Attachment:
Close observation
Clinical applications
John Richer
CHOX and DPAG
Oxford
Temper tantrum
•
•
•
•
3 years old
Behaviour problems +
Mother not coping +
Attachment insecurity ++
Video
Temper tantrum
Describe
What is going on?
What do the behaviours mean?
What are the child’s feelings / motivations?
What are the mother’s feelings / motivations?
Fear, Frustration, Insecurity
Child
Parent
Angry
avoidance
Let go
Approach,
Attachment behaviour
Pick up
/Retrieval
Escape
Go to
Attachment
driven
approach
Strength of
motivation
Tempers
happen
here
Near
Distance apart
Avoidance
Far
Fear, Frustration, Insecurity
Child
Parent
Distance apart
Avoidance
Pull away
Collapse on floor
Pull head back
Attachment behaviour
Move towards
Bury head in
“Mummy”
Let go
Move hands
away
Do little
Retrieval
Hold
Arm around
Speak to
Increasing
Decreasing
Video
Mum reduces her approach behaviour
Child increases his approach behaviour
///
Mum reduces her retrieval behaviour
Child increases his attachment behaviour
Video
Mum increases her approach behaviour
Child increases his avoidance behaviour
///
Mum increases her retrieval behaviour
Child increases his avoidance behaviour
Motivational conflict
•
•
•
•
•
•
•
•
•
[One wins out]
Alternation
e.g. dither
Simultaneous
e.g. approach +gaze avert
Compromise
e.g. side on
Overintensity
e.g. OTT, too close
Displacement activities e.g. stereotypies, tics
Aggression
Re-directed aggression e.g. to mother, sibs
Regression
e.g. baby behaviour
Ongoing behaviour is blocked
• Internally - motivational conflict
• Externally - frustration
Reactions to frustration
• Exploration
• Overintensity
• (impulsive , careless)
• Switch attention
– from task
– from person
• Displacement activities
• (fidget, fiddle, stereotypies, tics)
• (Re-directed) aggression
• Regression
• Attachment
Approach
Overintensity
OK
Too soon
To partial cues
Too intensely
Too briefly
Fear/Frustration/Anxiety
Avoidance
Maintain
focus
Switch
attention
Approach
OTT
OK
2 year old with mother
meeting a stranger
Fear/Frustration/Anxiety
Avoidance
“Relaxed”
“Silly”
“Shy”
Attachment Theory and Evolution
• All mammals born immature
• Need protection and care to survive
• Unprotected human children under 7 years rarely survive
• Survivors have genes which promote behaviour:
– Parent(s) - give protection and caregiving
– Offspring - seek protection and caregiving
• Mechanism: Attachment motivation/behaviour:
– Parent(s) - Retrieval
– Offspring - Attachment behaviour
• Very powerful motivation - survival depends on it
Attachment Behaviour
• Attachment behaviour - proximity seeking
– (cry, call, move towards. etc)
• Precipitant: anything fear provoking
– (strangers, novelty, illness/pain/discomfort, separation, dark, danger, etc.)
• Termination: proximity/fear reduction
Attachment Relationship
• Attachment relationship - between offspring and
parent or other important caregivers
• Parent = secure base
• Offspring can explore/play/learn, trusting that parent
will protect/care for
Attachment Relationship: Variable
Security
• Mary Ainsworth, 1970s
• Strange situation 18 months
• The attachment relationship varies in its security
• Secure <-> insecure
Types of Security of Relationship
• B Secure:
– Child plays well, comforted on reunion
• C Insecure Ambivalent:
– Vigilant about mother, hovers near mother, not cuddle, separation
anxiety and protest ++, less comforted on reunion,
• A Insecure Avoidant:
– Generally but covertly vigilant, no separation protest, ignores mother on
reunion, ?play is less varied.
• D Insecure Disorganised:
(Mary Main 1990s)
– Disrupted strategy, child confused, stereotypies.
– ?= severe Ambivalent / ?more stressed
Effect in increasing stress
0.
Ordinary, age appropriate sociable playful behaviour, able to balance own needs and those
of others.
I.
Attention seeking with attachment figures, wanting cuddles, separation protest,
demanding whinging behaviour, regressive and “silly” behaviour, not being very
exploratory, etc.. The child focuses on their own needs to the exclusion of the needs to
others. When more relaxed, or when improving and becoming more secure, avoidant
children sometimes this behaviour which is the opposite to stage III.
II.
Avoidance: over independence/appearance of self sufficiency, high achievement
orientation, compliance, wanting to please, seeming to be in control and coping, wanting
to be able to predict what will happen, liking routine, restricted playfulness, being
organising, not focussing on own or other’s feelings, etc.. The child denies its own needs.
It is often seen as happy and well adjusted because apparently coping with demands.
III.
Behaviour characterised by hyperactivity, self harm, destructiveness, very short attention
span, negativity, soiling, smearing, wetting, aggression, and/or unfocussed violence. It
seems out of control or hysterical. Underlying fears and angers come out.
