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(I pasted the entire article, in two parts, instead of the weblink to the article. It was not a permitted link for this forum.)

Attachment 101, a Primer for Parents
(and Suggested Readings)
How Attachment Relationships Impact Brain Development

As a prospective adoptive parent, the extent of my understanding of attachment could be found in a single line in Webster's: the bond felt between two people. I was dimly aware of dire stories of adopted children who were not able to bond, but the anecdotal information was overwhelmingly on the side of children bonding easily to their new parents. My sense was that attachment would happen intuitively, easily, and inevitably.

Ten years later, as the parent of one well attached child and one insecurely attached child, I have a much more complete understanding of the attachment process, the subtle signs of attachment problems, and the repercussions of attachment disorders. I've learned first hand that many adopted children indeed struggle with forming secure attachments, despite the best and most loving intentions of their parents. And I've seen how parents regularly miss the signs of impaired attachment, even as their children struggle with emotional, social, and learning issues.

While adoptive parents might be attentive to signs that a child is bonding, bonding is only a piece of the attachment profile. The red flags indicating attachment problems are often missed because they are subtle, counterintuitive or masquerade as typical development. For instance, it is extremely common for newly adopted infants and children to experience sleep problems, which are usually expressions of insecurity, grief, terror, or lack of control. Sleep issues in adopted children are best addressed by making extra efforts to reassure, whether by co-sleeping or otherwise meeting emotional needs. And yet parents routinely let children cry it out alone in the interest of fostering independence, often at the advice of friends, pediatricians or social workers. This advice might make sense for the securely attached but for those elsewhere on the attachment continuum it can impede attachment and generate further emotional difficulties.

Our children require extra sensitivity in evaluating their behaviors. In many ways they are not like the general population of non-adopted children and addressing behavior requires a different set of strategies. Certain maladaptive traits are over-represented in adopted children. In addition to sleep issues, our children commonly exhibit issues around food and eating, hoarding or difficulty with sharing, anxiety, emotional hyper-reactivity, hypervigilence, hyperactivity, problems with memory, concentration or attention, and fears of abandonment. Yet to address these issues without considering the critical element of attachment history is to miss what is central in their etiology.

I believe that adoptive parents need a more informed understanding of attachment, especially those who assume that attachment just happens more or less naturally. Sometimes what comes naturally, instead, are maladaptive responses, crystallized during a period of critical brain development and traumatic experience. Adopted children come to us with largely unknown, often difficult histories that can impact their emotional health, cognition, social competence, and ability to form healthy and happy relationships throughout their lifetimes. We need to understand this, recognize that these problems stem from a time before we were in the picture, and learn strategies to help our children develop into secure, emotionally healthy people.

So what IS attachment? At its most basic, it is the child's primary bond to her first caregiver, which becomes the template for all future relationships. But it is also a critical internal system for dealing with stress. Typically the foundation for this system is laid through the formation of attachment during the first year of life. Most adopted children today come to us as older infants or children without secure attachment histories, via institutional care or multiple disruptions in caregivers. This means that most of them experienced ruptures in the attachment process or never had the opportunity to form secure attachments or, by extension, an effective stress regulation system.

Can secure attachment, and a healthy stress regulation system, be formed after an insecure attachment history? Yes, but there are also ways in which early experience can derail their development, no matter how competent and loving the care afterwards. To understand this, it's necessary to look at how the infant brain develops.

At birth, the brain and central nervous system are very immature, a kind of primitive armature to be fleshed out by subsequent experience. Experience is what organizes the complex set of systems that are the brain and central nervous system. Many of the newborn's internal systems do not automatically self regulate, and one of the primary developmental tasks is to begin the regulation of these systems. This is accomplished through an emotionally attuned, committed caregiver who consistently responds to signals from the infant.

Initially, the states of the infant are as simple as being stressed or not stressed, expressed through crying when hungry, wet, tired, or startled, or calm when all is well. When an infant is stressed, there is a corresponding physiological response: stress hormones are released in her system, heartbeat races, muscles tense, breathing accelerates. If a caregiver doesn't respond quickly, stress escalates until the infant becomes overwhelmed as she is not instinctively able to regulate her stress to tolerable levels. By responding soothingly, the caregiver helps to bring the infant back into equilibrium.

What is happening neurobiologically in this exchange is that the infant's dysregulated state starts aligning with the caregiver's regulated state. With repetition, calming communication both verbal and nonverbal (soothing sounds, gentle touch, loving looks and body language) activates neural firings that become imprinted in the infant's brain. The firing neurons of the infant start mirroring the neural patterns of the caregiver. In this way, over time the caregiver effectively downloads her own stress regulation system into the infant's developing brain.

