Attachment problems are common in child who’ve suffered trauma in their early lives. This article written by Dr Kate Mason (BSc. Hons, DClinPsy), a Chartered Clinical Psychologist, sheds some light on what causes attachment issues and how parents and carers can provide support.

Dr Mason is based in the Midlands and together with her colleague, runs Roots Psychology Group. The practice provides treatment and training to support children and young people. Click here for full details of the services they provide.

Developmental Trauma

Developmental Trauma occurs when an individual is exposed to multiple traumatic events with an impact on immediate and long-term outcomes.​ When complex trauma occurs in childhood, with early onset,​ is chronic and prolonged,​ within the family (interpersonal) and has an impact on development, this can result in developmental trauma​. As a result of these experiences it can create attachment difficulties.

Children with attachment difficulties have had difficult early experiences and as a result they may have developed core beliefs about themselves, other people and the world. For example, ‘I am bad’ or ‘I am unlovable’ – ‘You will be unreliable’, ‘You will abandon me’ ‘the world is not safe’.

These core beliefs are easily stirred during typical parenting scenarios; such as being asked to tidy up, being told to wait for attention, going off to school or to bed. The behaviours that these children demonstrate get tangled up with the core fears they hold about themselves. If not mindful of this then traditional behavioural strategies can reinforce these core fears, further increasing insecurity and leading to increased challenging behaviour.

For example time-out or the “Naughty Step” is a traditional method of helping a child learn to manage their behaviour whereby the child is placed apart from the parent for a period of time. Imagine, however, how easily this might trigger fears of ‘you do not love me’ and ‘you will leave me’ for a child who holds deeply entrenched fears of being abandoned.

The child learns not that their behaviour is naughty, but that they are naughty – their behaviour and sense of self is interwoven. This leads to increased distress that the child then struggles to communicate, and therefore is expressed in even more challenging behaviour.

Traditional parenting

Think about how we traditionally exert influence on children. We tend to try and correct their behaviour through traditional methods such as time in/out, ignoring, rewards, problem solving, explaining, reasoning, grounding, subtraction of privileges, distraction/diversion. These methods are based on social learning theory – the idea that children will increase or decrease their behaviours though rewards and punishment. Correction (not punishment) in this context is the idea that parents can guide their children to behave in ways considered acceptable, fitting in with parents values and beliefs as well as cultural norms

Securely attached children have an experience of being loved unconditionally – they know they are loved even if things go a bit wrong sometimes. They trust and believe in emotional connection and although they may resist correction, they are more likely to accept it because they have built a secure base with their caregiver. They’ve therefore developed the solid foundations to feel safe enough to trust that their caregivers have their best intentions at heart.

Children who have been hurt, rejected, neglected and/or experienced separation and loss of parents early in life do not have an emotionally secure base. For these children, the social learning-based approaches are less helpful because they are centrally focused on behaviour, and therefore less focused on building trust and security with parents (connection).

Insecure children are not organised by Social Learning Theory. They are organised by increasing their sense of safety and security so will behave in ways which help them achieve this and we may therefore see illogical or aggressive behaviour. Therefore, when parenting children with attachment disorder the focus needs to be more on connection to build security and trust BEFORE we can correct behaviour

Attachment focused parenting combines the social learning ideas of traditional parenting interventions with ideas more centrally focused on building emotional security and helping children to heal from past trauma and loss. This parenting tends to focus on building security through higher levels of warm and empathic nurturing, greater attention to emotionally connecting with the child, and helping the child to experience love that is unconditional alongside the behavioural management that is always going to be a core part of parenting children.

Trauma and the brain

Developmental trauma can have a significant impact on the brain both psychologically and physically.

We all have a “social monitoring system” in our brain which detects how safe we are in a given environment. For children with early trauma their system is sensitized by early experience of maltreatment and so their development is organised around a central nervous system that’s prepared for danger​.

The brain develops from the bottom up – at the bottom we have the brain stem which is vital for survival and controls our automatic responses e.g. breathing, temperature control, heart rate, hunger, sleep etc. The brain stem is fully developed from birth and is not experience dependant.

