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Close observation Clinical applications John Richer CHOX and DPAG Oxford Temper tantrum 3 years old Behaviour problems Mother not coping Attachment insecurity Temper tantrum ID: 207596

attachment behaviour security mother behaviour attachment mother security secure child insecure avoidant feelings insecurity ambivalent approach disorganised focus effects

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Slide1

Attachment:Close observation Clinical applications

John Richer

CHOX and DPAG

OxfordSlide2

Temper tantrum3 years old Behaviour problems +

Mother not coping +

Attachment insecurity

++Slide3

Temper tantrum

VideoSlide4

DescribeWhat is going on?What do the behaviours mean?What are the child’s feelings / motivations?What are the mother’s feelings / motivations?Slide5

Fear, Frustration, Insecurity

Angry

avoidance

Approach,

Attachment

behaviour

Let go

Pick

up /Retrieval

Child

Parent Slide6

Strength of

motivation

Distance apart

Near

Far

Attachment

driven

approach

Avoidance

Escape

Go to

Tempers

happen

hereSlide7

Fear, Frustration, Insecurity

Avoidance

Pull away

Collapse on floor

Pull head back

Attachment

behaviour

Move towards

Bury

head in

“Mummy”

Let

Move hands awayDo little

RetrievalHold

Arm aroundSpeak to

Child

Parent

istance apart

ncreasing

DecreasingSlide8

Mum reduces her approach behaviour Child increases his approach behaviour ///Mum reduces her retrieval behaviour

Child increases his attachment

behaviour

VideoSlide9

Mum increases her approach behaviour Child increases his avoidance behaviour ///Mum increases her retrieval behaviour

Child increases his avoidance

behaviour

VideoSlide10

Motivational conflict

[One wins out]

Alternation

e.g.

dither

Simultaneous

e.g.

approach +gaze avert

Compromise

e.g.

side onOverintensity e.g. OTT, too closeDisplacement activities e.g. stereotypies, tics

Aggression Re-directed aggression e.g. to mother, sibsRegression e.g. baby behaviourSlide11

Ongoing

behaviour

is blocked

Internally - motivational conflict

Externally - frustrationSlide12

Exploration

Overintensity

(impulsive , careless)

Switch attention

from task

from person

Displacement activities

(fidget, fiddle, stereotypies, tics)

(Re-directed) aggression

RegressionAttachmentReactions to frustrationSlide13

Fear/Frustration/Anxiety

Approach

Switch attention

Overintensity

Maintain focus

Avoidance

Too soon

To partial cues

Too intensely

Too brieflySlide14

Fear/Frustration/Anxiety

Approach

OTT

“

Relaxed

”

Avoidance

“Silly”

“Shy”

2 year old with mother meeting a strangerSlide15

Attachment Theory and EvolutionAll mammals born immature

Need

protection and care

survive

Unprotected human children under 7 years rarely

survive

Survivors have genes which promote

behaviour:

Parent(s) - give protection and caregivingOffspring - seek protection and caregivingMechanism: Attachment motivation/behaviour:Parent(s) - RetrievalOffspring - Attachment behaviourVery powerful motivation - survival depends on itSlide16

Attachment BehaviourAttachment

behaviour

- proximity seeking

(cry, call, move towards.

etc

)

Precipitant:

anything fear provoking

(strangers, novelty, illness/pain/discomfort, separation, dark, danger, etc.)Termination: proximity/fear reductionSlide17

Attachment RelationshipAttachment

relationship -

between offspring and parent or other important caregivers

Parent =

secure base

Offspring can explore/play/learn,

trusting

that parent will protect/care forSlide18

Attachment Relationship: Variable SecurityMary Ainsworth, 1970s

Strange situation 18 months

The

attachment relationship varies in its security

Secure <->

insecureSlide19

Types of Security of RelationshipB

Secure

Child

plays well, comforted on reunion

Insecure

Ambivalent:

Vigilant about mother, hovers near mother, not cuddle, separation anxiety and protest ++, less comforted on reunion,A Insecure Avoidant: Generally but covertly vigilant, no separation protest, ignores mother on reunion, ?play is less varied.D Insecure Disorganised: (Mary Main 1990s) Disrupted strategy, child confused, stereotypies.?= severe Ambivalent / ?more stressedSlide20

Effect in increasing stress0. Ordinary

, age appropriate sociable playful behaviour, able to balance own needs and those

of others.

Attention

seeking with attachment figures, wanting cuddles, separation protest, demanding whinging behaviour, regressive and “silly” behaviour, not being very exploratory, etc.. The child focuses on their own needs to the exclusion of the needs to others. When more relaxed, or when improving and becoming more secure, avoidant children sometimes this behaviour which is the opposite to stage III

Avoidance

: over independence/appearance of self sufficiency, high achievement orientation, compliance, wanting to please, seeming to be in control and coping, wanting to be able to predict what will happen, liking routine, restricted playfulness, being organising, not focussing on own or other’s feelings, etc.. The child denies its own needs. It is often seen as happy and well adjusted because apparently coping with demands

Behaviour characterised by hyperactivity, self harm, destructiveness, very short attention span, negativity, soiling, smearing, wetting, aggression, and/or unfocussed violence. It seems out of control or hysterical. Underlying fears and angers come out. [ - more frustration behaviour/

fear-driven motivational conflict behaviour]Slide21

Approach

Fear / insecurity

Attachment behaviour

Avoidance

IIISlide22

Firing rate

Input

Resting rate

Firing rate of a nerve cellSlide23

Response strength

e.g. Salivation

Stimulus strength

e.g. bell volume/duration

Resting level

Pavlovian conditioning

Paradoxical response

Threshold of transmarginal inhibition

Law of StrengthSlide24

Variable Security, Caregiving Style

Secure

Trust that mother will meet needs

Caregiving

Sensitive

Insecure:

Do not trust that mother will meet needs Caregiving - Insensitive (but children’s needs vary)Ambivalent: Caregiver is unreliableAvoidant: Caregiver dismisses child’s feelings, expects child to be independent

[Disorganised: Caregiver is frightened or frightening]Slide25

Adult Attachment Interview

Mary Main and

Hesse

AAI

Account of own childhood, especially parent’s relationships to own family.

