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Archive for March, 2010

Can you tell us how we should be going about developing a secure attachment? I’m also interested to read how the insecure – avoidant and insecure – ambivalent types come about.

This question was posted in response to my blog post on attachment, and I wanted to respond to this, as it’s probably a question that all parents who read about attachment theory are interested in.

Studies show that the attachment style that we had with our own mother (again, mother can be substituted for primary caregiver) is generally predictive of the attachment style that we have with our own children. We generally parent in the way in which we were parented. There is evidence of neurobiological brain changes in infants and children which relate to their early experiences, and there is therefore an argument that our attachment style is hard- wired from a very early age.

Most children — and adults — are securely attached, so for the majority of people, we can just do what comes naturally when it comes to parenting and our children will develop secure internal working models. The factors which help this are parents being warm, empathic and consistently responsive. Parents respond to their children when their attachment behaviour is activated (crying, trying to get close to mother), and are able to empathise ie put themselves in the child’s shoes and recognise what they need at that time, and provide it.

Parents with insecure attachment styles  with their infants will generally have had that pattern with their own parents(analysed with an interview called the Adult Attachment Interview). Other factors which may influence the development of an insecure attachment include maternal mental illness (postnatal depression, psychosis), trauma, illness of the child, separation of the pair in early life etc – basically anything which affects a parent’s ability to respond to their child as above.

For this group of parents, there are things that can be done to promote secure attachment at-risk groups and individuals. The aim is to help parents develop an awareness of both their own and their child’s internal mental experiences — their reflective functioning –(Slade, 2005); to be able to put themselves in their child’s shoes; and to help with basic parenting skills.

I think that the most important thing to remember that the vast majority of parents are doing the best that they can with what they have. It’s such an important area of intervention for infants that has huge implications for the future health of our communities., and is still under-recognised and under-funded.

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At work, I use attachment theory to guide my clinical practice, and in my new work as a mother, I have been observing this every day, so I thought it was about time that I wrote about it.

Attachment, in child psychiatry, refers to a quality of the relationship beytween an infant and her mother (I’ll say mother as that is the usual attachment figure, but it could be the father or other primary caregiver). John Bowlby and Mary Ainsworth are the two people most associated with this.

                                                                                                                                                                                                                                         Bowlby studied juvenile delinquents in the early 1950s and believed that delinquency (antisocial/psychopathic traits) was associated with maternal deprivation, or being separated from their mothers at an early age. He also looked to work that had been done in the animal kingdom such as baby animals following adult animals around to ensure survival (imprinting). He concluded that infants have an inbuilt attachment system — activated at times of stress — to ensure that they stay close to their mother for physical survival.  

The idea is that the mother’s response to an infant gives the baby an internal working model of relationships. It’s as if they file away the expectation of what will happen when they are distressed and how their mother will respond. A mother who is warm, empathic and responsive to her baby’s cries teaches that baby trust and security.

Mary Ainsworth worked under Bowlby, mainly at the Tavistock clinic, and developed a laboratory ‘test’ called the strange situation to categorise attachment styles. This involves a room with video cameras, a 12 month old infant, her mother, and a ‘stranger’. The infant is exposed to increasingly stressful situations while being filmed, eg being left alone with the stranger. The child’s reaction to this stress, and behaviour on reunion with their mother, is analysed to put them into one of 3 categories:

Secure

The infant gets upset when mum leaves the room, seeks comfort when they are reunited, settles quickly with mum, and goes back to play.

Insecure – avoidant

The infant doesn’t show she’s upset when mum leaves the room, is distant when mum comes back in and doesn’t cling to her.

Insecure – ambivalent

This infant is often anxious even before  mum leaves, and becomes very upset when she goes and doesn’t settle. When they are reunited, the child is angry yet clingy and difficult to console.

What is the significance of this?

Studies have shown that the attachment style at 12 months is predictive of the attachment relationship throughout childhood and into adulthood. Our own attachment style generally predicts the attachment relationship that we will have with our own children. Insecurely attached children/adults have higher rates of mental health disturbance and social and emotional difficulties; a secure attachment is protective.

At the moment, I can’t leave the room without A crying, crawling after me and clinging to my leg. Last week, we went to dinner at a friend’s house. When we first got there, A took a look around and cried while clinging to me. AFter 5 or 10 minutes, she settled and started to explore, though if she became too stressed, she’d crawl back over to me for some reassurance. When A cries, and I respond, I know that I am teaching her that I am a secure base for her. Sadly, in our society, we seem to value children who don’t cry or protest – those with avoidant attachment styles. How many times have you heard “Oh, she’s a good baby – she’ll go to anyone, she hardly cries!” It is normal and desirable for babies to cry, and they should be clingy and wary of strangers. This is the way they have been designed so that they can survive. This is attachment at work.

