February 25, 2008
Attachment in Early Childhood
Interview with Prof. Charles Zeanah
Mihaela Chraif
EJOP Editor
Charles H. Zeanah, Jr., M.D. is Sellars-Polchow Professor of Psychiatry and Professor of Clinical Pediatrics, Director of Child and Adolescent Psychiatry, and Vice-Chair of the Department of Psychiatry and Neurology at the Tulane University School of Medicine. Professor Zeanah serves as Executive Director of the Institute of Infant and Early Childhood Mental Health. He also directs the Tulane/JPHSA Infant Team, a community-based intervention program for abused and neglected infants and toddlers in the New Orleans area. He has a longstanding interest in Infant Mental Health, and his research and clinical interests concern the effects of exposure to violence on the development of young children, attachment and its development in high-risk environments, risk and protective factors in development, psychopathology in early childhood, and infant-parent relationships. Professor Zeanah has published numerous scientific papers and book chapters on these topics. He is the editor of the Handbook of Infant Mental Health, published by Guilford Press. Prof. Zeanah serves as a member of the Council (Board) of the American Academy of Child and Adolescent Psychiatry.
What do attachment means?
Prof Zeanah: Attachment describes a tendency for human infants to seek comfort, support, nurturance and protection from one or more discriminated caregivers. The tendency for selective seeking of comfort is not apparent at birth, however. Following a period of sociability and comfort with a wide range of adult caregivers during the first 6 months, at about 7 to 9 months of age, two new infant behaviors appear, stranger wariness and separation protest. Stranger wariness describes an apparent discomfort with unfamiliar adults and a turning for comfort selectively to those they know and trust. Separation protest refers to the infant’s new tendency to protest separation from familiar caregivers. Although individual differences in the intensity and expression of these behaviours are clear, they may be considered virtually ubiquitous. When these behaviors appear, the infant is said to be attached to one or more caregivers.
EJOP: Professor Zeanah, can you tell us what are types of attachment?
Professor Zeanah: Types or patterns of attachment refer to individual differences in the way that a child’s attachment behaviors are organized towards a particular attachment figure. These patterns are derived from classifications of the child’s behavior in a separation-reunion paradigm known as the Strange Situation Procedure. When a child expresses distress about separation directly to the caregiver, seeks comfort from the attachment figure (but not from the stranger), and is soothed within a short period of time after separation, the child is said to have a secure attachment to that particular caregiver.
Children who have little or no distress and who ignore or actively avoid their attachment figures on reunion are classified as having avoidant attachments to the attachment figure. Infants who become distressed on separation but who fail to soothe on reunion are classified as having resistant attachments. Finally, children who have mixed patterns or who exhibit atypical behaviors in place of attachment behaviors have attachments classified as disorganized or as insecure/other..
EJOP: What can you tell us about attachment classifications as risk and protective factors?
Professor Zeanah: Especially within high risk samples of children, secure attachment appears to be an important protective factor. Disorganized and insecure/other attachments, on the other hand, appear to bsignificantly increase the risk that a child will exhibit psychopathology, either concurrently or subsequently.
EJOP: What are disorders of attachment?
Professor Zeanah: In extreme rearing conditions, however, such as social neglect or institutional care, attachment may be seriously compromised or even absent. Reactive attachment disorder (RAD) describes a constellation of aberrant attachment behaviors and other social behavioral anomalies that are believed to result from social neglect and deprivation. Two clinical patterns have been described: (a) an emotionally withdrawn/inhibited pattern, in which the child exhibits limited or absent initiation or response to social interactions with caregivers, and a variety of aberrant social behaviors, such as inhibited, hypervigilant, or highly ambivalent reactions, and (b) an indiscriminately social/disinhibited pattern, in which the child exhibits lack of expectable selectivity in seeking comfort, support and nurturance, with lack of social reticence with unfamiliar adults and a willingness to “go off” with strangers.
Although systematic study of attachment disorders is quite recent, these disorders have been described in young deprived children for more than half a century. From recent studies, it seems clear that signs of attachment disorders are rare to non-existent in low risk samples, increased in higher risk samples, and readily identifiable in maltreated and institutionalized samples. Recent research has demonstrated that these disorders often remit when caregiving conditions improve, though with variability for each type
Interestingly, the emotionally withdrawn/inhibited type of RAD is readily apparent in young children living in institutions and in young children when they are first placed in foster care following maltreatment, but it is rarely evident in samples of children adopted out of institutions. Further, in a randomized controlled trial in which children in institutions were randomized to continued care in institutions or to foster placements, the children in foster care demonstrated dramatic decreases in signs of emotionally withdrawn/inhibited RAD within months and became indistinguishable from levels of never institutionalized children. This suggests that the emotionally withdrawn/inhibited type is quickly responsive to improvements in the caregiving environment.
The indiscriminately social/disinhibited type of RAD, also is discernable in maltreated and institutionalized children, but it remains evident in a substantial minority of adopted post-institutionalized children. In fact, continued high levels of indiscriminate behavior is one of the most frequent social abnormalities in children adopted out of institutions, continuing in some cases for years following adoption. Further, in the study of children placed into foster care following institutionalization, levels of indiscriminately social/disinhibited RAD diminished, but the levels did not reach those of never institutionalized children, even two years later.
EJOP: What have you learned about attachment in the Bucharest Early Intervention Project?
Professor Zeanah: First, we learned that young children living in institutions are at substantially increased risk for disturbed attachments. That is, they were less likely to be securely attached, more likely to have disorganized or unclassifiable atachments, more likely to have incompletely developed attachments, and more likely to exhibit signs of attachment disorders, both the emotionally withdrawn/inhibited type and the indiscriminately social/disinhibited type.
Second we learned that removal from institutions and placement on foster care significantly increased the number of children who had secure attachments to their caregivers, as well as reduced the number of children who exhibited disorganized or insecure/other patterns of attachment.
Finally, we learned that children placed in foster care at younger ages were more likely to exhibit both secure and organized attachments. Although there is unlikely to be an age at which secure attachment can no longer develop, our data suggest that the younger the child, the more likely a secure attachment will develop following placement in foster care.
http://www.infantinstitute.com/faculty.htm