Focusing on attachment and stability
Updated: 09 February 2015
What's important to us
All mokopuna need to have secure attachments with adults who care about them. Having these attachments will give them a sense of security in all aspects of their lives and help them grow up to be healthy and productive adults.
Mokopuna who have been abused or neglected may have trouble forming secure attachments. It is important that the adults who care for them are aware of the importance of attachment, know about the different attachment types, and have the skills, knowledge and support to build a secure attachment with these mokopuna.
What is attachment and why is it important?
John Bowlby (1969) defined attachment as "a strong disposition to seek proximity to and contact with a specific figure and to do so in certain situations, notably when frightened, tired or ill". In this sense, attachment is about a special and enduring ‘emotional' relationship that exists between a mokopuna and their primary caregiver which brings safety, comfort, soothing and pleasure to both parties (Perry, 2001). Through healthy 'bonding' experiences (for example, face-to-face interaction, eye contact, and physical touch) positive attachments are formed and these experiences are critical to shaping a mokopuna's capacity to form healthy future relationships, including with their own children.
"Attachment experiences lay the foundation for the child's perception of self, others and the world around them" (Atwool, 2007: 11). A secure attachment shapes a mokopuna's sense of security, their resistance to stress, and their ability to balance their emotions. It promotes trust and confidence in other humans which leads to more skilled social interactions later in life (Kail & Cavanaugh, 2010), and helps them develop a positive self-image and cope better with fears and worries.
Mokopuna with a secure attachment to their primary caregiver will look to them for comfort when they are distressed, and use them as a secure base from which to explore their environment. The securely attached mokopuna trusts that they will be cared for, their needs will be met consistently, they will be helped to learn self-regulation, and they will be encouraged to learn and explore their environment. Because they feel safe and secure, they have the confidence and sense of competence to try new things and to learn.
With secure attachment, caregivers are sensitive, reliable and emotionally available and the mokopuna becomes secure and confident. This leads to optimum social and emotional development for the mokopuna, more compliance and co-operation, and better understanding of emotion regulation. Mokopuna with secure attachments tend to be better at problem-solving, less lonely and view others more positively. The mokopuna's internal working model is "I need you less because I know I've got you".
With ambivalent attachment, caregivers are sometimes available and responsive and sometimes not. This could be because of their depression, extensive absence or other life circumstances. The mokopuna isn't sure if the caregiver will be there for them, and will try to keep them close by clinging or fighting with their caregiver. Emotions tend to be intensified and maximised with an ambivalent attachment and it is often misdiagnosed as attention deficit hyperactivity disorder (ADHD). The mokopuna's internal working model is "I have to hold on tight because I'm not sure of you. I feel anxious but I'm not sure how to get to you".
With avoidant attachment, the caregiver is rejecting towards the mokopuna or is emotionally unavailable. The mokopuna expects rejection so seeks little contact and becomes angry and self-sufficient. The mokopuna then suppresses anger, draws attention away from emotions and relationships, and focuses on thoughts rather than feelings. Sometimes, when you attempt to talk with these mokopuna, they'll try to distract you with objects like a toy or puzzle. These mokopuna find it difficult to get close to other people and they often do well in structured environments such as school. The mokopuna's internal working model is "I've got to manage by myself. If I only rely on myself I don't get so anxious".
With disorganised attachment, the caregiver is either frightening to the mokopuna or is frightened (can't reassure the mokopuna when fearful). This creates an impossible dilemma for the mokopuna: Do I move towards or away from my caregiver? The mokopuna may become aggressive when their caregiver is hostile or they may take on the parenting role when the caregiver is withdrawn. The mokopuna may also become overly complaint as they have learned it is unsafe to step out of line, and they'll do whatever is necessary to calm their caregiver down and avoid provoking them. Disorganised attachment is most often seen in mokopuna who have been abused and/or neglected. When mokopuna have disorganised attachment, their sense of safety depends on acting as 'normal' as possible which makes it difficult for professionals to identify. The mokopuna's internal working model is "I need you desperately and you terrify me. I don't know what to do but I won't show I'm frightened".
