Bonding and Attachment in Maltreated Children, Bruce D. Perry
[ Pobierz całość w formacie PDF ]
The ChildTrauma Academy
www.ChildTraumaAcademy.org
Bonding and Attachment
in Maltreated Children
Consequences of Emotional Neglect
in Childhood
Bruce D. Perry, M.D., Ph.D.
Adapted in part from:
“Maltreated Children: Experience, Brain Development and the Next Generation”
(
W.W. Norton & Company, New York, in preparation)
Introduction
The most important property of humankind is the capacity to form and maintain
relationships. These relationships are absolutely necessary for any of us to survive, learn,
work, love and procreate. Human relationships take many forms but the most intense, most
pleasurable and most painful are those relationships with family, friends and loved ones.
Within this inner circle of intimate relationships, we are bonded to each other with "emotional
glue" - bonded with love.
Each individual's ability to form and maintain relationships using this "emotional glue" is
different. Some people seem "naturally" capable of loving. They form numerous intimate
and caring relationships and, in doing so, get pleasure. Others are not so lucky. They feel
no "pull" to form intimate relationships, find little pleasure in being with or close to others.
They have few, if any friends and more distant, less emotional glue with family. In extreme
cases an individual may have no intact emotional bond to any other person. They are self-
absorbed, aloof or may even present with classic neuropsychiatric signs of being schizoid or
autistic.
The capacity and desire to form emotional relationships is related to the organization and
functioning of specific parts of the human brain. Just as the brain allows us to see, smell,
taste, think, talk and move, it is the organ that allows us to love -- or not. The systems in
the human brain that allow us to form and maintain emotional relationships develop during
infancy and the first years of life. Experiences during this early vulnerable period of life are
critical to shaping the capacity to form intimate and emotionally healthy relationships.
All rights reserved © 2001 Bruce D. Perry
Bonding and Attachment in Maltreated Children
Perry
Empathy, caring, sharing, inhibition of aggression, capacity to love and a host of other
characteristics of a healthy, happy and productive person are related to the core
attachment
capabilities which are formed in infancy and early childhood.
Frequently Asked Questions
What is attachment?
Well, it depends.
The word attachment is frequently used by
mental health, child development and child
protection workers but it has slightly
different meanings in these different
contexts. The first thing to know is that we
humans create many kinds of “bonds.” A
bond is a connection between one person
and another. In the field of infant
development, attachment refers to a special
bond characterized by the unique qualities
of the special bond that forms in maternal-
infant or primary caregiver-infant
relationships. The attachment bond has
several key elements: (1) an attachment bond is an enduring emotional relationship with a
specific person; (2) the relationship brings safety, comfort, soothing and pleasure; (3) loss
or threat of loss of the person evokes intense distress. This special form of relationship is
best characterized by the maternal-child relationship. As we study the nature of these
special relationships, we are finding out about how important they can be for the future
development of the child. Indeed, many researchers and clinicians feel that the maternal-
child attachment provides the working framework for all subsequent relationships that the
child will develop. A solid and healthy attachment with a primary caregiver appears to be
associated with a high probability of healthy relationships with others while poor attachment
with the mother or primary caregiver appears to be associated with a host of emotional and
behavioral problems later in life.
In the mental health field, attachment is used loosely has come to reflect the global capacity
to form relationships. For the purposes of this paper,
attachment capabilities
refer to the
capacity to form and maintain an emotional relationship while
attachment
refers to the
nature and quality of the actual relationship. A child, for example, may have an "insecure"
attachment or "secure" attachment.
What is bonding?
Simply stated, bonding is the
process
of forming an attachment. Just as bonding is the term
used when gluing one object to another, bonding is using our emotional glue to become
connected to another. Bonding, therefore, involves a set of behaviors that will help lead to
an emotional connection (attachment).
Are bonding and attachment genetic?
The biological capacity to bond and form attachments is most certainly genetically
determined. The drive to survive is basic in all species. Infants are defenseless and must
www.ChildTrauma.org
2
Bonding and Attachment in Maltreated Children
Perry
depend upon a caregiving adult for survival. It is in the context of this primary dependence,
and the maternal response to this dependence, that a relationship develops. This
attachment is crucial for survival.
An emotionally and physically healthy mother will be drawn to her infant - she will feel a
physical longing to smell, cuddle, rock, coo and gaze at her infant. In turn the infant will
respond with snuggling, babbling, smiling, sucking and clinging. In most cases, the mother's
behaviors bring pleasure, soothing and nourishment to the infant and the infant's behaviors
bring pleasure and satisfaction to the mother. This reciprocal positive feedback loop, this
maternal-infant dance, is where attachment develops.
