Preventing and Healing Stress Related Depression, Anxiety and Childhood Behavior
Santa Barbara Graduate



Parenting: Attachment, Bonding and Reactive Attachment Disorder

On this page: What is secure attachment? | How is secure attachment related to optimum development? | Secure attachment doesn't have to be perfect | What causes insecure attachment and attachment disorder? | What are the signs and symptoms of insecure attachment? | How does neurological dis-regulation affect the attachment bond? | What is Reactive Attachment Disorder (RAD)? | How is inadequate attachment repaired? | Online resources on parenting and attachment

What is secure attachment?

In order to have a secure base from which to explore the world, be resilient to stress, and form meaningful relationships with themselves and others, all infants need a primary adult who cares for them in sensitive ways and who perceives, makes sense of and responds to their needs. Attachment is an instinctive system in the brain that evolved to ensure infant safety and survival. Primary caretakers are usually the natural mothers, but they need not be. A father, another relative or a non-relative can function in the role of primary caretaker provided they sustain a central role in a child's life for at least three, and preferably five years - the period when a child's brain develops most rapidly.

Each attachment occurs in a unique way. Infants vary in what it takes to calm and soothe them or what they find most pleasurable. Caretakers also have their own preferences, but the attuned caretaker will observe and follow the lead of the infant. Relationships characterized by secure attachment have the following attributes:

• The adult aligns his/her own internal state with that of the infant or child and communicates this alignment in non-verbal ways that the child understands. This "communication" forms a bond of trust that makes the infant feel that he/she is felt, known and respected. For example:

• The child cries; the adult feels concern and acts in ways that communicate this concern.
• The infant smiles and wants to interact in a positive manner. Seeing this, the adult understands and accommodates the infant's desire for joyful play.

• Through this mutually attuned interaction, the infant learns to attain balance in his body, emotions, and states of mind.

• The comfort, pleasure, and mutuality of the attuned interaction creates a sense of safety within the infant and inspires interpersonal connection to others.

How is secure attachment related to optimum development?

Human beings are highly social creatures. Our brains are designed to be in relationship with other people. Interactive communication shapes both the structure and function of the brain. The technology that brain scans have made available in the past fifteen years proves this point. Attachment experience directly influences the development of children and is directly responsible for activating or not activating their genetic potential. Interpersonal relationships and the patterns of communications that children experience with their caretakers directly influence the development of their mental processes. Secure attachment establishes the basis on which the child will form relationships with others; his sense of security about exploring the world; his resilience to stress; his ability to balance his emotions, make sense of his life, and create meaningful interpersonal relationships in the future.

Secure attachment doesn't have to be perfect

Attachment is not destiny because the brain remains flexible throughout life. Relationships with parents can and do change. If communication with the infant is secure at least a third of the time or more, that is enough to support a secure relationship. Repair, an important part of the attachment process, contributes as much to optimum development as joyous interaction. No caretaker will interpret a child's needs correctly all the time. And, as the child grows, there will be times of disagreement between the pair. The caretaker, who sets limits initiates repair as soon as the child indicates a desire for reconnection, strengthens the child's feeling of safety within the relationship. For example, mom says, "you can't play with fire" or "you must brush your teeth before bed." Infants and totters unable to see things from an adult perspective are easily put off by requests they dislike, temporarily severing the relationship with anger and tears. The attuned caretaker is not intimidated or put off by this disruption in their closeness. If the child is angry or pouting, the caretaker understands their feelings, but remains firm. Relatively soon the dependant party (the child) gives up because they need to reconnect. An attuned caretaker will respond positively and immediately.

What causes insecure attachment and attachment disorder?

If the attachment bond doesn't occur with sufficient regularity, then the necessary safe and secure experiences do not occur as they should. Instead, insecure attachments are formed. All insecure attachments arise from repeated experiences of failed emotional communication. They take one of three different forms. Before listing some of these, it is important to note that parents of insecure children are themselves products of insecure experiences. Insecure attachment is passed on from one generation to the next unless repair occurs.

• When a parent is unavailable or rejecting, a child may become "avoidantly" attached, meaning that the child adapts by avoiding closeness and emotional connection.

• An "ambivalently" attached child experiences the parents' communication as inconsistent and at times intrusive. Because the child can't depend on the parent for attunement and connection, he develops a sense of anxiety and feelings of insecurity.

