Attachment in children

Biological instinct

Attachment in children is "a biological instinct in which proximity to an attachment figure is sought when the child senses or perceives threat or discomfort. Attachment behaviour anticipates a response by the attachment figure which will remove threat or discomfort". Attachment also describes the function of availability, which is the degree to which the authoritative figure is responsive to the child's needs and shares communication with them. Childhood attachment can define characteristics that will shape the child's sense of self, their forms of emotion regulation, and how they carry out relationships with others. Attachment is found in all mammals to some degree, especially primates. Attachment theory has led to a new understanding of child development. Children develop different patterns of attachment based on experiences and interactions with their caregivers at a young age. Four different attachment classifications have been identified in children: secure attachment, anxious ambivalent attachment, anxious avoidant attachment, and disorganized attachment. Attachment theory has become the dominant theory used today in the study of infant and toddler behavior and in the fields of infant mental health, treatment of children, and related fields.

Attachment theory (developed by the psychoanalyst Bowlby 1969, 1973, 1980) is rooted in the ethological notion that a newborn child is biologically programmed to seek proximity with caregivers, and this proximity seeking behavior is naturally selected. Through repeated attempts to seek physical and emotional closeness with a caregiver and the responses the child gets, the child develops an internal working model (IWM) that reflects the response of the caregiver to the child. According to Bowlby, attachment provides a secure base from which the child can explore the environment, a haven of safety to which the child can return when he or she is afraid or fearful. Bowlby's colleague Mary Ainsworth identified that an important factor which determines whether a child will have a secure or insecure attachment is the degree of sensitivity shown by their caregiver:

The sensitive caregiver responds socially to attempts to initiate social interaction, playfully to his attempts to initiate play. She picks him up when he seems to wish it, and puts him down when he wants to explore. When he is distressed, she knows what kinds and degree of soothing he requires to comfort him – and she knows that sometimes a few words or a distraction will be all that is needed. On the other hand, the mother who responds inappropriately tries to socialize with the baby when he is hungry, play with him when he is tired, or feed him when he is trying to initiate social interaction. However, it should be recognized that "even sensitive caregivers get it right only about 50 percent of the time. Their communications are either out of synch, or mismatched. There are times when parents feel tired or distracted. The telephone rings or there is breakfast to prepare. In other words, attuned interactions rupture quite frequently. But the hallmark of a sensitive caregiver is that the ruptures are managed and repaired."

The most common and empirically supported method for assessing attachment in infants (12 months – 20 months) is the Strange Situation Protocol, developed by Mary Ainsworth as a result of her careful in depth observations of infants with their mothers in Uganda(see below). The Strange Situation Protocol is a research, not a diagnostic, tool and the resulting attachment classifications are not 'clinical diagnoses.' While the procedure may be used to supplement clinical impressions, the resulting classifications should not be confused with the clinically diagnosed 'Reactive Attachment Disorder (RAD).' The clinical concept of RAD differs in a number of fundamental ways from the theory and research driven attachment classifications based on the Strange Situation Procedure. The idea that insecure attachments are synonymous with RAD is, in fact, not accurate and leads to ambiguity when formally discussing attachment theory as it has evolved in the research literature. This is not to suggest that the concept of RAD is without merit, but rather that the clinical and research conceptualizations of insecure attachment and attachment disorder are not synonymous. The 'Strange Situation' is a laboratory procedure used to assess infant patterns of attachment to their caregiver. In the procedure, the mother and infant are placed in an unfamiliar playroom equipped with toys while a researcher observes/records the procedure through a one way mirror. The procedure consists of eight sequential episodes in which the child experiences both separation from and reunion with the mother as well as the presence of an unfamiliar stranger. The pattern the child develops after age five demonstrates the specific parenting styles used during the developmental stages within the child. These attachment patterns are associated with behavioural patterns and can help further predict a child's future personality.