Together, ambivalent, avoidant and disorganised attachment are forms of insecure attachment.
Maintaining and supporting early attachment when bringing a baby into care
The early attachment between a parent and their mokopuna is precious and needs to be strongly supported. There are times though when an infant needs to be removed from their caregiver in order to help him or her be safe. Think about the following factors when considering removing an infant from their parent:
- The baby's safety
- The baby's developing attachment to his or her parent
- The involvement of family/whānau in decision-making and planning
- The need to talk with other professionals who may be involved or may need to be involved.
When it looks like an infant may need to be removed from his or her parent, it is important to have a process on site which supports staff to think carefully about the situation and what this mokopuna needs. Does the mokopuna need to come in to care? Can the parent be supported to care for their mokopuna safely and, if so, what supports are needed? If the baby can't remain with their parent are there safe placement options within the family/whānau system? Talking these things through will strengthen decision-making and avoid unnecessary breakdown within the family/whānau. Involve other professionals (e.g. Plunket nurses) in this discussion as they will be crucial figures in providing support for new parents.
If a report of concern is received on the day of the birth it may not be possible to consult with everyone you need to immediately. Bringing available family/whānau together as soon as possible to consider the safety of the mokopuna is important and sets the scene for their ongoing involvement as decisions are made.
The ongoing attachment between the parent and their mokopuna is something we need to consider carefully.
Common causes of insecure attachment
According to Babb & Laws (1997), mokopuna may have attachment-related difficulties if they have experienced any of the following:
- Sudden or traumatic separation from a primary caregiver (through death, illness, hospitalisation of the caregiver, or removal of their mokopuna)
- Physical, emotional or sexual abuse
- Illness or pain which was not alleviated by their caregiver
- Hospitalisation of the mokopuna, causing separation from their caregiver
- Frequent moves and/or placements
- Inconsistent or inadequate care at home
- Chronic maternal depression or post-partum depression during the mokopuna's first year
- Neurological problems in the mokopuna which interferes with their ability to receive nurturing (commonly seen in babies exposed to drugs in the womb)
- Caregivers who themselves have disordered attachment/s.
What behaviours might I see in mokopuna who have insecure attachments?
The specific issues that you may see will vary depending on the nature, intensity, duration and timing of the abuse the mokopuna were subjected to. Some mokopuna will present with profound and obvious challenges, while others will have very subtle challenges that you may not realise are related to neglect in their early life. Sometimes these mokopuna do not appear to be affected by their experiences. There are some clues to consider when working with these mokopuna:
- Developmental delays: The bond between a young child and their caregiver provides the major vehicle for developing physically, emotionally and cognitively. It is in this primary context that mokopuna learn languages, social behaviours and a host of other key behaviours required for healthy development. Lack of consistent and enriched experiences in early childhood can result in delays in motor, language, social and cognitive development.
- Eating: Odd eating behaviours are common. Mokopuna will hoard food, hide food in their rooms, and/or eat as if there will be no more meals (even if they have had years of consistently available food). They may have failure to thrive, rumination (throwing up food), swallowing issues and, later in life, eating behaviours that are often misdiagnosed as anorexia nervosa.
- Soothing behaviour: Mokopuna will use primitive, immature and bizarre soothing behaviours such as touching, stroking and masturbating. They may also bite themselves, head bang, rock, chant, scratch or cut themselves. These symptoms will increase during times of distress or threat.
- Emotional functioning: A range of emotional issues are common in mokopuna with an insecure attachment. A common behaviour is 'indiscriminant' attachment. All mokopuna seek safety. Keeping in mind that attachment is important for survival, mokopuna may seek attachments for their safety. You may notice abused and neglected children are 'loving' and hug virtual strangers.
