Imagine for a moment being little…smaller than you can consciously remember being. Imagine you are very new to life…say about three months old...

You’ve been asleep and you are just waking up, lying on a mattress in a crib…You open your eyes and see your short, little arms and legs, new little fingers and toes that still seem to have a mind of their own. You have a big, heavy head and a short neck, a big, round tummy that is feeling very empty. As you come awake, you feel that wet thing around your middle that is beginning to feel heavy and cold.

Agitated, you begin to wiggle, move your arms, kick you feet, and you make a few soft sounds. Your eyes feel itchy, and you are getting this feeling in your tummy that you don’t like. You begin to rub your eyes and make a few more sounds. To your surprise you hear a loud cry coming out of your mouth and your face is wet and your eyes begin to feel worse. Now you are crying and kicking and breathing hard.

…but no one comes. You look to see,

…but no one comes.And you are crying harder and your middle is hurting now with the air you’ve swallowed and you are hot and wet and screaming.

Still no one comes.

And the room is still…and there’s nothing but the sheet and the slats of your crib. You are scared and your stomach hurts and you are alone. Finally, you hear footsteps. A cold nipple is stuck in you mouth and you see

the blurred back of someone leaving and you are sucking and turning to see who is walking away…and the bottle

falls over. And your mouth is empty and your eyes are hot and wet, your stomach still hurts. You are screaming for

someone to help.

You hear footsteps and see the arms sweep down and the hand you hope is reaching for you sticks the nipple in again, but hard…so it hurts and you choke. The footsteps go away and you cry out…

Your mouth loses the nipple and your arms are beating and your feet kick the mattress. You are hungry and angry and scared. You are screaming to any empty room…

Your need for food and attention followed by this response or a variation of it happens over and over again, several times a day, at least thirty times in the course of a week

Sometimes the wet thing around your middle comes off. Sometimes you are picked up. But the faces are not happy when they see you and the voices are often loud and angry. You spend a lot of time here alone, playing with your hands and the sheet, kicking your legs, feeling your body, and memorizing the pattern of the crib

bars, the blinds and the wallpaper…

Enduring form of a bond with a "special" person who provides sensory nourishment

Loss or threat of loss of the special person triggers significant negative reaction

Security and safety = fundamental aspects of this relationship

(The National Institute for Trauma and Loss, 2007)

Emotional glue enabling a child to connect with his caretaker

The ”Loop” = Reciprocity

The ability to develop significant emotional connections which cultivates feelings of safety, security, comfort, and pleasure

Fosters resilience in babies and children (Longres, 2000)

Attachment with a caretaker has been found to be essential to his physiological and psychological well-being

Increases protective factors such as coping skills, hardiness, positive emotions and resourcefulness (The National Institute for Trauma and Loss in Children, 2007)

Attachment = Bonding

The Brain is designed to promote relationships - It is ‘hardwired’ for interpersonal relating

Orbital Prefrontal Cortex (area behind eye) contains specialized functions related to attachment … regulates emotions, empathy and facial recognition …attachment experience directly influences the maturation of the right brain (Diamond and Hopson, 1999)

Orbital Prefrontal Cortex (area behind eye) is not fully developed at birth … both biology and experience will influence its growth

Systems in the brain that mediate pleasure are closely connected to the systems thatmediate emotional relationships (Perry, 2001)

Attachment Behavior System (unmet need)becomes activated,

Baby seeks a “sufficiently responsive and available attachment figure …only then is the Attachment Behavior System deactivated”

NOTE:80% probability that the attachment status of a

perspective parent will predict the attachment status of their child

to that parent.

“The Strange Situation”

SECURE ATTACHMENT = Babies became distressedbut soothed easily when reunited with caretaker

ANXIOUS AVOIDANT Appeared content during caretaker absenceDid not seek caretaker out or appear particularly soothed on return.. baby actively turned away from caretaker when reunited.

**Physiological testing later revealed high levels of anxiety during separation but had learned to suppress these emotions

ANXIOUS AMBIVALENTExperienced extreme anxiety andsought to stay near attachment figure Experienced various levels of anxiety as caretaker drew near them. Resisted physical contact with caretaker when reunited.

INSECURE:DISORGANIZED/ DISORIENTED ATTACHMENTExperienced confusion and had a similar reaction as ANXIOUS AMBIVILENT who simultaneously approached and avoided reuniting with caretakers. Many of these infants exhibited an inability to cope with any stressors or changes

PREMATURE BIRTHS

MEDICALLY FRAGILE INFANTS

UNEXPECTED IMPAIRMENTS OR PERCEIVED DEFICIENCY, MENTAL OR PHYSICAL ANOMALY IN ONE’S CHILD

SEPARATION FROM CARETAKER AFTER BIRTH FOR AN EXTENDED PERIOD OF TIME

ENVIRONMENT ~ A CHILD FEELS DISTRESS DUE TO A PERCEIVED THREAT OF HARM – LACK OF FEELING SAFE, CHAOTIC HOME ENVIRONMENT

HOSPITALIZATIONS DURING INFANCY OR CHILDHOOD

CAREGIVER BEHAVIORS:IGNORING, REJECTING, TEASING OR RESPONDING WITH ANGER BY CARETAKER TOWARD A CRYING INFANT OR CHILD

~ A BABY CRIES AND NO ONE REPONDS~

“GOODNESS OF FIT” VS. POOR FIT

10% = Difficult Children – place greater demands, leads to feelings of inadequacy for caretaker

