Attachment Theory

What are the Effects of Early Severe Deprivation on Attachment? Supportive caregiving relationships are key to many developmental domains of early childhood, including attachment. John Bowlby and Mary Ainsworth, the prime authors of attachment theory, argued that to assure survival, infants need to be physically close to the caregiver and form an enduring emotional bond. Sensitive caregiving and consistent responsiveness to the infants signals is fundamental for the infants development of secure attachment. In contrast, if caregivers provide insensitive and inconsistent care, babies develop alternative strategies for interaction with under conditions of stress, such as tuning away from caregivers (avoidant attachment), simultaneously seeking and resisting contact (resistant attachment) or displaying a breakdown in strategy (disorganized attachment), which are broadly characterized as insecure attachment.

Many people have wondered about the nature of attachment relationships developed by children reared in institutions, questioning the ability of the institutions to provide the environment needed for secure attachment to develop. Researchers have found that while orphanage conditions vary, most have high child-to-caregiver ratios, provide little to no stimulating or educational activities, and have inattentive, insensitive caregiving. With the rates of adoption increasing, more children who have experienced these conditions are becoming part of families and the effects of their early severe deprivation are emerging in this new context.

A host of studies has documented the occurrences of different attachment patterns, including attachment disturbances and atypical attachment behaviors, in post-institutionalized children this population. The link between attachment theory and psychopathology (the so called attachment disorders) is controversial and not well understood. The Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000) contains an attachment disorder called Reactive Attachment Disorder (RAD), a pathology resulting from the effects of deprivation and institutionalization on infants and young children. The concept and diagnosis of RAD (see articles by Richters and Volkmar, 1994 or Hall and Geher, 2003 for a review) have been highly controversial, with notable arguments surrounding the criteria for

diagnosis and the theoretical basis for considering it a disorder of attachment. For this reason, this article will not review the literature pertaining to RAD. Instead, it will discuss findings of atypical attachment patterns, such as indiscriminate friendliness or disinhibited behavior. These terms refer to a tendency to eagerly and openly approach strangers, a lack of proximity seeking of the attachment figure in situations that would ordinarily invoke it, and a superficial, rarely reciprocal quality of interaction (see the article by OConnor colleagues published in 2003). It is important to remember that atypical attachment patterns are distinct from insecure patterns.

Findings of Research Studies

A study of 111 Romanian adoptees (drawn from a larger sample of post-institutionalized Romanian children adopted into the UK) placed before 24 months, and 52 UK-born adoptees placed before 6 months, found significant differences in the distribution of attachment classifications between organized (secure, avoidant, ambivalent) and not organized (disorganized or insecure-other) classifications at age 4. Specifically, insecure-other classifications were the most common (51.3%) among Romanian adoptees who had experienced deprivation for more than 6 months, and the second most common (38.5%) for Romanian adoptees who had experienced deprivation for less than 6 months. Fifty percent of the non-deprived UK adoptees were classified as secure, while only 37.5% of the deprived Romanian adoptees were found to display this attachment type. In a study of children adopted from Romanian orphanages by Canadian parents (see for example the article by Chisholm, 1998) found that of the three groups of children: those institutionalized for at least 8 months, those institutionalized for under 4 months, and Canadian-born, nonadopted children more insecure attachments were found in the first group. These children also displayed several more of the atypical (less common and more extreme) attachment patterns. In a study of 86 infants residing in a Greek orphanage and a comparison group of 41 infants being raised in two-parent families and attending daycare, Panayiota Vorria and colleagues found a higher percentage of disorganized attachment classifications among institutionalized infants (66%) than among those in family care (25%). It is notable however, that 16 children were described as unclassifiable (see our discussion about appropriateness of the use of attachment measures in this population).

Attachment Disturbances and Atypical Attachment Behaviors The English and Romanian Adoptees Study Team found attachment disturbances of varying kinds among Romanian children who had experienced institutional deprivation (see he article by Michael Rutter in 2001). Most children (80%) in the group had been in an institution since the neonatal period. The attachment disturbances that Rutter colleagues observed were characterized by relatively undiscriminating social approach, a seeming lack of awareness of social boundaries, and a difficulty in picking up social cues on what is socially appropriate or acceptable to other people (p. 102).

Researcher Chisholm (1998) also found these patterns among the children institutionalized for at least 8 months. While these atypical attachment behaviors have been discussed and investigated in terms of RAD, a consideration of disordered attachment is beyond the scope of this review, as previously explained. Factors Influencing the Effects of Deprivation Research on the effects of early severe deprivation has consistently identified several influences on attachment outcomes. These include presence of attachment figures, interactions with caregivers, and duration of deprivation.

OConnor and colleagues (2003) suggest that the most likely explanation for the elevated rate of insecure-other classifications among their post-institutionalized group was the failure to develop a discriminating attachment early in life and the lack of consistently responsive caregivers.

