Maryland's Source for
Attachment Disorder Related Information
Bonding and Attachment
When it Goes Awry
Attachment problems, when they arise, do not stem from any single cause, but are the result of multiple influences. A number of risk factors have been identified as increasing the probability of attachment difficulties: pre-natal rejection of the infant, extended or repeated hospitalizations during the first three years, pre- or post-natal maternal substance abuse, parents retaining unrealistic images of the child, multiple caretakers, multiple changes in living location, early history of losses, harsh and inconsistent parenting, overindulgent parenting, physical or sexual abuse, neglect, chronic illness, and an extreme temperamental misfit between parent and child.
Children with attachment difficulties are most commonly found in the adoption and foster care systems. However, they are being identified in increasing numbers from biologically intact families.
What are the signs that attachment has gone awry? In many ways, they are the opposites of the healthy attachment signals described previously. For the infant of zero to 6 months, poor attachment appears as social withdrawal and/or frequent screaming, pulling away from all touch, rejecting comfort from others and repetitive motions which are unsuccessful attempts at self-soothing. If not corrected, attachment problems at this age can lead to rage outbursts, a negative self-identity as one who causes bad things to happen, behavior problems and learning impairments in later childhood.From 6 to 10 months the signs of weak attachment are: over- reliance on repetitive motions, such as rocking, for comfort; lack of stranger anxiety; and extreme precociousness that moves the infant towards a position of not needing anyone because she can handle it all.
Should attachment problems exist from 10 to 18 months, separation anxiety may intensify to the point that the child won’t leave the parent. There may be generalized disinterest in exploring the world and limited checking in with the parent. Frustration tolerance doesn’t develop, but in its stead, the child assembles a repertoire of aggressive behaviors as outlets for the frustration.
For the 15-to 24-month-old, attachment difficulties often mire the child in an inability to integrate dependence and independence. A child frozen in this dilemma usually ends up choosing one extreme or the other and may become withdrawn or clingy. If these difficulties aren’t addressed, separation anxiety can linger into the school-age years where it can interfere with behavior and performance in school. Attachment difficulties at this age also sensitize a child to frustration and failure which results in strong anxiety, anger, and a coloring of the self with shame. The outward sign is often heightened aggressive behavior.
Weak attachment from 24 to 36 months can interfere with achieving self and object constancy. Poor object constancy makes it difficult for a child to relate emotionally because of the expectation of inevitable loss. This will manifest as clingy behavior to prevent the loss or distancing behavior to avoid any pain. Poor self constancy undermines a child’s confidence in his ability to cope with changing situations. As a result, she may become very vigilant to prevent becoming overwhelmed. Additionally, there may be problems with transitions or sudden changes.
If attachment problems linger through the preschool years and into the elementary years, they are at risk of intensifying. In the most extreme cases, a child may exhibit an attachment disorder. Children with this disorder have a generalized distrust of others, particularly authority figures, who are seen as exploitive. They see themselves as defective victims of life and accept no responsibility for anything. Despite this outward presentation, internally they feel responsible for everything bad that happens. There is little satisfaction in mastery, and learning is seen as relevant only if it has survival value. Social skills are quite limited. People tend to be viewed as interchangeable sources of gratification. At home, a child with attachment disorder can be an enormous stress on all family members; parents can come to feel ineffective, and siblings may feel strong anger and jealousy.
While attachment problems can have severe consequences, their legacy is not necessarily destiny. Expectably, the younger the child, the easier difficulties are to correct. Some children and families will require professional assistance. However, there are interventions parents can use that can have significant impact on a weak attachment.
Parental Strategies:
0 - 6 months: Increase physical contact with your infant either by carrying her more or obtaining a front-mounting pack. Rocking her more often can help as well. If your infant responds more to one sensory modality than another, draw on that sense more when interacting. Identify which sounds, types of touch, rhythms, positions, sights, and smells your infant enjoys. Pair these up with things that cause a startle reaction to lower anxiety. If your infant is primarily a self-soother, imitate her soothing activities (e.g., rocking) and add an additional element such as singing or comforting touch.
