Attachment Disorganization in Childhood

Attachment Disorganization in Infancy and Early Childhood

Organized insecure attachment patterns in children, such as the anxious-resistant pattern and the anxious-avoidant pattern, are characterized by the anxiety reduction strategies that underlie them. For example, the anxious-resistant pattern is characterized by hyperactivating strategies comprised of persistent, sometimes hyperbolic, pleas from the child for the attention, and proximity of caregivers. The anxious-avoidant pattern, meanwhile, is characterized by deactivating strategies, the angry dismissal of attachment figures (Cassidy & Mohr, 2001). Attachment disorganization is distinguished from the two aforementioned patterns of insecurity in that young children exhibiting attachment disorganization, though clearly insecure, seem to lack a specific strategy for coping with that insecurity (Hesse & Main, 2006). Main and Solomon (1990) described the behavior of one such infant in the following manner:

One infant [upon reunification with a parent in a strange situation scenario] hunched her upper body and shoulders at hearing her mother’s call, then broke into extravagant laugh-like screeches with an excited forward movement. Her braying laughter became a cry and distress-face without new intake of breath as the infant hunched forward. Then she suddenly became silent, blank and dazed. (p. 119)

The Caregiving Environment and Attachment Disorganization

Cassidy and Mohr (2001) suggested that the fear-based behavior displayed by young children exhibiting disorganized attachment patterns stems from the highly problematic quandary into which such children are placed. They noted:

…disorganized infants are placed in the impossible situation of fearing the very figures upon whom they rely for protection. Thus, in contrast to the solvable fear faced by secure, avoidant and resistant babies, disorganized babies face fear without resolution. The breakdown in attachment strategies resulting from unsolvable fear is reflected in behavior that appears more pathological than the organized behavioral strategies seen in avoidant and resistant infants…. (p. 285)

Disorganized Attachment and Developmental Risk in School-Age Children

The behavior associated with attachment disorganization tends to change from contradictory and atypical patterns in infancy (described above) to controlling patterns of behavior as children approach school age. Although approximately 30% of children identified as disorganized in infancy continue to display atypical behaviors into early childhood (Cicchetti & Barnett, 1991), approximately 66% of such children develop controlling punitive, controlling caregiving, or a combination of these two strategies by age 6 (Moss, Cyr, & Dubois-Comtois, 2004). Controlling punitive patterns are characterized by attempts to direct parental behavior and attention through shaming and hostility, whereas the controlling-caregiving pattern involves radical role reversal, in which the child attends to parental needs with obsequious attentiveness (O’Connor, Bureau, McCartney, & Lyons-Ruth, 2011). The shift from atypical to controlling behaviors for the majority of children classified as disorganized in childhood likely reflects children’s emerging competence in language, cognition, and executive function. These new skills allow children to cope with parental messages of helplessness, fright, or hostility in new ways (Dubois-Comtois, Cyr, & Moss, 2011; Lecompte & Moss, 2014).

Despite the integration of new strategies into the disorganized children’s repertoire of coping in dysfunctional parent–child interactions, children classified as disorganized in infancy continue to face challenges later in life. In a longitudinal study measuring the quality of parent–child interactions and child well-being at ages 5 and 7 (n = 242), Moss et al. (2004) found that children classified with disorganized subtypes had poorer parent–child interaction patterns than children classified as either secure or organized-insecure. Further, children classified as controlling punitive were found to have increased stress over the 2 years between preschool and school age compared to other groups. Controlling-punitive children displayed higher externalizing difficulties (i.e., problems stemming from anger or aggressive behaviors), and controlling-caregiving children displayed more internalizing problems (i.e., difficulties associated with anxiety, depression, or social withdrawal) than the secure group of children at age 7. In similar research, O’Connor, Bureau, McCartney, and Lyons-Ruth (2011) conducted a longitudinal study assessing several aspects of relational and intrapersonal wellness in secure, organized-insecure, and disorganized children at age 36 months and again at age 54 months. Results indicated that at age 36 months, children displaying disorganized subtypes had more maladaptive mother–child interactions and more difficulties with social adaptation (e.g., peer cooperative play and other prosocial behaviors) than comparison groups of both secure and organized-insecure children. At 54 months, disorganized children displayed higher levels of internalizing (e.g. anxiety and depression) and externalizing problems (disruptive or aggressive behavior), both at home and at school, than children in secure and organized-insecure comparison groups.

