How does Attachment Develop?

The attachment system evolved over time to ensure the survival of the infant. The attachment system is a biologically based system found in nearly all mammals. The attachment system operates in a manner similar to your home heating and cooling system. If the temperature is just right, nothing happens. Only when the temperature goes outside of preset bounds does your heating and cooling system turn on. The same type “homeostatic” process is at the core of the attachment system.
In its most simple form, the attachment system is a proximity seeking system. When the child feels some threat, the child gravitates toward the preferred caregiver, who is most likely to care for and protect the child. This is how the attachment system evolved as a means of ensuring the survival of the vulnerable infant and child. The attachment system and the exploration system operate like a see-saw. If one is activated, the other is deactivated. When the child feels safe and secure, the exploration system is active. When threatened, fearful, anxious, the attachment system is active.
Attachment behavior, which is proximity seeking behavior, is exhibited throughout the life cycle. The toddler, when threatened, will go to the parent, maybe grab the parent’s leg, hide behind the parent, or in some other way make contact with the parent. Once the child feels safe, the child will then go about exploring the environment (playing). An example of attachment behavior in a young adult can be seen in the actions of a young student away at college on 9/ll 2001. On that day the student called home several times during the day to give her parents “news updates” about the unfolding events. Her first call was to, “turn on the TV Dad, a plane just hit the world trade center.” Her second call was, “Mom, did you see, a second plane hit….” And so it went throughout that awful day. Something terrible was happening that was a threat to the girl, and so she felt the need to make contact with her primary attachment figures. For a young adult, the telephone worked fine; while for a toddler, physical contract may be necessary.
So, then, how does this system develop? Remember Erik Erikson’s stages of development? The first stage, Trust vs. Mistrust? During this stage the foundation of attachment and patterns of attachment emerge. Infants cannot easily regulate themselves and they need a caregiver to regulate them. The normally sensitive parent responds to the child’s cries, figures out what is wrong, and then responds to meet the need. When this happens is a fairly regular and consistent manner the child learns, experientially, several important things. The child learns that the world is largely a benign place. The child learns that discomfort will be remedied before it gets too bad; this forms the basis for impulse control. The child learns that its needs will be met in a timely manner. The infant learns that caregivers are largely reliable, good, and helpful. And the child learns that the child is valued, valuable, loved, and loveable.
During the toddler years, which are about shame, the child is ambulatory, exploring the world, and “getting into trouble,” largely because the child does not recognize dangers. As a result, the caring parent is saying “NO!” a lot; to protect the child. When the parent sets this sort of limit, the child experiences shame. The child may cry, hide, cover the child’s face, or in some other manner evidence shame. Shame is about who you are and when we feel shame, we hide. The normally sensitive parent responds by comforting the child while setting the limit. “It’s ok, sweetie, I don’t want you to grab that cup because it is very hot and you could hurt yourself.” The child looks at the parent, experiences that the parent is not angry at the child, and then the parent repairs the relationship and reconnects with the child. When this happens repeatedly, the child moves from shame to guilt. The child learns, experientially, that while the child is loved and loveable, it is what the child does, not the child, that is upsetting the parent. Guilt is about what you do; shame is about who you are. When you feel shame you hide; when you feel guilt you want to confess and fix it.

Finding homes for Children in Foster Care

A recent article in the NY Times describes the efforts of one man to track down the relatives of children in foster care and to help children move into permanent adoptive homes. His work is quite inspiring. Mr. Lopez, a former police detective, now does gumshoe work for what he calls a more fulfilling cause: tracking down long-lost relatives of teenagers languishing in foster care, in desperate need of family ties and in danger of becoming rootless adults.

"Finding an adoptive parent for older children with years in foster care is known in child welfare circles as the toughest challenge. Typically, their biological parents abused or neglected them and had parental rights terminated. Relatives may not know where the children are, or even that they exist. And the supply of saints in the general public, willing to adopt teenagers shaken by years of trauma and loss, is limited."

This is an inspiring article.

The article can be found at:
http://www.nytimes.com/2010/01/31/us/31adopt.html?pagewanted=1&em


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New book for parents

Attachment Parenting, a new book edited by Arthur Becker-Weidman, Ph.D., & Deborah Shell, will be out in May of this year. Many of the chapters are written by myself and Deb. In addition, there are a number of chapters by various experts in the fields of Theraplay, Sensory-Integration, and Neuropsychology. The book is for parents and professionals and provides a home-based approach for parents to use to help children with complex trauma and disorders of attachment. The book is grounded in Dyadic Developmental Psychotherapy, which is an evidence-based, effective, and empirically validated treatment.