Therefore, despite the genetic potential for bonding and attachment, it is the nature,
quantity, pattern and intensity of early life experiences that express that genetic potential.
Without predictable, responsive, nurturing and sensory-enriched caregiving, the infant's
potential for normal bonding and attachments will be unrealized. The brain systems
responsible for healthy emotional relationships will not develop in an optimal way without the
right kinds of experiences at the
right times
in life.
What are bonding experiences?
The acts of holding, rocking, singing, feeding, gazing, kissing and other nurturing behaviors
involved in caring for infants and young children are bonding experiences. Factors crucial to
bonding include time together (in childhood,
quantity
does matter!), face-to-face
interactions, eye contact, physical proximity, touch and other primary sensory experiences
such as smell, sound, and taste. Scientists believe the most important factor in creating
attachment is positive physical contact (e.g., hugging, holding, and rocking). It should be no
surprise that holding, gazing, smiling, kissing, singing, and laughing all cause specific
neurochemical activities in the brain. These neurochemical activities lead to normal
organization of brain systems that are responsible for attachment.
The most important relationship in a child’s life is the attachment to his or her primary
caregiver, optimally, the mother. This is due to the fact that this first relationship
determines the biological and emotional ‘template’ for all future relationships. Healthy
attachment to the mother built by repetitive bonding experiences during infancy provides the
solid foundation for future healthy relationships. In contrast, problems with bonding and
attachment can lead to a fragile biological and emotional foundation for future relationships.
When are these windows of opportunity?
Timing is everything
. Bonding experiences lead to healthy attachments and healthy
attachment capabilities when they are provided in the earliest years of life. During the first
three years of life, the human brain develops to 90 percent of adult size and puts in place the
majority of systems and structures that will be responsible for all future emotional,
behavioral, social and physiological functioning during the rest of life. There are critical
periods during which bonding experiences
must be present
for the brain systems responsible
for attachment to develop normally. These critical periods appear to be in the first year of
life and are related to the capacity of the infant and caregiver to develop a positive
interactive relationship.
What happens if this window of opportunity is missed?
www.ChildTrauma.org
3
Bonding and Attachment in Maltreated Children
Perry
The impact of impaired bonding in early childhood varies. With severe emotional neglect in
early childhood the impact can be devastating. Children without touch, stimulation and
nurturing can literally lose the capacity to form any meaningful relationships for the rest of
their lives. Fortunately most children do not suffer this degree of severe neglect. There are,
however, many millions of children who have some degree of impaired bonding and
attachment during early childhood. The problems that result from this can range from mild
interpersonal discomfort to profound social and emotional problems. In general, the severity
of problems is related to how early in life, how prolonged and how severe the emotional
neglect has been.
This does not mean that children with these experiences have no hope to develop normal
relationships. Very little is known about the ability of replacement experiences later in life to
“replace” or repair the undeveloped or poorly organized bonding and attachment capabilities.
Clinical experiences and a number of studies suggest that improvement can take place, but it
is a long, difficult and frustrating process for families and children. It may take many years
of hard work to help repair the damage from only a few months of neglect in infancy.
Are there ways to classify attachment?
Like traits such as height or weight, individual attachment capabilities are continuous. In an
attempt to study this range of attachments, however, researchers have clustered the
continuum into four categories of attachment: secure, insecure-resistant, insecure-avoidant,
and insecure-disorganized/disoriented. Securely attached children feel a consistent,
responsive, and supportive relation to their mothers even during times of significant stress.
Insecurely attached children feel inconsistent, punishing, unresponsive emotions from their
caregivers and feel threatened during times of stress.
Classification of
Attachment
Percentage at
One-Year
Response in Strange Situation
Explores with M in room; upset with separation;
warm greeting upon return; seeks physical touch
and comfort upon reunion
Securely attached
60-70 %
Ignores M when present; little distress on
separation; actively turns away from M upon
reunion
Insecure: avoidant
15-20 %
Little exploration with M in room, stays close to
M; very distressed upon separation; ambivalent
or angry and resists physical contact upon
reunion with M
Insecure: resistant
10-15 %
Confusion about approaching or avoiding M; most
distressed by separation; upon reunion acts
confused and dazed – similar to approach-
avoidance confusion in animal models
Insecure:
disorganized
disoriented
5-10 %
Above -- Dr. Mary Ainsworth developed a simple process to examine the nature of a child’s
attachment. This is called the Strange Situation procedure. Simply stated, the mother and
infant are observed in a sequence of “situations:” parent-child alone in a playroom; stranger
entering room; parent leaving while the stranger stays and tries to comfort the baby; parent
returns and comforts infant; stranger leaves; mother leaves infant all alone; stranger enters
to comfort infant; parent returns and tries to comfort and engage the infant. The behaviors
during each of these situations is observed and “rated.” The behaviors of children in this
testing paradigm
www.ChildTrauma.org
4
Bonding and Attachment in Maltreated Children
Perry
What other factors influence bonding and attachment?
