Reconstructing Bonds:
Forming Attachments in the
Aftermath of War
Joan K Vanderlaan BSN, MN
www.MilitaryChild.org
Sesame Street Video Clip
Talk, listen, connect
Changes, adult section
www.MilitaryChild.org
Sesame Street Video – Changed Parent
I remember he really couldn’t really
remember me, which was hard for me.
Because it was like you’ve known him
and he’s been there for you, he was the
guy that named you. And him not being
able to remember your name was very
hard to take and frustrating. All you
could really do was … you really couldn’t
do anything at all, just watch and pray.
3
www.MilitaryChild.org
Learning objectives
Explore how the alternations in a service member with
PTSD or TBI can disrupt development attachments with
very young children and change attachments with older
children.
Be aware of symptoms related to TBI and PTSD
Discuss the concept of ambiguous loss and how that
relates to child/parent attachment in the aftermath of
war
Develop parenting styles and strategies that can assist
the Changed Parent in forming a close relationship with
his/her children after return from war.
Identify resources that can be used to enhance
parenting skills and ultimately strengthen attachment
bonds at all stages of the child’s development.
4
www.MilitaryChild.org
The Bowlby–Ainsworth Perspective:
Some Relevant Issues
Attachment theory is concerned with the
development of infant/child–caregiver
relationships, the maintenance of such
relationships through the lifespan, and
the role those relationships play in future
close relationships and individual
development.
5
Chapter 7 Attachment Ties in Military Families: Mothers’ Perception of
Interactions with Their Children, Stress, and Social Competence: Germán
Posada, Nancy Longoria, Casey Cocker, and Ting Lu) S. MacDermid
Wadsworth and D. Riggs (eds.), Risk and Resilience in U.S. Military
Families, DOI 10.1007/978-1-4419-7064-0_7, © Springer
Science+Business Media, LLC 2011
www.MilitaryChild.org
Biological Bases of Attachment Behavior
“Attachment behavior has the predictable outcome
of increasing the proximity of the child to the
attachment figure (usually the mother). Some
attachment behaviors (smiling, vocalizing) are
signaling behaviors that alert the mother to the
child’s interest in interaction and thus serve to bring
her to the child. Other behaviors (crying) are
aversive, and bring the mother to the child to
terminate them. Some (approaching and following)
are active behaviors that move the child to the
mother. “
(Handbook of Attachment, pg 4, emphasis mine)
6
www.MilitaryChild.org
Ainsworth Maternal Care Variables
sensitivity to the infant’s signals and
communications
cooperation with baby’s ongoing behavior
acceptance of the baby’s needs
physical and psychological accessibility
Chapter 7,
pg 138 Attachment Ties in Military Families: Mothers’ Perception of
Interactions with Their Children, Stress, and Social Competence: Germán Posada,
Nancy Longoria, Casey Cocker, and Ting Lu) S. MacDermid Wadsworth and D. Riggs
(eds.), Risk and Resilience in U.S. Military Families, DOI 10.1007/978-1-4419-70640_7, © Springer Science+Business Media, LLC 2011
7
www.MilitaryChild.org
Outcomes beneficial to the child
Feeding
Learning about the environment
Social interaction
Less likely to be killed by predators
“Attachment is considered a normal and
healthy characteristic of humans throughout
the lifespan, rather than a sign of immaturity
that needs to be outgrown.”
(Handbook of Attachment, pg 5)
8
www.MilitaryChild.org
The Exploratory System
Links exist between exploratory & attachment
systems
Exploratory system gives survival advantages
to the child - provides information about the
workings of the environment
use tools
build structures
obtain food
negotiate physical obstacles
(Handbook of Attachment, pg 8)
9
www.MilitaryChild.org
Attachment & Exploratory Balance
Secure base from which to explore
(Ainsworth 1963)
Attachment-exploration balance
(Ainsworth, Bell & Stayton 1971)
10
www.MilitaryChild.org
Dynamic Equilibrium
Mother provides “a secure base from
which to explore.” The mother’s
monitoring of infant-mother proximity
frees the infant from such monitoring
and permits greater attention to
exploring.
(Handbook of Attachment, pg 10)
11
www.MilitaryChild.org
Infant-Father Attachment
“Individual differences in quality of
infant-father attachment are related to
paternal behavior: Infants are more likely
to be securely attached to fathers who
have been sensitively responsive to
them.”
(Handbook of Attachment, pg 14)
12
www.MilitaryChild.org
Sense of Safety & Security - Young
Derived from maintaining a bond with an
accessible and responsive caregiver.