Treatment for PTSD

Post Traumatic Stress Disorder (PTSD) is quite different from Complex Trauma. PTSD is a clinical diagnosis usually applied when an person has experienced a life-threatening event and develops certain symptoms. Complex Trauma refers to the pervasive effects of chronic early maltreatment within a care-giving relationship. Complex Trauma usually results in more impairments that does PTSD.

Dyadic Developmental Psychotherapy is an evidence-based, effective, and empirically validated treatment for Complex Trauma.

Post-traumatic stress disorder (PTSD) is characterized by symptoms such as repeated, intrusive upsetting memories of the trauma; avoidance of similar situations and things which might remind one of them; a feeling of detachment from others; hypervigilance, and overarousal. It is associated with problems at work and at home and it is estimated that between 1% and 14% of people might suffer from it over the course of their lifetime. A team of researchers from New York reviewed 57 studies into treatments for PTSD and acute stress disorder which can often lead to it. They found that there was the strongest evidence for trauma-focused cognitive-behavioural therapy (CBT) and eye-movement desensitization and reprocessing (EMDR). There was some evidence that stress innoculation training, hypnotherapy, interpersonal psychotherapy and psychodynamic psychotherapy were effective for PTSD and that trauma-focused CBT was effective for acute stress disorder. The study also found evidence that trauma-focused CBT was effective for assault- and road-traffic-accident-related PTSD.

Ponniah, Kathryn and Hollon, Steven D. - Empirically supported psychological treatments for adult acute stress disorder and posttraumatic stress disorder: a review Depression and Anxiety December 2009, 26(12), 1086-1109

ADHD among Internationally Adopted Children: Empirical Study

There is a very interesting and informative study in the most recent issue of the European Child & Adolescent Psychiatry titled, ADHD in international adoptees: a national cohort study The abstract is summarized below:

Several investigators have reported an increased frequency of attention/hyperactivity symptoms in internationally adopted children. In this national cohort study, the authors aimed to determine the prevalence of ADHD medication in international adoptees in Sweden, in comparison to the general population. A further purpose was to study gender, age at adoption and region of origin as predictors of ADHD medication in international adoptees. The study population consisted of all Swedish residents born in 1985–2000 with Swedish-born parents, divided into 16,134 adoptees, and a comparison population of 1,326,090. ADHD medications were identified in the Swedish Prescribed Drug Register during 2006. Logistic regression was used to calculate the "odds ratios".

The rates of ADHD medication were higher in international adoptees than in the comparison population for both boys (5.3 vs. 1.5% for 10–15-year olds) and girls (2.1 vs. 0.3% for 10–15-year olds). International adoptees from all regions of birth more often consumed ADHD medication compared with the majority population, but the age and sex adjusted odds ratios were particularly high for adoptees from Eastern Europe, Middle East/Africa and Latin America. Adjusting for maternal education and single parenthood increased the odds ratios even further. The risk also increased with higher age at adoption. Adoptees from Eastern Europe have a very high risk for ADHD medication. A structured identification and support programme should be tailored for this group. Adoptees from other regions have a more moderately increased risk, which should be communicated to adoptive parents and to professionals who care for adoptees in their clinical practice.

Of course it is still unclear whether the children actually had ADHD since attention difficulties and related "ADHD" symptoms can also be caused by sensory-integration dysfunction, trauma symptoms, Complex Trauma, attachment difficulties and disorders, and Bipolar disorder. The fact that the children from Eastern Europe had the highest rate of use of ADHD medication does suggest some environmental rather than a genetic cause for the attention problems; suggesting that the cause may lie with the effects of chronic early maltreatment on development (Complex Trauma)

How the brain is affected by relationships

In the “Clinician’s Digest” section of the November/December 2009 issue of Psychotherapy Networker http://psychcentral.com/psychotherapy/, Garry Cooper discusses a study led by psychiatrist Jakob Koch of Christian-Albrechts University in Kiel, Germany suggesting that “effective psychotherapy with depressed clients is associated with changes at the brain’s cellular level,” increasing the production of a key brain protein that assists in creating neural pathways. In this study they used Interpersonal Psychotherapy (IPT) which looks through the lens of both cognitive and interpersonal issues. It would be interesting to know how other theoretical orientations would fare.