Any factors that interfere with bonding experiences can interfere with the development of
attachment capabilities. When the interactive, reciprocal "dance" between the caregiver and
infant is disrupted or difficult, bonding experiences are difficult to maintain. Disruptions can
occur because of primary problems with the infant, the caregiver, the environment or the
"fit" between the infant and caregiver.
Infant
: The child’s “personality” or temperament influences bonding. If an infant is difficult
to sooth, irritable or unresponsive compared to a calm, self-soothing child, he or she will
have more difficulty developing a secure attachment. The infant's ability to participate in the
maternal-infant interaction may be compromised due to a medical condition such as pre-
maturity, birth defect, or illness.
Caregiver
: The caregiver's behaviors can impair bonding. Critical, rejecting, and interfering
parents tend to have children that avoid emotional intimacy. Abusive parents tend to have
children that become uncomfortable with intimacy and withdraw. The child’s mother may be
unresponsive to the child due to maternal depression, substance abuse, overwhelming
personal problems, or other factors that interfere with her ability to be consistent and
nurturing for the child.
Environment
: A major impediment to healthy attachment is fear. If an infant is distressed
due to pain, pervasive threat or a chaotic environment, they will have a difficult time
participating in even a supportive caregiving relationship. Infants or children in domestic
violence, refugee, community violence or war zone environments are vulnerable to
developing attachment problems.
Fit
: The "fit" between the temperament and
capabilities of the infant and the mother is
crucial. Some caregivers can be just fine with
a calm infant but are overwhelmed by an
irritable infant. The process of paying
attention to, reading each other's non-verbal
cues and responding appropriately is essential
to maintain the bonding experiences that
build in healthy attachments. Sometimes a style
of communication and response familiar to a
mother from one of her other children may
not fit her current infant. The mutual
frustration of being "out of sync" can impair
bonding.
www.ChildTrauma.org
5
[ Pobierz całość w formacie PDF ]
zanotowane.pl doc.pisz.pl pdf.pisz.pl lemansa.htw.pl
The ChildTrauma Academy
www.ChildTraumaAcademy.org
Bonding and Attachment
in Maltreated Children
Consequences of Emotional Neglect
in Childhood
Bruce D. Perry, M.D., Ph.D.
Adapted in part from:
“Maltreated Children: Experience, Brain Development and the Next Generation”
(
W.W. Norton & Company, New York, in preparation)
Introduction
The most important property of humankind is the capacity to form and maintain
relationships. These relationships are absolutely necessary for any of us to survive, learn,
work, love and procreate. Human relationships take many forms but the most intense, most
pleasurable and most painful are those relationships with family, friends and loved ones.
Within this inner circle of intimate relationships, we are bonded to each other with "emotional
glue" - bonded with love.
Each individual's ability to form and maintain relationships using this "emotional glue" is
different. Some people seem "naturally" capable of loving. They form numerous intimate
and caring relationships and, in doing so, get pleasure. Others are not so lucky. They feel
no "pull" to form intimate relationships, find little pleasure in being with or close to others.
They have few, if any friends and more distant, less emotional glue with family. In extreme
cases an individual may have no intact emotional bond to any other person. They are self-
absorbed, aloof or may even present with classic neuropsychiatric signs of being schizoid or
autistic.
The capacity and desire to form emotional relationships is related to the organization and
functioning of specific parts of the human brain. Just as the brain allows us to see, smell,
taste, think, talk and move, it is the organ that allows us to love -- or not. The systems in
the human brain that allow us to form and maintain emotional relationships develop during
infancy and the first years of life. Experiences during this early vulnerable period of life are
critical to shaping the capacity to form intimate and emotionally healthy relationships.
All rights reserved © 2001 Bruce D. Perry
Bonding and Attachment in Maltreated Children
Perry
Empathy, caring, sharing, inhibition of aggression, capacity to love and a host of other
characteristics of a healthy, happy and productive person are related to the core
attachment
capabilities which are formed in infancy and early childhood.
Frequently Asked Questions
What is attachment?
Well, it depends.
