1 Early Relationships and Attachment Healthy Steps for Young Children Program Advocate Health Care

2 Goals Clinicians will be able to define social-emotional development in the first three years of life using Erikson’s two stages Clinicians will be able to describe the quality of interaction between parent and child and be able to express their concerns to the family Clinicians will understand the importance of attachment on a child’s social-emotional development Clinicians will be able to describe/demonstrate techniques to assist parents to communicate and bond with their child

Case Study Erica is a 17-year-old first time mom of baby boy James. She brings him for his newborn checkup along with her mother and appears hesitant in her answers about the baby as her mother interrupts and gives information. How would you assess and encourage attachment? 3

4 Erikson’s Psychosocial Stages of Development 1 Trust vs. Mistrust Birth to 2 years Infant develops trust that his needs will be met # 2 Autonomy vs. Doubt, Shame 2 to 3 years Child seeks to discover a sense of self control without a loss of self-esteem

5 Parent-child Relationships Attachment Bond that forms in time between an infant and his caregiver. A secure bond is important for healthy social and emotional development in infancy and toddlerhood.

6 Development of Attachment Pre-attachment phase: Birth to 6 weeks Attachment in the making: 6 weeks to 6 months Attachment phase: 6 months to 18 months—separation anxiety begins Formation of a Reciprocal Relationship: 18 mo. to 2+ years

7 Early professional voices included that of Rene’ Spitz A psychoanalyst, who studied infants raised in foundling homes and demonstrated that those without handling or loving attention withered away, became ill, and often died.

Behavior Correlates of Attachment Stranger Anxiety Social Referencing Secure Base Checking In b 8

9 Disorders of Attachment Disorders of attachment result from inconsistent caregiving and increased family stressors: Poverty Drug Use Emotional Illness Affected toddlers show decreased interest in exploration, and may display separation problems

10 Later behaviors… They found that two-year-olds assessed as secure at 18 months were: Enthusiastic and persistent in solving easy tasks, Effective in using maternal assistance when needed Anxiously attached counterparts tended to be frustrated and whiny.

11 Preschoolers Securely attached children were: More sympathetic to the distress of their peers, More assertive about what they wanted, More likely to be leaders Findings persisted through elementary age

12 Concerning “avoidant” kids… Most intriguing Minn. Findings, confirmed by other studies: Far less able to engage in fantasy play When engaged in such play, often characterized by irresolvable conflict Often victimize other insecurely attached children

13 The good news… A child’s attachment pattern can change, usually as a result of a major alteration in the mother’s circumstance or in alternate caregiver’s response: A single mother’s forming a stable supportive relationship. A teacher persistently refusing to reject a devious and hostile child, and in fact seeking ways to be close.

14 Good news (cont’d) A parent, through therapeutic intervention, can learn to understand and alter his/her own attachment patterns, although timing is critical…the longer a child has experienced a negative pattern the more difficult it may be to revise her “working model” of the relationship.

15 Good news (cont’d) Insecurely attached children seem relatively amenable to change throughout their early years, IF there is another caring adult… By adolescence such changes may require therapeutic intervention.

16 Questions to consider Contributions of temperament to attachment styles. Parent-infant “fit” Meaning for parents who work…the day care dilemma. Cultural differences in attachment patterns.

17 More Questions… Societal trends and time/energy for relating and sociability Developing secure attachments in isolation from or away from one’s own supportive relationships How do parents’ “Ghosts in the nursery” affect attachment?

18 Strategies to help parents build secure attachment with infant Encourage parents to recognize infant’s individuality Emphasize importance of private time with infant Encourage face-to-face quiet time when infant quietly alert

19 Another Strategy--Speaking for the Baby Designed for work with adolescent mothers who frequently experience problems in mother-infant interaction Based on work of Selma Fraiberg—allows mothers to learn to interpret infant’s cues while expressing her own emotions in the context of mother-child relationship Provides parents with increased understanding of baby’s developmental needs

20 Another strategy—Watching, Waiting, and Wondering Designed to help mother distinguish between her perceptions based on her own past unresolved conflicts and a real appraisal of the infant’s actual attributes. Primary therapeutic action takes place in play space between infant and mother.

21 More strategies Assist parents in identifying infants’ communication cues Offer parents alternatives for managing infants’ inattentiveness and excessive stimulation

22 Finding the Words Try to highlight at least one positive aspect of the parent child relationship: “Look at how he looks up at you before he does something new. He is checking in, and you help him to feel secure in his environment. You are helping him to learn about new things and you are teaching him about what he can trust, and what is safe.”