It is important to note that although most children with attachment disorganization adopt more sophisticated methods for coping with fear-inducing parental behaviors by the time they reach school age, the fundamental uncertainty associated with fear of caretakers remains a distressing impetus that guides children’s behaviors. Dubois-Comtois, Cyr, and Moss (2011) conducted a longitudinal study in which the attachment style of 83 children was assessed at age 5.5 and was followed by an assessment of children’s attachment representations at 8.5 years of age. Attachment representations were assessed utilizing story stems designed to activate children’s attachment systems (e.g., stories about a hurt knee, a scary noise in the bedroom, and parent–child separation and reunion). Notably, children who displayed disorganized-controlling behavior at age 5.5 displayed attachment representations at age 8.5 who were marked by fear and chaos and in which parents were often portrayed as untrustworthy. These findings are similar to those that emerged in earlier research. Bureau, Easlerbrooks, and Lyons-Ruth (2009) found that children classified as disorganized-punitive at age 8 (many of whom had been classified as disorganized in infancy) displayed disorganized attachment representations in response to story cards depicting parent–child separation. The researchers noted that though these children had developed highly controlling and punitive stances toward caregivers, their attachment stories contained themes that were fearful, emotionally dysregulated, and bizarre. The results of the two aforementioned studies suggest that even after children develop more sophisticated ways of coping with fear of caretakers, a deep sense of insecurity pertaining to parental predictability and stability remains a component of school-age children’s working models.

Disorganized Attachment and Developmental Risk in Adolescence

The effects of attachment disorganization in infancy and early childhood tend to persist into preadolescence and adolescence. Lecompte, Moss, Cyr, and Pascuzzo (2014) assessed the association between early life (i.e., preschool age) attachment style and the development of self-esteem, anxiety, and depressive symptoms in preadolescence (age 11–12). Preadolescents who displayed attachment disorganization in preschool scored higher on measures of depression and anxiety and lower on a measure self-esteem than groups of preadolescents classified as secure or organized-insecure at 3–4 years of age. Lecompte and Moss (2014) examined the association between early school-age attachment style and externalizing problems in adolescence. At age 13, children who had been classified as disorganized at age 5–6 were found to have more difficulties stemming from externalizing problems than secure children. Of the three disorganized subtypes, children classified as controlling punitive at early school age reported the highest levels of difficulties stemming from aggression and behavior problems. Lecompte and Moss (2014) speculated that the behavioral patterns designed to humiliate parents into submission displayed by children classified as controlling punitive at early school age may account for the higher levels of externalizing problems encountered by these children in adolescence. They noted that the hostile and directive behavior utilized by controlling-punitive children at early school age was likely to continue to be utilized by these children in subsequent relationships, such as those with teachers and authorities. The authors suggested that this pattern might account for the increase in reported externalizing problems for this subgroup.

There is evidence that suggests that the impact of attachment disorganization in early childhood persists into late adolescent and early adulthood. Carlson (1998) found that attachment disorganization in infancy predicted behavior problems in preschool, elementary school, and high school. Moreover, early life attachment disorganization predicted significant difficulties pertaining to psychopathology (dissociation in particular) at age 17.5 years. Jacobsen, Edelstein, and Hofmann (1994) examined the association between early life attachment disorganization and ability to engage in complex reasoning in late adolescence. They found that children who had exhibited attachment disorganization at age 9 exhibited significant delays in ability to engage in sophisticated reasoning at age 17. The researchers noted that anxiety and poor self-esteem appeared to have mediated disorganized adolescents’ ability to engage in complex reasoning.