- Inappropriate modelling: Mokopuna model adult behaviour, even when it is abusive. They learn abusive behaviour is the 'right' way to interact with others. This potentially causes problems in their social interactions with adults and their peers. For mokopuna who have been sexually abused, they may become more at risk of future victimisation, or go on to sexually abuse others.
- Aggression: The two primary challenges in neglected mokopuna are a lack of empathy and poor impulse control. The ability to emotionally 'understand' the impact of their behaviour on others is impaired in these mokopuna. They do not understand or feel what it is like for others when they do or say anything hurtful. In fact, these mokopuna often feel compelled to lash out and hurt others, typically something less powerful than they are (for example, animals, small children, peers and siblings). One of the most disturbing elements of this aggression is that it is often accompanied by a detached, cold lack of empathy. Mokopuna may show regret (an intellectual response) but not remorse (an emotional response) when confronted about their aggressive or cruel behaviours.
Is it ever too late for mokopuna to form a secure attachment?
During the first three years of life, the brain develops quickly (up to 90 percent of adult size) and puts in place the majority of systems and structures that will be responsible for all future emotional, behavioural, social and physiological functioning. A critical period for a mokopuna is in their first year of life, when bonding experiences must be present for the brain systems responsible for attachment to develop normally (Perry, 2001). The future impact of impaired bonding in a mokopuna's early childhood will vary according to how early in life, how prolonged and how severe the neglect has been.
"Early intervention when there are difficulties has a significantly great chance of success" (Atwool, 2007: 17). However, this does not mean that older mokopuna with insecure attachments have no hope of developing healthy relationships. Research shows that improvement can occur, although it can be a difficult and often frustrating process and may take many years of hard work to help repair the damage caused by only a few months of neglect in infancy (Perry, 2001).
Can mokopuna be attached to multiple caregivers?
Research tells us that mokopuna can and do form attachments to many caregivers at the same time (Bowlby, 1969). This means it is possible for a mokopuna to maintain contact with their birth parents without this contact compromising the development of a secure attachment to their caregivers. Other research suggests that continuing contact with birth parents after a separation may help a mokopuna come to terms with the separation and could play a crucial role in preparing the mokopuna to accept their new caregiver (Haight, Kagle & Black, 2003). Contact with birth parents may also alleviate divided loyalty in mokopuna by showing that the parents accept the new placement.
Remember that for a secure attachment to form there must be quality and quantity time spent with the mokopuna. Being attached to more than one person does not necessarily dilute the quality of the attachment. However if there are too many people around, there may not be enough time for a secure attachment to form (Smith, 1988).
If the plan is for the mokopuna to return home, make sure they have plenty of quality contact with their family/whānau to help strengthen the attachment that exists. Professional help may also be needed to improve the attachment.
Assessing the attachment needs of mokopuna in care
Assessing a mokopuna's attachment needs is vital, and the accuracy of the assessment has a firm bearing on the success of the mokopuna's plan — the more accurate the assessment, the more successful the plan is likely to be. It may be entirely appropriate for you to do the assessment yourself (in the form of a Tuituia assessment), or you might ask a psychologist and share what you know with this person. If you are unsure how to proceed, talk to your supervisor. Don't forget that you will often know more about the mokopuna and family/whānau than any other professional and will therefore likely have good insight into their attachment type and needs.
Williamson (2002) has developed a set of questions that can be asked of a caregiver and mokopuna to give an indication of the attachment the mokopuna has formed with significant others in their life. He states that to properly apply these questions, the interviewer needs to have formed a rapport with the mokopuna and their family/caregivers and have an understanding of the basic attachment types and their implications.
Understanding a mokopuna's internal working model
The first step is to explore the mokopuna's history, making special note of behaviour that results in people being pushed away, or changes of placement or suspension from school, and any:
- changes of caregiver, including being placed back and forth with family/whānau
- losses of contact with significant people, whether through death or separation
- circumstances where the mokopuna has been singled out from the sibling group or family/whānau, such as being sent away or being the only child removed from the birth family while other siblings remain with the parents.