In optimal situations, emotionally attuned caregivers positively shape the stress regulation system of infants. But if the caregiving is inconsistent, neglectful, or abusive, the infant is left to fend for herself in a totally dysregulated state of growing stress, which can have devastating long term emotional, neurological and physiological impact. Often the only relief from this overwhelming and unendurable state is an emotional numbing and withdrawal called dissociation. Dissociation in infants is a key predictor of future Post Traumatic Stress in children.

Healthy stress regulation systems prepare children to meet a range of challenging and stressful events without becoming overwhelmed. Over a lifetime, emotionally healthy individuals draw on this internalized system to tolerate both normal daily stress and larger, more catastrophic stress. The ability to moderate stress to tolerable levels is key to emotional health and resiliency. The absence of healthy stress regulation results in individuals who are easily overwhelmed or who respond in maladative ways.

Many of our children endured chronic neglect, trauma, even abuse as infants. The typical orphanage structure is one where the emotional needs of babies go summarily unmet as staff concentrates on meeting basic standards of care. Many institutions do their very best with limited resources and actively attend to physical, nutritional and medical needs. But emotional need is less well valued or fostered. These infants rarely benefit from the consistent, attuned, devoted attention that most infants in biological families receive on a daily basis. Even in the best orphanages, infants are routinely left physically and emotionally alone for long stretches of time during a period of critical brain development.

Although it is tempting to postulate that infants who are fostered fare much better, the reality is that they often experience sub-optimum care as well. In theory, foster care is a better context for consistently meeting emotional needs, and for some fortunate children this is borne out by their secure attachment and emotional health. However, far too often foster care provides a similar set of traumas. Sometimes foster parents are only part of a rotating matrix of care, taking a child for a time before she is returned to the orphanage until adoption, creating new trauma. Fostering might mean that a caregiver brings an infant home at night, while she spends her days with her emotional needs unmet in the institution. Or a foster family might tend to multiple infants in the home, replicating on a smaller scale the group care of orphanages. Sometimes foster parents are just plain inattentive, inept or abusive. The result is that many children who were fostered come to their adoptive homes with the same range of trauma and neglect issues that are found in post-institutionalized children.

Not only do these infants fail to benefit from consistent, warm, emotional interaction and stimulation, they fail to learn effective stress regulation and they experience a form of trauma. Many of us are used to thinking of trauma as acute, one time events that are highly stressful to experience but which then resolve. For an infant, chronic neglect is experienced as ongoing trauma without resolution. Minus the moderating influence of a healthy stress regulation system or an attuned caregiver, the neurobiological response to neglect can permanently alter the biochemistry of the brain, creating a lifelong hypersensitive response to stress.

Emotional neglect has other physical manifestations in developing neurology. The neurobiological responses to neglect and trauma can become embedded in the emerging personality, creating a distorted lens through which the world is viewed. Innate personality can be trumped by the superimposition of maladaptive response, resulting in children who are unusually prone to a host of traits. How many of our children can be described as strong willed, bossy, controlling, easily frustrated, anxious, lacking self-esteem, emotionally immature, or experiencing learning issues? There is a disproportionate intersection of these characteristics in kids with histories of neglect, trauma and poor attachment.

The parts of the brain that are coming online in the first six months or so are in the limbic system, which processes emotions and emotional regulation, memory and the emotional meaning of events, and social cues and responses. High stress experiences during this stage of infancy can profoundly impact a child's ability to self regulate, trust others, read social cues, and understand her own internal experiences. Stressed infants often go on to have classic attachment difficulties affecting mood regulation, behavioral control, interpersonal relationships, cognitive abilities, self concept, and physical health.

One of the challenges of addressing issues that stem from early neglect and trauma is that in the first several months of life, experiences are processed by the preverbal right side of the brain, which develops first. Traumatic experience can become embedded as part of subconscious, implicit emotional memory that can later be triggered by simple emotions, sensations, or events. Meanwhile the left side of the brain, where verbal, logical, explicit memory resides, comes online later.

In kids with preverbal trauma experiences there is often a disconnect between implicit memory and explicit memory. In effect, the two sides of the brain can't communicate and can't integrate traumatic experiences, which makes it nearly impossible to process them and move on. Early experience may have molded a child to be emotionally hyper-reactive in ways that she has no way of logically understanding. She may have trouble interpreting the meaning of events or her own internal states, which will impact her sense of herself, her social relationships, as well as memory, concentration and attention.

This is the reason that many attachment impaired kids don't respond well to traditional parenting techniques such as time outs. A parent may issue a time out as a way to "teach a lesson" about cause and effect. But attachment impaired kids have poor cause and effect reasoning, and might instead be catapulted back to a time of great stress, reflexively responding by becoming severely dysregulated.


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