6 -10 months: Maintain a consistent routine to promote regulation. Allow your infant her full range of feelings. Crying now may just signal a feeling and not a call for help. Such a cry need not be immediately soothed, but attachment can be promoted by staying with your infant while she’s distressed, for your physical presence validates her feeling. Attachment problems make an infant prone to backslide or regress developmentally. Allowing some regression and interacting with your infant at a younger level can help fill in earlier gaps in the attachment process. Imitate self-soothing behaviors if they predominate.
If you adopt an infant at this age, learn as much as you can about the previous placement and transfer as many elements as possible into your home. If your infant attached to her previous caretaker, expect a grief reaction, a cry unlike other infant cries. Offer physical comfort, but know that this grief can be inconsolable. If your infant doesn’t relax, then remain with her so that her grief becomes part of his relationship with you. This will facilitate bonding and attachment.
10-18 months: Many of the techniques for younger infants also apply here. As the child ages, allowing regression and interacting with your infant while she is regressed can become more important as a method of filling in the previous attachment gaps. If your child moves away from you to explore but does not return to check in you can encourage checking-in by placing some favorite objects near you after she has moved away and calling her attention to them. Praise your child for returning.
15 - 24 months: When your child’s wooing becomes coercion, limit the attention available and redirect your toddler to another activity. Firm limits are important to complete the bonding cycle of trusting limits. If this isn’t done, there is a risk of unraveling the attachment gains made to this point. Overindulgence, though well-intended, will bear no good fruit. Watch for opportunities to use language to assist your child to understand and express feelings and ideas. If things can be expressed verbally they won’t be acted out behaviorally.
If you adopt a child of this age, record all the details of placement day and of the previous caretakers. Maintain contact with those caregivers, including visits, and later phone calls and cards. The frequency of contact should lessen over time. Allow open discussion about previous caretakers. This will facilitate the transfer of bonding and attachment from them to you.
24 - 36 months: Regressions are also likely during this period if attachment is poor. Allowing for these and interacting with your toddler during them can strengthen weak spots from previous stages. Guard against any temptations to be overprotective because this will interfere with resolving separation anxiety. Build in planned absences which can facilitate the resolution of separation anxiety. When discipline is required, the "One Minute Scolding Technique" (see van Gulden and Bartels-Robb 1995, pp.154-155 for an explanation) can fill the need while also strengthening object constancy. Make a clear distinction between the child and the behavior. Keep expectations realistic. This is particularly important for parents who adopt a 2- or 3-year-old. Unrealistic expectations will block attachment from developing by creating a preponderance of disappointment.
As children move into the preschool and school-age years, lingering attachment problems will result in increasing behavioral difficulties. There are some fundamental principles for parenting an older child with attachment problems.
Educate her over and over that her behavior results from her choices and does not simply happen.
Maintain a balance between empathy for your child’s struggle and expectations of change.
Provide specific unavoidable consequences for specific behaviors. This helps teach cause and effect.
Provide forced choices for your child to choose between (example: pick up your toys or leave them on the floor and they will be taken away until tomorrow).Teach your child that she will be happier if she learns to control her choices than by trying to control you.
When disciplining, provide empathy for the impact of the consequence while imposing it. This preserves attachment while maintaining discipline. It also prevents parents from unintentionally reinforcing behavior with an emotionally negative reaction.
Regressions in older children are more complex than in infants and toddlers. There is a more elaborate technique, termed Reparenting, for working with regression in the older child. (See van Gulden and Bartels-Robb 1995, 157-161 or Hughes 1997, pp. 235-7 for detailed explanations. Hughes [1997, Ch. 12] provides a detailed list of strategies for day-to-day situations with the older child).
Children with attachment problems can be very exhausting for parents, be they adoptive, foster, or biological children. They have a sixth sense for finding every button a parent has and pushing them all. If you have reached the point of feeling completely ineffective and discouraged, that is a warning signal that professional assistance should be considered.
References:
Greenspan, S., and Greenspan N.T. 1985. First Feelings. New York: Penguin.
Hughes, D.A. 1997. Facilitating Developmental Attachment. Northvale: Jason Aronson.
Peterson, J. 1994. The Invisible Road. Boulder, Colorado.
van Gulden H. and Bartels-Robb, L. 1995. Real Parents, Real Children. New York: Crossroad.
Lawrence Smith is a child, adolescent, adult and family therapist in private practice in Silver Spring.
Attachment Disorder Maryland
lbsmith@md.net
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Last updated
Wednesday, September 19, 2007