The purpose of this page is to give an overview of attachment, in order to provide a rationale for why public services should be attachment aware, rather than go into depth about the neuro-psychology of early development. References at the end of the page provide further reading for anyone who wants to know more about attachment and the developing brain.
Attachment and the developing brain
Attachment is the term we give to the relationship between children and their primary caregivers. Instinctively, we know that these are important relationships. We now know that these relationships are as important as food and warmth for healthy development. Relationships with caregivers literally “build babies’ brains”. The video below from the Centre for The Developing Child at Harvard describes how the experiences a child has are reflected in the way their brain can grow and develop.
Babies and children that have difficult experiences with caregivers have brains that grow in different ways than children who have lots of positive experiences with caregivers. Children are totally dependant on the adults to get their needs met, including their emotional needs. Children need their parents to respond to them in a timely and sensitive way – sometimes this is called a ‘lead-follow-lead’ or a ‘serve and return’ interaction. This pattern is a unique dance between the child and the person who cares for them. As human beings we are very social and disruptions in relationships with people who are important to us, however minor, cause us distress.The video below shows how children seek out interaction and can become uncomfortable and distressed if there are short breaks in their communciation with a caregiver. It also shows how active children are at seeking to re-connect with their caregiver and how mending the break in the relationship provides comfort and is a rewarding experience in itself.
This sensitive dance needs the adult to be attuned to the child and able to think about the child as a different person with their own unique take on the world. Adults who are attuned to their child can respond to the childs needs sensitively, picking up in the child’s cues that they don’t understand, have had too much, are getting bored, are very interestsd or are frightened. When the child is too excited or angry or upset, the adult can come close to them and help them cope with the situation, help them understand what is going on or soothe them- co-regulating their emotion.
Children have many, many opportunities to interact with caregivers. The interactions children have with caregivers are deeply emotional. Emotions are not just ‘in the mind’ they are deeply left throughout the body, because of the action that chemicals in the brain have throughout our nervous system. These hormones have an effect on every part of our bodies, including our muscles, sense of touch, experience of pain, breathing, heart rate and digestion. If the caregiver is able to respond in a ‘good enough’ way, the child feels safe and can learn how to cope with their emotions. They learn how cope with the physical sensations that go with needing to wait for a response or someone doing something unexpected. This is because they can predict how others will respond to them and they know that their needs, including their need for soothing and comfot will be met.
Learning that carers will reliably respond to them helps children learn how to trust themselves and others. However, all children have times when their carers can’t respond in just the way they want. This is also a good thing- the child learns a a more nuanced meaning for the concept of trust as they learn how to cope with unpleasant events and feelings that go with them. We all have patterns in our behaviour that we learnt in our early attachment relationships. It is easier to see these patterns when we are stressed or upset. At these times might be avoidant of others, or keep busy to cope with our feelings, or find it hard to be on our own.
However, if the child has lots of difficult experiences, if perhaps they do not have enough food, or are not comforted when they need it or if the adult hurts them, the stress they experience can be so severe that it gets in the way of their brain developing in an healthy way. This is because chemicals that this stress produces are toxic to the cells in the brain. The cells might find it hard to connect with one another, or lots of them might die off. Some parts of the brain which are about feeling frighted, which are linked to beahviours such as fighting, freezing, running away or being very compliant might get used a lot. The more you use a pathway in the brain the more that pathway gets ingrained. Child abuse and neglect and other adverse experiences therefore, don’t only leave physical scars; they change the brain. This is a hidden injury.
It is important that we understand that some parents can’t respond in the way the child needs because the child has a developmental disability that makes it harder to work out what they want, or perhaps because the parent is ill. It is also important that we understand that the brain is plastic- the way it is built means that it is very adaptable and can find ways away around difficulites and problems, that it can learn and hange. Healing from early hardship is always possible and at any point it is possible to learn new things about ourselves or others. Healing may be harder for adults who experienced difficult things as children, because the brain has times in its development (especially in early childhood and the early teens) when this learning is easier. Children who have hardships growing up can and do on on to be healthy, happy adults. Adults who have had had hard times in their childhood can and do also go on to have fulfilling happy lives.
Our societies now know how widespread ACE’s are. Many people are carrying with them some level of pain because of difficult experiences. This pain may be within our culture’s current ability to see and respond to it; or it may not yet be something we can recognise and understand. Within any culture at any given time, we may decide to label the pain that some people feel as a mental illness, while seeing other people’s distress as normal. Research into the brain and traumatic stress is just beginning to help us all understand fully how painful childhood experiences of loss, or poor caregiving, or abuse are. It helps us see the ‘hidden injury’. However we choose to recognise that injury & suffering in our culture, whether it is through a mental health diagnosis or not, we are learning that many people are hurting. Mental health categories seem too limited and too formulatinc to fully capture the variety of ways people try to make sense of their situation and the complex ways brains try to accomodate those experiences as they grow. Perhaps our societies are going to be able to integrate this new knowledge. One way this is happening is in changes to the DSM-V. This is a book that lists all the mental health diagnosis that psychiatrists are proposing at the moment. It changes quite often, which suggests that each category is not as ‘fixed’ and ‘real’ as the concept of diagnosis might suggest. The current version of this book describes PTSD in a more complex way. As one commentator put it the concepts are “heading in the right direction, but still not as complex as the brain” (Julian Ford, downloaded 23:06 06/07/2006).
What do public services need to do?
We now know how much communities may need to put into helping children and adults who have had these experiences. It takes a village to raise a child and it also takes a whole community to help children and the adults they go on to become, when they have had adverse early experiences.We would not ignore or fail to provide help if someone had a physical injury. We need to start to see psychological injuries in the same way. On a societal level, when someone is injured through unmet attachment needs or adverse childhood experiences, we need to learn how to recognise the harm, to respond helpfully to the harm and to stop doing even more harm.
For too long public services have behaved in ways that increase distress, re-traumatise or re-victimise people who have unmet attachment needs or have experienced adverse childhood events. Perhaps this was because when they were set up we had a very different level of understanding about how childhood experience affect us and how the brain develops. Perhaps we would set up our public services very differently today, if we were taking into account this knowledge.
Services need to become attachment aware. Workers also need to be able to understand how trauma affects the developing brain and that this leads developmental trauma– complex forms of traumatic stress. Workers in the service need to know that preventing trauma and avoiding revictimisation is an important part of their job. This requires that services recognise that we are all human; there is no artificial divide between service users and service providers that keeps workers physically or emotionally safe. All this work will be slow and difficult; to get to the point of trauma informed services so very many people will have to give up a little bit of their belief in a just world, a bit of their belief that they are worthy of the good things that come to them and some of their belief that things happen for a reason. All these people will have to find a way of feeling safe and enjoying life, even while knowing that they live in an unsafe world. That is a lot of people who will have to make a journey into the pain that people who have survived traumatic events live withand a lot of people who will have to grow in the way that trauma survivors grow. There is no way around it; this is a very big task. However, just because it is a big task, doesn’t mean that we should start to do it.
Cairns, K. (2002). Attachment, Trauma and Resilience.