Perceived threats to caregiver’s availability
causes feelings of anxiety and anger
Persistent disruption of attachment bond
results in feelings of sadness and despair
(Handbook of Attachment, pg 24, emphasis author’s)
13
www.MilitaryChild.org
Sense of Safety & Security - Older
Perceive threats to caregiver’s availability
when lines of communication are
disrupted by
prolonged absence
emotional disengagement
signals of rejection or abandonment
Can produce feelings of anxiety, anger, and
sadness similar to younger children after
physical separation
(Handbook of Attachment, pg 24)
14
www.MilitaryChild.org
Chad, 17 yrs old
“Dad was in Kandahar for six months.
I emailed him there. We talked about how we were
going to go fishing when he got back, maybe get a car
and fix it up for the drag races. We were talking about
how he was going to retire, but that’s not happening
now. He’s staying in for a few more years. He wants to
get his chief ranking.
Before Kandahar, he was quiet, but he always
wanted to do stuff with us. Now he’s always running
around all over the place, trying to keep himself busy.
He lives on the base with me… My dad and I live here
on the base so I can finish high school here. We share
a house, and we hang out, but we don’t talk.”
15
Off to War – Deborah Ellis, pg 56)
www.MilitaryChild.org
Threats to Availability – Child/Parent
Threats of suicide by parent can lead to..
Child experiencing anxiety about
physical accessibility
fear of violence
prospect of loss
Child interpreting an implied message that
he or she is responsible for the parent’s
desperation and despair
(Handbook of Attachment, pg 33)
16
www.MilitaryChild.org
Witnessing Violence – Parent/Parent
Seeing parents argue violently may
threaten child’s confidence in
parent’s availability
create fear in the child about harm to
one or both parents
“Parents who are living with constant
conflict and fear are likely to have reduced
capacities to attend to the child.”
(Handbook of Attachment, pg 33)
17
www.MilitaryChild.org
Symptomatic Expressions of Aggression
“Parents are likely to be most frightening
to their children when their unusual
behavior occurs in unpredictable ways.”
Threats to availability
Threats to safety
(Handbook of Attachment, pg 36)
18
www.MilitaryChild.org
Traumatic Brain Injury
Neurologic injury
Possible physical, cognitive, behavioral,
and emotional symptoms
Range
Mild
Moderate
Severe
Penetrating
Battlemind Training System Office
19
www.MilitaryChild.org
Mild Traumatic Brain Injury (mTBI)
Type of concussion
Results from a “blow to the head”
Does NOT result in obvious physical
injury
Don’t have to be knocked out to have a
mTBI
May be dazed, confused, had your “bell
rung”
If knocked out, for less than 30 min
Battlemind Training System Office
20
www.MilitaryChild.org
Symptoms of mTBI
Headache
Confusion
Dizziness
Blurred vision or tired eyes
Ringing in the ears
Change in ability to smell or taste
Sensitivity to sound or light
Nausea/vomiting
Irritability (possibly anger or aggression)
Fatigue
Change in sleep patterns
Mood changes
Trouble with memory, concentration, attention, or
thinking
Battlemind Training System Office
21
www.MilitaryChild.org
Invisible Injuries
Hardest for children to understand
Why does a parent seem angry or sad?
Why does he forget things or just seem
“out of it”?
Help the child understand an injury may
change the way a parent feels, talks, and
acts.
Validate the child’s confusion, and make
sure that he knows he is not to blame.
22
Sesameworkshop.org/tlc
www.MilitaryChild.org
Sesame Street Video – Changed Parent
Too many people talking. Too many
decisions about dinner. Do you
want a coke. And that will never
end. That will always be my biggest
mental weakness, I can’t intake a lot.
23
www.MilitaryChild.org
Post Combat Stress
Also referred to as
Post Traumatic Stress
Can result in a diagnosis of
Post Traumatic Stress Disorder
Preferred terminology
Post Traumatic Stress Illness
24
www.MilitaryChild.org
Physical Symptoms of PCS
Fatigue and/or weakness
Chest pain
Pounding heart
Breathing difficulty
Sleep problems (insomnia or nightmares)
Muscle tremors or twitches
Grinding of teeth
Profuse sweating
Headaches
Diarrhea/Intestinal upsets
Battlemind Training System Office – List not all inclusive
25
www.MilitaryChild.org
Behavioral Symptoms of PCS
Withdrawal
Pacing & Restlessness
Emotional outbursts
Anti-social acts
Suspicion & Paranoia
Inability to rest
Loss of interest in hobbies
Alcohol consumption
Substance abuse
Battlemind Training System Office – List not all inclusive
26
www.MilitaryChild.org
Emotional Symptoms of PCS
Anxiety or panic
Guilt
Fear
Denial
Irritability
Depression
Intense anger
Agitation
Apprehension
Isolating & withdrawing from others
Battlemind Training System Office – List not all inclusive
27
www.MilitaryChild.org
Kaela, 13 yrs old
“Dad had a lot of combat stress when he came
home. He tried to hide it from us kids, but I
could see that he was a lot quicker to get
angry. Before he went, he was so patient with
my brothers, more patient even than Mother
Teresa would be, my mom says. When he
came back he lost it. His patience was gone –
not just with my brothers, but with me, too.
