Why does attachment matter for children’s development?

The importance of soothing

Why does attachment matter for children’s development?

Anxiety attachment behaviours

comfort from caregiver

reduction in anxiety

Bowlby, 1973

Attachment behaviours present from birth

Selective attachment present from around 6 or 7 months

Attachment patterns are a measure of the relationship, not of the child

Attachment and Attachment Disorders

Why does attachment matter for children’s development?

General population:

~70% secure

~30% insecure

Ainsworth, 1979

Attachment can be measured at 12-18 months using the strange situation procedure

Why does attachment matter for children’s development?

Secure attachment

•Infant goes to parent when stressed

•Easily comforted

•Back to the job of exploring/learning

Why does attachment matter for children’s development?

Insecure-avoidant attachment

•Infant doesn’t use parent for soothing

Why does attachment matter for children’s development?

Insecure-resistant/ambivalent attachment

•Infant goes to parent when stressed

•But not easily comforted

Some insecure attachment patterns make perfect sense!

Why does attachment matter for children’s development?

Insecure-disorganised/disorientated attachment

•Acts as if not sure what to do when stressed

Higher risk of aggressive behaviour later

What happens if children are not

soothed as babies?

Why does attachment matter for children’s development?

Normal diurnal rhythm of cortisol

Stress

Why does attachment matter for children’s development?

Romanian orphans

Response to stress ca n be unpredictable

Stress

Why does attachment matter for children’s development?

Maltreated children pre-schoolDozier

Stress

Why does attachment matter for children’s development?

Why does attachment matter for children’s development?

Edlington boys

Exposed to neglect and violence, alcohol and cannabis

Why does attachment matter for children’s development?

The parts most affected are those which have the most rapid development after birth

What can happen to the brain with maltreatment in early life?

Hippocampus

Why does attachment matter for children’s development?

Role in dissociative states, anxiety disordersApparent hippocampal shrinkage with PTSD but twin study suggests small hippocampus might predispose to PTSD

Hippocampus retains its ability to generate neurons throughout life e.g. taxi drivers “knowledge”

Eriksson et al 1998 Nature MedicineMaguire et al 1997 Journal of Neuroscience

“Its not grey matter that I’ve got in mine… its faecal matter because of all the s**t that comes through that partition!”

Glasgow Taxi Driver

But there is always hope…

Why does attachment matter for children’s development?

Amygdala

Why does attachment matter for children’s development?

Role in fear conditioning, control of aggressive and sexual behaviours

Corpus callosum and interhemispheric

integration

•Left hemisphere - language and logical thought•Right hemisphere - perception and expression of emotion, particularly negative•Reduced corpus callosum size in childhood maltreatment, especially in boys

Why does attachment matter for children’s development?

Why does attachment matter for children’s development?

Neurobiology of Maltreatment

Cerebellum

•Role in attention, language, cognition, affect and movement•Very high density of stress hormone receptors – may be very susceptible to stress postnatally

Neurobiology of Maltreatment

Cerebral cortex

•Lots of stress hormone receptors – may be very susceptible to stress in postnatal period

•Fronto-temporal area is particularly important – involved in “executive functioning” i.e. planning, complex social interaction

Neurobiology of Maltreatment

Cerebral cortex

•maltreatment may cause a precociously mature cerebral cortex with “stunted final capacity”

Teicher, 2003

Neurobiology of Maltreatment

HPA axis and stress

Adapts, in a situation of neglect/violence, to deal with stressful early environment: fight, flight, freeze

Stress thermostat

-Adaptive in situations of high stress-Maladaptive or leading to psychiatric disorders in situations of low stress

Neurobiology of Maltreatment

Gunnar 2002 Psychoneuroendocrinology

Doctors for a jag

Neurobiology of Maltreatment

HPA axis and stress•At 3 months, children cry and see cortisol peak on immunisation

•By 12-18 months, securely attached infants cry but no longer see cortisol peak

•In insecurely attached or temperamentally inhibited children, still see a cortisol peak in presence of caregiver

Gunnar 2002 Psychoneuroendocrinology

Infants:

Attachment and Biobehavioural Catch-up (ABC) –

•Trains carers of maltreated children to be extra-nurturing

•Randomised Controlled Trial evidence that can return cortisol patterns to normal

Treatment?

Attachment Disorders

Older children:

•Dyadic Developmental Psychotherapy

•Good US pilot study suggests very effective in reducing behaviour problems

•Needs Randomised Controlled Trial – plans for this in Glasgow

Treatment?

Attachment Disorders

Neurobiology of Maltreatment

Who is right?

Ed Balls asks 'Can we sort out the problems

in the family?'

Martin Nary (Barnardos) says

more children should be adopted

at birth

Prevention?

New Orleans Model:

•Every maltreated child under 5 and their family has an intensive attachment-based assessment

•Intensive intervention for birth family (while child in foster care) to maximise chance of rehabilitation

•Time limit of 15 months, then decision:

Adoption or Rehabilitation?

Prevention?

Attachment Disorders

New Orleans Results:

•Increased freeing for adoption

BUT

•Where rehabilitated, reduction in maltreatment of both that child and subsequent siblings

•i.e. good decisions

Plan for Glasgow pilot and trial

Attachment Disorders

Prevention?

Why does attachment matter for children’s development?

Final points:

•Lets support parents to get attachment right in the first place

•Lets prevent damage to development by making decisions about children early

•Lets find and test ways of helping when there have been problems

These are some of the core aims of Scottish Attachment in Action