Kaplan + Sadock's Synopsis of Psychiatry, 11e

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Chapter 31: Child Psychiatry

Table 31.1-7 Types of Attachment

relationships. Patterns of attachment vary among babies; for example, some babies signal or cry less than others. Sensitive responsiveness to infant signals, such as cuddling the baby when it cries, causes infants to cry less in later months. Close bodily contact with the mother when the baby signals for her is also associated with the growth of self-reliance, rather than cling- ing dependence, as the baby grows older. Unresponsive mothers produce anxious babies. Ainsworth also confirmed that attachment serves to reduce anxiety. What she called the secured base effect enables a child to move away from the attachment figure and explore the envi- ronment. Inanimate objects, such as a teddy bear or a blanket (called the transitional object by Donald Winnicott), also serve as a secure base, one that often accompanies children as they investigate the world. A growing body of literature derived from direct observation of mother–infant interactions and longitudi- nal studies has expanded on, and refined, Ainsworth’s original descriptions. Maternal sensitivity and responsiveness are the main determinants of secure attachment. But when the attach- ment is insecure, the type of insecurity (avoidant, anxious, or ambivalent) is determined by infant temperament. Overall, male infants are less likely to have secure attachments and are more vulnerable to changes in maternal sensitivity than are female infants. The attachment of the firstborn child is decreased by the birth of a second, but it is decreased much more when the first- born is 2 to 5 years of age when the younger sibling is born than when the firstborn is younger than 24 months. Not surprisingly, the extent of the decrease also depends on the mother’s own sense of security, confidence, and mental health. Social Deprivation Syndromes and Maternal Neglect.  Investigators, especially René Spitz, have long documented the severe developmental retardation that accompanies mater- nal rejection and neglect. Infants in institutions characterized by low staff-to-infant ratios and frequent turnover of person- nel tend to display marked developmental retardation, even with adequate physical care and freedom from infection. The same infants, placed in adequate foster or adoptive care, exhibit marked acceleration in development. Fathers and Attachment.  Babies become attached to fathers as well as to mothers, but the attachment is different. Generally, mothers hold babies for caregiving, and fathers hold babies for purposes of play. Given a choice of either parent after separation, infants usually go to the mother, but if the mother is unavailable they turn to the father for comfort. Babies raised in extended families or with multiple caregivers are able to estab- lish many attachments. Stranger Anxiety.  A developmentally expected fear of strangers is first noted in infants at about 26 weeks of age, and more fully developed by 32 weeks (8 months). At the approach of a stranger, infants cry and cling to their mothers. Babies exposed to only one caregiver are more likely to have stranger anxiety than babies exposed to a variety of caregivers. Stranger anxiety is believed to result from a baby’s growing ability to distinguish caregivers from all other persons. Separation anxiety, which occurs between 10 and 18 months of age, is related to stranger anxiety but is not identical to it.

Secure Attachment

Children show fewer adjustment problems; however, these children have typically received more consistent and developmentally appropriate parenting for most of their life. The parents of securely attached children are likely better able to maintain these aspects of parenting through a divorce. Given that the family factors that lead to divorce also impact the children, there could be fewer securely attached children in divorcing families Children become anxious, clinging, and angry with the parent. These children typically come from families with adults who were also insecurely attached to their families and, thus, were unable to provide the kind of consistency, emotional responsiveness, and care that securely attached parents could offer. Such parents have a more difficult time with divorce, and are more likely to become rejecting. Children generally are raised with disorganized, neglecting, and inattentive parenting. The parents are even less able to provide stability and psychological strength for them after a divorce and, as a result, the children are even more likely to become clinging but inconsolable in their distress, as well as to act out, suffer mood swings, and become oversensitive to stress.

Insecure/Avoidant Attachment

Insecure/Ambivalent Attachment

raised with terry-cloth surrogates showed intense clinging behavior and appeared to be comforted, whereas those raised with wire-mesh surrogates gained no comfort and appeared to be disorganized. The results of Harlow’s experiments were widely interpreted as indicating that infant attachment is not simply the result of feeding. Both types of surrogate-reared monkeys were subse- quently unable to adjust to life in a monkey colony and had extraordinary difficulty learning to mate. When impregnated, the female monkeys failed to mother their young. These behavioral peculiarities were attributed to the isolates’ lack of mothering in infancy. John Bowlby.  John Bowlby studied the attachment of infants to mothers and concluded that early separation of infants from their mothers had severe negative effects on chil- dren’s emotional and intellectual development. He described attachment behavior, which develops during the first year of life, as the maintenance of physical contact between the mother and child when the child is hungry, frightened, or in distress. Mary Ainsworth.  Mary Ainsworth expanded on Bowlby’s observations and found that the interaction between mother and baby during the attachment period influences the baby’s cur- rent and future behavior significantly. Many observers believe that patterns of infant attachment affect future adult emotional