Supporting Attachment - Humanities
Read the article Supporting healthy relationships between young children and their parents. Examine the function of attachment in both the family and childcare setting. Specifically, how can the early childhood educator support attachment in the childcare setting, while reassuring and supporting the child’s attachment to family? Be sure to support your discussion with information from the text and at least one other scholarly resource.
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Supporting Healthy Relationships Between Young Children and Their Parents
Lessons from Attachment Theory and Research
Karen Appleyard, Ph.D.
Lisa J. Berlin, Ph.D.
At a child care center, 18-month-old Hannah is clinging to her mother and crying as they enter. Her mother
pulls Hannah’s hands from her arm, saying, “Don’t be such a crybaby and go play.” In a pediatrician’s
waiting room, two-year-old Carlos climbs dangerously high on the furniture. He throws a toy at his mother
when she calls his name. His mother laughs nervously and says quietly, “I don’t know what to do with him.”
In a family’s kitchen, one-year-old Keisha yanks on a locked kitchen cabinet while her father is cooking. Her
father kneels next to Keisha and says, “Oh - I see you are trying to get into this cabinet, but these glass pans
are for me. Let’s make a drawer with some plastic kitchen things for you. You can use them while Daddy
cooks.”
These examples illustrate how much child-parent interactions can differ from each other. Many people
would see Keisha’s interactions with her father as the most harmonious and developmentally appropriate
example. What may be less apparent is why these types of interactions matter, and what can be done to
support healthy relationships between young children and their parents.
One theory about child development—attachment theory—is particularly useful for understanding early
child-parent relationships and how to support them. According to attachment theory and research, early
child-parent relationships lay the foundation for children’s later social, emotional, and school functioning.
Attachment theory and research also point to specific strategies for supporting relationships between
young children and their families.
What are Attachments?
Attachments are unique, lasting emotional ties between infants and their parents. All infants will develop
attachments to their parents, even if the parent is harsh or abusive. The only exception to this rule is children
reared without parents or specific primary caregivers (such as children in some orphanages). Thus, rather
than describing a child as being attached or not, attachment theory and research focus on the quality of
the relationship between the child and parent. An attachment usually takes the first year of life to develop,
through repeated interactions between the child and parent.
Attachment differs from bonding. Bonding refers to the parent’s tie to the infant which develops in the first
few hours of life. Infants are capable of developing multiple attachments (e.g., to mothers, fathers,
grandparents). Usually, however, they have one parent who is their “primary attachment figure.”
Attachment Quality
There are two basic patterns of attachment: “secure” and “insecure.” The key factor in promoting a secure
attachment is parenting behavior. Many research studies have shown that sensitive, responsive parenting
promotes secure attachment. Insensitive, rejecting, or inconsistent parenting has been linked to insecure
attachment.
A secure attachment is characterized by the child’s ability to use his or her parent as a source of comfort
and a “secure base” from which to explore. A key principle of attachment theory is that dependence
leads to independence. In other words, it is only when a child feels confident in his parent’s availability that
he can fully explore and play on his own.
Parental behaviors typically associated with secure attachment include:
• Sensitive and responsive care
• Clear, consistent, developmentally appropriate expectations and supervision
• Warm, positive, and responsive verbal interaction
• Seeing the child as a unique individual, having insight into the child (i.e., why he does what he does)
• Holding the child in mind” (i.e., awareness of and ability to reflect on the parent’s own feelings and
responses to the child)
Infant and early childhood behaviors associated with secure attachment include:
• Comfort exploring in presence of an attachment figure
• When hurt, going to an attachment figure for comfort (i.e., not a stranger)
• Seeking help when needed
• Willingness to comply with requests with minimal conflict
• No pattern of controlling or directing the behavior of caregivers (no role-reversal)
An insecure attachment is characterized by the child’s inability to use his or her parent for comfort or as a
secure base. There are three basic types of insecure attachment.
1. Some children are overly dependent, expressing difficulty with separation and with independent play.
This pattern is called insecure-resistant attachment.
