Where love fails, the
abandoned child
Bonding, attachment and separation anxiety
Attachment - definition
Atkinson et al (1990 p. 88)
 "The infants tendency to seek closeness to
particular people and to feel more secure in
their presence“
George Kelly (personal construct theory)
 The type of attachment is subject to change
but on the whole is constant.
Stages of attachment
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Birth
3/12
8/12
10/12
No social discrimination
Preference for permanent carer
Stranger anxiety
Object permanence
Ainsworth et al 1978
Phase 1 initial pre-attachment (0-3 months)
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Baby exhibits proximity promoting behaviour
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No preference for a particular adult
Phase 2 attachment in the making (3-6 months)
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Baby more discriminating
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Smiles more to familiar adults
Phase 3 clear cut attachment (6-7 months)
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Directs attachment behaviour to 1 or 2 people
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Exhibits proximity seeking
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Object permanence
Social referencing and separation protest
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Social referencing (10 months+)
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Uses attachment person as safe base
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Tests new behaviours
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Uses other as meter, checking facial expressions in new situations
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Cannot use strangers for social referencing
Ainsworth et al 1978 (continued)
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Separation anxiety (7 months - 16 months)
Declines after about 16 months
Temperament, some more fearful than others (Berberion and
Snyder 1982)
Recent family life events increases separation anxiety
Experience of multiple carers may have an effect
Phase 4 (Multiple attachments)
 Child uses other people (teachers) for social referencing
Fathers
Parke and Tinsley (1981)
 Fathers early attachment behaviour similar to
mothers
 More ‘roughhousing’
Failure of attachment
Turn taking
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Bee (1989) refers to as a well practised dance, exhibits smoothness and predictability.
Brazelton et al (1974) describe asynchronous (maladaptive) turn taking.
Because either:
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The infant lacks skills (mental handicap)
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The parents lack skills
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Abuse is more common in premature babies and those that have been sick
(Sherrod et al 1984)
Parents may have experienced their own failure of attachment as children
The abused are more likely to abuse their own children (Sroufe and Fleeson 1986)
Egocentric parents more likely to abuse (Newberger and Cook 1983)
Depression, poor housing and stress etc. likely to exacerbate poor attachment
Kempe and Kempe (1978) describe a successful scheme showing the benefit of a
hot line, support and counselling.
Ainsworth and Wittig (1969)
Secure and insecure attachment
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Securely attached
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Insecurely attached (detached / avoidant)
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avoids contact with mother
does not resist mothers attempts to make contact but does not initiate contact seeking
treats strangers similarly to mother.
Insecurely attached (resistant ambivalent)
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Prefers mother to strangers
Reassured by mother easily
Does not resist mother
Tolerates short separation
very upset on separation
not comforted by mother on return
both seeks and avoids contact
resists comfort and contact with strangers
Insecurely attached (disorganised / disorientated) added by Main and Soloman (1985)
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Appears confused
Strong proximity followed by strong avoidance
Reliability
Main, Kaplan and Cassidy (1985)
 Measures of attachment between 18 months
and 6 years correlate
Waters , Wippman and Sroupe (1979),
Described in Bee (1989)
Securely attached children – tended to become:
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social leaders
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initiating
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admired by other children
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self directed and eager to learn
Insecurely attached children – tended to become:
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Socially withdrawn
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hesitant at participating
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less curious
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less likely to pursue their goals
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No relationship with intelligence
But may be due to the child’s personality rather than quality of attachment.
Radke-Yarrow et al (1985)
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Mothers of insecurely attached children
avoided contact. They avoid their infants as
much as their infants avoid them.
Harlow and Suomi (1970)
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Monkeys separated at birth would cling to cloth monkeys
rather than wire ones with food.
Fearful monkeys were less fearful when holding onto the
cloth monkey
Monkeys preferred moving (rocking) monkey to a still
monkey
Monkeys preferred warm monkeys to cold ones
Monkeys that were raised with pretend monkeys (all):
Cowered or were aggressive to other monkeys when grown
up
Exhibited inappropriate sexual responses
Were poor parents, neglecting or abusing their offspring.
