Attachment

MRCPsych Paul McArdle

attachment

attachment

• Distress on separation

attachment

• Distress on separation• Proximity seeking

attachment

• Distress on separation• Proximity seeking• Comforted by attachment figure•

attachment

• Distress on separation• Proximity seeking• Comforted by attachment figure• exploration

Attachment styleSecure Uses caregiver as a secure base for exploration. Protests caregiver's departure and seeks proximity and is comforted on return, returning to exploration. May be comforted by the stranger but shows clear preference for the caregiver. Responds appropriately, promptly and consistently to needs. Caregiver has successfully formed a secure parental attachment bond to the child.

Attachment style

Avoidant Little affective sharing in play. Little or no distress on departure, little or no visible response to return, ignoring or turning away with no effort to maintain contact if picked up. Treats the stranger similarly to the caregiver. The child feels that there is no attachment; therefore, the child is rebellious and has a lower self-image and self-esteem. Little or no response to distressed child. Discourages crying and encourages independence.

Attachment style

Avoidant Little affective sharing in play. Little or no distress on departure, little or no visible response to return, ignoring or turning away with no effort to maintain contact if picked up. Treats the stranger similarly to the caregiver. The child feels that there is no attachment; therefore, the child is rebellious and has a lower self-image and self-esteem. Little or no response to distressed child. Discourages crying and encourages independence.

Attachment style

DisorganizedStereotypies on return such as freezing or rocking. Lack of coherent attachment strategy shown by contradictory, disoriented behaviours such as approaching but with the back turned.Frightened or frightening behaviour, intrusiveness, withdrawal, negativity, role confusion, affective communication errors and maltreatment. Very often associated with many forms of abuse towards the child.

resilience

• Resilience is a dynamic process whereby individuals exhibit positive behavioral adaptation when they encounter significant adversity

• Resilience can be described by viewing:– good outcomes regardless of high-risk status,– constant competence under stress,– recovery from trauma,[29] and– using challenges for growth that makes future

hardships more tolerable.

Longitudinal studies

• ‘Steeling’ effects– Elder G. (1974) Children of the Great Depression. University of

Chicago Press

• Kuai 1/3 ‘high risk’ – chronic discord, alcohol abuse or parental mental illness, poverty. 1/3 ‘grew into competent, confident, caring young adults’

Kauai• At 1 year – ‘cuddly…good natured…easy to deal with (sleeping and eating)• 20 months ‘alertness and autonomy’ – more sociable and developmentally

advanced. Close bond with at least one care giver’ including ‘substitute caregivers’

• Better reading, interests and hobbies that ‘were not narrowly sex typed’• ‘Structure and chores’• Emotional support outside the family ‘informal network of kin and

neighbours, peers and elders…’• Scholastic competence at 10 was associated with Self-efficacy at 18 • Age 18 ‘their relationships with members of the opposite sex were still

tentative…’• The resilient youngsters …all had at least one person in their lives who

accepted them unconditionally regardless of temperament…intelligence physical attractiveness…’

Kauai

• Age 30 follow up – the vocational achievements of the high risk resilient children equalled that of low risk

Iowa

• Academic and social competence ‘significant others who provide affection, the disciplines of accomplishment and moral guidance (e.g. avoidance of ‘street life’)

• Buffer of strong family life (e.g. vs rejection) • Supportive grandparent, teacher or sibling• Fathers who encourage…sense of responsibility…

shared work• Elder and Conger (2000) Children of the Land. University of

Chicago Press

Kauai – especially vulnerable

• Maltreated children with isolated single parents with no roots in a community

• Preadolescents with conduct disorders and poor reading skills

• Critical periods…– Werner E. (1993) Risk Resilience and Recovery: perspectives

from the Kauai longitudinal study. (n = 648) Development and Psychopathology 5:503-515.

Protective factors

• Reduce the risk impact• The likelihood of negative chain reactions• Promote self esteem and self efficacy• Open up opportunities

– Rutter M. (1987) Psychosocial resilience and protective mechanisms. American Journal of Orthopsychiatry 57:316-331.

Raised ‘in care’

• 94 (51) girls, studied 1964.• 2/5 vs none of controls pregnant pre-19 years• Of those with children, fewer stable

relationships and 22% without a current male partner

• 18% (0%) own children in care

Raised ‘in care’

• 1/3 showed good parenting• Supportive partner (rate of good parenting in

group with sp equal to controls)• Not explained by women’s earlier ‘deviance’• But by planfulness ‘courtship’• ‘Provided that ‘marital support’ was available

poor parenting was a rare occurrence (3%)’• Quinton D. et al (1984) parenting behaviour of mothers

raised in care. Psychological Medicine 14:107-124.

Institutional care

• Lack of close confiding relationships• Indiscriminate friendliness• Lack of differentiation in response to different

adults• Lack of checking back with a parent in anxiety

provoking situations– Rutter et al (2007) Early adolescent outcomes for

institutionally- deprived and non-deprived adoptees.: 1. Disinhibited attachment. JCPP 48:17-30.

Institutional care – Romanian orphans

• Contemporaneous adaptations• Biological programming?• Are the consequence of mile disinhibition

which was common, similar?• Is it associated with significant malfunction?

• N = 324.

Institutional care

• Those adopted <6 months not different from UK adoptees

• 10% quasi autism

Institutional care – disinhibition at 6 years

Institutional care – disinhibition and attachment 6 years

Institutional care – disinhibition and other problems at 11

Mehta et al (2009) Amygdala, hippocampal and corpus callosum size following severe early deprivation. JCPP 50:943-951.