2. Some children are under-dependent, seeming disengaged from the parent and barely noticing them
upon separation. This is called insecure- avoidant attachment. Such “independence” in an infant or
toddler, although sometimes praised, is usually developmentally inappropriate.
3. Disorganized/disoriented attachment refers to children who seem frightened or disorganized in the
presence of their parents.
Parental behaviors typically associated with insecure attachment include:
• Interfering with the child’s attempts at exploration (i.e., intrusive, overly controlling)
• Unclear, inconsistent, developmentally inappropriate expectations and supervision
• Ignoring the child’s needs and cues
• Inconsistent, unreliable responsiveness
• Hostile, threatening, and frightening behaviors
• Prioritizing the parent’s needs over the child’s (i.e., self-absorbed)
• Behaving like a child or treating the child as though he/she is in charge (i.e., role-reversal)
• Marked withdrawal, fright, hesitance or timidity around the child
• Sexualized or overly intimate behaviors
Infant and early childhood behaviors associated with insecure attachment include:
• Excessive dependence
• Marked shyness, withdrawal, or unfriendliness
• Failure to seek contact, comfort when needed
• Indiscriminate friendliness or contact seeking
• Punitive, bossy behaviors
• Over-concern with the parent’s well-being (i.e., role reversal)
• Disoriented or frightened in presence of the parent, such as approaching while looking away, stilling,
freezing, or rocking
• Promiscuous, sexualized behavior
Back to top
The Importance of Early Attachments for Later Development
Early attachments lay the foundation for social and academic skills. A number of studies that have
followed children from infancy to adolescence or adulthood have illustrated that attachment quality is one
of the strongest predictors of later development.
Secure attachment forecasts healthy social, emotional, cognitive, and motivational development. For
example, a child who had a secure attachment with her parent as an infant is more likely in childhood to
be independent and self confident, to have appropriate interactions with peers and teachers, to manage
her emotions, to be focused, curious and motivated in school, and to have strong problem solving skills.
Insecure attachment forecasts developmental and adjustment problems. For example, a child who was
insecurely attached in infancy is more likely in childhood to have poor social skills (e.g., withdrawal or
aggression), to act out and be disobedient, to have poor communication skills, to be impulsive and easily
distracted, and to lack curiosity and motivation in school.
It is important to note that an insecure attachment does not fate a child to failure. Change certainly can
occur. The longer a child is on a specific path, however, the harder it is to alter the course.
Back to top
Lessons from Attachment Theory and Research for Supporting Healthy Relationships
between Young Children and Their Parents
Attachment theory and research suggest several guidelines that practitioners may follow to support early
child-parent relationships in a variety of contexts (e.g., home visiting, child care, mental health). These
guidelines, in turn, may help practitioners prevent or intervene to address child behavioral, emotional, and
academic problems. We begin this section with an overview of these guidelines. Specific strategies for
following the guidelines will vary based on the contexts in which they are used and the nature and age of
the child. Second, we present a selection of attachment theory- and research-based programs and
curricula.
Guidelines for Supporting Healthy Relationships between Young Children and Their Parents
First and foremost, attachment theory and research suggest that establishing a supportive and trusting
relationship between the parent and practitioner is key to the practitioner’s work with the child-parent
relationship. The parent-practitioner relationship also serves as a model for the child’s relationship with the
parent. A healthy parent-practitioner relationship is especially important in working with parents who
themselves received harsh or inconsistent care as children.
Within the framework of a supportive relationship between the parent and the practitioner, we offer the
following guidelines based on attachment theory and research:
1. Help parents understand that two of their principal responsibilities as a parent are to comfort their child
and to facilitate their child’s exploration of the world. Moreover, knowing how to tailor the responsibility to
the situation and according to the needs of the child is central to supportive parenting. For example:
• An in-home practitioner could provide praise, positive reinforcement, or modeling during playtimes with
the parent and child. She could encourage the parent to respond to the childs requests for comfort and to
follow the childs lead in play.