Bowlby (1973)
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Failure of secure attachment related to
inability to develop close personal
relationships in adulthood
Matas, Arend and Sroufe (1978)
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Securely attached children (2 years) got less
upset when given a problem they could not
solve.
Less securely attached children became angry,
quickly gave up and rejected adult help.
Campbell and Taylor (1980), De
Chateau (1980)
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Previous research changed hospital policies
Introduced concept of critical period for attachment
May be due to early non-alertness
No clear evidence of attachment failure in hospital
However, attachment experience is clearly rewarding
Kennell et al (1974) found lasting effects of hospital
maternal deprivation but others have failed to
 Replicate their results.
 Difficult to identify what should be measured.
Other clinical findings
De Chateau (1987)
 Early contact associated with longer breast feeding
Sostek et al (1982)
 Early contact associated with more positive attitude
and greater parental confidence
O'Connor et al ( 1980)
 Early contact associated with less likelihood of
inadequate parenting and abuse (effect was small)
Separation anxiety
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Bowlby, Robertson and Rosenbluth (1967) ..
protest, despair and denial
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Brain and Maclay (1968) Children admitted
with parents
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adjusted better to hospital
less disturbed after discharge
reduced incidence of surgical complications
A two year old goes to hospital 1967
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Bowlby, Robertson and Rosenbluth (1967) the film 'a two
year old goes to hospital'
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MacKieth (1953 p. 679):
'The film shows clearly how a happy self controlled little girl
reacted. She pulled at her lips, clung to her doll, was
unusually quiet, took five minutes to thaw when her mother
visited her, and so on. This film opens one‘s eyes to the quiet
unhappiness that a young child in hospital may suffer much
of the day, almost unnoticed by the nurses and doctors. We
do not want to see the grief and we see only a 'good' quiet
child .. we tend to dismiss all crying as common and
unimportant'.
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Other factors
Prugh et al (1953)
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Children under 4 years suffered most.
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Children with good relationship with their parents had less severe reaction
to hospital.
Brown (1979) the 'initiating' child less easily upset.
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Vulnerable children had anxious mothers
Stacey et al (1970)
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number of carers and experience of separation
Rosenberg (1963)
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extreme parental indifference related to low child self esteem
Parental anxiety
Davies (1984):
 Correlation between maternal and child
anxiety in hospital.
 Children less anxious when parents resident
 Staff did appreciate parent's anxiety
 Mothers most worries about operation and
anaesthetic
Cause of parental anxiety
Wood (1988)
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poor support given to parents,
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often due to low staffing
Williamson and Williamson (1987) parental stress caused by:
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noise at night
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routine generalized care
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lack of information and concern for child's welfare
Cocks (1990) personal experience:
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petty and unnecessary restrictions (anaesthetic room)
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uncomfortable bed at night
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nurses having no time to stay with child, unable to leave
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non individualized care and routine
Parents’ positive experience
Williamson and Williamson (1987) positive experience
linked to:
 single room accommodation (parent and child room)
 relaxed atmosphere
 Facilities and promotion of children's play
 getting to know staff as friends .. most enjoyable
O'Toole (1990) describes positive experience of being
able to go into the anaesthetic room
Benefit of ‘own’ nurse
Skipper, Leonard and Rhymes (1968) parents benefited
from 'special' (key) nurse
Mahaffy (1965) used 'key' nurse:
 children recovered more quickly (tonsillectomy)
 significant differences on physiological measures
 better fluid intake, less vomiting, less crying
 fewer post discharge complications
Information
Meadow (1969):
 25% of parents had been told too little
 parents 'longed for' information (about
operation)
 hospital boring and claustrophobic
 being resident caused them to worry less
 parents worried unnecessarily because of poor
info
Information
Knox and Hayes (1983):
 parents wanted preadmission info. for themselves
 anxiety decreased when information given
 parents lacked confidence in carrying out care
 parents were uncertain about their role in hospital
 parents longed for the opportunity to talk openly to
staff
 fathers felt 'left out' and ignored by staff
Information
Mishel (1982):
 parents stress correlated with uncertainty
 parents likely to interpret child's condition as
unduly serious
Lynn (1986) the more parents were able to
anticipate events the less anxiety was
experienced