This Issue:
Attachment Relationships - Unapproved Draft May 31, 2001

THE DCFS PERSPECTIVE
Article Title

LITERATURE SUMMARIES
Attachment Relationships and Development
1. Overview of Attachment Disorders
2. Effects of Early Attchment Relationships
3. Adolescent Attachment Relationships

Attachment Relationships in Substitute Care
4. Minimizing the Trauma of Removal
5. Foster Parent Training Improves Parent Contact
6. Making Visits Work

Group Title
7. Guidelines for Custody Decisions
8. Evaluating Attachment Relationships
9. The Cultural Context of Parenting

Helping Children Mourn
10. Help for Grieving Toddlers
11. Children's Grief: Myths and Realities

Reactive Attachment Disorder
12. RAD: A Literature Review

WEB RESOURCES


DCFS Article     top


1. Overview of Attachment Disorders     top

Dozier, Mary and Kathleen E. Albus (2000). "Attachment Issues for Adopted Infants." Pages 171-197 in Adoption and Prenatal Alcohol and Drug Exposure. Washington, D.C.: Child Welfare League of America.

Stovall, K. Chase and Mary Dozier (1998). "Infants in Foster Care: An Attachment Theory Perspective." Adoption Quarterly v2 n1 p55-88.

Troutman, Beth, Susan Ryan and Michelle Cardi (2000). "The Effects of Foster Care on Young Children’s Mental Health." Englewood, CO: American Humane Association. On the Web at: http://www.americanhumane.org/children/prof/art_0500.htm

The authors review research that underscores foster and adoptive parents’ need for special training and support in order to meet the needs of insecurely attached infants and toddlers.

Caregivers Influence Attachment Relationships
Secure attachments are formed when caregivers are consistently sensitive and responsive to infants’ needs. Confident that their caregivers will be available if needed, securely attached infants are able to play and explore new environments when there is nothing immediately threatening in their environments.

Most Infants in Foster Care Have Insecure or Disorganized Attachments
Most infants in foster care form one of three types of attachment relationships before they are placed:

Insecure Avoidant Attachments may form when caregivers feel angry and irritated with their infants more often than caregivers of securely attached infants. These caregivers are also more averse to physical contact, are more emotionally rigid and interfere more in their babies’ activities. Infants with avoidant attachment often appear detached from their caregivers, fail to express their distress and generally appear "tougher" and more independent than other infants.

Insecure Resistant Attachments may form when caregivers alternate between responsiveness and rejection. Caregivers do not show aversion to physical contact but are not as affectionate as caregivers of securely attached infants. They usually limit contact only to what is necessary for basic care. Babies with resistant attachment show extreme distress on separation from their caregivers and are often difficult to soothe when reunited. In experimental situations their play is usually poor or absent because they are preoccupied with their caregivers’ availability.

Disorganized/Disoriented Aattachments may form when caregivers are severely neglectful or abusive. Their infants show inconsistent behavior toward caregivers and/or moments when an infant appears "frozen." For example, an infant may approach a parent with her or his head turned away. Some researchers think disorganized responses reflect unresolved conflict about how to deal with frightening caregivers. Others argue that inconsistent behavior is purposeful, reflecting the best possible strategy under unpredictable and/or dangerous circumstances.

Early insecure attachment relationships are not pathological in themselves, but they place children at some risk for later emotional and relationship difficulties.

Foster and Adoptive Families May Have Attachment-Related Problems

  • After losing a primary caregiver, however inadequate that person may be, it is sometimes difficult for children to learn to rely on a substitute.
  • Children wilth multiple placements are more likely to have difficulty forming lasting relationships with caregivers and to have more emotional and behavioral problems.
  • The emotional and behavioral problems that result from disrupted relationships are more likely to be serious if the disruptions occur after the first 12 months of life.
  • It may be hard for foster or adoptive parents without special training to respond appropriately when an infants’ behavior is challenging. For example, there is a tendency for adults to mirror children’s behavior, meeting anger with hostile rejection and meeting withdrawal or apparent indifference with lack of attention.
  • Some foster or adoptive parents have insecure attachments themselves, and are less able to respond appropriately to children’s needs.
  • Infants with prenatal drug exposure are vulnerable to insecure attachments unless their caregivers understand their special needs.
  • It may be hard for foster parents to support visits with birth parents because they are stressful, but they are needed to preserve children’s attachment relationships.
  • Concurrent planning may increase foster parents’ emotional investment in children they hope to adopt but it can also create friction between birth and foster parents or lead to premature reunification.
  • Infants placed in institutional settings have little opportunity to form attachments with caregivers and are more vulnerable to later physical, psychological and interpersonal problems.