Clinical Interventions: Helping the Child by Helping the Parent

It is noteworthy in considering the place of parental internal working models of self and others (i.e., cognitive and affective patterns that guide how one experiences, interprets, and predicts interactions with others) in counseling involving a disorganized child, that disorganized parental behavior is a very strong predictor of attachment disorganization in children (Wang, Cox, Mills-Koonce, & Snyder, 2015). Moreover, failure to address this link in counseling can perpetuate the difficulties experienced by the child. Indeed, Hesse and Main (2006) hypothesized that dissociation resulting from the unresolved trauma of parents likely plays a role in the etiology of child attachment disorganization. They noted that parental dissociation may result in a variety of frightening behaviors manifesting unpredictably in parent–child interactions, as parental states of mind fluctuate. The accessing of separate and unintegrated memories during transient dissociative periods may lead a person to experience sudden and significantly altered states of mind in response to anxiety cues, much to their own confusion and to the confusion to those around them (McWilliams, 2011). In situations in which parents are interacting with children, parental dissociative states may lead to circumstances in which a child is unable to predict parental responses in parent–child interactions, as unresolved trauma memories are accessed and acted upon.

Research pertaining to parental states of mind (i.e., working models) has clarified how some parents of children with attachment disorganization struggle in the caretaking role. Lyons-Ruth and Jacobitz (2008) noted that the contradictory and fragmented nature of the attachment narratives of parents with disorganized children is consistent with transient states of dissociation; trauma memories and related alterations in parents’ working models manifest in response to anxiety triggers (see also, Hazen, Allen, Christopher, Umber, & Jacobitz, 2015). Sroufe (2005), in explaining the manifestation of dissociative symptoms in adults with a history of early life attachment disorganization, noted:

In infancy, in the face of confusing or frightening caregivers, these children had been confronted with the irresolvable conflict of striving to flee from the source of fear and yet flee to the source of fear-the caregiver. Collapse of strategies, rapid state changes, and other proto-dissociative mechanisms were all that were available to them. Thus, a prototype of psychic collapse or segregating of experience [as a mechanism of escape] was established. (p. 361)

Parental State of Mind and Treatment Planning

Due to their central contribution to the development of attachment disorganization in children, the unresolved trauma experiences of parents need to be addressed when considering the therapeutic needs of disorganized children (Mannassis, Bradley, Goldberg, Hood, & Swinson, 1994; van Ijzendorn, 1995; Wang et al., 2015). In addressing the needs of parents with unexplored trauma histories, counselors must assist parents in acknowledging the occurrence of the traumatic experiences and in reflecting on how these experiences may have shaped their internal working models of self and others, as they pertain to their children (Bowlby, 1988; Hughes, 2007). This involves helping parents to gain recognition of, and agency over, terribly painful historical experiences that have impacted their ability to provide caretaking for their children, but that have remained unresolved, meaning wordless, timeless, and without context (Wallin, 2007). Depending on the severity of abuse histories, and the degree to which previous trauma has been resolved, parents may need to spend a significant amount of time in individual counseling preparing for participation in family counseling with their children (Hughes, 2007). This work may include helping parents to identify feelings and cognitions associated with the trauma, helping parents to learn to regulate autonomic and affective arousal, and helping parents to recognize and respond intentionally to high-risk situations that have previously lead the parent’s state of mind to fluctuate (Rothschild, 2000).

Wallin (2007) noted that successful therapeutic outcomes with unresolved clients requires the maintenance of a stable, predictable, and secure therapeutic alliance. He hypothesized that over time, as the therapeutic alliance between counselors and unresolved clients remains predictable and secure, even in the face of rapidly changeable client states of mind with regard to the counselor and the counseling process, clients begin to develop secure working models of self and others in the context of the therapeutic alliance. These new models compete with rigid or unstable models developed in insecure relationships earlier in life. This process helps position parents to provide a secure and predictable relationship for their children.

In working initially with unresolved parents, it is important for counselors to be aware that the quality of the therapeutic alliance between the counselor and the parent may be somewhat unstable. Wallin (2007) and others (Gubman, 2004; Liotti, 2011) have noted that counselors should be prepared for unexpected fluctuations in the strength of the therapeutic alliance, as unresolved clients’ unintegrated and conflicting models of self and others may affect how the client views the counselor and the counseling process. For the unresolved client, experiences of self and others may be compartmentalized, oversimplified, unrealistic, unstable, and subject to rapid unpredictable shifts, which may leave both the client and the counselor in a state of confusion. Recognizing these fluctuations for what they are (the anxiety-based manifestation of competing models of self and others), and helping the client to recognize them as such, helps position the client to adapt in a healthy way to the demands of caretaking.

