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« April 2014 »

A Review of Early Infant Attachment Issues

Author: Dina R. Sokal, M.D., MPS President
Publication Year: Summer 2002
Edition Vol. 29
Type of resource: Newsletter


I have submitted the article below to The Maryland Psychiatrist due to my interest in working with mothers or caretakers of children below the age of three. I believe that this area is neglected during our training and that it's important for both adult and child psychiatrists to recognize when early intervention is needed.

Though parents have always known how important their early interactions with their infants are, scientists have only researched the importance of these early attachments in the last 20-40 years. Psychologists and psychiatrists were initially influenced by Harlow, who demonstrated the importance of "mothers" as a secure base for monkeys. They designed two fake mother monkeys – one out of cloth and another out of wire mesh. When the baby monkeys were frightened, they scurried to the soft cloth monkey. John Bowlby, a psychiatrist in England, began to wonder whether human infants were similar to monkeys. He theorized that by the first year of life, the infant begins to know what to expect from a consistent, responsive and available caretaker, and in turn begins to see one’s self as worthy of care. On the other hand, an infant whose mother is unavailable, or unable to respond consistently enough to the baby’s needs, will begin to feel insecure and later, anxious about themselves and relationships. His ideas have been confirmed by more recent research.

One of the most important researchers is Mary Ainsworth whose studies of attachment were done at The Johns Hopkins University School of Medicine. She was able to identify three different styles of attachment. Ainsworth and her co-workers observed infants and their mothers in their homes. They paid close attention to each mother’s style of responding to her baby. They observed feeding, responses to crying, eye contact between mother and infant, and smiling. When the babies were 12 months old, they had the mothers bring them to the hospital where they observed the infant’s reaction to being separated from the mother and left with a stranger. She defined three types of attachment behaviors and these behaviors were directly related to how responsive the mothers were to the infants in the home setting. The three types of attachments are:

1. Secure –The child may briefly cry or appear upset when mother leaves but is then able to establish some contact with the stranger and even explore the room. On mother’s return, the child is happy to see her. These children have caretakers that are reliable and enable babies to feel secure enough to explore their surroundings.

2. Insecure/Anxious resistant types --These children are clingy from the beginning and extremely upset when mother leaves. They find it hard to explore the room during mother’s absence and continue to be upset even after mother’s return.

3. Insecure/anxious avoidant –These children show little interest in others and tend to explore the room without engaging another. They show little response when mother leaves the room and avoid her when she returns.

More recent research shows that insecurely attached infants become insecure children with troubled relationships. For example, children with secure attachments were more empathic to others and had deeper friendships, while children with insecure attachments were more commonly victimized by others. It has also been shown in monkeys that those with secure attachments were able to form friendships more readily when separated from their mothers as compared to monkeys with poor attachments. Insecurely attached children may do better if they find someone stable to relate to, though their difficult behaviors may tend to alienate caretakers. This means that caretakers have to struggle with being consistent and available, despite the child’s pushing them away, anxiously clinging to them, making excessive demands, and remaining dissatisfied with the caretaker's efforts. It also means allowing the child to express negative emotions and pain that they have held inside.

Now I will describe the more specific problems of children raised by mentally ill parents, substance abusing parents, or abusive parents. It has been found that children of any mentally ill parent are more likely to be insecurely attached, and to themselves be at risk for mental illness. Conflict in families is greater when one or both parents are mentally ill. Often, there are more financial problems as well. Depressed mothers are less positive when interacting with their infants and the infants, are likewise less positive when interacting with their mothers and perhaps when interacting with other adults as well. In addition, young children of depressed mothers tend to be more impulsive and to have more difficult peer interactions.

Children whose parents are substance abusers have a number of problems. Prenatally, these children’s brains may be exposed to drugs and/or alcohol. If exposed to heroin or methadone, they often have abnormalities that interfere with their ability to engage caretakers. Other substances may also affect their behaviors as newborns, particularly their ability to respond to stimuli. They may under react or over react. They need a caretaker who is attuned to this difficulty and can stimulate them when under aroused and help them relax when over aroused. Unfortunately, the caretakers often continue to abuse drugs and are less able to care for the baby. If the mother over stimulates the baby, the result may be a restless, hyperactive child who is also impulsive and distractible. Or, if the mother pays little attention to an under aroused infant, the result can be neglect and failure to thrive. In addition, there is usually more violence and depression in these homes.

When children are abused, the impact varies depending on when the child was abused, whether it was intermittent or constant, what type of abuse occurred and the health of the child before the abuse occurred. The earlier the abuse, the more harmful its effects. Children under three may not survive abuse and if they do, they will have more permanent physical impairments such as brain damage, delayed growth, delayed language, inability to fight infections, etc. There may even be an increase in brain hormones in response to abuse that affects the development of behaviors. For example, they may become more aggressive, hyper- vigilant and unable to express feelings because of the brain hormones released when they’ve been abused. Abused children are often insecurely attached and may be delayed in their development. They are angrier, reject friendly overtures, and are not empathic to others’ distress. The most disturbed children are retarded emotionally and intellectually. Less disturbed children can be depressed and extremely sensitive to rejection. Others alternate between showing pleasure and extreme anger or withdrawal, while others may be hyperactive, disorganized, impulsive, and inappropriate.

To summarize, if we can recognize parenting problems early on, we may be able to prevent children from developing some of the problems described above so that they can grow up to be more happy and productive adults. As always, we should focus on prevention as well as treatment.

Resources: Try and go to their "Bookstore" for such books as Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood or From Neurons to Neighborhoods: The Science of Early Childhood Development. To subscribe to the Zero to Three newsletter, a bulletin of the National Center for Clinical Infant Programs, call: 1-800-899-4301. One center specializing in early intervention is the Taghi Modaressi Center for Infant Study at the University of Maryland at 410-706-2485, now under the directorship of David Pruitt, M.D. In Rockville, there is the Reginald S. Lourie Center for Infants and Children, 12301 Academy Way, Rockville, MD 20852, 301-984-4444. If anyone has additional resources, please call the MPS at 410-625-0232.


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