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‘Nighttime Parenting: How to get your baby and child to sleep’ by William Sears (La Leche League International book)

Penguin, 1999 (Revised edition)

Dr Sears makes a very valid point in this book when he says that “sleep problems occur when night waking exceeds your ability to cope”. In contrast to much of the parenting advice which says what your child ‘should’ be able to do, Dr Sears is refreshing as he emphasises that your night waking child is normal, and discusses ways to increase your ability to cope with it rather than ‘train’ the child.

Dr Sears is a paediatrician and a father to eight children, and strongly advocates for ‘attachment parenting’ as opposed to ‘detachment parenting’. After birth, this involves breastfeeding, child led weaning, co-sleeping, and responding to your baby’s cries promptly (as well as other emotional commitments and preparation). He is opposed to letting babies ‘cry it out’ or enforcing routines onto infants, which is a reason why this book resonated with me.

In terms of his advice about sleep, he begins by explaining the basic science of sleep and how it differs between adults and parents, and why babies wake at night. As well as listing possible medical causes, he explains the survival and developmental triggers for waking. In contrast to the advice that most mothers — including me — were given, he encourages us to ‘parent’ our children to sleep, whether that be by rocking or breastfeeding, and he also strongly suggests that we sleep with out babies in our beds.

This book is written in simple, gentle, encouraging language and it certainly gave me a feeling of peace and reassurance. Dr Sears states clearly that our culture’s expectations of infant sleep are too high, and that as parents we must expect to rearrange our lives to cope with night waking. There is some sensible advice about ways to stop night feeding, and a great chapter reminding fathers of their role in parenting.

I am not sure how helpful this book would be to someone who was not breastfeeding, as one of his main suggestions feeding your baby back to sleep, and there is no discussion about bottle fed babies. His other big suggestion is bringing baby into your bed, and for families who are not willing to do this, it may again have limited use. This clearly is aimed at parents who are not looking for a quick fix, and unfortunately, so many parents now have expectations which are just too high.

However, for mothers who breastfeed and are opposed to parent-led routines, and know that it is not right to leave your child to cry, it is a lovely book which affirms and reassures you that your instincts are correct. Dr Sears reminds us that the long term gain for your child from responding to her cries is worth the sleepless nights.

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Do working mothers raise couch potato kids?

It was reported in the news last week that ‘children are healthiest when mother works part time’ A study done by NSW’s University of New England found that children of mothers who worked part time ate less junk food, watched less television, and were less likely to be overweight compared to those whose mothers worked full time or were stay at home mums.

At first glance, this could make sense if we think about mothers who work full time as they probably have less time to cook and do activities with their children. Part time mothers, it could be assumed, are more likely to ensure that the time they do spend with their children is of higher quality.

In that case, why would stay at home mothers have unhealthier children? Perhaps when you are at home full time with your children, you are overwhelmed with them and it is easy to stick them in front of the television to give yourself a break. But why would they eat more junk food and be more obese?

The news reports have assumed that there is a causative relationship, ie, that staying at home full time leads to unhealthy children. However, it is probably more likely that there is a factor which is common to both being a full time stay at home mum, and unhealthy children, that hasn’t been examined (a confounding factor).

For example, we know that people of lower socioeconomic status and with lower incomes are more likely to be overweight, obese and unhealthy. It is not clear from the reports on this study whether the mothers were working before having children, or what income or educational achievements they had. Perhaps mothers are at home full time because it makes no financial sense for them to work once they factor in childcare because their income is low. Or, if they have no specific ‘career’ and worked in unskilled jobs, giving up work may not be as difficult a decision for them. So, it may appear as if being a stay at home mum causes childhood obesity, but the reality may be that there is a casuative factor common to them both.

There are more details that are important too: are the parents overweight and how much television do they watch? For working mothers, who is caring for the child while they are at work? A child in day care is less likely to watch television (I assume that child care centres don’t switch on televisions) that one being looked after by a family member. And where are the fathers? Are mothers working full time because they are single parents? This would make it more likely that they have lower incomes, which again is a risk factor for obesity.

It’s easy to see the results of a study like this reported and make assumptions. Mothers have enough to deal with without headlines making them feel guilty and inviting the wider community to make judgements on their work choices.

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