Foster Parents Need Training and Support
Foster parents should be educated about insecure or disorganized attachment behaviors and the neediness that underlies them. They should learn specific behaviors that infants and toddlers are most likely to find supportive and reassuring when they are in distress. In addition, foster families may need:

  • weekly support meetings with agency staff and other foster parents
  • day care and respite care so foster parents can maintain the energy they need
  • therapy for children to help them express their needs to caregivers
  • therapy for caregivers who have not successfully resolved their own attachment issues.

A Two-Session Foster Parent Training Program
Dozier and Albus have developed a brief intervention to help new foster and adoptive parents understand, reinterpret and respond appropriately to the attachment behaviors of infants and toddlers.

Session One covers:

  • the importance of secure attachment
  • the adaptive qualities of insecure and disorganized attachments in maltreated children
  • the effects of prenatal drug exposure on infant behavior
  • how foster parents react to children who push them away or are difficult to soothe
  • how to respond therapeutically to a child’s alienating behaviors.

As Homework, caregivers:

  • observe themselves reacting to their children when they need comfort
  • reinterpret the childrens’ resistant and avoidant behaviors
  • try the new responses learned in Session One.

Session Two pays closer attention to the caregivers’ individual situations, focusing on how to maintain the new caregiving behaviors learned in Session One and to reinforcement the positive changes in their children’s behavior.

As expected, this intervention has proved most helpful to caregivers who have no major unresolved attachment issues of their own.


2. Effects of Early Attachment Relationships     top

Thompson, Ross A. (2000). "The Legacy of Early Attachments." Child Development v71 n1 p145-152.

The author reviews recent literature on the relationship between children’s early attachments and later development.

Effects of Early Attachment Relationships Are Varied
Attachment theorists and researchers agree that early attachment relationships interact in complex ways with later experience to influence children’s development. In general:

  • The effects of early attachment relationships wane over time.
  • Early attachment relationships have varying degrees of influence on different areas of development and on adaptive behavior later in life.
  • The quality of a person’s attachment relationships at any given time has much greater impact on his or her current social and emotional adaptation than on future adjustment
  • The relative influence of past and current relationships varies for different children.

Development is Affected by Changes in Parenting Quality
Relatively little is known about why the influence of early attachment relationships on children varies as they mature, but changes in parenting quality are likely to be a major factor. Parenting quality may vary due to changes in family circumstances such as:

  • children’s capabilities and parents’ ability to respond appropriately to them
  • external events such as birth of siblings, divorce, child care arrangements, changes in places of residence or employment, etc,
  • aspects of caregivers’ personal lives such as satisfaction with parenting or marriage, sickness or development of mental health problems.

Changes in family circumstances can affect attachment relationships both by changing the quality of parenting children receive and by placing more demands on them for adaptive coping.

Attachment to Other People Has an Impact
Attachment relationships formed with people other than the primary caregivers also affect children’s development. For example, secure attachment to a sibling, grandparent, day care provider or teacher may provide a child with some protection from the influence of neglectful or abusive parents.

Attachment Relationships Affect Self-Concept
Children’s self-concepts and their expectations of others are significantly affected by attachment relationships as they develop. Because young children are unlikely to develop a coherent self-concept before age three, the quality of their attachment relationships may have a greater impact on self-concept and self-esteem after age three.

Quality of Parent-Child Conversation is Important
Conversations with a primary caregiver contribute to children's understanding of themselves and others. When parents often talk about feelings and their causes and thoroughly explore the events their children describe, children have greater psychological understanding of others and a more complete recollection of their own lives.

Mother’s Conversation Predicts Conscience
Mothers of securely attached toddlers respond to their children with more elaborate conversation and with more references to feelings and moral evaluations. The quality of children’s attachment and their mothers' conversational style predict how children’s conscience will develop.

Conflict Negotiation Should be Learned Early
Conflict negotiation is another important aspect of early parent-child relationships. Research shows that children who start learning conflict negotiation when they first assert their independence as toddlers have a better understanding of self, of emotions and morality.


3. Adolescent Attachment Relationships     top

Allen, Joseph P. and Deborah Land (1999). "Attachment in Adolescence." Pages 319-335 in Handbook of Attachment: Theory, Research and Clinical Applications. New York: Guilford Press.

The authors summarize recent research on adolescent attachment relationships.

