1. Nature or Nurture? The Role of Attachment & Temperament in Infant Mental Health : An Introduction Mitchell Davenport, LCPC Associate Director Mildred Berry Center

2. The gifts we treasure most over the years are often small and simple. In easy times and in tough times, what seems to matter most is the way we show those nearest us that we’ve been listening to their needs, to their joys, and to their challenges.” --Fred Rogers, The World According to Mr. Rogers

3. “I didn’t care about anything on this earth except the way her face tipped toward mine, our noses just touching, how wide and gorgeous her smile was, like sparklers going off. She had fed me with a tiny spoon. She had rubbed her against mine and poured her light on my face….I was loved. Sue Monk Kidd, The Secret Life of Bees

4. The Role of Attachment Nurture

6. INTRODUCTION 1950’S John Bowlby—institutionalized kids Harry Harlow—cloth vs. wire Konrad Lorenz—imprinting Mary Ainsworth—attachment classification system (Infant Strange Situation)

10. Attachment Defined “Attachment theory, developed by John Bowlby (Bowlby, 1969; Bowlby, 1973; Bowlby, 1980), postulates a universal human need to form close affectional bonds. At its core is the reciprocity of early relationships, which is a precondition of normal development probably in all mammals, including humans (Hofer, 1995). The attachment behaviors of the human infant (e.g. proximity seeking, smiling, clinging) are reciprocated by adult attachment behaviors (touching, holding, soothing) and these responses strengthen the attachment behavior of the infant toward that particular adult. The activation of attachment behaviors depends on the infant’s evaluation of a range of environmental signals which results in the subjective experience of security or insecurity. The experience of security is the goal of the attachment system, which is thus first and foremost a regulator of emotional experience (Sroufe, 1996). In this sense it lies at the heart of many forms of mental disorder and the entire psychotherapeutic enterprise. “ Transgenerational Consistencies of Attachment: A New Theory Peter Fonagy, PhD, FBA Paper to the Developmental and Psychoanalytic Discussion Group, American Psychoanalytic Association Meeting, Washington DC 13 May 1999

11. Most Essential Developmental Task “The essential task of the first year of life is the creation of a secure attachment bond of emotional communication between the infant and the primary caregiver.” Shore, Allen. (2003) Early Relational Trauma, Disorganized Attachment, and the Development of a Predisposition to Violence. In Healing Trauma, edited by Marion Solomon and Daniel J. Siegel, p. 115.

12. Principles of Attachment Usually formed by the age of 7 months Most infants become attached Formed with only a few persons These “selective” attachments appear to be derived from social interactions with the attachment figures. They lead to specific organizational changes in the infant’s behavior and brain function. Main, in Siegel, The Developing Mind, p. 67

13. Attachment Impacts Actual circuitry of the brain Sense of trust in the world Ability to relate to others Regulation of emotion Self Image Cognitive development Memory

14. Secure or Insecure

15. Secure Attachments provide a sort of Emotional Resilience.

16. Insecure Attachments are a Significant Risk Factor in the development of psychopathology. Siegel, in the Developing Mind, p. 68

17. Securely Attached Infants, in Later Childhood--- More ego resilient More ego control More persistent More enthusiastic More imaginative More positive affect More symbolic play More cooperative More self-aware More sociable Stollak, E. Gary, Barlev Anat, and Kalogiros Ioanna D. (2000). Assessment of the Child and Family in Play Contexts in Play Diagnosis and Assessment edited by Gitlin-Weiner, Karen, Sandgrund, Alice, and Schaefer, Charles. New York: John Wiley and Sons.

18. Insecurely Attached Children in Later Childhood-- Low self esteem Dependent Negative affect Noncompliant Less empathy Less popular with peers Stollak, E. Gary, Barlev Anat, and Kalogiros Ioanna D. (2000). Assessment of the Child and Family in Play Contexts in Play Diagnosis and Assessment edited by Gitlin-Weiner, Karen, Sandgrund, Alice, and Schaefer, Charles. New York: John Wiley and Sons.

19. Two Key Concepts Secure Base Safe Haven

22. Attachment & the Brain

25. “The mind emerges from the activity of the brain, whose structure and function are directly shaped by interpersonal experience.” Siegel, Daniel J. The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are. New York: The Guilford Press. 1999. P. 1

26. Use Dependant Modification Infants are born with more brain cells than they need (potential) Interaction with its social environment is what determines how the brain develops. Synapses (neural connection) that are used become a permanent part of the infants brain. Synapses that are not used are discarded (pruned)

27. During the first three years of life the anatomic structures that govern personality traits, learning processes, and coping with stress and emotions are established, strengthened, and made permanent. By 8 months the typical baby has 1,000 trillion synapsis. By age 10, a typical child has only 500 trillion synapses (same as the avg adult) The Once of Prevention Fund (1996)