The next step is to put yourself in the place of the person who has had those experiences and displayed this behaviour, and consider what sort of view that person might have of themselves or others. If you were a mokopuna who has been through several placements, what would you conclude about relationships? How would dfficulties be solved? What if you didn't want to be around someone? If you keep getting shifted, what would you think that meant about you, especially if you were the only mokopuna out of several to be shifted? Think about the function of the mokopuna's behaviour: Is it designed to push people away? To get a new placement? To get some rest?
Once you have answered these questions, a clear view begins to emerge about what the mokopuna needs to feel more secure and begin to thrive. This can include providing the mokopuna with a mentor, joining a sports team, having contact with a grandparent, or placing them in a smaller class (Kelly, 2006).
What can caregivers do to help mokopuna in care who have insecure attachments?
Caregivers need to understand that change is not going to happen overnight, and the process of creating a secure attachment with a mokopuna who has been abused or neglected will take time and be challenging. Even when a mokopuna has been placed in a safe environment, they may still try to fight and push their caregiver away because they are trying to confirm that their internal working model is correct. This helps them feel safe and makes the world predictable. Caregivers will undoubtedly feel like giving up, but they need to be encouraged to keep going — mokopuna with insecure attachments will likely have had people 'give up' on them their entire lives which just confirms their own belief that they are 'bad' and 'not worth loving'. Caregivers need to know that the mokopuna's actions are not personal, even though it may feel like it.
Keep in close contact with these caregivers and ensure that they have the support they need to manage any difficulties as they arise. This includes support from family/whānau and friends and from professionals with a specialist interest and knowledge of insecure attachments.
Practical things that caregivers can do to help these mokopuna
Nurture them: Mokopuna with insecure attachments need to be held, rocked and cuddled. Remember that these types of interactions may be foreign to them so take it slowly, and be attuned to their reactions. In many ways, caregivers are providing replacement experiences that should have happened when the mokopuna were in their infancy, but they are doing this when their brains are harder to change. This means they will need even more 'bonding' experiences to help develop secure attachments.
Try to understand the behaviours before the consequences: The more that the caregiver can learn about attachment, bonding and brain development, the better for them and for the mokopuna in their care. Knowing what they are dealing with can prevent them from misunderstanding the mokopuna's behaviours. For example, when mokopuna with insecure attachments hoard food, it should be not viewed as 'stealing' but as a predictable response to being deprived of food when they were younger. Punishing the mokopuna for this behaviour may just increase their sense of insecurity and distress.
Parent the mokopuna based on their emotional age: Abused and neglected mokopuna with insecure attachments will often be emotionally and socially delayed, and whenever they are frustrated or fearful their behaviour will likely regress to their emotional age. This means that at any given moment a 10-year-old child may emotionally be a 2 year old. Although we may want them to act their age they are simply not capable of doing this. When the mokopuna in their care is acting like a 2 year old, caregivers need to parent them as if they were actually that age — hold them, rock them and use soothing non-verbal interactions.
Be consistent, predictable and repetitive: Abused and neglected mokopuna with insecure attachments are often very sensitive to changes in daily routines. Any change will probably overwhelm them, even if the change is pleasant (for example, a birthday party or family trip). Because of this, caregivers should make every effort to be as predictable and consistent as possible. If change needs to happen, it will be important for the caregiver to prepare the mokopuna for this ahead of time — they’ll need to give the mokopuna lots of notice and talk with them about what the change will look like (for example, "Soccer practice is now on Thursday, but it will still be the same time and I will still be there to watch you").