Clinical Interventions: Parent–Child Interpersonal Functioning

Once the parent of the disorganized child has made significant progress on the integration of past trauma experiences, and developed or refined abilities pertaining to self-regulation, the interpersonal functioning in the parent–child relationship can begin to be addressed in family counseling (Hughes, 2007). There is a great deal of data utilizing both animal models and research with families, which suggests that the provision of attachment security is an essential component of assisting children in recovering from early life stress (Francis, Diorio, Liu, & Meaney, 1999; Gunnar, Frenn, Wewerka, & Van Ryzin, 2009; Zeanah et al., 2004). These findings can be reasonably generalized to inform the provision of attachment-based therapy when working with disorganized children and their parents. Attachment-based counseling focuses on fostering parents’ ability to provide attachment security for children even under trying intrapersonal and interpersonal circumstances. In attachment-based family therapy, both the parental state of mind and the interpersonal processes between caretakers and children must be taken in account when conceptualizing the needs of the family as a whole.

As noted previously, the interaction between parents and disorganized children is often characterized by role reversal in which the child attempts to control the caretaker through hostility and shaming or fawning attendance to perceived parental needs. A focus on changing these patterns is central to addressing attachment disorganization in children. Dubois-Comtois et al. (2011) found evidence that strongly suggests that secure parent–child interactions play an important role in the renegotiation of the internal working models of children with attachment disorganization. The application of this finding requires that the counseling process involve multiple opportunities for the parent and the child to interact together, while the counselor is available to observe and provide consultation for the parent pertaining to the maintenance of boundaries and to parental executive functioning.

During this phase of counseling, the counselor observes the interaction of the parent–child dyad while they work on some task that requires cooperation and sharing and that elicits emotion. Examples may include a parent being asked to play emotional charades with the child, or the parent completing a “color how you feel” exercise with the child, with certain colors corresponding with certain feelings. Activities can be adjusted to correspond with the age of the child or adolescent involved. While observing the parent–child interactions, the counselor remains vigilant for behaviors or perceptions that may lead to the repetition of unhealthy relational patterns. For example, counselors may suggest a consultation break from the play if the parent appears to have difficulty recognizing or attending to the child’s needs, if the parent has difficulty setting limits in a regulated manner, or if the parent appears to be, intentionally or unintentionally, encouraging the child to attend to the parent’s needs. Over time, as the parent’s responses become predictable to the child, and patterns of controlling behavior on the part of the child are consistently extinguished, the child has the opportunity to development new and more adaptive internal working models.

Conclusion

Two primary tenets of attachment theory, noted by Sroufe (2005), are highly relevant to the research reviewed in this article. The first tenet is that the security of the parent–child attachment relationship is the mechanism that mediates the developmental capacity to regulate fear and emotional turmoil during early life development. The second tenet is that absent early life attachment security, clients are at risk for interpersonal and intrapersonal difficulty associated with an inability to regulate fear and other strong emotions. As Cassidy and Mohr (2001) note:

…children who face unsolvable fear do not receive a caregiver’s help with regulating their fears because the caregiver is the source of the fear. Thus, these children may develop into adults who lack the benefit of having learned how to soothe and steady themselves in difficult or frightening circumstances…[and] may be less able than others to use challenging experiences to develop increasingly mature coping strategies. (p. 287)

Collectively, the studies reviewed for this article suggest that attachment disorganization in early life is a significant barrier to client well-being that persists across the life span and across generations. Treatment planning for attachment disorganization in children requires counselors to carefully consider the possibility that children and adolescents who present for counseling with atypical or bizarre behaviors, with excessive hostility, or with behaviors consistent with parentification may be acting on a profound sense of fear and insecurity stemming from significant difficulties in the parent–child attachment relationship.