interaction to foster attachment security. Preliminary research suggests that the program is successful in achieving its goal of improving the infant-caregiver relationship. </p> <p>Numerous attachment-based interventions have been developed over the years, many are still under development, and a growing number are being tested with increasing scientific rigor. The future holds promise for the development of proven interventions to improve caregiver sensitivity and reduce the risk of developing insecure and/or disorganized attachment. </p> <p>In <a href="/Article?contentid=744&language=English">Attachment Part Six: Implications of attachment theory: past, present, and future</a> we will explore the societal implications of attachment theory.<br></p><p>Benoit, D. Modified Interaction Guidance. <i>Newsletter of the Infant Mental Health Promotion Project.</i> Winter 2001-2002;32:61-65.</p> <p>Goldberg S. <i>Attachment and Development</i>. Hillsdale, NJ: The Analytic Press; 2000.</p> <p>Goldberg S, Muir R, Kerr J, eds. <i>Attachment Theory</i>. Hillsdale, NJ:The Analytic Press;1995.</p>Attachment part five: Attachment under adversity

Thank you to our sponsors

AboutKidsHealth is proud to partner with the following sponsors as they support our mission to improve the health and wellbeing of children in Canada and around the world by making accessible health care information available via the internet.