Promoting Attachment and Emotional Regulation of Children with Complex Trauma Disorder

Article excerpt

Introduction

Attachment has been studied for many years. Bowlby (1988), Ainsworth (1978) and others have documented their observations and research concerning attachment. Through the work of these early pioneers we are able to recognize the factors that promote secure attachments such as experiences through facial expressions and eye contact, emotional attunement and play. A secure attachment provides a protective source of mutual regulation. This is accomplished through mirroring the child's responses including facial expressions, tone and excitement or calm and the child gradually develops the ability to self-regulate (Davies, 2004). The child becomes securely attached when the parent/caregiver is available and able to meet the child's needs in a responsive and appropriate manner. Secure attachment provides a sense of safety, and assistance with regulation of affect and arousal. The parent/caregiver's ability to read the infant's affect accurately and provide stimulation or soothing helps the infant to self regulate and form a secure attachment with the caregiver. Secure attachment promotes the expression of feelings, through parent/caregiver modeling and teaching the child how to cope with problems that arise (Hughes, 2007). The child will freely explore with the parent/caregiver present and will interact with strangers. The child will also be visibly upset when the parent/caregiver leaves and will be happy upon their return. The child who develops a secure attachment has more confidence in exploring the environment and is ready to learn new things (Davis, 2004).

In contrast, when the caregiver is neglecting or abusive to the child, the child's ability to self-regulate and form a secure attachment is limited. Neglect and abuse significantly effect attachment and brain development. Prolonged, severe or unpredictable stress, including neglect and physical, emotional, and sexual abuse, as well as domestic violence during early childhood, can cause the brain's development to be altered (Solomon & Siegel, 2003). The child's experiences have a negative impact on his/her physical, sensory, emotional, cognitive, and social growth. Neglect alone can cause neuronal pathways to wither and die, and as a result, the child may not achieve the usual developmental milestones. Children who have been raised in abusive, neglectful environments, where their parents totally disregard their children's need for comfort, stimulation and affection may be at risk for developing Reactive Attachment Disorder (RAD) (DSM-IV, 1994) (U.S. Department of Health and Human Services, Oct 2001).

RAD (DSM-IV, 1994) is a psychophysiologic condition with markedly disturbed and developmentally inappropriate social relatedness in most contexts that begins before age five years and is associated with grossly pathological care. This pathological caregiving behavior may consist of any form of neglect, abuse, mistreatment or abandonment. However, the diagnosis of RAD does not adequately describe the physiological and psychological problems traumatized children present; also trauma and traumatic grief are not age limited.

Many children experience stressful events and are sometimes faced with painful situations, such as death of a close elderly relative or parent's divorce, but these events would not usually be considered traumatic (Cohen, Mannarino & Deblinger, 2006). Traumatic events are characterized as sudden unexpected events, shocking in nature or death/threat to life or body integrity as well as subjective feelings of intense horror, terror or helplessness (American Psychiatric Association, 2000). Prolonged, severe or unpredictable stress, including physical, sexual, emotional abuse and neglect are considered traumatic events.

Post-traumatic stress disorder (PTSD) (DSM-IV, 1994) is a term used to explain consequences of exposure to, or confrontation with stressful events that the person experiences as highly traumatic. …