• The NCAST-AVENUW program at the University of Washington recently produced a short video and a
deck of cards, both called “Baby Cues.” These materials are designed to help parents interpret their
infants’ nonverbal communications. For more information about these materials, go to
http://www.ncast.org/p-baby-cues.asp
2. Help parents understand typical child development. Providing parents with verbal and written
information about developmental milestones and typical child development can help parents be more in
tune with their children. For example:
• Many parents are frustrated by infants’ frequent crying. A practitioner in a pediatric clinic might offer
information about normal crying and how some babies cry more than others. She also could explain that a
parent cannot spoil a crying baby by picking her up. Rather, parents who respond to their babies typically
have children who become more self-sufficient.
• Parents of two-year-olds may experience difficulties balancing their children’s intense need to explore
with the need to set boundaries and limits. In the example at the beginning of the brief, a home visitor
working with Carlos’s mother might talk about Carlos’s need to explore and to do everything “by myself.”
The home visitor also could discuss how to set firm but gentle limits in order to establish the mother’s
authority and keep Carlos safe.
• Many parents have difficulty with children’s sadness or clinginess. Child care providers might use
“teachable moments” during drop off and pick up times to “wonder” with parents about strategies that
might help their child transition more smoothly.
3. Help parents reflect on their own parenting strengths and challenges. Some parents have more difficulty
comforting; others letting go. Every parent brings a history of their own relationships (with parents,
caregivers, loved ones) that “filter” how they interpret their child’s actions. For example:
• A father whose mother mocked him when he cried as a child may find himself scolding his own infant
when she cries.
• A mother whose parent was anxious and overprotective may struggle when her toddler explores the
world.
• A parent who was mistreated by her mother may know that she does not want to be the same kind of
mother as she had.
Talking with parents about these issues may help parents see themselves and their children in new and
different ways. For example, a practitioner could ask, “Who does Joey remind you of? What is the
hardest/easiest part of being his mom/dad? What experiences that you had growing up do you want for
him? What would you like to be different?” With carefully structured self-examination and guided practice,
parents may learn how to interact differently with their children.
4. Use the parent-child relationship as an “engine of change.” Practitioners working with young children
who show behavior problems may find it useful to consider children’s challenging behaviors through the
lens of attachment. Many behavior problems are rooted in relationship difficulties with the parent. Helping
a parent to see their child’s acting out as a cry for attention, or as a need for parental limit-setting, may
engage the parent in working with the child. It may: (a) help the parent see how important they are to their
child, (b) increase the parent’s empathy for their child, and (c) suggest specific, perhaps new, parenting
strategies such as daily “special playtimes” when the child has the parent to himself. In short, practitioners
can use the child-parent relationship to help drive healthier child functioning.
The strategies outlined above may work better for some families than others. Certainly parenting does not
occur in a vacuum. Many factors can promote or impede supportive parenting, such as financial stability,
mental health, marital quality, social support, and neighborhood safety and cohesion. Promoting healthy
child-parent relationships cannot be viewed as a cure-all, but, rather, as one component of good practice.
Back to top
Some Attachment Theory- and Research-based Curricula and Programs
Several curricula and programs have been developed to help practitioners support healthy relationships
between young children and their parents. Many others are in the process of being developed and
rigorously evaluated. These protocols are specifically focused on enhancing child-parent relationships. They
can be used alone or in combination with other family support services. They vary in the extent to which
they (a) are manualized, (b) come with standard training and/or requirements for certification, (c) are
supported by rigorous research. We selected the five protocols described below on the basis of their
accessibility and/or the research findings that support them.
We distinguish these programs and curricula from “attachment therapies” such as holding and rebirthing
techniques. Such therapies are not based in attachment theory or research. They have resulted in tragic
outcomes for children, including at least six documented child fatalities.
Child-Parent Psychotherapy (CPP):
CPP is a therapeutic treatment used with mothers and young children. CPP is supported by findings from
several randomized trials demonstrating increases in attachment security in maltreated infants and
toddlers, toddlers of depressed mothers, and preschoolers exposed to domestic violence. The program also
shows evidence for improving children’s behaviors and reducing mothers’ distress. The CPP approach is
described in: Lieberman, A. F. & Van Horn, P. (2005). Don’t hit my mommy: A manual for child-parent
psychotherapy with young witnesses of family violence. Washington, DC: Zero to Three.