Attachment Status Can Change Over Time
Studies suggest that adolescent attachment relationships are affected both by the developmental changes that take place in adolescence as well as environmental challenges. In general:

  • There is moderate correlation between adolescents’ attachment status and that of their parents.
  • There is weaker correlation between an adolescent’s attachment status in infancy and his or her status in adolescence.
  • Adolescents who live with both biological parents and who have not experienced significant changes in parenting quality are more likely to continue the same attachment status they had as infants.
  • The stresses of early adolescence appear to disrupt attachment status temporarily or to interfere with our ability to measure it.
  • Researchers do not know if an individual’s attachment status ever reaches a point where it can no longer change.

Secure Relationships with Parents Promote Independence
While adolescents become more independent in many ways, their relationships with their parents do not diminish in importance. Studies show that:

  • Securely attached adolescents are better able to balance concern for achieving their immediate goals with maintaining important relationships.
  • Youth can more readily become independent when their relationships with their parents are close and stable, and they know they can turn to their parents in times of need.
  • Both adolescents and their parents deal better with conflict when their attachment is secure. In secure relationships, discussions may sometimes be heated and intense but stay focused on resolving the conflict at hand.
  • Insecure parent-teen dyads are more likely to avoid problem solving, the teens are less confident in their ability to negotiate, and there is more dysfunctional anger and use of pressuring tactics that undermine adolescents’ independence.

Attachment Needs Transfer to Peer Relationships
Many attachment needs are appropriately transferred from parents to peers during adolescence. In the process, attachment relationships become more egalitarian. Peer relationships take on many of the functions they will serve for the rest of adolescents’ lives, becoming important sources of intimacy, information and feedback about social behavior.

Responses to peer pressure can be seen as a transfer of the need to please from parents to peers, a process adolescents must negotiate if they are to be successful at developing adult relationships.

Securely attached adolescents tend to have higher-quality peer relationships, fewer sexual partners, more contraceptive use and a greater tendency for young women to insist on emotional commitment from sexual partners.

Behavior Problems are Linked to Attachment Status
Recent studies suggest that attachment status in adolescents is linked to behavior problems.

  • Avoidant Attachment is linked to externalizing behaviors such as aggression and delinquency, and symptoms that distract youth and others from distess-related cues.
  • Resistant Attachment is linked to internalizing behaviors such as depression, and symptoms that emphasize distress-related cues.
  • Combined Resistant and Unresolved Attachment is linked to suicidal behaviors.

Externalizing and internalizing behaviors may also be related to factors other than attachment status, such as gender, socioeconomic status, failure to learn emotion regulation skills, attempts to gain needed positive response from caregivers or developmentally inappropriate dependence on parents.


4. Minimizing the Trauma of Removal     top

Folman, Rosalind (1998). " ‘ I Was Tooken’: How Children Experience Removal from Their Parents Preliminary to Placement into Foster Care." Adoption Quarterly v2 n2 p7-35.

First Study to Examine How Children Experience Removal
The author describes the first study examining how maltreated children typically experience removal from their homes, with suggestions for helping children and their families cope with this event. The study included 90 children from inner city Detroit.

Maltreated Children Have More Insecure Attachments and Vulnerability to Stress
The great majority of the children in this study had experienced maltreatment most of their lives, interspersed with a few months or a year of good care. About 10% had experienced longer periods of "good enough" parenting, and an equally small group had no positive memories.

Research has found that approximately two thirds of maltreated children form insecure attachments to their parents or other primary caregivers. Thus, they are more likely to have difficulty dealing with stresses and relating effectively to new people, both of which are demanded of children who are removed from their homes and placed in substitute care.

Emergency Removals Were Traumatic
Most of the children experienced emergency removals, although they were not in immanent danger of harm. Some were taken into custody during raids on crack houses, which greatly increased their trauma. Those removed by police usually thought they were being taken to jail, and some actively resisted. Workers did not prepare children for being separated from their siblings when that was necessary.

Almost all of the children reacted by:

  • feeling disbelief, fear, confusion, loss, abandonment and mistrust of the strange adults
  • believing they would never see their families again
  • being too fearful and/or distrustful to ask questions, seek support or make other efforts to cope.

Children Received Little or No Support

  • Caseworkers were frequently insensitive to the children’s love for and attachment to their parents and failed to validate their feelings about being removed.
  • Being told that they were "going to a nice lady’s house" or that removal was "for the best" simply intensified the children’s feelings of mistrust and apprehension.
  • Children were rarely given information about where their parents were or what was going to happen next. Sometimes they were left alone or handed off to other workers while waiting for a placement.

Guidelines to Minimize the Trauma of Removal
The following guidelines for supporting children during removal are based on

  • one removal that was handled particularly well,
  • children’s comments about what would have helped them
  • the attachment literature.