Our mid-brain or Limbic area is our brains “smoke detector” and houses our Amygdala which controls our fight flight system – it’s our emotional centre and connects high and low parts of the brain​ alerting us to any threats and helping us to react to them.

The last area of the brain to develop and the most crucial part in the context of trauma is the Cortex. A fully developed Cortex allows a person to develop highly skilled abilities such as the ability to reflect, be able to think in an abstract way, to make decisions, plan, problem solve and reason. It is also related to memory, attention and impulse control.

This part of the brain is experience dependant which means in order for it to fully mature and develop, it relies on the caregiver to provide the infant with positive experiences of the world. Safe and supportive interactions with other people and experience of themselves​ through empathic, nurturing relationships.

Negative experiences

Negative experiences impair brain development. Children who experience frightening parenting ​become “amygdala driven”. ​ When a child perceives or is on the lookout for danger persistently, this causes higher and prolonged levels of cortisol to be present in the bloodstream, resulting in toxic stress. This may cause the prefrontal cortex to be underdeveloped. The result doesn’t just change brain functioning. It can actually change the brain structurally too.

​Trauma effects our ability to think – it shuts it down​. The typical child will spend little time focused on survival and can devote most of their waking time to cognition and social-emotional functioning. For a child who has experienced developmental trauma, the majority of the brain’s attention is focused on survival, leaving little left for cognition and social relationships.​ They become more concerned with staying alive and so become more brain stem driven essentially “closing off” higher functioning areas of the brain.

The child becomes highly alert for signs of rejection, anger and abandonment. They may walk into a room and immediately feel threatened. This explains why some children may react intensely and misinterpret neutral facial expressions, body language and language of others as being threatening.

Concept of shame

Shame is a complex emotion that develops later than the development of more straightforward emotions such as anger, joy or sadness. Usually around the same time that parents are providing more boundaries and discipline because children are becoming more mobile​ and need this to keep them safe. Shame is uncomfortable for children who learn to limit behaviours that induce it.

We all need appropriate doses of shame and children require support and reassurance to help them manage this. Shame is protective and helps children to learn socially acceptable behaviour to develop relationships.​ Eventually through support and guidance, shame tends to be short lived and the child will quickly move from shame to guilt which in turn moves children into a position where they wish to make amends ​and be open to repairing the relationship.

​Children need boundaries and behaviour needs to be corrected. However, it’s vital that a relationship is repaired by the caregiver after these corrections have been put in place. Children who don’t experience this repair will experience unregulated shame that overwhelms them and becomes toxic.

If children are continually punished and the caregiver does not communicate with the child that despite there being a slight break in the relationship “we are still ok”, this can lead to shame becoming part of their core-identity. “I am a shameful/bad person”, this leads to chronic anger (defensiveness) and controlling behaviours – they feel alienated and defeated and never quite good enough to belong.

As a result, children experience difficulty regulating emotion and thinking rationally (cortex area of the brain) and are thus unable to respond flexibly or to control impulses. Brain areas shut down to protect them from these painful feelings.

Children therefore need to develop defences against overwhelming shame. They may lie, blame others or minimise what’s happened in order to avoid accepting their reality that they are innately “bad”. If they become so terrified, they will display aggressive physical behaviour. Traditional behavioural management strategies served to a child who has an overwhelming sense of shame will only increase this shame.​ If caregivers are able to connect with a child’s emotional experience this will help regulate shame.​ As anxieties, worries and fears are understood, these defensive behaviours start to reduce.​ Connection before correction reduces shame and improves behaviour.​

Therapeutic parenting

Kim Golding, is a Clinical Psychologist in the UK who further developed Dan Hughes’ parenting programme adopting the attitude of PACE. She talks about therapeutic parenting being that which provides healing from trauma as well as behavioural support.

It’s a dual task of building trust and providing boundaries and discipline. It’s not the same as therapy but is more of an attitude, a way of being rather than a strategy or technique that you can turn on and off when needed. These children have experienced prolonged trauma that has shaped them over time and created a blueprint for how they see the world.