Reveals the parent’s own

“

Internal Working Model”

of attachment relationshipsSlide26

Mother’s Attachment Relationship with

her

mother

and later AAI type

Secure

Autonomous Realistic, resolvedAmbivalent Preoccupied. Angry/hurt feelings still present Avoidant Dismissive.

Denies feelings Slide27

Mother’s AAI type and Attachment Relationship

with her child

utonomous

Secure

Realistic

, resolved

Preoccupied. AmbivalentAngry/hurt feelings still present (BUT, or A)Dismissive. Avoidant

Denies feelings (BUT, or C)Unresolved Disorganised Unresolved traumaViolence, abuseSlide28

But - associations are not strongIntergenerational transmission of security type

78% of variance

accounted for

22% due mainly to

(secure / autonomous)

i.e. security is transmitted but insecurity types are less associatedSlide29

Temperament effectsTemperament (reactivity, fearfulness etc.)General finding:

Security – insecurity affected by

maternal sensitivity,

not temperament

Type of

security may be affected by temperamentSlide30

Gene – environment effects on attachmentAdopted siblings, genetically unrelatedAAI as adults

61% concordance in security

nvironment is the main factor in attachment security status

Caspers

et al (2007)Slide31

Genetic protective/vulnerability factorsDRD4 7-repeat allele: lower dopamine receptor efficiency(Dopamine associated with reward /Go /appetitive behaviour)

Maternal loss + DRD4

7-repeat

allele Disorganised

Maternal loss + DRD4

shorter

allele Not DisorganisedRutter et al (2006), Gervai et al (2005)Slide32

Barry, Kochanska, Philibert, (2008)

Variable impact of poor parenting

Differential susceptibility

0.3

-0.2

0.0

-0.4

0.2

Infant’s attachment (continuous score)

Less secure

More secure

low

Maternal responsivenessmediumhigh

ss/slInfant genotypeSerotonin transporter gene 5-HTTLPRSlide33

Maternal sensitivity

Low

High

“Good”

“Poor”

Outcome

Less susceptible

to experience (?resilient?)

More susceptible

to experience (?vulnerable?)

Differential susceptibility (Belsky 1997, 2001)Slide34

Maternal sensitivity

Low

High

“Good”

“Poor”

Outcome

Differential susceptibility

(

Belsky

1997, 2001

)- Openness to experienceSlide35

Openness to experienceChildren Mothers Externalising behavioursDRD4-7R

allele Insensitive Highest frequency

DRD4-7R

allele Sensitive Least frequency

DRD4 short allele no effect of maternal sensitivity

Bakermans-Kranenburg and van IJzendoorn (2006)Slide36

Childcare quality

Low

High

“Few”

“Many”

Behaviour

problems at 54 months

(Achenbach)

Pluess

and

Belsky JCPP 2009Differential susceptibility (Belsky 1997, 2001)

4058Low negativity

High negativity(Infant temperament questionnaire at 1 & 6 months)Slide37

Nietzsche“What does not kill us makes us stronger”Slide38

Protective effects of security 2,4,6 months 2 yearsCortisol levels, Security Fearfulness rating by Mreactivity

High Insecure Fearful

High

Secure

Not

fearful

Security protects against later fearfulness

Gunnar et al (1996)Slide39

Attachment and developmentEffect of parenting:Sher: Infants and toddlers developmental follow up: maternal sensitivity and play .

Greatest developmental progress:

1. Mothers were sensitive to baby’s intentions and feelings

2. Mother’s energetically played with babies

“Mothers who were sensitive to what was in

baby’s mind

shared what was in their

own mindHad baby’s with the best minds”Slide40

Later effectsInfants /toddlers 4-5 years in preschool Secure histories warm, socially mature,

popular with peers

Ambivalent insecure low status

LaFreniere and Sroufe (1985)Slide41

General security effects on developmentSecurity

has effects on development

When insecure, a child must attend to:

short

term safety/attachment needs,

not

learning

for later success in the long term

Wastes time, constrains learningGeneral finding: insecurity, especially disorganised, has negative effects on development and social behaviour, but individual variation and context dependencySlide42

Constraints of insecurity on learning

Both: distracted from learning by insecurity

C Ambivalent:

Bullies, aggressive, blame others,

Dominating

/ obsequious

Focus more on own immediate benefit and status in group,

Focus

less

on truth, accuracyA Avoidant:Compulsively compliant, wanting to pleaseCompulsively caretaking, helpfulUncreative, less initiative, over objective.Achievement oriented / compulsiveVulnerable to an accumulation of failure –depression, sudden collapse, ? ME/Chronic Fatigue Syndrome / anorexiaCan be seen as devious, deceitful or manipulativeSlide43

Crucial ages in AttachmentProbably several.Romanian orphans: adverse effects of gross neglect and malnutrition

rarely

persist if “rescued” before

months

Rutter

et al (2007)

Avoidant insecurity develops after 26 weeks.

(After

“relationships between two events” can be understood)Woolmore and RicherSlide44

61-2

72-3

Principles