Some of the following procedures may result in difficult encounters with birth parents, but those are temporary, whereas the trauma of poorly executed removals can have much more lasting effects on children. Policies must be changed and funding provided so that these supportive measures can be undertaken:

  • Information - Inform children prior to removal that they are leaving their parents to live temporarily with another family. If possible, a familiar caseworker should carry out the removal.
  • Birth Parents - Permit birth parents to accompany their children through removal whenever feasible. At the very least, allow children to contact their parents very soon afterward.
  • Video or Photos - Allow children to see their new foster families and their new homes before they are placed. A video of foster family members talking about themselves and what they like to do with children is ideal. At least describe the family and show pictures of the family members and their house.
  • Peer Support - Provide new foster children with peer support from more experienced foster children to help them deal with what has happened to them and give their experiences more positive meaning.
  • Counseling - When necessary, arrange crisis counseling for children and families who have been through removal to ensure good adjustment to foster care.


5. Foster Parent Training Improves Contact With Birth Parents     top

Sanchirico, Andrew and Kary Jablonka (2000). "Keeping Foster Children Connected to Their Biological Parents: The Impact of Foster Parent Training and Support." Child and Adolescent Social Work Journal v17 n3 p185-203.

The authors surveyed 650 foster parents in New York State. They found that foster parents who receive special training and support do more to promote birth parents’ involvement with their children.

Contact with Birth Parents Increases Children’s Well-Being
Apart from facilitating reunification, contact with birth parents can reduce the feelings of abandonment, grief and depression children often experience during placement. It reassures them about their parents’ well-being and promotes positive adjustment to substitute care.

Contact May Produce Conflict and Stress for Foster Parents
As active members of the service delivery team, foster parents are commonly expected to facilitate children’s contact with their birth parents, but this is often problematic for foster parents. Some foster parents are hostile to birth parents and resist contact. Others who try to support contact can be confronted with situations that are stressful for everyone and difficult to manage.

Combined Training and Support Facilitate Contact
In this study, foster parents who received both training and support were involved in the most pro-contact activities, while those who received either training or support engaged in the fewest. The effect of a combination of training and support on foster parents’ facilitation of contact was much greater than the effects of any other factor considered in this study, including foster parents being supportive of family reunification or being related to the foster child.

50% of Participants Had No Training or Support
Unfortunately, only about 20% of the participants received both training and support, while 33% received one but not the other, and approximately 50% received no assistance in helping foster children stay connected with their birth parents.

Training is Essential
Training and support send a clear message to foster parents that their involvement in parent-child contact is highly valued and is an essential part of the foster care system. In training, foster parents should learn why contact between children and their birth families is important for reunification and how it contributes to children’s well-being while they are in care. They also need to learn the following skills:

  • negotiating and coordinating visits and other types of contact
  • how to work with birth parents
  • how to deal with children’s reactions to contact.

Support Should be Ongoing
Ongoing support is necessary to help foster parents deal with situations that cannot be anticipated in training. They should be encouraged to consult with agency professionals whenever they are uncertain about how to deal with a specific situation or to discuss other services birth parents and/or the child may need to help them stay connected.


6. Making Visits Work     top

Loar, Lynn (1998). "Making Visits Work." Child Welfare v77 n1 p41-58.

The author reviews the benefits of visits with birth parents and provides guidelines for successful visiting plans.

Visits Have Important Benefits
Visits between birth parents and children in substitute care play a crucial role in:

  • maintaining family ties and facilitating reunification
  • reassuring children about their parents’ well-being and helping them stay grounded in reality
  • helping children adjust to placement and form new relationships
  • empowering birth parents and allowing them to practice new behaviors
  • allowing staff to accurately assess parental capacity.

Agencies Should Provide Supports for Visits

Agencies should facilitate visiting with the following basic supports:

  • transportation and child care
  • convenient visiting hours that include evenings and weekends
  • safe and appealing visiting rooms equipped with appropriate toys and with access to food preparation areas
  • support for visits in foster and biological parents’ homes and other locations when this is safe
  • instruction in child development and parenting skills.

Parents May Lack Knowledge and Skills
Basic supports are necessary but not sufficient to ensure successful visits. Visiting plans should be based on a realistic assessment of parents’ abilities and needs, as well as those of their children. Otherwise, families experience unnecessary failures that may discourage them from visiting again, and thus make reunification less likely.