40 % = Easy Children50% = Mixture of two types (Sadock & Sadock, 2003)

POSTPARTUM DEPRESSION

CAREGIVERS WITH A HISTORY OF TRAUMA

CARETAKER WHO IS EMOTIONALLY UNAVAILABLE (UNDERLYING STRESSORS)

CAREGIVERS WHO ARE EXPERIENCING MENTAL HEALTH ISSUES

TRAUMA INDUCING EXPERIENCES FOR MOM DURING HER PREGNANCY

BIOCHEMICAL STRESS CAUSED FROM SUBSTANCE ABUSE DURING PREGNANCY (Kuban, 2007)

LOSS, ABUSE, PHYSICALLY NEGLECTED, EMOTIONALLY NEGLECTED, KIDS IN FOSTER CARE OR RELATIVE PLACEMENTS, OR ADOPTED CHILDREN

UNWANTED / UNPLANNED PREGNANCY

DIFFICULTY MAKING AND MAINTAINING EYE CONTACT

AVERSION TO TOUCH AND PHYSICAL AFFECTION INABILITY TO RESPOND TO AFFECTION

EXCESSIVE SEPARATION FEARS

WITHDRAWN, AVOIDANT BEHAVIOR

LACK OF SELF-CONTROL, SELF ESTEEM

GENERAL FEARFULNESS, FUSSINESS, NEEDY AND CLINGY BEHAVIOR

RARELY SMILES

DOES NOT REACH OUT TO BE PICKED UP

REJECTS EFFORTS TO CALM, SOOTHE AND CONNECT

DOES NOT CARE WHEN YOU LEAVE HIM ALONE

CRIES INCONSOLABLY

DOES NOT COO OR MAKE SOUNDS

DOES NOT FOLLOW YOU WITH HIS EYES

INABILITY TO TRUST

NEED TO BE IN CONTROL

ANGER

AGGRESSION

FEELINGS OF ABANDONMENT

POWERLESSNESSCHILDREN LEARN QUICKLY WHEN THEY

CANNOT OR SHOULD NOTDEPEND ON OTHERS

SPEECH AND LANGUAGE PROBLEMS

DIFFICULTY LEARNING

APATHY

LACK OF EMPATHY AND COMPASSON

INCESSANT CHATTER AND QUESTIONS

SUSCEPTIBLILITY TO CHRONIC ILLNESS(The National Institute for Trauma and Loss in Children,2007)

FACT ~RESPONDING AND ATTENDING TO YOUR BABY WHEN HE CRIES DOES NOT SPOIL THEM! SOOTHING CHILDREN WHEN THEY CRY TEACHES THEM THAT THEY HAVE THE POWER TO GET THEIR NEEDS MET AND THAT THEY CAN DEPEND ON THEIR CAREGIVERS TO FEEL SECURE, SAFE AND LOVED IN THEIR ENVIRONMENT

FACT ~ BABIES THRIVE ON TOUCH, ONE-ON-ONE INTERACTION, AND AN ABUNDANCE OF EYE CONTACT

FACT ~ A BABY’S SOCIAL-EMOTIONAL LIFE BEGINS WITH THE EARLIEST CONVERSATIONS FROM THE EARLIEST MOMENTS OF LIFE BETWEEN THE CAREGIVER AND THE CHILD

(EDGELAND & ERICKSON, 1999; GUNNAR & BARR, 1998; PERRY, 2001; Waters, 2004)

FACT ~ RESEARCH AND CLINICAL EXPERIENCE INDICATE THAT ATTCHAMENT CAPACITY HAS GREATER POTENTIAL TO DEVELOP, MEND OR BE ENHANCED IF IDENTIFIED EARLY AND EARLY INTERVENTION TAKES PLACE

FACT ~ A BABY IS SPEAKING TO ITS CARETAKER ALL THE TIME ALTHOUGH HE MAY NOT YET HAVE WORDS

FACT ~ HUMAN DEVELOPMENT IS SIGNIFICANTLY IMPACTED BY BIOLOGY AND EXPERIENCE

FACT ~ “HUMAN RELATIONSHIPS AND THE EFFECTS OF RELATIONSHIPS ON RELATIONSHIPS ARE

THE BUILDING BLOCKS OF HEALTHY DEVELOPMENT” (Fenichel, 2001, P. 11)

FACT ~ A BABY’S CAPABILITY TO CONNECT WITH THE WORLD AND WITH HIS CARETAKERS HAS A SIGNIFICANT IMPACT ON THE DEVELOPMENT OF SPEECH

(Goldstein, Cornel University Study)

FACT ~ BABIES THAT RECEIVE ATTENTIONAND SENSORY NURISHMENT DEVELOPINTO INDEPENDENT, RESOURCEFULLESS DEMANDING TODDLERS (Kuban, 2007)

FACT ~ “THE COURSE OF A CHILD’SDEVELOPMENT CAN BE ALTEREDIN EARLY CHILDHOOD BY EFFECTIVE INTERVENTIONS” (FENICHEL. 2001)

ENGAGING WITH A BABY BY HUGGING, SMILING, HOLDING, TOUCHING, CUDDLING, AND SINGING ARE JUST SOME OF THE WAYS TO ESTABLISH A BOND BETWEEN CARETAKER AND BABY.