The word attachment is frequently used by
mental health, child development and child
protection workers but it has slightly
different meanings in these different
contexts. The first thing to know is that we
humans create many kinds of “bonds.” A
bond is a connection between one person
and another. In the field of infant
development, attachment refers to a special
bond characterized by the unique qualities
of the special bond that forms in maternal-
infant or primary caregiver-infant
relationships. The attachment bond has
several key elements: (1) an attachment bond is an enduring emotional relationship with a
specific person; (2) the relationship brings safety, comfort, soothing and pleasure; (3) loss
or threat of loss of the person evokes intense distress. This special form of relationship is
best characterized by the maternal-child relationship. As we study the nature of these
special relationships, we are finding out about how important they can be for the future
development of the child. Indeed, many researchers and clinicians feel that the maternal-
child attachment provides the working framework for all subsequent relationships that the
child will develop. A solid and healthy attachment with a primary caregiver appears to be
associated with a high probability of healthy relationships with others while poor attachment
with the mother or primary caregiver appears to be associated with a host of emotional and
behavioral problems later in life.
In the mental health field, attachment is used loosely has come to reflect the global capacity
to form relationships. For the purposes of this paper,
attachment capabilities
refer to the
capacity to form and maintain an emotional relationship while
attachment
refers to the
nature and quality of the actual relationship. A child, for example, may have an "insecure"
attachment or "secure" attachment.
What is bonding?
Simply stated, bonding is the
process
of forming an attachment. Just as bonding is the term
used when gluing one object to another, bonding is using our emotional glue to become
connected to another. Bonding, therefore, involves a set of behaviors that will help lead to
an emotional connection (attachment).
Are bonding and attachment genetic?
The biological capacity to bond and form attachments is most certainly genetically
determined. The drive to survive is basic in all species. Infants are defenseless and must
www.ChildTrauma.org
2
Bonding and Attachment in Maltreated Children
Perry
depend upon a caregiving adult for survival. It is in the context of this primary dependence,
and the maternal response to this dependence, that a relationship develops. This
attachment is crucial for survival.
An emotionally and physically healthy mother will be drawn to her infant - she will feel a
physical longing to smell, cuddle, rock, coo and gaze at her infant. In turn the infant will
respond with snuggling, babbling, smiling, sucking and clinging. In most cases, the mother's
behaviors bring pleasure, soothing and nourishment to the infant and the infant's behaviors
bring pleasure and satisfaction to the mother. This reciprocal positive feedback loop, this
maternal-infant dance, is where attachment develops.
Therefore, despite the genetic potential for bonding and attachment, it is the nature,
quantity, pattern and intensity of early life experiences that express that genetic potential.
Without predictable, responsive, nurturing and sensory-enriched caregiving, the infant's
potential for normal bonding and attachments will be unrealized. The brain systems
responsible for healthy emotional relationships will not develop in an optimal way without the
right kinds of experiences at the
right times
in life.
What are bonding experiences?
The acts of holding, rocking, singing, feeding, gazing, kissing and other nurturing behaviors
involved in caring for infants and young children are bonding experiences. Factors crucial to
bonding include time together (in childhood,
quantity
does matter!), face-to-face
interactions, eye contact, physical proximity, touch and other primary sensory experiences
such as smell, sound, and taste. Scientists believe the most important factor in creating
attachment is positive physical contact (e.g., hugging, holding, and rocking). It should be no
surprise that holding, gazing, smiling, kissing, singing, and laughing all cause specific
neurochemical activities in the brain. These neurochemical activities lead to normal
organization of brain systems that are responsible for attachment.
The most important relationship in a child’s life is the attachment to his or her primary
caregiver, optimally, the mother. This is due to the fact that this first relationship
determines the biological and emotional ‘template’ for all future relationships. Healthy
attachment to the mother built by repetitive bonding experiences during infancy provides the
solid foundation for future healthy relationships. In contrast, problems with bonding and
attachment can lead to a fragile biological and emotional foundation for future relationships.
When are these windows of opportunity?
Timing is everything
. Bonding experiences lead to healthy attachments and healthy
attachment capabilities when they are provided in the earliest years of life. During the first
three years of life, the human brain develops to 90 percent of adult size and puts in place the
majority of systems and structures that will be responsible for all future emotional,
behavioral, social and physiological functioning during the rest of life. There are critical
periods during which bonding experiences
must be present
for the brain systems responsible
for attachment to develop normally. These critical periods appear to be in the first year of
life and are related to the capacity of the infant and caregiver to develop a positive
interactive relationship.