There is a lot known about the power of oxytocin (the hormone of love) to bond people together but oxytocin can also be an ally to encourage therapeutic change. According to Linda Graham, MFT and trainer on the integration of relational psychology, mindfulness and neuroscience, it is “the neurochemical basis of the sense of safety and trust that allows clients to become open to therapeutic change.” It was a class I recently took with Linda, “The Neuroscience of Attachment,” that left me feeling so inspired about the implications of this in my practice. As a therapist, it’s nice to have something solid and research-based to hang my hat on.

Daniel Siegel, MD, one of the pioneers in this field has been saying for years that there is potential for the growth of new brain cells via relationships. I remember seeing him speak at a conference about five years ago but got derailed somehow and didn’t follow up on any further research on the matter. I’m glad to have made my way back to these concepts so I can further learn how to provide the most fertile soil possible for therapeutic change within the four walls of my own psychotherapy office.

The power of the “relationship” is not to be underestimated. Important relationships can do monumental damage – or they can facilitate profound healing. Many psychotherapists have known that the therapeutic relationship is one that can provide a “safe container” for emotional and psychological healing. Many of us believe that by providing a stable, nurturing model of something “different,” there is the potential for a corrective experience that the client can integrate into his life.

Now we know there is the potential for changes within the brain as well — which is only more encouragement for the lasting, deep shifts that we hope for our clients — and they hope for themselves. Perhaps the commonly held belief that “people can’t change” will finally, truly be a thing of the past.

Trauma's effects

Having a stressful childhood may slash decades off a person’s life, researchers from the Centers for Disease Control and Prevention (CDC) report.

Among people who reported experiencing at least six of eight different bad childhood experiences-from frequent verbal abuse to living with a mentally ill person-average age at death was about 61, compared to 79 for people who didn’t have any of these experiences as children, the researchers found.

Dr. David W. Brown and Dr. Robert Anda of the CDC and colleagues from the CDC and Kaiser Permanente have been following 17,337 men and women who visited the health plan between 1995 and 1997 to investigate the relationship between bad childhood experiences and health.

So far, Anda noted in an interview, they have shown links between childhood stressors and heart disease, lung disease, liver disease and other conditions. “The strength of it really surprised me, how powerfully it’s related to health,” the researcher said.

In the current analysis, the researchers reviewed death records through 2006 to investigate whether these experiences might also relate to mortality. During that time, 1,539 study participants died.

Each person was asked whether they had any of eight different categories of such experiences, including verbal abuse, physical abuse, sexual abuse with physical contact, having a battered mother, having a substance-abusing person in the household, having a mentally ill person in the household, having a household member who was incarcerated, or having one’s parents separate or divorce.

Sixty-nine percent of the study participants who were younger than 65 reported at least one of the adverse childhood experiences, while 53 percent of people 65 and older did.

Those who reporting experiencing six or more were 1.5 times more likely to die during follow-up than those who reported none, the researchers found. They were 1.7 times as likely to die at age 75 or younger, and nearly 2.4 times as likely to die at or before age 65.

There are a number of ways that a traumatic childhood could contribute to ill health, Anda noted. For example, childhood stress affects brain development, so individuals who’ve experienced it may be more likely to suffer from depression and anxiety, and more prone to deal with stress in unhealthy ways, for example by drinking alcohol or smoking cigarettes.

Just a third of the people in the study were completely free of any sort of childhood trauma, Anda added, making it clear that these sorts of harmful experiences are widespread.

“If we want to address a lot of major public health issues we’ve got to address the kind of stressors children have in our society as a way of primary prevention,” he said.

SOURCE: American Journal of Preventive Medicine, November 2009.

Having a stressful childhood can significantly reduce people’s life expectancy. Researchers from the U.S. Centers for Disease Control and the Kaiser Permanente Organisation studied 17,337 men and women to investigate the links between bad childhood experiences and health. The researchers defined eight different adverse childhood experiences: verbal abuse, physical abuse, sexual abuse with physical contact, having a battered mother, having a substance-abusing person in the household, having a mentally ill person in the household, having a household member who was incarcerated, or having one’s parents separate or divorce. 69% of the study participants under the age of 65 reported at least one of these experiences while 53% of those over 65 did. Those people who reported six or more adverse experiences were 1.7 times more likely to die at 75 or younger and 2.4 times more likely to die at 65 or younger. The authors of the study thought that having a troubled childhood makes people more likely to develop anxiety and depression which they cope with by using tobacco and alcohol.