FREQUENTLY CHECKING IN WITH AN INFANT/CHILD TO LET HIM HEAR YOU OR SEE THE CARETAKER SO HE KNOWS THEY ARE PRESENT

DAILY TIME SET ASIDE FOR “SNUGGLE TIME”. EMOTIONAL DEVELOPMENT IS LINKED TO A SENSE OF TOUCH.

BE LESS EFFICIENT AND MORE EFFECTIVE!!!!DIAPERING, FEEDING, AND BATHING TIMES ARE GREAT OPPORTUNITIES FOR ATTACHMENT AND BONDING

BEING SUFFICIENTLY RESPONSIVE TO A BABY’S CRIES…

PATIENCE IS ESSENTIAL AND CRITICAL

HAVE REALISTIC EXPECTATIONS

MAINTAIN ROUTINES AND SCHEDULES

QUALITY AND QUANTITY MATTER

SUPPORT AND SELF CARE ~ IT TAKES A VILLAGE

ATTACHMENT REQUIRES TIME, PATIENCE AND SIGNIFICANT EFFORT

CULTURAL CONSIDERATIONS

OPPORTUNITY AND RESPONSIBILITY~ EARLY INTERVENTION IS KEY

INTAKE / ASSESSMENTS / BDI 2 ~ A CHANCE TO CHANGE A LIFE

~ENGAGE / EXPLORE / IDENTIFY~ ~PROBLEM SOLVE~

Now imagine being another baby…waking up…like the first…from a long nap on a mattress in a crib. You open your eyes and feel your body and make a few soft sounds as you begin to

look around the room…Familiar faces of colorful smiling nursery characters capture your attention for a

few minutes as you focus on the sound of your own voice. Within a few minutes, you hear rhythmic footsteps and a voice you know that sounds happy and soothing. Arms reach down and scoop you up over the shoulder that feels and smells just right. You rub your nose and eyes against a soft neck and feel the pats and cuddles that go with the familiar voice. Soon you are lying down looking into eyes that see only you. That wet thing around your middle goes away and is replaced with something warm and dry. And now you are lying back in those arms with a warm nipple in your mouth, and there is the best face of all singing a sound you love to listen to. You are rocking and your tummy is relaxing with warm milk and you are right with the world.

Infant Mental Health Promotion Project, Hospital for Sick Children, Toronto ON (1998)

A Simple Gift: Comforting Your Baby “Bonding with your Baby” http://www.parentbooks.ca

Zero to Three732 15th Street, NW, Suite 1000Washington, DC 20005www.zerotothree.org

24 hour Parent Helpline1-888-435-7553

The National Healthy Start Associationhttp://www.healthystartassoc.org/

Attachment Parenting Internationalhttp://www.attachmentparenting.org

Society for Neurosciencehttp://sfn.org

www.ChildTrauma.org

Diamond, M., & Hopson, J. (1999). Magic trees of the mind: How to nurture your child’s intelligence, creativity, and healthy emotions from birth through adolescence. New York, NY: Penguin, Inc.

Edgeland, F. & Erickson, M. R. (1999). Attachment Theory and Research. Zero to Three Journal.

Fenichel, E (2001). From Neurons to Neighborhoods: What’s in it for you? Zero to Three: National Center for Infants, Toddlers and Families. April/May 2001.

Karr-Morse, R. and Wiley, M.S. (1997) Ghosts From The Nursery:Tracing the Roots of Violence . New York NY: The Atlantic Monthly Press.

Sadock, B. J., MD & Sadock, V. A., MD (2003). Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 9th Edition. Phila., PA: Lippincott Williams & Wilkins.

Kuban, C. (2007). A Handbook of Trauma Interventions: Zero to Three. Gross Point, Michigan: TLC.

Longres, J. F. (2000). Human Behavior In The Social Environment. 3rd Edition. Itasca, IL. F. E. Peacock Publishers, Inc.

Perry, B., MD., PhD. Maltreated Children: Experience, Brain Development and the Next Generation. W. W. Norton & Company, New York.

Perry, B., MD., PhD. Aggression and Violence: The Neurobiology of Experience. The Child Trauma Academy.

Perry, B., MD., PhD. Attachment: The First Core Strength. The Child Trauma Academy

Perry, B., MD., PhD Bonding and Attachment In Maltreated Children: Consequences of emotional Neglect in Childhood. W. W. Norton & Company, New York.