An analogy we use in our training is that when you’re a child, you learn to ride a bike through repetition and practice. Eventually this becomes second nature – you don’t need to think about the ‘how’s’ any more you just subconsciously know.

In this context, with children who have learned that the world and the people in it are frightening, when we are offering caring, sensitive parenting, it’s like we’re trying to ask them to “unlearn” how to ride that bike. Its alien to them. This way of relating to the world is all they’ve known and has become part of who they are. Iit’s not a quick and easy task.

A therapeutic parenting approach we use is PACE which stands for Playfulness, Acceptance, Curiosity and Empathy. Developed by Dan Hughes in the United States, PACE is a central component within Dyadic Developmental Psychotherapy (DDP). It’s an attitude to help parents connect with their children. Through a playful, highly accepting, curious and empathic approach, care givers can more deeply connect with their child’s internal experience. This is the foundation for healthy relationships and the development of attachment security.

PACE focuses on the whole child, not simply the behaviour. It helps children be more secure with adults and reflect upon themselves, their thoughts, feelings and behaviour. The child discovers that they are not “bad” and that trust can be developed in a relationship and enjoyment in that relationship can be reciprocal.

Playfulness

A playful attitude conveys optimism that things can change.​ It demonstrates that the child is experienced positively as the caregiver experiences a joyful fascination with the child.​ We can notice the strengths and uniqueness of the child and take pleasure in these.​

By sharing giggles and laughter we can be mindful of the joy of parenting and the child experiences the relationship as unlike past experiences, with unconditional acceptance.​ The child experiences having a positive impact on the other person which builds to provide experience of reciprocal enjoyment within the family.​

Acceptance

This is about accepting and not evaluating wishes, thoughts, feelings, beliefs and desires of the child.​ Acceptance means becoming aware of and understanding the inner life of another without trying to change it or coat it with our own ideas about the situation.

By accepting a child’s feelings (no matter how seemingly out of context/proportion they are) demonstrates that their inner life is safe with the caregiver. We are not judging, nor trying to change this inner experience. ​ By accepting we are also reducing shame​.​

Curiosity

Curiosity is an attitude of not knowing. It’s a tentative wondering coming out of the experience of child.​ It’s the search for alternative stories about events, conversations and actions.

​If we’re not curious, we make rapid judgements leading to non-reflective action which can shut down our ​relationship with another. And quite often means we get a completely different story to that of the child because we have put our own judgements on it.

Empathy

Empathy is the ability to “feel” with someone. With empathy, when the child is sad or in distress, the adult is feeling the sadness and distress as well and communicates that they know how difficult this experience is and that they are there to support them through it.

Through empathy we build relationships and make connections.​ When we express empathy, we are expressing our understanding of the other.​ The adult is also communicating strength, love and commitment, with confidence that sharing the child’s distress will not be too much. Together they will get through it.

As much as we’d like to, we can’t directly change a child’s experience, or the way it is communicated through language or behaviour. But what we can do is change our response to it.​ If caregivers respond differently, over time they will notice the child change the way they behave or communicate.​

It can be difficult to maintain a PACE-ful stance all of the time and caregivers need to exercise some self-compassion at times when parenting is hard. If caregivers can adopt the stance of PACE most of the time, they can reduce the intensity of conflict, defensiveness and withdrawal that tends to be ever present in the lives of developmentally traumatised children. Using PACE enables the caregiver to see the strengths and positive features that are so often masked by negative and challenging behaviour.

Through PACE and feeling safer, children learn to rely on adults, particularly their parents, and trust them to truly know them. They learn that their parents can look after them in a way that they could never do on their own.

 

Recommended Reading:

Everyday Parenting with Security and Love: Using PACE to Provide Foundations for Attachment , Kim S. Golding, London and Philadelphia, Jessica Kingsley Publishers, 2017

Creating Loving Attachments: Parenting with PACE to Nurture Confidence and Security in the Troubled Child. Jessica Kingsley Publishers, 2012

 

 

 

 

 

 

 

 

 

 

 

 

 

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