He’d start in on me for making just the
smallest sort of thirteen-year-old comment.
He’d get so upset about the smallest, dumbest
things.” Off to War – Deborah Ellis, pg 44-45)
28
www.MilitaryChild.org
What about the children?
Common symptoms of mTBI or PCS are
diametrically opposed to the behaviors
young or older children need to
form/maintain attachments
Young children need a consistent
response to their behaviors
Parent may be unable to respond
consistently depending on degree or
severity of his or her symptoms
29
www.MilitaryChild.org
What about the children? (cont)
Older children seek consistent
communication pathways
Parents may be unable to re-establish
previous patterns of communication or
shared activities
30
www.MilitaryChild.org
Kaela, 13 yrs old (cont)
“The whole deployment has improved my
relationship with my mom, but it didn’t start out that
way. At first she would keep stuff from me. She didn’t
want to worry me. She’d hear things from Afghanistan
and keep them to herself. I knew she was bothered by
something but didn’t know what it was. I thought she
was angry with me. I was hurting and angry and
lonely, and we weren’t talking to each other. This big
space opened up between us until one day we had this
huge fight. I told her, “Mom, you’re not helping me,
you’re hurting me.” Since then, things have gotten a
lot better. We’re communicating again.”
Off to War – Deborah Ellis, pg 45)
31
www.MilitaryChild.org
Ambiguous Loss
Physical Absence
and
Psychological
Presence
32
Physical
Presence
and
Psychological
Absence
Loss, Trauma, and Resilience by Pauline Boss, pg 9
www.MilitaryChild.org
Ambiguous Loss
“Ambiguous loss is a problem
structurally when parenting roles
are ignored, decisions are put on
hold, daily tasks are not done,
and family members are ignored
or cut off. “
Loss, Trauma, and Resilience by Pauline Boss, pg 15
33
www.MilitaryChild.org
Ambiguous Loss
“In United States culture, the
valued and expected goals are to
fix, cure, win, and solve. Living
with loss is discouraged. Rather,
one is supposed to get over it
and do so quickly.”
Loss, Trauma, and Resilience by Pauline Boss, pg 19
34
www.MilitaryChild.org
Absolute Reactions to Ambiguous Loss
Prematurely closing out the
changed parent by acting as if
they were dead
Denying the parent’s
psychological absence and acting
as if nothing changed
Loss, Trauma, and Resilience by Pauline Boss, pg 165
35
www.MilitaryChild.org
Double Whammy
“Lose one parent {to TBI or PCS} and
the remaining parent becomes
depressed and preoccupied with the
missing mate.
Child ends up losing both parents,
but no one notices because they are
still there in the home.”
Loss, Trauma, and Resilience by Pauline Boss, pg 8
36
www.MilitaryChild.org
Tips for Parenting to Enhance Attachment
Safety of the Child must be paramount
Regardless of age
37
www.MilitaryChild.org
Tips for Parenting to Enhance Attachment
Encourage all parents to participate in
Child Growth & Development Classes
and Parenting Classes, or to read
books on positive patenting
techniques.
Knowledge of normal infant and
toddler behaviors is not intuitive in today’s
society.
38
www.MilitaryChild.org
Resources
Zero to Three
Behavior & Development
Care & Education
Offers podcasts, printable handouts,
videos to watch on-line, free Parent
Brochures and Guides
http://www.zerotothree.org/early-care-education/
39
www.MilitaryChild.org
Zero to Three
ZERO TO THREE is a national nonprofit that
informs, trains and supports professionals,
policymakers and parents in their efforts to
improve the lives of infants and toddlers.
All of our work is:
Grounded in research and experience
Multidisciplinary
Collaborative
Culturally responsive
Clinically informed
Accessible
40
www.MilitaryChild.org
Illinois Early Learning Project
http://illinoisearlylearning.org/tipsheets/curiouschild.htm
The Curious Child
41
"Where did Navy Pier come from?" "Why do we have to wear seat belts?"