28. Impact on Circuitry: Influence on Right Brain Affect regulation Stress Response Social interpretation of visual/audio systems Inability to see things from the perspective of its impact on others (lack of empathy)

29. “The central thesis of my work is that the early social environment, mediated by the primary caregiver, directly influences the final wiring of the circuits in the infant brain that are responsible for the future social and emotional coping capacities of the individual.” Shore, Allen. (2003) Early Relational Trauma, Disorganized Attachment, and the Development of a Predisposition to Violence. In Healing Trauma, edited by Marion Solomon and Daniel J. Siegel

30. Caregiver Behaviors that Foster a Secure Attachment (A 1997 review of 60 studies) Sensitivity— the prompt response of the caregiver to the child’s needs. Positive Attitude— expressions of positive emotion & Affection Synchrony—(Attunement)— feeling understood..same wavelength reciprocal interactions with caretakers mood matching babies; sharing intersubjective states Mutuality— coordinated activities / events Emotional Support Stimulation— Sclafani, Joseph D. (2004). The Educated Parent: Recent Trends in Raising Children, Westport, CT: Praeger Publishers, p. 38.

31. The Unattached Child “...the unattached child as frequently superficially charming and affectionate with strangers. In addition he describes extremely manipulative and controlling behaviors, lack of eye contact, lack of friends, and a frequent preoccupation with fire, blood, and gore.... abnormal eating and speech patterns, and always shows lack of a normally developing conscience....” Foster Cline, cited in, Wesselmann, Debra. (1998) The Whole Parent: How to Become a Terrific Parent Even if you Didn’t Have One. New York: Insight Books, p. 85.

32. Recent Classification System Zeanah, Charles H. & Boris, Neil W. (2000) Disturbances and Disorders of Attachment in Early Childhood. In Handbook of Infant Mental Health, second edition, Zeanah, Charles H. Jr., Editor.

33. Attachment Disorder: No Discriminated Attachment Figure Lack of evidence of a preferred caregiver as evidenced by one of the following: –Lack of differentiation among adults –Seeking comfort preferentially from unfamiliar adults rather than from familiar caregivers –Failure to seek or to respond to comfort from caregivers when hurt, frightened, or distressed –Lack of emotional responsiveness to and reciprocity with familiar caregivers. Child has a mental age of at least 10 months Child does not meet criteria for pervasive developmental disorder (Zeanah, p. 364)

34. Other Features of NDAF Poorly regulated emotions Failure to check back with caregiver after venturing away Absence of usual social reticence with unfamiliar adults Willingness to go off readily with strangers (Zeanah, p. 364)

35. Attachment Disorder: Secure Base Distortions The child has a discriminated attachment figure, but the relationship is disturbed or disordered as indicated by a pattern of one or more of the following: Self-endangering, risk taking, and/or aggressive behavior that is clearly worse in the presence of the attachment figure rather than other caregivers. Inhibition of exploration and excessive clinging when attachment figure and less familiar adults are present. Excessive vigilance and anxious hypercompliance directed towards the attachment figure and the associated absence of spontaneous exploratory behavior. The child behaves as if he or she is afraid of the caregiver. Inverted caregiving in which the child feels responsible for the caregiver’s emotional well being. The child behaves as if he or she is afraid for the caregiver. (Zeanah, p. 364)

36. The Role of Temperament: Nature

37. Definition of Temperament “your inborn predisposition to how you will react and interact with other people, situations in your life, and events” Default setting Genetic Presdispostion Sclafani, Joseph D. (2004). The Educated Parent: Recent Trends in Raising Children, Westport, CT: Praeger Publishers, p. 22.

38. New York Longitudinal Study (NYLS—approx. 1956-1988) Reacted against the view that parents are solely responsible for their kids problems. 125 subjects were measured from infancy to early adulthood. Identified 9 dimensions of infant temperament Derived 3 general classifications Introduced the concept of “goodness of fit” (Child’s temperament & environment) ( Thomas, Chess, Birch,Hertzig & Korn, 1963)

39. The Role of Temperament It is objectively definable It has a biological basis It is measurable in infancy. It remains relatively stable across development Sclafani, Joseph D. (2004). The Educated Parent: Recent Trends in Raising Children, Westport, CT: Praeger Publishers, p. 22.

