Attachment can be defined as the strong preference of a person to be in close proximity to another specific person and to feel comfortable when close to the person and distressed when separated from the person (Watson, M. W.). It is a psychological and biological event that provides us with the ability to connect with other human beings. It is mostly referred to as the emotional bond between a primary caregiver, usually the mother, and her infant (Parker, L.) and is a crucial factor for an optimal child development. Optimal attachment occurs when the caregiver provides a secure base for the child to seek a natural balance between comfort-seeking and protection as well as exploration, learning and independence (Bowlby, 1969; 1982).
The attachment theory is a result of John Bowlby’s (1907 – 1990) concern with explaining how children react to the loss of a loved one and their need for protection. Bowlby, the primary founder of attachment theory, also proposed the internal working models which are basically a child’s mental representations of self, the person to whom he or she is attached and the relation between them. This model is thought to develop when the child is separated from the attached person and it is constantly under revision. Mary Ainsworth’s associations with and influence on Bowlby’s theory, led her to becoming the cofounder of the attachment theory. They both together developed a theory of parent-child attachment that focused entirely on the process of how and why this attachment develops in children and what happens when a healthy attachment does not develop. Mary Ainsworth developed a technique called the strange situation task to assess the type of attachment formed between a parent and child. She then classified the patterns found during this assessment into four types of infant attachment – one secure and three insecure types – secure attachment, insecure-ambivalent attachment, insecure-avoidant attachment and insecure-disorganized or disoriented attachment. She argued that secure attachments versus insecure attachments are made when parents are consistent in their interactions with their children. Insecure attachments are primarily the result of inconsistent parent-child interactions.
Attachment and adoption
The concept of consistency varies largely in the context of institutionalized and adopted children. Institutionalized children fail to develop strong attachment systems due to multiple rotating caregivers which in turn results in issues of negligence, rejection and inconsistency in interactions with one specific caregiver. Some of them also experience physical, psychological and sexual abuse. This lack of interaction and insecure and disrupted attachment with a primary caregiver presents a significant risk factor for impairments in the development of later social relationships by negatively impacting the child’s ability to be intimate and develop trust (Bowlby, 1951; Spitz, 1945). These children when adopted face difficulties in adapting to the new family environment. They tend to be withdrawn, aggressive, display superficial sadness and refusal to be comforted. Moreover, most of the parents of these adopted kids can manage to recognize these behaviours but are unfortunately not skilled enough to tackle them. In addition, many other factors such as family functioning and environmental stress also have a negative impact on the development of attachment systems. According to the attachment theory, the quality of care giving from the primary care giver is the key to attachment security. Along with it, if the child has been adopted at an early age i.e. before 6 months, the likelihood of developing secure attachment systems is very high. The longer the children are institutionalized, the greater the risk for abnormal attachment behaviours (Chisholm, 1998; O’Connor et al., 1999, 2000).
Review of literature
Research background. Pace, C. S. & Zavattini, G. C. provide empirical evidence for the above mentioned notion of better attachment when adopted at an early age, through their brief longitudinal study – ‘Adoption and attachment theory’ – the attachment models of adoptive mothers and the revision of attachment patterns of their late-adopted children, which focused on the internal working models of attachment and aimed at studying the attachment patterns of late-adopted children and their mothers during the first 7 to 8 months after adoption. Late-placed children are those who have been adopted after 12 months of age and who have suffered at least one relationship rupture of an attachment figure (Howe 1997). Along with it they also aimed at evaluating the impact of the mother’s attachment security on the changing attachment patterns of their children. They hypothesized that a transformation of attachment patterns from insecurity to security could be highlighted. Adoption of late-placed children has often been described as a ‘natural experiment’ which (Rutter et al. 2004; Van IJzendoorn & Juffer 2005; Van IJzendoorn et al. 2005) enables them to alter the course of their lives. It provides them with the possibility of building new attachments with their new caregivers, thereby helping them revise their insecure and disorganized attachment patterns and re-orienting their developmental pathways. Secondly, they predicted that this transformation may be more secure for children placed with adoptive mothers having secure internal working models. Third, they hypothesized that there exist links between representations of attachment among adoptive mothers – secure vs. insecure – and the attachment patterns of late-adopted children both at the attachment behavioural and representational levels.