Do you know a child who is full of questions? Young children are naturally curious. They believe
parents, caregivers, and teachers know a lot about the world. Asking questions and listening to
answers are vital to their learning. The way you respond can affect what and how a child learns.
Do you...
...reject questions?
"Stop asking. Be quiet. Don't bother me." Responses like these may tell a child that curiosity is
unimportant or annoying. If you are too busy, or uncomfortable about a question, you might say,
"Let's talk about it later. Right now my mind is on something else."
..deflect questions?
Answers like "Because I said so" give the child no information. It may be true that he must
sometimes do something "because Daddy said." But too many responses like this can squelch his
curiosity and creativity.
...give answers?
A short explanation accepts her question and acknowledges your ability to answer. "We wear
seat belts because it's safer and the law says to." It's also all right to tell her, "I don't know!"
...invite the child to find answers?
Your response can encourage higher-order thinking. Depending on the question and the child's
age, you might:
Suggest ways to look for answers (reference books, the Internet, an expert, an experiment). "I
wonder about Navy Pier, too. Let's look it up in ___."
Invite her to brainstorm with you. "I don't know the answer. Let's write down some possibilities."
When you brainstorm, don't throw away any ideas. (That's the next step.) www.MilitaryChild.org
Tips for Parenting to Enhance Attachment
Structure interactions with child based on
“best” potential
Best time of day
for the parent
for the child
morning
after nap
bedtime routine
Best activity - accommodates
parent’s symptoms
child’s likes/developmental stage
42
www.MilitaryChild.org
Strategies
Situation: Child wants parent to
attend their (name sport here) game.
Parent is unable to tolerate crowds,
loud noises, or closed in spaces.
Possible solutions:
43
www.MilitaryChild.org
Strategies
Situation: Child wants parent to
attend their (name sport here) game.
Parent is unable to tolerate crowds,
loud noises, or closed in spaces.
Possible solutions:
attend practice
watch game day video with child
ask about access to a press box or
private box that minimizes the effects of
crowd or noise
44
www.MilitaryChild.org
Strategies
Situation: Child wants to go to Chuck
E Cheese with parent like before.
Parent is unable to tolerate crowds or
loud noises.
Possible solutions:
45
www.MilitaryChild.org
Strategies
Situation: Child wants to go to Chuck
E Cheese with parent like before.
Parent is unable to tolerate crowds or
loud noises.
Possible solutions:
call the manager and ask when is the
least crowded time to come
pick a new restaurant that is quieter but
still a special treat for parent & child
46
www.MilitaryChild.org
Strategies
Situation: Child wants to “rough
house” with parent like before the
deployment
Parent is agitated by physical contact.
Possible solutions:
47
www.MilitaryChild.org
Strategies
Situation: Child wants to “rough
house” with parent like before the
deployment
Parent is agitated by physical contact.
Possible solutions:
identify new physical activities where
contact is controlled or predictable and
parent is able to tolerate
find physical activities that minimize
physical contact but provide time together
48
www.MilitaryChild.org
Strategies
Re-assign parent and child activities
Service member parent could:
Take child to library – routine,
enjoyable event, quiet environment
Walk child to school in the
mornings (even park car a block away and
walk the last bit to avoid car congestion)
Adjust nap time so toddler is
waking up when parent available to
play quietly or share snack time
49
www.MilitaryChild.org
My Child Psychologist
http://mychildpsychologist.com/articles/
Welcome to MyChildPsychologist.com’s original articles.
Dr. Dawn Koontz and Dr. Catherine Judkins write
commentaries and summaries on anything child-related,
most often issues related to child psychology. Please
browse our entries! Dr. Dawn Koontz and Dr. Catherine
Judkins are licensed clinical psychologists who received
their graduate and clinical training in child and
adolescent psychology
19 Really Cheap Activities for Summer Fun with the Kids
Bedtime and Sleep Problems
Managing Increased Independence in Toddlers
50
www.MilitaryChild.org
Kids Growth
http://www.kidsgrowth.com/resources/articledetail.cfm?id=1796
20 reasons why your child needs you to be an active
father
Fathers play a critical role in the development of their
children; however, many fathers are uncertain about the
responsibilities and privileges associated with this role.
Children need fathers who love and care for them on a
consistent basis. The latest research indicates that
fathers who are actively involved in raising their children
can make a positive and lasting difference in their lives.
In contrast, this same research reveals a number of
potentially negative outcomes for children whose fathers
are not involved. Listed below are 20 reasons why your
child needs you to be an active father.
51
www.MilitaryChild.org