"Disorganized" attachment occurs when the child's' need for emotional closeness remains unseen or ignored, and the parents behavior is a source of disorientation or terror. When children have experiences with parents that leave them overwhelmed, traumatized, and frightened, the youngsters become disorganized and chaotic. Disorganized attachment leads to difficulties in the regulation of emotions, social communication, academic reasoning as well as to more severe emotional problems.

Socio-economic status has nothing to do with the ability to establish successful attachment relationships. Orphaned children who spend their early years in orphanages or move from foster home to foster home are at risk for severe attachment disruption. It also can occur as a result of severe illness in the parent or the child, parental unavailability, or emotional trauma. Some children have inborn disabilities or temperaments that make it difficult for them to form a secure attachment, no matter how hard the parent tries. In any case, there generally are several factors involved. The major causes are:

• physical neglect
• emotional neglect
• abuse
• separation from primary caregiver
• changes in primary caregiver
• frequent moves or placements
• traumatic experiences
• maternal depression
• maternal addiction to drugs or alcohol
• undiagnosed, painful illness such as colic, ear infections, etc.
• lack of attunement or harmony between mother and child
• young or inexperienced mother with poor parenting skills.

What are the signs and symptoms of insecure attachment?

Insecure attachments influence the developing brain, which in turn affects future interactions with others, self-esteem, self-control, and the ability to learn and to achieve optimum mental and physical health. Symptoms can include the following:

• low self esteem
• needy, clingy or pseudo-independent behavior
• inability to deal with stress and adversity
• lack of self-control
• inability to develop and maintain friendships
• alienation from and opposition to parents, caregivers, and other authority figures
• antisocial attitudes and behaviors
• aggression and violence
• difficulty with genuine trust, intimacy, and affection
• negative, hopeless, pessimistic view of self, family and society
• lack of empathy, compassion and remorse
• behavioral and academic problems at school
• speech and language problems
• incessant chatter and questions
• difficulty learning
• depression
• apathy
• susceptibility to chronic illness
• obsession with food: hordes, gorges, refuses to eat, eats strange things, hides food
• repetition of cycle of maltreatment and attachment disorder in their own children when they reach adulthood.

How does neurological dis-regulation affect the attachment bond?

If either parent or child is unable to maintain a calm and balanced nervous state, the attachment bond will be compromised. Both infant and caretaker must feel calm and be focused for positive attachment to occur. When an infant is so dis-regulated that all they do is clench their fists, and scream with their eyes tightly closed or the mother is so depressed or caught up in her own needs that she misses her child's cues for engagement and comfort, opportunities for attachment will be missed. According to Dr. Connie Lillas: Once one loses the balance of being in a calm and present state, one's stress responses (at any age) go into one of there primary directions:

• "too hot" stress response -- acceleration of the nervous system such as frustration or anger.

• "too cold" stress response -- shutting down and tuning out behaviors.

• "mix" of hot and cold stress responses -- blend of out of balance behavior including anxious withdrawal, anxious clinging or hyper-vigilant.

Positive attachment begins with a neurologically regulated dyad but high stress experiences (before and after birth) can create neurological dis-regulaton and be traumatizing for both parties. The first step in healing poor attachment is to bring about a calm and focused state in both parties. But because what one adult or child may find regulating or balancing, may not fit another's' needs, the process of repair requires a willingness to experiment in determining what works to calm and sooth. Certain kinds of movements or movement itself is often a key but touch, sounds and other kinds of sensory experiences may also create calming and the sense of safety the characterizes a balanced nervous state.

What is Reactive Attachment Disorder (RAD)?

Reactive Attachment Disorder (RAD) is a clinically recognized form of severe insecure attachment. Children with RAD are so neurologically disrupted that they cannot attach to a primary caregiver or go through the normal developmental processes. Often these children who cannot establish positive relationships with other people have been abused, neglected or separated from their primary caretakers. Many have been incorrectly diagnosed as having severe emotional and behavioral disturbances ranging from attention-deficit hyperactivity disorder (ADHD) to bipolar disorder to depression. In response to these diagnoses, they may have received various combinations of unnecessary psychotropic mediation. See Online Resources for an excellent website that thoroughly describes the problem.

How is inadequate attachment repaired?

