Magazine article Clinical Psychiatry News

Attachment Disorders Can Be Spotted Early

Magazine article Clinical Psychiatry News

Attachment Disorders Can Be Spotted Early

Article excerpt

NEW ORLEANS -- Attachment disturbances in very young children can be recognized as early as 7-9 months of age, and are predictive of troubled future relationships, Dr. Charles H. Zeanah Jr. said at the annual meeting of the American Academy of Pediatrics.

"An infant who has attachment problems is one who has failed one of the first key developmental steps of life," said Dr. Zeanah of Tulane University, New Orleans. "This is important because it's the time when the child establishes his rules for what happens in intimate relationships: When you are distressed you tell someone you trust, who helps you feel better."

Infants are born with the propensity to attach to one or more caregivers, upon whom they rely for comfort and survival. Such attachments also provide a secure base from which the child can safely explore the world around him, and are the foundation of future independence.

In early infancy, attachment is not yet focused, but by 7-9 months attachment to a caregiver is clear. The type of attachment the child develops, however, depends on the experiences he has had with his caregivers. Secure attachment usually occurs in a child whose caregivers are emotionally and physically available, and who consistently provide warmth, empathy, nurturance, comfort, and protection.

Children whose caregivers fail to consistently exhibit these positive attributes become emotionally withdrawn; they may fail to seek comfort or fail to respond to comfort. Alternatively, such children may become indiscriminately social, seeking comfort from strangers.

Type of attachment can be assessed by the "strange situation" procedure. In this scenario, the child and caregiver are allowed free play in a room with toys. A stranger then enters the room and attempts to engage the child and caregiver, and then the caregiver leaves the child alone with the stranger for a few minutes. Attachment is assessed by observing the child's reaction during the separation and, most importantly, to the caregiver when she returns.

A securely attached child will be happy to play when the caregiver is present and distressed by the caregiver's absence, but easily soothed by her return. The child will then soon return to exploratory play. A child with disorganized attachment may stay very close to his caregiver and be very distressed when she leaves. When she returns, however, the child will simultaneously seek comfort and distance; for example, the child may cry and reach up to be held, but then turn his head away or arch backward in the caregiver's arms. The cues may be much subtler; the child may reach for comfort but then avoid eye contact or close his eyes altogether when picked up, he said. …

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