40. Chess and Thomas’ Nine Aspects of Temperament: Matching Activity Level (the motor activity) Rhythmicity (regularity of functions) Approach (positive response to new stimuli vs. withdrawal) Adaptability (ease with which responses are modified) Threshold of Responsiveness (sensitivity level) Intensity of Reaction (the general energy level of a response) Quality of Mood (the intensity and nature of emotional responsiveness) Distractablity (responsiveness to extraneous stimuli altering ongoing behavior) Attention span/persistence (vigilance in attending to task at hand)

42. 3 Main Temperaments (According to NYLS) Easy—40% Difficult—10% Slow to Warm—15% Unclassifiable—35%

43. It is not nature vs. nurture it is nature and nurture.

44. Capacity For Happiness Environment Temperament

45. Temperament and Attachment Temperament A “Constitutional Feature” of the child: Inborn (not necessarily genetic) – Constitutional predisposition of the Nervous System May have lifelong impact that is influenced by Experience – especially with Caregivers Attachment The Relationship of the child to the caregiver over time Research has shown Attachment shapes the developing mind Attachment impacts Self- Regulatory Circuits

46. Holding Environment “In an environment that holds the baby well enough, the baby is able to make personal development according to inherited tendencies.” Winnicot, Donald W. (1986). Home is Where We Start From: Essays by a Psychoanalyst. New York: Viking Penguin, p. 28

47. Additional Material

49. Ainsworth’s Classification of Attachment Secure Attachment (60%) –Infant feels comfortable in presence of mother and able to explore surroundings –Infant shows appropriate but not undue distress when the mother leaves the room. –Infant seeks out the mother to be comforted upon her return.

50. Ainsworth’s Classification of Attachment Insecure-Resistant Attachment (10%) –Infant becomes extremely distressed when mother leaves and cannot be comforted by others –When mother returns, the infant continues to protest angrily, alternatingly seeking out the mother for comfort but then rejecting it when offered. –Behavior patterns seem to be whiny and clingy –Acting out to gain attention

51. Ainsworth’s Classification of Attachment Insecure-Avoidant Attachment (20%) –Infant relatively unaffected when the mother leaves. –Upon her return, the infant appears to either ignore or actively avoid her. The infant shows a high level of physiological arousal during the separation and reunion. –Prone to bully other children

52. Main & Solomon (1990) Disorganized-Disoriented Attachment (10%) –The infant shows confused, fearful, or conflicted behavior in the presence of the mother suggesting a disturbed and unpredictable relationship. –Often in cases where the mother is abusive or using drugs. –Most likely of all attachment styles to develop emotional / psychological problems later in life.

53. Infant Strange Behaviors & Corresponding Adult Mind States Adult Mind StateInfant Strange Situation Behaviors Secure / AutonomousSecure DismissingAvoidant PreoccupiedResistant or Ambivalent Unresolved / DisorganizedDisorganized / Disoriented Siegel (1999) The Developing Mind

54. Sources Bowlby, John. (1988) A Secure Base: Parent-Child Attachment and Healthy Human Development. Basic Books. USA Campbell, Susan B. (2002). Behavior Problems in Preschool Children: Clinical and Deveopmental Issues. The Guilford Press. NYC Diagnostic Classification: 0-3: Diagnositic Classification of Mental Health and Developmental Disorders of Infancy or Early Childhood. 1994. National Center for Infants Toddlers, and Families Hughes, Daniel A. (2007) Attachment Focused Family Therapy. W.W. Norton & Company: NY Karr-Morse, Robin and Wiley, Meredith S. (1997) Ghosts from the Nursery: Tracing the Roots of Violence. The Atlantic Monthly Press, NYC.

55. Sources (Con’t.) Luby, Joan L. Ed. (2006). Handbook of Preschool Mental Health: Development, Disorders, and Treatment. The Guilford Press. NYC Sclafani, Joseph D. (2004) The Educated Parent: Recent Trends in Raising Children. Praeger. Westport, Connecticut Shore, Allen. (2003) Early Relational Trauma, Disorganized Attachment, and the Development of a Predisposition to Violence. In Healing Trauma, edited by Marion Solomon and Daniel J. Siegel Siegel, Daniel J.(1999) The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are. New York: The Guilford Press.

56. Sources (Con’t) Steiner, Hans. Ed. (1997). The Preschool Child. Jossey Bass/Pfeiffer. San Francisco. Stollak, E. Gary, Barlev Anat, and Kalogiros Ioanna D. (2000). Assessment of the Child and Family in Play Contexts in Play Diagnosis and Assessment edited by Gitlin-Weiner, Karen, Sandgrund, Alice, and Schaefer, Charles. New York: John Wiley and Sons Veitch Wolf, Vicky, and Birt, Jo-Ann. Child Sexual Abuse in Marsh, Eric J., and Terdal, Leif G. (1997). Assessment of Childhood Disorders, Third Ed. New York: Guilford Press. Thomas, Nancy L. 1997. When Love is Not Enough: A Guide to Parenting children with RAD—Reactive Attachement Disorder.

57. Sources (Con’t) The Once of Prevention Fund (1996) Winnicot, Donald W. (1986). Home is Where We Start From: Essays by a Psychoanalyst. New York: Viking Penguin. Wesselman, Debra (1998). The Whole Parent: How to Become a Terrific Parent Even if You Didn’t Have one. Insight Books, NYC. Zeanah, Charles H. Jr. Ed. (2000) Handbook of Infant Mental Health. Second Edition. The Guilford Press. NYC (various articles)