Stansfeld, S. et al., examined the effects of social position and early deprivation on the development of attachment. They proposed that effects of childhood social danger on emerging parent/child attachments partly elucidate the effects of less advantaged childhood social position on adulthood mental health. The Whitehall II Study was established up to examine the degree and reasons of the social rise in morbidity and mortality. The various categories included to judge the above mentioned reasons were: emotional and material deprivation in which a 7 item scale of emotional deprivation during childhood was involved within the questionnaire. Following that was the parental style in which 3 dimensional parenting styles, that is, warmth, maltreatment or abuse or neglect and discipline and monitoring were chosen. Third category was attachment which said that the styles of attachment may replicate diverse patterns of ego-resilience or skill to successfully control and lessen the affect when it arises in crises in recognized relationships. Different criteria such as socio-demographic measures, separation and psychological distress helped in investigating the distribution of attachment style, the time of separation between the child and his/her mother during childhood and depressive symptoms respectively.
Material adversity in childhood is a risk factor for both physical and mental ill-health in childhood and adult adulthood. Much of the details for the above mentioned effects are in terms of disclosure to environmental stressors like poor housing, insufficient diet and pollution. Patterns of relationship formed in childhood forms the prototype for relationships in adulthood. If a child experiences secure relationship during his childhood he develops healthy and stable relations when an adult. Conversely insecure relationships during childhood lead him or her to a decreased potential for developing lasting relationships in adulthood. And this leads to the prediction that such adults are less likely to get married and more likely to be divorced. In a study done on “Adoption, attachment and relationship concerns: A study of Adult adoptees’, Feeney, J. A. et al., examined the impact of adoptive status and family experiences on adult attachment security and how attachment predicts relationship concerns. The authors distinguished that infants who are adopted can be at larger threat of prenatal or genetic complications and paternal Psychopathology. Attachment theory recommends possible lasting implications of these problems. Experiences with caregivers are progressively assumed in the form of operational models, or generalized probabilities about the self in relation to others closely related. Moreover, the conception of attachment style smears to both kinds of relationships; that is, early social involvements (including loss and rejection) create individual alterations in security, which forms relational assertiveness and manners. In the framework of adult attachment, these differences have been conceptualized in terms of classes (styles) or continuous magnitudes, such as avoidance and relationship anxiety (Shaver & Mikulincer, 2004). The study addressed these issues by employing a sample of adults who had been adopted as infants and a comparison sample of adults from intact biological families, following them over a 6-month period. The primary aim was to assess the extent to which adoption represents a risk factor for insecure attachment in adulthood and the secondary aim was to assess the role of adult attachment in predicting relationship attitudes and behaviours.
Brodzinsky, D. M. highlights the influence of adoption on emotional, social, behavioural and academic functioning of the children in his study on long term outcomes in adoption. He argued that there is a considerable increased psychological risk among children who are adopted in comparison to those who are non-adopted. He mentioned three research studies explaining these risks: first, an epidemiological study which shows the percentage of adoptees in general population. The second study stresses on comparing adopted and non-adopted individuals in the clinical setting. It determines the existence of unique patterns of symptoms among adopted children in clinical settings. And finally, the third study compares adopted and non-adopted children in non-clinical setting and studies the behavioural and personality characteristics along with the adjustment patterns among adoptees and non-adoptees. Age, gender and family structure and dynamics are some of the variables that have a significant impact on adjustment patterns in adopted children. Pre-placement history involving prenatal and postnatal experiences also helps establishing adjustments problems. Steele, M. et al., evaluated the process of developing attachment relationships between previously maltreated children adopted in latency and their new adoptive parents with respect to the change in their mental representations (internal working models). The shift from the experience of multiple caregiving situations to a permanent placement is the central feature of an older child’s adoption. The study also addressed the changes within the child’s internal world and aimed at highlighting the hopes, goals and fantasies of each of the parent-child dyad in their new developing relationship. The move into an adoptive placement is the most radical intervention for a child involving a freshly drawn map and an entirely new set of experiences. Moreover, it of utmost importance to identify how and what might change due to this dramatic shift from less than optimal caregiving conditions to more favourable ones. All those children have common experiences of having lost birth parents or having been abandoned. Some also have a history of neglect, rejection and abuse. These horrifying experiences make them more vulnerable to negative outcomes in terms of their mental health and psychological functioning and abnormalities in social interactions. Niemann, S. & Weiss, S. conducted a pilot study – Attachment Behaviour of Children Adopted Internationally at Six Months Post Adoption – with a purpose of describing the attachment behaviour in children, six months post-adoption (international). They explored the role of two main factors – time and pre-adoption care in the development of attachment.
