CAMHS - Attachment Disorders PDF

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Notes on Attachment Disorders for Child and Adolescent Mental Health Psychiatry ...

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CAMHS – Attachment & Attachment Disorders Attachment  Attachment refers to the strong emotional bond that exists between a child and a caregiver  Develops through appropriate sensitive parental responses to the child’s behavioural cues  Allows the child to develop an understanding of his ‘inner world’ + how to safely explore the world around him  Establishes beliefs in the child’s mind around the consistency & reliability of relationships o Foundation of safe separation o Development of autonomy John Bowlby  A child’s need to be attached to protective figures is as basic as the child’s need for food o Contradicted earlier theories that attachment was due to the association of parents + food  Supported by Harlow’s infant monkey experiment o Contact comfort with the softness of a cloth was more important than feeding in the formation of an infant monkey’s attachment to its mother  Children usually develop attachment to small group of people at age 6-12 months  Separation from caregivers is usually well -tolerated in early infancy  as long as the substitute care is good o Separation between the ages 6 months and 4 years is more stressful  Bowlby’s conclusion was that to grow up mentally healthy the infant should experience intimate & continuous relationship with mother/caregiver, that both find satisfactory & joyful Sequence for Development of Attachment Phase 1 Birth  8-12 weeks

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Phase 2

3  6 months

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Phase 3

6 months  3 years

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Infants visually tracking, smiling & babbling Behaviours sustain the attention of other & their proximity to the infant Infants are more marked towards mother / father Social responses more selective Principle attachment figure begins to emerge Infant focusses on attachment figure  cries when tried to leave Strangers treated with caution Separation anxiety

Phase 4

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3 years  end of childhood

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Attachment Style Secure  Parents are affectionate & reliable  Child values relationships  Confident in self-worth

Stranger anxiety Child has developed a greater understanding of parents’ plans  can envision parents’ behaviour while separated Child is more willing + able to let go

Insecure  Parents are unresponsive & unreliable child shows little reaction parent’s presence or absence  Children often cry / act out to convey anger

Securely attached (% of non-clinical samples)  60%

Insecurely attached

Attachment style Secure

Characteristic Child Behaviour  Child values relationships & is confident of self-worth  Uses caregiver as a secure base from which to explore  May be distressed by separation  On reunion  greets caregiver positively o May seek comfort o Then gets on with play / exploring  Child appears emotionally independent  Does not value relationship  Explores with little reference to caregiver  Minimally distressed by separation  Ignores caregiver on reunion  Values relationship BUT is cautious about their safety  Minimal exploration  Highly distressed by separation  Hard to settle on reunion o Ambivalent mixture of

Insecure – avoidant

Insecure – ambivalent

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Avoidant  15% Ambivalent  10% Disorganised  15%

Insecure – disorganised

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Insecure – anxious

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clinging + anger Neither effectively self-sufficient NOR able to use relationships Lack of coherent pattern in exploratory or reunion behaviours Fear or confusion in caregiver’s presence o Suggested by disorganised behaviours o Rocking / covering face / freezing Self-worth depends on approval of others Values relationships but sees then as unreliable Develops strategies for achieving attention

Consequence  Different attachment styles can co-exist  Parental style can influence style heavily  Early attachment experiences typically have long lasting effects o Effects are not totally irreversible o Can be changed by radically altered life circumstances  In general, securely attached children do better o However, not all securely attached children do well and not all insecurely attached children do poorly  Disorganised attachment is the strongest predictor of externalising problems Secure attachment  More likely to form harmonious relationships with adults & children  More cooperative with mothers  More likely to comfort younger siblings  More likely to have good friends  Less likely to be non-compliant with parents / quarrelsome with siblings / controlling with friends  Better able to ask for teacher’s help  More popular with classmates / less victimised  More empathetic with peers / less conflict in playing Reactive Attachment Disorder of Childhood  Starts within first 5 years  Characterised by persistent abnormalities in the child’s pattern of social relationships  Abnormalities are associated with emotional disturbances + reactive to changes in environment o Fearfulness + hypervigilance o Poor social interactions with peers

o Aggression towards self & others o Misery o Growth failure in some cases Aetiology  Probably occurs as a direct result of severe o Parental neglect o Abuse o Serious mishandling o Being raised in institutions Clinical features 1. Lack of social & emotional responses 2. Absence of attachment behaviours even in times of stress 3. Problems with emotional regulation 4. Lack of positive emotional responses o With negative responses seen despite minimal triggers 5. Impairments in social & emotional reciprocal interactions Disinhibited Attachment Disorder of Childhood...