Unfortunately, visiting plans are often based on incorrect assumptions. Abusive or neglectful parents may not:

  • know how to play with their children, how to enjoy their company and how to talk respectfully with them
  • have constructive leisure and recreational skills that can be used during visits
  • be able to separate visiting from the frustration and humiliation they feel about their children being removed
  • understand what children experience when parents fail to come for a visit
  • have literacy skills to read to their children.

Visiting Plans Must Include These Elements
The quality and outcomes of visits can be improved through realistic, thorough assessment and planning. Effective visiting plans should follow these guidelines:

  • Structured Activities - center visits around an enjoyable activity within the current interests and capabilities of both parents and children. Highly structured activities, such as community programs or classes, allow parents who have been unable to be positive with their children to experience a pleasant activity with the child without having to be primarily responsible for discipline and control.
  • Neutral Settings - locate visits in safe, public settings that have neutral or positive associations, such as the children’s room of the public library or a park.
  • Teach Parenting Skills – include sensitive teaching and modeling of parenting skills, such as positive reinforcement and discipline of children, accommodating children’s attention spans and developing rituals that help children and parents deal with the emotions they feel when coming together and parting.
  • Positive Reinforcement - provide compliments and other positive reinforcement for the parents.
  • Review - be periodically reviewed and modified to accommodate family members’ growth.


7. Guidelines for Custody Decisions     top

Skolnick, Arlene (1998). " Solomon’s Children: The New Biologism, Psychological Parenthood, Attachment Theory, and the Best Interests Standard." Pages 236-255 in All Our Families: New Policies for a New Century. New York: Oxford University Press.

The author reviews attachment research and provides general guidelines for custody decisions.

Early Loss is a Risk Factor - Losing a parent early through separation or death is a risk factor for later social and emotional difficulties, but much depends on how the child responds to loss, the quality of later caregiving received, and the number of losses and other misfortunes experienced during childhood and adulthood.

Distress May Be Delayed – Sometimes children seem not to show distress when they are separated from attachment figures. But we know from studies of hospitalized children and those who function "normally" after traumatic events such as war or the murder of a parent that overt distress may not surface until years later.

Focus on Preserving Attachments - Custody decisions should focus on the importance to children of ongoing relationships with caregivers who have provided sustained, loving care. It is crucial that very young children be placed with the individual(s) to whom they are most attached. However, as children gain emotional and cognitive maturity, custody arrangements can be more flexible, as long as attachment remains an important basis for decision making.

Quality not Quantity - The quality of attachment cannot be measured by the amount of time an adult spends with the child. What matters is how attentive, responsive and affectionate the adult is when interacting with the child.

Maintain Secondary Attachments - Children at all ages can develop attachment to more than one person, and usually are attached to both mother and father in two-parent families. While young children in particular may have a more important attachment to the primary caregiver, children will benefit from maintaining contact with both parents and anyone else with whom they have emotional bonds.


8. Evaluating Attachment Relationships     top

Stokes, John C. and Linda J. Strothman (1996). "The Use of Bonding Studies in Child Welfare Permanency Planning." Child and Adolescent Social Work Journal v13 n4 p347-367.

The authors practice in Chicago.

Bonding Studies are Used to Evaluate Attachment
In current practice, bonding studies involve a smorgasbord of procedures that are used to evaluate the relationship between a child and an actual or potential caregiver. Bonding studies are used to examine:

  • the attachment style and needs of a particular child
  • the quality of attachment in established adult-child relationship
  • the capacity for attachment between a potential caretaker and the child.

Substantial Interview Time May be Needed
Multiple interviews with all parties involved may be needed for an adequate evaluation. It is important to have enough contact with each person to build rapport, gather all pertinent information and determine how he or she functions in varying circumstances. During interviews, encourage empathy for the others involved in the case, particularly for the child. This can draw out more information from each participant and make the participants more supportive of the child as questions about custody are resolved.

Essential Activities of the Bonding Study
A bonding study includes these activities:

  • studying the circumstances of the case.
  • identifying all individuals who could contribute useful information and each person’s interests in the case.
  • gathering information from multiple sources including records, tests, interviews, formal and informal observations, collateral contacts with teachers, therapists, day care workers, extended family members, and caseworkers, and any other relevant source.
  • thoroughly reviewing any records and tests prior to conducting interviews.
  • interviewing each collateral source.
  • conducting at least two individual interviews with the child and each potential caregiver prior to the bonding interviews.
  • conducting a bonding interview with the child and each potential caregiver.
  • perhaps administering a self-report questionnaire on parenting attitudes and practices, such as the Parent Child Relationship Inventory.

The interviews should answer the following questions about the caregivers, child, and adult-child relationships.

Considerations About Potential Caregivers

  • What is the person’