Attachment and Biobehavioral Catch-up (ABC):
This 10-week, home-based program is designed to educate foster parents and to support relationships
between foster infants and their foster parents. Preliminary findings from a randomized trial with 100 foster
infant-parent pairs indicate that those infants who received the ABC treatment were more likely to be
securely attached than those who did not. For more information, go to:
http://icp.psych.udel.edu/index.htm
The Circle of Security (COS):
COS is a 20-week, group-based parent education and psychotherapy program. A recent pre-post
evaluation of 65 low-income young children and their caregivers indicated promising changes from
disorganized to organized (secure and insecure) attachment patterns, with the majority changing to the
secure pattern. For more information, go to: www.circleofsecurity.org
Partners in Parenting Education (PIPE):
This curriculum is designed for parent educators to support the development of healthy relationships
between infants and toddlers and their parents. The curriculum focuses on maximizing the parent’s
emotional availability to his or her child. Two-day trainings in PIPE are offered regularly in Colorado. A pilot
study of PIPE has been conducted. For more information, go to: www.howtoreadyourbaby.org/pipe.html
Promoting First Relationships (PFR):
This curriculum focuses on the early child-parent relationship. Materials include a manual and handouts
that can be used with parents and caregivers. PFR does not offer a step-by-step protocol, however. Several
studies are currently under way to rigorously evaluate PFC. Initial pre-post (non-randomized) evaluations
show promise for PFR to enhance understanding of child development and interactions between children
and their parent and child care provider. For more information, go to:
www.son.washington.edu/centers/pfr/
For administrators considering such evidence-based programs, rating scales are available which summarize
clinical or empirical support, documentation, acceptance in the field, and potential for harm. For example,
the National Crime Victims Research and Treatment Center’s scientific rating scale ranges from 1 (wellsupported, efficacious treatment or practice) to 6 (concerning treatment or practice). For more
information, go to: http://colleges.musc.edu/ncvc/resources_prof/OVC_guidelines04-26-04.pdf. Although
the curricula and programs described above have not been rated formally according to this scale, we
estimate that these attachment programs would be rated between level 2 (“supported and probably
efficacious practice”: CPP, ABC, and COS) and level 4 (“promising and acceptable practice”: PIPE and
PFR). Our estimated ratings reflect the relative newness of the field of attachment programs, most of which
require more evaluation. At the same time, the attachment programs reviewed here offer promising
practices from which communities can choose, depending on their interests, needs, and resources.
Attachment Theory- and Research-based Curricula and Programs in the Larger Public Health Context
The attachment curricula and programs just reviewed share goals with many broad-based child
development programs such as Early Head Start, the Nurse-Family Partnership, Parents as Teachers, and
Healthy Families. Some of these broad-based programs are experimenting with adding attachment
curricula to their services. These experiments could strengthen these and other public health initiatives
focusing on young children and their families.
Conclusion
Attachment theory and research illuminate key dimensions of early relationships between young children
and their parents. Attachment theory and research also have informed a number of strategies and
programs for supporting early child-parent relationships. A growing body of research illustrates the promise
of these strategies for promoting the health and development of young children.
Drawing upon these lessons from attachment theory and research, practitioners can support parents to
raise secure, well-adjusted children.
Back to top
Resources for Practitioners
Bowlby, J. (1988). A secure base. New York: Basic Books.
Carlson, E. A., Sampson, M. C., & Sroufe, L. A. (2003). Implications of attachment theory and research for
developmental-behavioral pediatrics. Developmental and Behavioral Pediatrics, 24, 364-379.
Fenichel, E. (1992). Learning through supervision and mentorship to support the development of infants and
toddlers and their families: A source book. Washington, DC: Zero to Three.
Gowen, J. W ...
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