Recent studies show that it's never too late to create positive change in a child's life, or in an adult's, for that matter. The learning that accompanies new experiences can alter neural connections in the brain. Relationships with relatives, teachers and childcare providers can provide an important source of connection and strength for the child's developing mind. In attempts to repair attachment, here are some things to consider:

• Attachment is an interactive process. It is an evolutionary fact that our brains are structured to connect to one another. The attachment process alters the brains of both parent and child. But what makes attachment so unique is that the stronger, older, more experienced parent attunes and follows the lead of the younger, less experienced, more vulnerable child

• Following an infant's lead does not mean that that the infant makes all the decisions. It does mean that the caretaker follows and responds to the infant's emotional needs and defers to the infants emotional needs when appropriate.

• Attachment is a nonverbal process. It takes place many months and even years before speech and thought develop.

• Communication is based wordless messages that are physical and emotional in nature.

• Interactive exchange is accomplished through:

• eye contact
• facial expression
• tone of voice
• speech rhythm and rate
• posture
• gesture
• body movement
• timing, intensity and voice modulation

Children vary in what they find soothing. There is no "one size fits all" for every child. In determining what constitutes "just right" communication for a particular child, it will be up to the adult to follow the nonverbal cues of that child.

• Attachment is akin to falling in love, but can't begin until both parties feel safe in their bodies and safe with one another. When adults are anxious, mad, tuned out or overwhelmed, they will not be able to make an attuned connection with a child. They should regulate themselves before attempting to connect. If a child is overwhelmed or inconsolable, he may not be available for an attuned emotional connection until he feels safer in his body. Sensory activities such as rocking, singing, moving, touching, and feeding can sooth children, but youngsters vary in their sensory preferences. What sooths a parent may not soothe an infant. Thus, parents may have to become sensory detectives to determine the best techniques for soothing their child and soothing themselves in order to make connection with the child.

• The key to shared emotional experience is not simply to mirror or give lip service to the child, but to share his experience by feeling it to some degree within your own body. This process of shared experience helps both infants and children regulate their feeling states. It is usually more important to share a negative state with a child than to problem solve. Sharing enables children to learn to problem solve for themselves.

• The shared positive emotional experiences of joy are as important to the attachment bond as the shared negative emotional experiences of fear, sadness, anger and shame. Some parents are very good at detecting a child's distress and responding appropriately to it. Other parents share joyous moments but leave or space out in times of trouble and unhappiness. A strong attachment bond includes the full range of shared emotional experience.

• Rupture and repair is a crucial part of secure attachment. No matter how much we love our children, there comes a point where we are not in agreement with them, a point when we have to set limits, and say "no." This is usually a point of rupture in the relationship as the child angrily protests. Such protest is to be expected. The key to strengthening the attachment bond of trust is to be available the minute the child is ready to reconnect. It is also important to initiate repair when we have done something to hurt, disrespect, or shame a child. Parents aren't perfect. From time to time, we are the cause of the disconnection. Again, our willingness to initiate repair can strengthen the attachment bond.

• Families who have children who are neurologically dis-regulated or have Reactive Attachment Disorder (RAD) will benefit from treatment and therapeutic parenting. Other disorders may accompany severe attachment disorder -see links listed below.


Online resources on parenting and attachment

Becoming Attached - An 18-page, very readable 1991 Atlantic Monthly article, later expanded into a book, which reviews the clinical research that has become the basis of our understanding of attachment.

Trauma, Brain and Relationship: Helping Children Heal - This 30-minute documentary video describing attachment is available free, online in segments

Daniel Siegel, MD - Professional Interview - Web article by Daniel Siegel, for both lay and professional audiences, breaks down and details the kinds of personal and interpersonal experience that results in successful or unsuccessful attachment bonds.

Bruce Perry, M.D., Ph.D. - Attachment: The First Core Strength - Provides a detailed description of the attachment bond.

What is Attachment? - Helps parents about to adopt a child to understand what to expect and how to handle potential problems.

Reactive Attachment Disorder - Combines a personal experience of an adoptive parent with a thorough description of RAD.

When Beauty becomes the Beast --An article by Brian Post who specializes in working with parents and their dis-regulated children in their homes.

Towards a New Alternative to Behavior Modification and Understanding Why Consequences is Not an Effective Tool -Another article by Brian Post - Offers information on attachment and disrupted attachment for families who have adopted traumatized children, especially those from foreign countries. For an excellent list of practical things parents and others can do to promote secure attachment click on Activities to Promote Attachment.

Bonding and Attachment in Maltreated Children; how you can help - Bruce Perry, M.D., Ph.D. provides tips on interacting with and nurturing children who may have insecure attachments





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