Child Abuse and Attachment

What is Attachment?

Attachment is a concept for understanding the relationship between a child and their carer. When an infant is born they rely on their carer for nurturance, support, safety and general care, with this the child forms an attachment. There are four main attachment styles a child may develop. The type of attachment style the child develops with their carer affects their movement through different developmental stages and forms the ‘blueprint’ for all future relationships. The four attachment styles are:

Secure Attachment

This is the most common attachment style and is characterised by a carer who is sensitive to the child’s needs and wants, they offer security and the child feels confident in the carer’s ability to care for them and keep them safe, and connected to that carer.

Anxious Resistant Attachment

This is characterised by an erratic carer who appears hesitant and preoccupied. The child interprets this and becomes resistant, anxious and dependant.

Anxious Avoidant Attachment

This develops when the carer is un-responsive to the needs of the child, they appear distant and flat. The child in turn behaves aggressively and lacks empathy for others as they have received none from their primary carer.

Disorganised Attachment

Probably the most damaging attachment style and the one most commonly associated with severe abuse and neglect. This is when the child has endured consistent threat from the caregiver, they become confused and anxious as a result and the child eventually dissociates from the relationship and often life.

Disruptions in Attachment due to Abuse

Disrupted development due to maltreatment often results in attachment disruption. As a result they will have their emotional development disrupted which in turn affects their overall development. Sometimes a child’s ‘unwanted’ or ‘unusual’ behaviours can be linked to this developmental delay. It is often useful to consider a child who has experienced abuse or neglect as having their social and emotional development frozen in time at the developmental stage at which they experienced maltreatment.

Some common behaviour that you may see when a child has suffered abuse/and or neglect during each stage of development are:

Stage 1: Birth to One year

Trust versus Mistrust

At this stage the infant is dealing with the internal conflict of trust versus mistrust of their carer and the world in general. This is learnt by the carer consistently providing nurturance and responding to the infants’ cries. Given a secure environment and carer, the infant is allowed to adopt the concept of basic trust. This is created by routine and consistency organised by the carer; they learn to trust that their carer will return when out of sight. This translates into the general sense of trust in other adults and the notion that the world is a safe place.

For a child suffering maltreatment during this stage of development, attachment is significantly disrupted, consistency and routine no longer exist and the child develops a general mistrust in their carer and the world. The infant’s cries are ignored and they perceive the world as terrifying and unreliable. During this time the child will appear fussy, constantly crying, irritable and unable to be soothed. They may also have problems with feeding, sleeping and toileting.

Stage 2: One to Three years

Autonomy versus Shame and Doubt

The infant becomes a toddler; they learn the simple skills of language and refine their motor skills, beginning with crawling and then walking. This stage is characterised by independence from the carer. The toddler learns that they control their behaviour; they learn impulse control, independence and self restraint. They master toileting while motor and language skills help the toddler learn autonomy and move through to the next stage.

However, if maltreatment is suffered during this time these newly acquired skills are the first to go. For example the child may regress, begin bed wetting, soiling, use ‘baby’ speech or in extreme cases become mute. Other behaviours that are common include; clingy, tearful/ excessive crying, whiney, fussy, difficult to soothe, sleep difficulties (nightmares), temper tantrums and non compliance. In general the child may be fearful and continuously want to be held due to their need to feel safe again.

Stage 3: Three to Six years

Initiative versus Guilt

The toddler becomes a child; they often begin kindergarten and then pre–school. They begin to explore different adult roles through play and identify themselves with their significant carers. Through mastery of skills in previous developmental stages the child has become egocentric; in contrast they also begin to realise that some of their behaviour is socially more acceptable than others. Traditional conflict during this stage stems from these contradictory thoughts.

If maltreatment occurs at this stage, the child’s fear that the world is unsafe and that bad things do happen is confirmed. The child is plagued by fear and guilt; they fear further punishment and suffer the guilt of having ‘bad’ fantasies, thoughts and feelings. Again, regression is a common symptom of maltreatment at this developmental stage. The child may revert to thumb sucking, bed wetting, soiling and baby talk. Other behaviours include: temper tantrums, repetitive play, clinginess and general fear behaviours.

Stage 4: Six to Twelve years

Industry versus Inferiority

The child enters their social prime. They develop a sense of personal satisfaction and competence by learning new skills and how to get along with peers. They also begin to seek and receive recognition from others for becoming productive members of society (usually associated with schooling). Newly acquired skills include the understanding of more abstract concepts including: the ability to distinguish fantasy from reality, understand time and space, and the development of an appreciation for real life danger.

At this stage maltreatment crosses into the school environment as well so social problems are prominent. Similarly regression behaviours occur, but include social regression as well, i.e. the child loses the ability to appropriately relate to and interact with their peers. Other behaviours evident include; repetitive play and re-enactment of trauma, sleep disturbances (nightmares), intrusive thoughts, sounds and images, school refusal, poor concentration, anxiousness, tearfulness, somatic complaints (stomach pain, headaches, aching with no medical cause), aggression and impulsivity. Overall, the child loses trust in the world and in particular the people who are meant to keep them safe.

Stage 5: Twelve to Eighteen years

Identity versus Role Confusion

Adolescence begins, puberty takes over and the child prepares for early adulthood. This stage is generally marked by experimentation in an attempt to find the self. The adolescent returns to the egocentric phase and embark on their quest to find out how they fit into the world, what their role will be in society and what their identity will be. Probably the most concerning (as perceived by the carer) experimentation evident during this stage is risk taking through drug and alcohol experimentation and sexual exploration.

At this stage in development when the adolescent is attempting to forge their own identity, if maltreatment occurs, they may align with and adopt an identity similar to that of their aggressor. Parentified behaviour is common during this stage, when the carer is no longer caring for them the child will prematurely take on this adult role; this is most common where the child has younger siblings they feel responsible for. Alternatively they delay their identity development and stay in adolescence. Behaviours include; nightmares, poor concentration, school refusal and truancy, poor academic performance, alcohol and drug use, promiscuity, anxiousness, social difficulties, withdrawal, appetite fluctuations, suicidal ideation and attempts, self harm, somatic complaints and intense anger.

Amanda Paton
Senior Psychologist
Director of Therapeutic Services
Parkerville Children and Youth Care

References

Hutchison, S.B. (2005) Effects of and interventions for childhood trauma from infancy through adolescence: pain unspeakable. New York: The Hawthorn Maltreatment and Trauma Press.

Kagan, R. (2004) Rebuilding attachments with traumatised children: healing from losses, violence, abuse and neglect. New York: The Hawthorn Maltreatment and Trauma Press.

Kail, R. V., & Cavanaugh, J.C. (1999) Human Development: A life span view. (2nd Ed). Australia: Wadsworth.

Lieberman, A .F., & Van Horn, P. (2004). Assessment and treatment of young children exposed to traumatic events. In J. D. Osofsy (Ed), Young children and trauma: intervention and Treatment. (pp.111-138). New York: The Guildford Press.

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