[ - more frustration behaviour/ fear-driven motivational conflict behaviour]
Attachment behaviour
Approach
C
B
Fear / insecurity
A
Avoidance
0
I
II
III
Firing rate of a nerve cell
Firing rate
Resting rate
Input
Pavlovian conditioning
Threshold of transmarginal inhibition
Response
strength
e.g. Salivation
Resting level
Stimulus strength
e.g. bell volume/duration
Paradoxical
response
Variable Security, Caregiving Style
• Secure: Trust that mother will meet needs
Caregiving - Sensitive
• Insecure: Do not trust that mother will meet needs
Caregiving - Insensitive (but children’s needs vary)
– Ambivalent:
– Avoidant:
Caregiver is unreliable
Caregiver dismisses child’s feelings,
expects child to be independent
– [Disorganised: Caregiver is frightened or frightening]
Adult Attachment Interview
• Mary Main and Hesse
• AAI
• Account of own childhood, especially parent’s
relationships to own family.
• Reveals the parent’s own
“Internal Working Model”
of attachment relationships
Mother’s Attachment
Relationship with
her mother
and later AAI type
Secure
Autonomous
Realistic, resolved
Ambivalent
Preoccupied.
Angry/hurt feelings still present
Avoidant
Dismissive.
Denies feelings
Mother’s AAI type and
Attachment Relationship
with her child
Autonomous.
Secure
Realistic, resolved
Preoccupied.
Ambivalent
Angry/hurt feelings still present
Dismissive.
(BUT, or A)
Avoidant
Denies feelings
Unresolved
Unresolved trauma
Violence, abuse
(BUT, or C)
Disorganised
But - associations are not strong
Intergenerational transmission of security type
• 78% of variance unaccounted for
• 22% due mainly to Bs (secure / autonomous)
• i.e. security is transmitted but insecurity types are
less associated
Temperament effects
Temperament (reactivity, fearfulness etc.)
General finding:
Security – insecurity affected by
– maternal sensitivity,
– not temperament
Type of insecurity may be affected by temperament
Gene – environment effects on attachment
• Adopted siblings, genetically unrelated
• AAI as adults
• 61% concordance in security
• Environment is the main factor in attachment security status
Caspers et al (2007)
Genetic protective/vulnerability factors
DRD4 7-repeat allele: lower dopamine receptor efficiency
(Dopamine associated with reward /Go /appetitive behaviour)
• Maternal loss + DRD4 7-repeat allele
Disorganised
• Maternal loss + DRD4 shorter allele
Not Disorganised
Rutter et al (2006), Gervai et al (2005)
Variable impact of poor parenting
Infant’s attachment (continuous score)
Less secure
More secure
Differential susceptibility
0.3
0.2
Infant
genotype
ll
0.0
ss/sl
-0.2
Serotonin transporter gene 5-HTTLPR
-0.4
low
medium
high
Maternal responsiveness
Barry, Kochanska, Philibert, (2008)
Differential susceptibility (Belsky 1997, 2001)
Less susceptible to experience (?resilient?)
More susceptible to experience (?vulnerable?)
“Good”
Outcome
“Poor”
Low
High
Maternal sensitivity
Differential susceptibility (Belsky 1997, 2001)
- Openness to experience
“Good”
Outcome
“Poor”
Low
High
Maternal sensitivity
Openness to experience
Children
Mothers
Externalising behaviours
DRD4-7R allele
DRD4-7R allele
Insensitive
Sensitive
Highest frequency
Least frequency
DRD4 short allele
no effect of maternal sensitivity
Bakermans-Kranenburg and van IJzendoorn (2006)
“Few”
(Achenbach)
Behaviour problems at 54 months
Differential susceptibility (Belsky 1997, 2001)
40
Low negativity
High negativity
(Infant temperament questionnaire at 1 & 6 months)
“Many”
58
Low
High
Childcare quality
Pluess and Belsky JCPP
2009
Nietzsche
“What does not kill us
makes us stronger”
Protective effects of security
2,4,6 months
Cortisol levels,
Security
reactivity
2 years
Fearfulness rating by M
High
Insecure
Fearful
High
Secure
Not fearful
Security protects against later fearfulness
Gunnar et al (1996)
Attachment and development
Effect of parenting:
Sher: Infants and toddlers developmental follow up: maternal
sensitivity and play .
Greatest developmental progress:
1. Mothers were sensitive to baby’s intentions and feelings
2. Mother’s energetically played with babies
“Mothers who were sensitive to what was in baby’s mind
+ shared what was in their own mind
Had baby’s with the best minds”
Later effects
Infants /toddlers
4-5 years in preschool
Secure histories
warm,
socially mature,
popular with peers
Ambivalent insecure
low status
LaFreniere and Sroufe (1985)
General security effects on development
• Security has effects on development
• When insecure, a child must attend to:
– short term safety/attachment needs,
– not learning for later success in the long term
• Wastes time, constrains learning
• General finding: insecurity, especially disorganised, has
negative effects on development and social behaviour,
but individual variation and context dependency
Constraints of insecurity on learning
Both: distracted from learning by insecurity
C Ambivalent:
–
–
–
–
Bullies, aggressive, blame others,
Dominating / obsequious
Focus more on own immediate benefit and status in group,
Focus less on truth, accuracy
A Avoidant:
–
–
–
–
–
Compulsively compliant, wanting to please
Compulsively caretaking, helpful
Uncreative, less initiative, over objective.
