Part four of our series on attachment described how child and parent factors contribute to the attachment relationship. In this fifth feature, Dr. Goldberg discusses
the development of attachment under conditions of adversity.
By Susan Goldberg, PhD
Infants depend on caregivers for their survival and well-being. Fortunately infants are predisposed to solicit care from parents
and parents are predisposed to provide such care. But sometimes a child’s care-seeking behaviours or a parent’s caregiving
behaviours are impaired, overridden, or suppressed. When this happens, the attachment relationship can suffer.
Adversity comes in many forms and can originate in the child, the parent, or from circumstances outside of the child-parent
relationship. Most often, adversity involves multiple interacting factors.
Premature birth
Some infants are limited in their capacity to solicit care from parents 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 babies are also more likely to spend extended time in hospital and have limited time with caregivers compared to
full-term babies.
Attachment researchers have studied premature infants to see whether these child-based challenges adversely affect the infant-parent
relationship. They have found that despite pre-term infants’ limitations, the majority are securely attached by 12-18 months
of age. In general, if other adversities do not arise, parents of premature babies are able to compensate for their children’s
difficulties.
Child maltreatment
Parents are able to compensate for child limitations but the same cannot be said for most children facing neglect or abuse.
A child’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.
The majority of maltreated children 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 strategies that repeatedly break down. When stressed, in the presence of their caregiver, disorganized children 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.
Maltreated children who are classified as disorganized tend to remain so and those who are rated as secure often do not maintain
their secure status throughout development.
Caregiver depression
There are other circumstances which leave parents unable to provide adequate care for their children. Maternal depression
can interfere with normal caregiving by limiting a mother’s emotional availability. To the child, a depressed parent is perceived
as inaccessible and unresponsive. There is clear evidence that maternal depression increases the likelihood that an infant
will develop insecure attachment.
Social disadvantage
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 parents’ ability to care for their children.
Research shows that children growing up under conditions of high social risk have less secure and less stable attachments
than children growing up in more secure 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.
Recovery from early deprivation or inadequate care
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 children who are removed from adverse conditions
and placed in more advantageous environments.
Orphanage care
Early accounts of institution-reared infants describe children who display unusual social behaviours, are unable to form close
relationships, and are often indiscriminately friendly. Even children 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.
Foster care
Children in foster homes have been removed from conditions of inadequate care. Infants who are put into care before 12 months
of age usually show a stable pattern of attachment behaviours within two weeks of their placement. But for infants placed
into care after 12 months of age it can take up to two months for stable patterns to emerge. These children also develop more
insecure attachments than children who are placed into care earlier.
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 require more
than good care to establish normal attachments. They need therapeutic intervention and their caregivers need adequate support
and guidance.
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.
Help for victims of maltreatment
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 of abuse must be taught to be open to new and potentially positive relationships and experiences.
Essentially, therapy 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 parents. When faced with situations
that are contrary to these expectations, even though positive, disequilibrium results and anxiety escalates. Treatment for
maltreated children must focus on helping them believe that not all adults will reject or abuse them.
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.
Adults who suffered childhood abuse present a special challenge to therapists. Most 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 problems.
Improving the parent-child relationship
A number of attachment-driven therapeutic approaches focus on improving the mother-child relationship. Infant-parent therapy
has been used successfully with high-risk groups although it has not specifically been used with maltreating populations.
Low socioeconomic status mothers and mothers with a number of other life stressors and their offspring have responded well
to infant-parent therapy. Mothers show greater empathy and interaction with their children, and children show less avoidance,
resistance, and anger.
Most interventions which focus on caregiver-infant relationships focus on parent sensitivity to infants’ 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.
A recent pilot study conducted by Diane Benoit and colleagues at The Hospital for Sick Children explored the effectiveness
of a brief, focused, parent-training intervention. Modified Interaction Guidance was designed to focus specifically on caregiver behaviours associated with disorganized attachment. The intervention involves
videotaped interactions between parent and child followed by discussion and feedback with a therapist.
Preliminary findings with Modified Interaction Guidance are promising. Parent behaviours associated with disorganized attachment
declined after participation in the programme. A number of studies across Canada are testing the effectiveness of this approach
with high-risk families, children with clinical problems, and in promoting secure attachment in families involved with child
protection services.
Other attachment-based programmes have been offered to parents of children at risk of developmental delay due to biological,
medical, or psychosocial risk. Right from the Start, an 8-week parent training course developed by Alison Niccols of the Infant-parent program at Hamilton Health Sciences and
McMaster University, was designed to improve parent-child interaction to foster attachment security. Preliminary research
suggests that the programme is successful in achieving its goal of improving the infant-parent relationship.
In our sixth and final episode of the series we will discuss the societal implications of attachment theory.
