Psy. HC2 Attachment: From normal to abnormal

• Infant mental health


  • Physiological functioning
  • Temperament
  • Attachment
• Infant mental health


  The young child's capacity to experience, regulate, and express emotions, form close and secure relationships, and explore the environment and learn. All of these capacities will be best accomplished within the context of the caregiving environment that includes family, community and cultural expectations for young children. Developing these capacities is synonymous with healthy social and emotional development.
• Physiological functioning in infancy

  • Rhythmic routines of feeding, dressing, comforting
  • Communicating feelings and intentions through gestures and vocalizations
  • Exploring the environment by crawling, walking etc.
• Disturbances in physiological functioning

  • Pica
  • Rumination
  • Avoidant/restrictive food intake disorder
  • Sleep-wake disorders
• Disorder vs Problem (feeding disturbances)

  • Disorder: inefficient and ineffective feeding pattern, no experience of hunger and relief from hunger, developmental delay in feeding routine due to neglect, aversive experiences with feeding
• Disorder vs Problem (sleep disturbances)

  • Disorder: marked and persistent difficulties settling down and falling asleep, as well as maintaining sleep through the night, associated with impaired daily functioning
  • Problem: 10-30% problems in families with typically developing young children
• Temperament


  • Reactivity: Infant's excitability and responsiveness
  • Regulation: What the infant does to control its reactivity
• Temperament traits/ big five


  • Surgency/extraversion: sociability and positive emotionality
  • Negative affectivity/neuroticism: predispositions to experiences of fear and frustration/anger
  • Effortful control/conscientiousness attempts to regulate stimulation and response
• Well-adjusted temperament


  Access to the full range of positive and negative emotions as well as mild, moderate and strong intensities of experience
• Parenting dimensions impacting temperament

  • Warmth: connected to the child's social and emotional needs
  • Positive and negative control: connected to the child's need for autonomy and self-regulation
• Goodness of fit


  Interplay between infant temperament and parenting: easy-going baby with easy-going parents, or fearful baby with strict parents
• Lessons from goodness of fit

  • In any infant-caregiver pair there are matches and mismatches; growth by 'match-mismatch-repair' cycles (shy children benefit from moderate challenges)
  • Extreme mismatches are problematic for children who are more susceptible due to their temperament (differential sensitivity)
• Central hypotheses of attachment theory

  • Individual differences in the quality of infant-caregiver relationships are largely the product of the history of interaction with the caregiver
  • Variations in attachment quality are the foundation for later individual differences in personality
• Organizational perspective on attachment and development

  • Development is characterized as changes in behavioral organization (including emotion and cognition)
  • Qualitative differences in behavioral organization build on previous adjustments
  • Relations between early development and later outcomes are probabilistic and in continuous interaction with complex developmental processes and systems
• Developmental tasks at the end of first year of life

  • Development of attachment relationship: experiences of safety, comfort and affection
  • Development of a rudimentary sense of identity/ self: earliest set of cognitions and emotions focused on the infant as a separate being
  • Basic understanding of others and the world: early ideas about unfamiliar adults and children, along with new situations
• Four attachment patterns


  • Secure attachment
  • Resistant/ ambivalent attachment
  • Avoidant attachment
  • Disorganized/ disoriented attachment
• Secure attachment and caregiving history

  • The caregiver often responds sensitively, consistently and appropriately to physical, emotional and social needs of the child
  • More cooperative interactions between parent and child
  • Deeply rooted sense of safety and security
  • Rudimentary cognitions and emotions include beliefs like "I am worthy of care" and "I am lovable" (self), "I can trust that you will respond to me appropriately" (significant others), and "The world is safe and pleasant" (world).
• Resistant attachment and caregiving history

  • The caregiver often responds inconsistently or unpredictable to the physical, emotional and social needs of the child
  • Lower levels of psychological awareness in mothers and developmental lags in infants
  • Basic sense of insecurity and uncertainty
  • Rudimentary negative cognitions and emotions include beliefs like "I'm not worthy of being loved" (self), "I can trust that you usually do not respond" (significant others), and "The world is unfriendly and not responsive" (world).
• Avoidant attachment


  • Caregiver responds with inadequate, intrusive or excessively controlling care
  • Basic sense of insecurity and unfriendliness
  • Rudimentary negative cognitions and emotions include beliefs like "I'm not worthy of being loved" (self), "I can trust that you usually do not respond" (significant others), and "The world is unfriendly and not responsive" (world).
• Avoidance is more acceptable in 'Western' countries than ambivalence
• Ambivalent attachment


  • Difficulty dealing with novel, complex objects
  • More hesitance, less flexibility, less effective in problem solving
  • Seeks help for smaller problems; asks for more nurturance as if they are younger than their actual age
• Avoidant attachment


  • No problems handling novel objects
  • Close physical and emotional encounters with peers are very challenging
  • Seeks help / contact when stress is over; often disobedient; others often respond instructive and controlling, not nurturant
• Disorganized attachment


  • Caregiver is perceived as frightening, frightened, or malicious
  • Pattern of both approach and avoidance
  • "Fright without solution": caregiver is both a source of comfort and a source of anxiety
  • Temporary collapse of attention, emotion, and behavioral strategies when experiencing stress
• Prevalence of disorganized attachment: 15% non-clinical groups, 50-80% clinical groups
• Disorganized attachmentand later outcomes


  • Predicts more symptoms and more severe symptoms of psychopathology (e.g. self-harm)
  • Predicts dissociation or psychic collapse
  • Predicts development of conduct disorder
  • Predicts development of borderline personality disorder, sometimes in conjunction with avoidant attachment
• Secure attachment


  Protective factor: more resilience to deal with problematic situations
• Insecure-avoidant and insecure-ambivalent attachment


  Higher risk for developing problems, not directly related to clinical disorders
• Insecure-disorganized attachment


  Strong predictor of subsequent psychopathology
• Reactive attachment disorder (RAD)


  • Lack of organized attachment behaviors, do not seek comfort when distressed, problems with emotion regulation
• Disinhibited social engagement disorder (DSED)


  • Little if any reticence with unfamiliar others, do not look back to caregiver while wandering off, social superficiality and attention seeking, sometimes inappropriate physical contact
• RAD more responsive to enhanced quality of caregiving than DSED, DSED more difficult to treat, "bottomless pit"
• Risk factors for attachment disorders

  • Inadequate, inattentive, inconsistent and intrusive care
  • Psychopathology in parent
  • Difficult temperament, genetic vulnerability and neurological difficulties in children
• History of extreme insufficient care (DSM-5 C)

  • Social neglect or deprivation
  • Repeated changes of primary caregivers
  • Rearing in settings that limit forming selective attachments
• Prevention/intervention for attachment disorders

  Prevention:

  1. Enhance positive parenting (STEEP)

  2. Attachment and biobehavioral catchup (ABC)

  3. Placement in better caregiving environments (e.g. foster care)

  
  

  Intervention:

  4. Home visits and parenting education/support

  5. Infant-parent psychotherapy