Why does attachment matter for children’s development? The importance of soothing

Why does attachment matter for children’s development? Bowlby, 1973 Anxiety attachment behaviours comfort from caregiver reduction in anxiety

Attachment behaviours present from birth Selective attachment present from around 6 or 7 months Attachment patterns are a measure of the relationship , not of the child Attachment and Attachment Disorders

Attachment behaviours present from birth

Selective attachment present from around 6 or 7 months

Attachment patterns are a measure of the relationship , not of the child

Why does attachment matter for children’s development? General population: ~70% secure ~30% insecure Ainsworth, 1979 Attachment can be measured at 12-18 months using the strange situation procedure

Attachment can be measured at 12-18 months using the strange situation procedure

Why does attachment matter for children’s development? Secure attachment Infant goes to parent when stressed Easily comforted Back to the job of exploring/learning

Secure attachment

Infant goes to parent when stressed

Easily comforted

Back to the job of exploring/learning

Why does attachment matter for children’s development? Insecure-avoidant attachment Infant doesn’t use parent for soothing

Insecure-avoidant attachment

Infant doesn’t use parent for soothing

Why does attachment matter for children’s development? Insecure-resistant/ambivalent attachment Infant goes to parent when stressed But not easily comforted Some insecure attachment patterns make perfect sense!

Insecure-resistant/ambivalent attachment

Infant goes to parent when stressed

But not easily comforted

Why does attachment matter for children’s development? Insecure-disorganised/disorientated attachment Acts as if not sure what to do when stressed Higher risk of aggressive behaviour later

Insecure-disorganised/disorientated attachment

Acts as if not sure what to do when stressed

What happens if children are not soothed as babies? Why does attachment matter for children’s development?

Normal diurnal rhythm of cortisol Stress Why does attachment matter for children’s development?

Romanian orphans Response to stress ca n be unpredictable Stress Why does attachment matter for children’s development?

Maltreated children pre-school Dozier Stress Why does attachment matter for children’s development?

Why does attachment matter for children’s development? Edlington boys Exposed to neglect and violence, alcohol and cannabis

Why does attachment matter for children’s development? The parts most affected are those which have the most rapid development after birth What can happen to the brain with maltreatment in early life?

Hippocampus Why does attachment matter for children’s development? Role in dissociative states, anxiety disorders Apparent hippocampal shrinkage with PTSD but twin study suggests small hippocampus might predispose to PTSD

Hippocampus retains its ability to generate neurons throughout life e.g. taxi drivers “knowledge” Eriksson et al 1998 Nature Medicine Maguire et al 1997 Journal of Neuroscience “ Its not grey matter that I’ve got in mine… its faecal matter because of all the s**t that comes through that partition!” Glasgow Taxi Driver But there is always hope… Why does attachment matter for children’s development?

Amygdala Why does attachment matter for children’s development? Role in fear conditioning, control of aggressive and sexual behaviours

Corpus callosum and interhemispheric integration Left hemisphere - language and logical thought Right hemisphere - perception and expression of emotion, particularly negative Reduced corpus callosum size in childhood maltreatment, especially in boys Why does attachment matter for children’s development?

Left hemisphere - language and logical thought

Right hemisphere - perception and expression of emotion, particularly negative

Reduced corpus callosum size in childhood maltreatment, especially in boys

Why does attachment matter for children’s development?

Neurobiology of Maltreatment Cerebellum Role in attention, language, cognition, affect and movement Very high density of stress hormone receptors – may be very susceptible to stress postnatally

Role in attention, language, cognition, affect and movement

Very high density of stress hormone receptors – may be very susceptible to stress postnatally

Neurobiology of Maltreatment Cerebral cortex Lots of stress hormone receptors – may be very susceptible to stress in postnatal period Fronto-temporal area is particularly important – involved in “executive functioning” i.e. planning, complex social interaction

Lots of stress hormone receptors – may be very susceptible to stress in postnatal period

Fronto-temporal area is particularly important – involved in “executive functioning” i.e. planning, complex social interaction

Neurobiology of Maltreatment Cerebral cortex maltreatment may cause a precociously mature cerebral cortex with “stunted final capacity” Teicher, 2003

Cerebral cortex

maltreatment may cause a precociously mature cerebral cortex with “stunted final capacity”

Teicher, 2003

Neurobiology of Maltreatment HPA axis and stress Adapts, in a situation of neglect/violence, to deal with stressful early environment: fight, flight, freeze Stress thermostat -Adaptive in situations of high stress -Maladaptive or leading to psychiatric disorders in situations of low stress

Neurobiology of Maltreatment Gunnar 2002 Psychoneuroendocrinology Doctors for a jag

Neurobiology of Maltreatment HPA axis and stress At 3 months, children cry and see cortisol peak on immunisation By 12-18 months, securely attached infants cry but no longer see cortisol peak In insecurely attached or temperamentally inhibited children, still see a cortisol peak in presence of caregiver Gunnar 2002 Psychoneuroendocrinology

HPA axis and stress

At 3 months, children cry and see cortisol peak on immunisation

By 12-18 months, securely attached infants cry but no longer see cortisol peak

In insecurely attached or temperamentally inhibited children, still see a cortisol peak in presence of caregiver

Infants: Attachment and Biobehavioural Catch-up (ABC) – Trains carers of maltreated children to be extra-nurturing Randomised Controlled Trial evidence that can return cortisol patterns to normal Treatment? Attachment Disorders

Infants:

Attachment and Biobehavioural Catch-up (ABC) –

Trains carers of maltreated children to be extra-nurturing

Randomised Controlled Trial evidence that can return cortisol patterns to normal

Older children: Dyadic Developmental Psychotherapy Good US pilot study suggests very effective in reducing behaviour problems Needs Randomised Controlled Trial – plans for this in Glasgow Treatment? Attachment Disorders

Older children:

Dyadic Developmental Psychotherapy

Good US pilot study suggests very effective in reducing behaviour problems

Needs Randomised Controlled Trial – plans for this in Glasgow

Neurobiology of Maltreatment Who is right? Ed Balls asks 'Can we sort out the problems in the family?' Martin Nary (Barnardos) says more children should be adopted at birth Prevention?

New Orleans Model: Every maltreated child under 5 and their family has an intensive attachment-based assessment Intensive intervention for birth family (while child in foster care) to maximise chance of rehabilitation Time limit of 15 months , then decision: Adoption or Rehabilitation? Prevention? Attachment Disorders

New Orleans Model:

Every maltreated child under 5 and their family has an intensive attachment-based assessment

Intensive intervention for birth family (while child in foster care) to maximise chance of rehabilitation

Time limit of 15 months , then decision:

Adoption or Rehabilitation?

New Orleans Results: Increased freeing for adoption BUT Where rehabilitated, reduction in maltreatment of both that child and subsequent siblings i.e. good decisions Plan for Glasgow pilot and trial Attachment Disorders Prevention?

New Orleans Results:

Increased freeing for adoption

BUT

Where rehabilitated, reduction in maltreatment of both that child and subsequent siblings

i.e. good decisions

Plan for Glasgow pilot and trial

Why does attachment matter for children’s development? Final points: Lets support parents to get attachment right in the first place Lets prevent damage to development by making decisions about children early Lets find and test ways of helping when there have been problems These are some of the core aims of Scottish Attachment in Action

Final points:

Lets support parents to get attachment right in the first place

Lets prevent damage to development by making decisions about children early

Lets find and test ways of helping when there have been problems

These are some of the core aims of Scottish Attachment in Action