"The strength of a child's attachment behaviour in a given circumstance does not indicate the 'strength' of the attachment bond. Some insecure children will routinely display very pronounced attachment behaviours, while many secure children find that there is no great need to engage in either intense or frequent shows of attachment behaviour".

A toddler who is securely attached to its parent (or other familiar caregiver) will explore freely while the caregiver is present, typically engages with strangers, is often visibly upset when the caregiver departs, and is generally happy to see the caregiver return. The extent of exploration and of distress are affected by the child's temperamental make up and by situational factors as well as by attachment status, however. A child's attachment is largely influenced by their primary caregiver's sensitivity to their needs. Parents who consistently (or almost always) respond to their child's needs will create securely attached children. Such children are certain that their parents will be responsive to their needs and communications. In the traditional Ainsworth et al. (1978) coding of the Strange Situation, secure infants are denoted as "Group B" infants and they are further subclassified as B1, B2, B3, and B4.

Ainsworth herself was the first to find difficulties in fitting all infant behaviour into the three classifications used in her Baltimore study. Ainsworth and colleagues sometimes observed 'tense movements such as hunching the shoulders, putting the hands behind the neck and tensely cocking the head, and so on. It was our clear impression that such tension movements signified stress, both because they tended to occur chiefly in the separation episodes and because they tended to be prodromal to crying. Indeed, our hypothesis is that they occur when a child is attempting to control crying, for they tend to vanish if and when crying breaks through'. Such observations also appeared in the doctoral theses of Ainsworth's students. Crittenden, for example, noted that one abused infant in her doctoral sample was classed as secure (B) by her undergraduate coders because her strange situation behaviour was "without either avoidance or ambivalence, she did show stress related stereotypic headcocking throughout the strange situation. This pervasive behaviour, however, was the only clue to the extent of her stress". Drawing on records of behaviours discrepant with the A, B, and C classifications, a fourth classification was added by Ainsworth's colleague Mary Main and Judith Solomon. In the Strange Situation, the attachment system is expected to be activated by the departure and return of the caregiver. If the behaviour of the infant does not appear to the observer to be coordinated in a smooth way across episodes to achieve either proximity or some relative proximity with the caregiver, then it is considered 'disorganised' as it indicates a disruption or flooding of the attachment system (e. g. by fear). Infant behaviours in the Strange Situation Protocol coded as disorganised/disoriented include overt displays of fear; contradictory behaviours or affects occurring simultaneously or sequentially; stereotypic, asymmetric, misdirected or jerky movements; or freezing and apparent dissociation. Lyons Ruth has urged, however, that it should be wider 'recognized that 52% of disorganized infants continue to approach the caregiver, seek comfort, and cease their distress without clear ambivalent or avoidant behavior.' There is 'rapidly growing interest in disorganized attachment' from clinicians and policy makers as well as researchers. Yet the Disorganized/disoriented attachment (D) classification has been criticised by some for being too encompassing. In 1990, Ainsworth put in print her blessing for the new 'D' classification, though she urged that the addition be regarded as 'open ended, in the sense that subcategories may be distinguished', as she worried that the D classification might be too encompassing and might treat too many different forms of behaviour as if they were the same thing. Indeed, the D classification puts together infants who use a somewhat disrupted secure (B) strategy with those who seem hopeless and show little attachment behaviour; it also puts together infants who run to hide when they see their caregiver in the same classification as those who show an avoidant (A) strategy on the first reunion and then an ambivalent resistant (C) strategy on the second reunion. Perhaps responding to such concerns, George and Solomon have divided among indices of Disorganized/disoriented attachment (D) in the Strange Situation, treating some of the behaviours as a 'strategy of desperation' and others as evidence that the attachment system has been flooded (e. g. by fear, or anger). Crittenden also argues that some behaviour classified as Disorganized/disoriented can be regarded as more 'emergency' versions of the avoidant and/or ambivalent/resistant strategies, and function to maintain the protective availability of the caregiver to some degree. Sroufe et al. have agreed that 'even disorganised attachment behaviour (simultaneous approach avoidance; freezing, etc.) enables a degree of proximity in the face of a frightening or unfathomable parent'. However, 'the presumption that many indices of "disorganisation" are aspects of organised patterns does not preclude acceptance of the notion of disorganisation, especially in cases where the complexity and dangerousness of the threat are beyond children's capacity for response'. For example, 'Children placed in care, especially more than once, often have intrusions. In videos of the Strange Situation Procedure, they tend to occur when a rejected/neglected child approaches the stranger in an intrusion of desire for comfort, then loses muscular control and falls to the floor, overwhelmed by the intruding fear of the unknown, potentially dangerous, strange person'. Main and Hesse found that most of the mothers of these children had suffered major losses or other trauma shortly before or after the birth of the infant and had reacted by becoming severely depressed. In fact, 56% of mothers who had lost a parent by death before they completed high school subsequently had children with disorganized attachments. For example, Solomon and George found that unresolved loss in the mother tended to be associated with disorganised attachment in their infant primarily when they had also experienced an unresolved trauma in their life prior to the loss.