What happens if this window of opportunity is missed?
www.ChildTrauma.org
3
Bonding and Attachment in Maltreated Children
Perry
The impact of impaired bonding in early childhood varies. With severe emotional neglect in
early childhood the impact can be devastating. Children without touch, stimulation and
nurturing can literally lose the capacity to form any meaningful relationships for the rest of
their lives. Fortunately most children do not suffer this degree of severe neglect. There are,
however, many millions of children who have some degree of impaired bonding and
attachment during early childhood. The problems that result from this can range from mild
interpersonal discomfort to profound social and emotional problems. In general, the severity
of problems is related to how early in life, how prolonged and how severe the emotional
neglect has been.
This does not mean that children with these experiences have no hope to develop normal
relationships. Very little is known about the ability of replacement experiences later in life to
“replace” or repair the undeveloped or poorly organized bonding and attachment capabilities.
Clinical experiences and a number of studies suggest that improvement can take place, but it
is a long, difficult and frustrating process for families and children. It may take many years
of hard work to help repair the damage from only a few months of neglect in infancy.
Are there ways to classify attachment?
Like traits such as height or weight, individual attachment capabilities are continuous. In an
attempt to study this range of attachments, however, researchers have clustered the
continuum into four categories of attachment: secure, insecure-resistant, insecure-avoidant,
and insecure-disorganized/disoriented. Securely attached children feel a consistent,
responsive, and supportive relation to their mothers even during times of significant stress.
Insecurely attached children feel inconsistent, punishing, unresponsive emotions from their
caregivers and feel threatened during times of stress.
Classification of
Attachment
Percentage at
One-Year
Response in Strange Situation
Explores with M in room; upset with separation;
warm greeting upon return; seeks physical touch
and comfort upon reunion
Securely attached
60-70 %
Ignores M when present; little distress on
separation; actively turns away from M upon
reunion
Insecure: avoidant
15-20 %
Little exploration with M in room, stays close to
M; very distressed upon separation; ambivalent
or angry and resists physical contact upon
reunion with M
Insecure: resistant
10-15 %
Confusion about approaching or avoiding M; most
distressed by separation; upon reunion acts
confused and dazed – similar to approach-
avoidance confusion in animal models
Insecure:
disorganized
disoriented
5-10 %
Above -- Dr. Mary Ainsworth developed a simple process to examine the nature of a child’s
attachment. This is called the Strange Situation procedure. Simply stated, the mother and
infant are observed in a sequence of “situations:” parent-child alone in a playroom; stranger
entering room; parent leaving while the stranger stays and tries to comfort the baby; parent
returns and comforts infant; stranger leaves; mother leaves infant all alone; stranger enters
to comfort infant; parent returns and tries to comfort and engage the infant. The behaviors
during each of these situations is observed and “rated.” The behaviors of children in this
testing paradigm
www.ChildTrauma.org
4
Bonding and Attachment in Maltreated Children
Perry
What other factors influence bonding and attachment?
Any factors that interfere with bonding experiences can interfere with the development of
attachment capabilities. When the interactive, reciprocal "dance" between the caregiver and
infant is disrupted or difficult, bonding experiences are difficult to maintain. Disruptions can
occur because of primary problems with the infant, the caregiver, the environment or the
"fit" between the infant and caregiver.
Infant
: The child’s “personality” or temperament influences bonding. If an infant is difficult
to sooth, irritable or unresponsive compared to a calm, self-soothing child, he or she will
have more difficulty developing a secure attachment. The infant's ability to participate in the
maternal-infant interaction may be compromised due to a medical condition such as pre-
maturity, birth defect, or illness.
Caregiver
: The caregiver's behaviors can impair bonding. Critical, rejecting, and interfering
parents tend to have children that avoid emotional intimacy. Abusive parents tend to have
children that become uncomfortable with intimacy and withdraw. The child’s mother may be
unresponsive to the child due to maternal depression, substance abuse, overwhelming
personal problems, or other factors that interfere with her ability to be consistent and
nurturing for the child.
Environment
: A major impediment to healthy attachment is fear. If an infant is distressed
due to pain, pervasive threat or a chaotic environment, they will have a difficult time
participating in even a supportive caregiving relationship. Infants or children in domestic
violence, refugee, community violence or war zone environments are vulnerable to
developing attachment problems.
Fit
: The "fit" between the temperament and
capabilities of the infant and the mother is
crucial. Some caregivers can be just fine with
a calm infant but are overwhelmed by an
irritable infant. The process of paying
attention to, reading each other's non-verbal
cues and responding appropriately is essential
to maintain the bonding experiences that
build in healthy attachments. Sometimes a style
of communication and response familiar to a
mother from one of her other children may
not fit her current infant. The mutual
frustration of being "out of sync" can impair
bonding.
www.ChildTrauma.org
5
[ Pobierz całość w formacie PDF ]