What Can Be Done? Groark, Muhemedrahimov, Palmov, Nikiforova, and McCall (2005) reviewed an institution-based intervention program for promoting positive social-emotional relationships and attachments between caregivers and children in orphanages in St. Petersburg, Russia. The intervention consisted of two parts, one to increase the stability of caregivers and support relationship building, and the other to train and promote sensitive, responsive caregiving. The emphasis in these orphanages, which house children from birth and 48 months, is health-related care, rather than social-emotional development or education, there is high staff turnover (creating instability of caregivers), and caregivers lack socially responsive

caregiving behaviors. Prior to the intervention, caregivers had little communication with and overall detachment from the children. Infants and toddlers displayed little or no social interest in the researchers and older children often displayed inappropriate behaviors, including open aggression, avoidant behaviors, or indiscriminant friendliness. The intervention involved teaching caregivers to be more socially responsive in their interactions with children, dividing groups of 12 to 13 children into subgroups of 6 to 7, and assigning each subgroup a primary caregiver. Results showed an increase in the consistency and stability of caregivers and significant changes in caregiver behaviors. Results also indicated that children displayed improvements in many developmental domains. Though very preliminary, these results are highly promising, as they may suggest that staff training coupled with structural changes are effective, can generate socially responsive caregiving behaviors, and can improve social interactions of children, at least temporarily.

Methodological Limitations and Future Research As previously mentioned, one major limitation of this research is the use of attachment measures that have been designed for use on the typical population on this unique population. The fact that institutions may not provide the environmental input that promotes species-typical attachment relationships or species-typical organizations among attachment-related behaviors (OConnor et al., 2003, p. 21), necessitates a thorough investigation into atypical attachment styles observed in post-institutionalized children. It may be that children who have experienced early severe deprivation simply display different attachment patterns than typically developing children with histories of discriminating attachments. Understanding these potentially unique patterns would aid substantially in investigating their implications for future attachment relationships. In addition to ambiguities created by attachment instruments, there are many other variables, such as cognitive abilities, behavior problems, and family stress, which can confound the impacts of early severe deprivation on attachment. For example, Vorria and colleagues (2003) suggested that the securely attached infants in their sample had employed their social abilities to gain the most from their deprived environment, or that, because their sociability made these infants more rewarding to interact with as compared to their institutionalized peers, their caregivers paid more attention to them.

References and Suggested Readings

Chisholm, K. (1998). A three year follow-up of attachment and indiscriminate friendliness in children adopted from Romanian orphanages. Child Development, 69(4), 1092-1106. Groark,

C.J, Muhemedrahimov, R.J., Palmov, O.I., Nikiforova, N.V. & McCall, R.B. (2005). Improvements to early care in Russian orphanages and their relationship to observed behaviors. Infant Mental Health Journal, 26(2), 96-109. OConnor, T.G., Bredenkamp, D., Rutter, M., & the English and Romanian Adoptees Study Team. (1999). Attachment disturbances and disorders in children exposed to early severe deprivation. Infant Mental Health Journal, 20(1), 1029. OConnor, T.G., Marvin, R.S., Rutter, M., Olrick, J.T., Britner, P.A., & the English and Romanian Adoptees Study Team. (2003). Child-parent attachment following early institutional deprivation. Development and Psychopathology, 15, 1938. Richters, M.M. & Volkmar, F.R. (1994). Reactive attachment disorder of infancy or early childhood. Journal of the American Academy of Child and Adolescent Psychiatry, 35(3), 328-332. Rutter, M., Colvert, E., Kreppner, J., Beckett, C., Castle, J., Groothues, C., Hawkins, A., O'Connor, T. G., Stevens, S.E., Sonuga-Barke, E.J.S. (2007). Early adolescent outcomes for institutionally-deprived and non-deprived adoptees. I: Disinhibited attachment. Journal of Child Psychology and Psychiatry, 48(1) 17-30. Rutter, M., Kreppner, J.M., O'Connor, T.G. (2001). Specificity and heterogeneity in childrens responses to early profound institutional privation. The British Journal of Psychiatry, 179, 97-103. Vorria, P. Papaligoura, Z., Dunn, J., van IJzendoorn, M.H., Steele, H., Kontopoulou, A., & Sarafidou, Y. (2003). Early experiences and attachment relationships of Greek infants raised in residential group care. Journal of Child Psychology and Psychiatry, 44(8), 12081220. Vorria, P., Papaligoura, Z., Sarafidou, J., Kopakaki, M., Dunn, J., Van IJzendoorn, M.H., & Kontopoulou, A. (2006). The development of adopted children after institutional care: a follow-up study. Journal of Child Psychology and Psychiatry 47(12), 12461253.

by Nicole Shapiro and Maryna Vashchenko