Attachment
MRCPsych
Paul McArdle
attachment
attachment
• Distress on separation
attachment
• Distress on separation
• Proximity seeking
attachment
• Distress on separation
• Proximity seeking
• Comforted by attachment figure
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attachment
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•
Distress on separation
Proximity seeking
Comforted by attachment figure
exploration
Attachment style
Secure Uses caregiver as a secure base for
exploration. Protests caregiver's departure and
seeks proximity and is comforted on return,
returning to exploration. May be comforted by
the stranger but shows clear preference for the
caregiver. Responds appropriately, promptly
and consistently to needs. Caregiver has
successfully formed a secure parental
attachment bond to the child.
Attachment style
Avoidant Little affective sharing in play. Little
or no distress on departure, little or no visible
response to return, ignoring or turning away
with no effort to maintain contact if picked up.
Treats the stranger similarly to the caregiver.
The child feels that there is no attachment;
therefore, the child is rebellious and has a
lower self-image and self-esteem. Little or no
response to distressed child. Discourages
crying and encourages independence.
Attachment style
Avoidant Little affective sharing in play. Little
or no distress on departure, little or no visible
response to return, ignoring or turning away
with no effort to maintain contact if picked up.
Treats the stranger similarly to the caregiver.
The child feels that there is no attachment;
therefore, the child is rebellious and has a
lower self-image and self-esteem. Little or no
response to distressed child. Discourages
crying and encourages independence.
Attachment style
Disorganized Stereotypies on return such as
freezing or rocking. Lack of coherent
attachment strategy shown by contradictory,
disoriented behaviours such as approaching
but with the back turned.
Frightened or
frightening behaviour, intrusiveness,
withdrawal, negativity, role confusion, affective
communication errors and maltreatment. Very
often associated with many forms of abuse
towards the child.
resilience
• Resilience is a dynamic process whereby
individuals exhibit positive behavioral
adaptation when they encounter significant
adversity
• Resilience can be described by viewing:
– good outcomes regardless of high-risk status,
– constant competence under stress,
– recovery from trauma,[29] and
– using challenges for growth that makes future
hardships more tolerable.
Longitudinal studies
• ‘Steeling’ effects
– Elder G. (1974) Children of the Great Depression. University of
Chicago Press
• Kuai 1/3 ‘high risk’ – chronic discord, alcohol abuse
or parental mental illness, poverty. 1/3 ‘grew into
competent, confident, caring young adults’
Kauai
• At 1 year – ‘cuddly…good natured…easy to deal with (sleeping and eating)
• 20 months ‘alertness and autonomy’ – more sociable and developmentally
advanced. Close bond with at least one care giver’ including ‘substitute
caregivers’
• Better reading, interests and hobbies that ‘were not narrowly sex typed’
• ‘Structure and chores’
• Emotional support outside the family ‘informal network of kin and
neighbours, peers and elders…’
• Scholastic competence at 10 was associated with Self-efficacy at 18
• Age 18 ‘their relationships with members of the opposite sex were still
tentative…’
• The resilient youngsters …all had at least one person in their lives who
accepted them unconditionally regardless of temperament…intelligence
physical attractiveness…’
Kauai
• Age 30 follow up – the vocational
achievements of the high risk resilient children
equalled that of low risk
Iowa
• Academic and social competence ‘significant
others who provide affection, the disciplines of
accomplishment and moral guidance (e.g.
avoidance of ‘street life’)
• Buffer of strong family life (e.g. vs rejection)
• Supportive grandparent, teacher or sibling
• Fathers who encourage…sense of
responsibility…shared work
• Elder and Conger (2000) Children of the Land. University of
Chicago Press
Kauai – especially vulnerable
• Maltreated children with isolated single
parents with no roots in a community
• Preadolescents with conduct disorders and
poor reading skills
• Critical periods…
– Werner E. (1993) Risk Resilience and Recovery: perspectives
from the Kauai longitudinal study. (n = 648) Development and
Psychopathology 5:503-515.
Protective factors
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Reduce the risk impact
The likelihood of negative chain reactions
Promote self esteem and self efficacy
Open up opportunities
– Rutter M. (1987) Psychosocial resilience and protective
mechanisms. American Journal of Orthopsychiatry 57:316331.
Raised ‘in care’
• 94 (51) girls, studied 1964.
• 2/5 vs none of controls pregnant pre-19 years
• Of those with children, fewer stable
relationships and 22% without a current male
partner
• 18% (0%) own children in care
Raised ‘in care’
• 1/3 showed good parenting
• Supportive partner (rate of good parenting in
group with sp equal to controls)
• Not explained by women’s earlier ‘deviance’
• But by planfulness ‘courtship’
• ‘Provided that ‘marital support’ was available
poor parenting was a rare occurrence (3%)’
• Quinton D. et al (1984) parenting behaviour of mothers
raised in care. Psychological Medicine 14:107-124.
Institutional care
• Lack of close confiding relationships
• Indiscriminate friendliness
• Lack of differentiation in response to different
adults
• Lack of checking back with a parent in anxiety
provoking situations
– Rutter et al (2007) Early adolescent outcomes for
institutionally- deprived and non-deprived adoptees.: 1.
Disinhibited attachment. JCPP 48:17-30.
Institutional care – Romanian orphans
• Contemporaneous adaptations
• Biological programming?
• Are the consequence of mile disinhibition
which was common, similar?
• Is it associated with significant malfunction?
• N = 324.
Institutional care
• Those adopted <6 months not different from
UK adoptees
• 10% quasi autism
Institutional care – disinhibition at 6
years
Institutional care – disinhibition and
attachment 6 years
Institutional care – disinhibition and
other problems at 11
Mehta et al (2009) Amygdala, hippocampal and corpus callosum size following
severe early deprivation. JCPP 50:943-951.