Research based on data from longitudinal studies, such as the National Institute of Child Health and Human Development Study of Early Child Care and the Minnesota Study of Risk and Adaption from Birth to Adulthood, and from cross sectional studies, consistently shows associations between early attachment classifications and peer relationships as to both quantity and quality. Lyons Ruth, for example, found that 'for each additional withdrawing behavior displayed by mothers in relation to their infant's attachment cues in the Strange Situation Procedure, the likelihood of clinical referral by service providers was increased by 50%.' Behavioural problems and social competence in insecure children increase or decline with deterioration or improvement in quality of parenting and the degree of risk in the family environment.

With respect to the ecological validity of the Strange Situation, a meta analysis of 2,000 infant parent dyads, including several from studies with non Western language and/or cultural bases found the global distribution of attachment categorizations to be A (21%), B (65%), and C (14%). This global distribution was generally consistent with Ainsworth et al. 's (1978) original attachment classification distributions. However, controversy has been raised over a few cultural differences in these rates of 'global' attachment classification distributions. In particular, two studies diverged from the global distributions of attachment classifications noted above. One study was conducted in North Germany in which more avoidant (A) infants were found than global norms would suggest, and the other in Sapporo, Japan, where more resistant (C) infants were found. Of these two studies, the Japanese findings have sparked the most controversy as to the meaning of individual differences in attachment behaviour as originally identified by Ainsworth et al. (1978). In a recent study conducted in Sapporo, Behrens et al. (2007) found attachment distributions consistent with global norms using the six year Main & Cassidy scoring system for attachment classification. In addition to these findings supporting the global distributions of attachment classifications in Sapporo, Behrens et al. also discuss the Japanese concept of amae and its relevance to questions concerning whether the insecure resistant (C) style of interaction may be engendered in Japanese infants as a result of the cultural practice of amae. A separate study was conducted in Korea, to help determine if mother infant attachment relationships are universal or culture specific. The results of the study of infant mother attachment were compared to a national sample and showed that the four attachment patterns, secure, avoidance, ambivalent, and disorganized, exist in Korea as well as other varying cultures. Van IJzendoorn and Kroonenberg conducted a meta analysis of various countries, including Japan, Israel, Germany, China, the UK and the USA using the Strange Situation. The research showed that though there were cultural differences, the four basic patterns, secure, avoidance, ambivalent, and disorganized can be found in every culture in which studies have been undertaken, even where communal sleeping arrangements are the norm. Selection of the secure pattern is found in the majority of children across cultures studied. This follows logically from the fact that attachment theory provides for infants to adapt to changes in the environment, selecting optimal behavioural strategies. How attachment is expressed shows cultural variations which need to be ascertained before studies can be undertaken. The original Richter's et al. (1998) scale is strongly related to secure versus insecure classifications, correctly predicting about 90% of cases.