Achievement oriented / compulsive
Vulnerable to an accumulation of failure –depression, sudden collapse,
? ME/Chronic Fatigue Syndrome / anorexia
– Can be seen as devious, deceitful or manipulative
Crucial ages in Attachment
• Probably several.
• Romanian orphans: adverse effects of gross neglect and
malnutrition rarely persist if “rescued” before 6 months
Rutter et al (2007)
• Avoidant insecurity develops after 26 weeks.
• (After “relationships between two events” can be understood)
Woolmore and Richer
Plooij: Regressions and developmental stages
System
Principles
Programmes
Sequences
Categories
?
Relationships
Events
Transitions
Transition markers:
Configurations
Regression, upset,
irritability, comfort seeking.
Sensations
0 5
8
12 17
Age in weeks
25
36
44
52
61-2
72-3
Regression Periods
Parental stress and coping
Depressed mothers
avoidant babies
Children of depressed mothers:
Regression periods at:
12 and 17 weeks
longer
25 weeks
shorter
(Woolmore and Richer)
Mean length of regression periods
0.8
0.7
mean length over 1 week
0.6
0.5
0.4
Control
Depressed
0.3
0.2
0.1
0
3 (12/14-15)
4 (16/17)
regression period (control/depressed)
5 (24/25)
Attachment security types
• Avoidant insecure
• Ambivalent insecure
• Secure
Avoidant children
Experience: mother rarely attends to negative feelings
Strategy: keep mother close by denying own feelings
Tactics: Be independent, don’t show feelings, be compliant, caretaking, role
reversal, be in control, predict what will happen, be vigilant
Focus on external world, achievement
Negatives – depression, psychosomatic, sudden explosions of anger, distant
relationships, ?uncreative.
Ambivalent children
Experience: mother unreliable
Strategy: keep mother close and attentive
Tactics: Attention seeking by:
Demanding, noisy, protesting,
disruptive, emotional,
aggressive
(“You shall attend to me”)
Babyish, helpless, injury/illness
feigning, nurturance seeking
(“Poor little me, look after me”)
Focus on own emotions, and emotions of others towards self
Negatives – Not liked, rejected
Secure children
Experience: mother is reliable and sensitive
Strategy: can focus on world trusting mother will protect / come and help if
necessary
Tactics: Exploration, play etc. undistracted by need to attend to one’s own
security.
Focus on integrating
-one’s own needs
with
-a clear understanding of the social and non social world,
undistorted by own needs
Negatives – ?None
Disorganised children
Experience: mother is frightening or frightened
Strategy: short term, focus on immediate survival
Tactics: various, indiscriminate approaches, over independence, (much
motivational conflict behaviour)
Focus: on immediate survival
Negatives – High chance of later severe psychosocial problems and
underachievement.
• Dr Patricia Crittenden
• Dispense with Disorganised category
Disorganised = highly insecure
• Developmental approach
• More avoidant: more distorted affect
• More ambivalent: more distorted cognition
• Useful clinically
Disorganised?
Crittenden:
• Increasing severity of insecurity + developmental effects
Fonagy:
• Disorganised subsumed in Ambivalent category
Assessment methods
(Strange situation)
Many others
Story Stem test (Bretherton et al,1990)
1.
2.
3.
4.
5.
Spilled Juice
Hurt knee
Monster in the bedroom
Departure
Reunion
Story stem
Close observation
Girl: (5 years) two siblings, 3 & 1, all in care
Average IQ, articulation difficulties.
Mother: Young single, unsupported, several partners, strangers in
house ++, drugs, mother’s handling grossly insensitive, loud, minimal
insight.
Child: Careless, impulsive, accident prone, frenetic caring for siblings,
demanding, attention seeking, clingy, controlling and defiant towards
mother.
Disorganised attachment.
Sudden shifts of behaviour. “Leakage” of fear and anger.
Video
Implications:
Principles of handling
C Ambivalent:
– Warm undivided attention
– Very firm boundaries
A Avoidant:
–
–
–
–
Joint activity focus
Clear structures and expectations
Forewarn of changes
With improvement goes through a period of more difficult behaviour,
attention seeking, over assertive, (cf C)
<30AD Rabbi Hillel the Elder
Essence of his religion
1. If you don’t look after yourself nobody else will
–
Don’t be avoidantly insecure
2. If you only look after yourself, what is the point?
–
Don’t be ambivalently insecure
3. If not now, when?
– Carpe diem
johnricher@oxhs.co.uk
john.richer@nhs.net
john.richer@dpag.ox.ac.uk