Model and teach appropriate social behaviours: Social occasions can often be a very difficult and challenging time for mokopuna with insecure attachments. One of the best ways to teach these mokopuna about appropriate behaviour is for caregivers to model this in their own behaviours and tell the mokopuna what they are doing and why (for example, "I am going to the bathroom to wash my hands before dinner because..."). An area that insecurely attached mokopuna can have problems with is physical contact. They may not know when to hug, how close to stand, and what are appropriate contexts to pick their nose and touch their genitals. They may also initiate physical contact with complete strangers. Caregivers often misinterpret this behaviour as affectionate but it isn't. Caregivers should never refuse to hug the mokopuna, nor should they lecture them about 'appropriate' behaviour. Instead, they should gently guide the mokopuna on how to interact differently (for example, "Why don't you sit over here?")
Listen to and talk with mokopuna: One of the most pleasurable things to do is just stop, sit, listen and play with mokopuna who have insecure attachments. When you are quiet and interactive with them you find that they will begin to show you and tell you what is really inside them. However, as simple as this sounds, it is actually one of the most difficult things for adults to do — to stop worrying about the time or their next task and just relax into the moment with a mokopuna. Practise doing this and you will be amazed at the results. These mokopuna will sense you are there just for them and they will feel how you care for them. This is also a great time to begin teaching these mokopuna about their different 'feelings':
- Let them know that all feelings are okay — it is okay to feel sad, glad or mad (more emotions for older mokopuna)
- Teach mokopuna healthy ways to act when sad, glad or mad
- Begin to explore with the mokopuna how other people may feel and how they show their feelings — "How do you think Jack feels when you push him?"
- When you sense that the mokopuna is clearly happy, mad or sad, ask them how they are feeling and help them begin to put words to these feelings.
Have realistic expectations of these mokopuna: Abused and neglected mokopuna with insecure attachments have so much to overcome and some may never completely overcome all of what they have been subjected to. For a Romanian orphan adopted at age 5 after spending her early years without emotional nurturing, expectations should be limited, while also still recognising the potential that exists.
Take care of yourself: Caring for abused and neglected mokopuna with insecure attachments can be exhausting and demoralising, and caregivers need to realise they cannot provide the consistent, predictable, enriching and nurturing care these mokopuna need if they (the caregivers) are burned out. Make sure the caregiver gets rest and support, including respite care, and encourage them to use friends, family/whānau, and community resources that will be enduring.
References and further reading
Ainsworth, M.D.S. & Bell, S. M. (1970). Attachment, exploration and separation: Illustrated by the behaviour of one year olds in a strange situation. Child Development, 41, 49-67.
Atwool, N. (2007). The role of secure attachment as a protective factor for vulnerable infants. Social Work Now, December 2007 , pp. 11-20.
Babbs, L.A., & Laws, R. (1997). Adopting and Advocating for the Special Needs Child: A Guide for Parents and Professionals. USA: Greenwood Publishing Group.
Bowlby, J. (1969). Attachment and Loss: Vol 1. Attachment. New York, USA: Tavistock Institute of Human Relations.
Haight, W.L., Kagle, J.D., & Black, J.E. (2003). Understanding and supporting parent-child relationships during foster care visits: Attachment theory and research. Social Work, April.
Kail, R.V. & Cavanaugh, J.C. (2010). Human Development: A Life-Span View. California: Cengage Learning.
Kelly, W. (2006). Understanding the patterns and relationships. Social Work Now, August 2006 , pp. 11-16.
Pearce, C. (2009). A Short Introduction to Attachment and Attachment Disorder. London, UK: Jessica Kingsley Publishers.
Perry, B.D. (2001). Bonding attachment in maltreated children: Consequences of emotional neglect in childhood. The ChildTrauma Academy.
Smith, A.B. (1988). Understanding Children's Development (2nd ed). Wellington: Allen & Unwin/Port Nicholson Press.
Szalavitz, M. & Perry, B.D. (2010). Born For Love: Why Empathy is Essential - and Endangered. New York, USA: William Morrow.
Williamson, C. (2002). Attachment: guidelines and procedures for assessment and interventions. Social Work Now, December 2002 , December, pp. 23-28.