Attachment

What do I need to know about Attachment?
What are the common causes of attachment problems, and how do I decode my child(ren's) behaviors?

What is Attachment?
Attachment is a reciprocal process by which an emotional connection develops between an infant and his/her primary caretaker. It influences the child's physical, cognitive, and basic trust or mistrust, and shapes how the child will relate to the world, learn, and form relationships throughout life. Healthy attachment occurs when the infant experiences a primary caretaker as consistently providing emotional essentials such as touch, movement, eye contact and smiles, in addition to the basic necessities - food, shelter, and clothing.

If this process is disrupted, the child is at risk for failing to develop to secure base necessary to support all future healthy development. Factors which may impair healthy attachment include: multiple caretakers, invasive and painful medical procedures, hospitalization at critical developmental periods, neglect, sexual or physical abuse, poor prenatal care, prenatal alcohol or drug exposure, and neurological problems.

Children with attachment disturbances often project an image of self-sufficiency and charm while masking inner feelings of insecurity and self hate. Beneath the surface, infantile fear, hurt and anger are expressed in disturbing behaviors that serve to keep caretakers at a distance and perpetuate the child's belief that he/she is unlovable. These children have difficulty giving and receiving affection on their parent's terms, are overly demanding and clingy, and may annoy parents with endless chatter. They attempt to control by engaging adults in frequent power struggles and seeking attention in negative ways. Additional behaviors associated with attachment disturbance include: poor eye contact, abnormal eating patterns, poor impulse control, poor conscience development, chronic, "crazy" lying, stealing, destructiveness to self, others, and property, cruelty to animals and preoccupation with fire, blood, and gore.

Such children often do not respond well to traditional parenting or therapy since both rely on the child's ability to form relationships, and to internalize the parents and their values. Therapy and parenting that utilize the elements of basic attachment have been found to be more helpful. A more directive approach utilizing nurturing touch, eye contact, and physical and emotional closeness can provide a corrective emotional experience and create a foundation for a healthier attachment between child and parent.

Common Causes of Attachment Problems
(Highest risk if these occur in first two years of life)

1. Sudden or traumatic separation from primary caretaker (through death, illness, hospitalization of caretaker, or removal of child)
2. Physical, emotional, or sexual abuse
3. Neglect (of physical or emotional needs)
4. Illness or pain which cannot be alleviated by caretaker
5. Frequent moves and/or placements (foster care, adoptions, changes of caretaker within family)
6. Inconsistent or inadequate care at home or in day care (care must include holding, talking, nurturing as well as meeting basic physical needs)
7. Chronic depression of primary caretaker
8. Neurological problem in child which interferes with perception of or ability to receive nurturing (i.e. babies exposed to crack cocaine in utero)

Decoding Children's Behaviors

Behavior	Stage	Response
He has been in your home for 6 months and has never mentioned his previous family.	Denial	Talk about your families Previous experiences before child came.
She falls on the floor and screams over small frustrations	Anger	Be there. Sit in room until anger subsides
She is taking money from your purse	Anger	Keep purse out of sight. Say if we need money we ask.
He does not want to go on a visit with his biological family.	Denial Despair Recycle old Grief	Relate a personal experience a loss that hurt.
She runs away.	Denial	Give her a place she can run to.
It has been 10 months and he has gone through a period.	Denial Despair Recycle old Grief	Remain supportive. Be there for child.
He does not want to go on a visit with his adoptive family.	Denial Despair Recycle old Grief	Talk about your feelings about his leaving. Fears he had before coming to your family
He is good and does what you ask. He seems like a normal Child and has done nothing the social worker predicted.	Shock/Denial	Enjoy but be prepared for next stage.
He cries every time you leave the room.	Despair	Reassure child. Explain where you are going - when you'll return.
He does not want to return to the foster family after the first preplacement visit with you (the adoptive family).	Denial Recycle old Grief	Simply proceed with plans. He will go back and then go over what will happen

Activities to Promote Attachment

• Hold the child with skin to skin contact
• Take baths together
• Swim together
• Carry infants in snuggles sacks while doing chores
• Rock children to sleep
• Sing to the child substituting words which are specific to your child
• Play peek-a-boo
• Limit introduction of new people. A new family is enough strangers for a while. Have your relatives and friends wait to meet your child. Time is needed just being together and following a daily routine.
• Practice being physically close-gently but firmly. Lay your baby directly against your flesh so he can sense your breathing and heartbeat and use a gentle voice and touch. For a toddler or slightly older child hugging and kissing at bedtime is a good way to begin if the child is comfortable with this level of "togetherness." Bathing and hair care are good times for nurturing and touching. If he is reluctant, make a game of "5 minutes on dad's lap, 5 minutes of mom's lap" (look at a picture book, do a puzzle, dress a doll).
• Increase your confidence as new parents-read about child rearing practices. Babysit for others, talk to other adoptive families and subscribe to publications about adoption and parenting.
• Try to duplicate former environments-lights on for sleeping? Type of bed? Mattress on the floor? Limit space to help the child become familiar with his room. Start with a few toys for play. Introduce pets gradually. Keep food similar.
• Study each other's faces by face-to-face interaction - as when feeding an infant. Hold an older child in your lap when eating "fun food" like popcorn, apple slices, raisins and play “one for you and one for me.
• Even tantrums can provide and opportunity to bond. Do not completely isolate the child. Walk away but leave the door of the room open. Afterwards, your child is open to being close. Talk about love and anger quietly while holding your child in your lap.