The DSM-IV-TR and ICD 10, both have included the features of the above mentioned abnormalities in social interactions such as a lack of close confiding relationships, indiscriminate friendliness, lack of differentiation in the response to different adults, a tendency to go off readily with strangers, and a lack of checking back with a parent in anxiety-provoking situations into a concept of reactive attachment disorder, also known as disinhibited attachment. Rutter, M., et al., compared the levels of disinhibited attachment in the institutionally deprived children taken up for adoption subsequently and non-deprived children (age 11) adopted before the age of 6 months. They looked at the features and correlates of disinhibited attachment and examined 6 key issues comprising of the ratings of disinhibited attachment based on parental interviews, persistence of the disinhibited behaviour patterns measured at age 6, the similarity between consequences of mildly disinhibited attachment behaviour and severe disinhibition, the effect of the duration of institutional care and association of the disinhibited pattern at age 11 with significant malfunction or pathology. Zeanah, C. H. et al., provided an update on the recent findings in areas of serious disturbances of attachment in young children reared in atypical and hostile environments. They identified two patterns of RAD, namely: the emotionally withdrawn/inhibited pattern and the indiscriminately social/disinhibited pattern. Children with both these patterns belong to similar neglected environments but tend to respond differently to interventions. The researchers also placed emphasis on relational disorders of attachment i.e. attachment disorders between individuals in comparison to a mere focus on within-the-individual disorders.
Another study – Placement in Foster Care Enhances Quality of Attachment among Young Institutionalized Children – conducted by Smyke, A. T. et al., examined the different classifications of attachment in 42-month-old institutionalized children. These children were assessed through a random assignment to care as usual (CAU) or to foster care and were compared to family-reared children. The researchers majorly focused on the placement of young children being raised in institutions into families to increase their security of attachment and decrease their atypical patterns of attachment as compared to those who received on-going institutional care, the age of placement in foster care and its impact on the development of secure or organized attachments, along with other factors such as gender, ethnicity, developmental quotient and the effects of intervention on security or organization of attachment.
In an interesting cross-national study on children from India, Proctor, C. et al., highlighted the association between the style of parenting and the psychosocial outcomes in children. They identified two major components of parenting style, namely, structure and nurturance. The combination of these components results in different styles of parenting: indulgent or permissive parents (high nurturance, low structure), authoritarian parents
(low nurturance, structure), authoritative parents (high nurturance and high structure), and
uninvolved/under-involved parents (low nurturance and low structure). This study exhibits a comparison between in-country adoption (India) and inter-country adoption (Norway) and aims at studying the influence of parenting style as a function of the cultural background of the adoptive parent.
Research findings. Pace, C. S. & Zavattini, G. C. found that the majority of the late-placed children showed attachment insecurity at the beginning of the placement and it was greater when compared to the children who were brought up by their natural parents. A significant enhancement of late adopted children’s attachment security was found after less than a year. Thus, it is possible to reshape the insecure internal working models of traumatized children in the direction of security by ensuring stability and continuity in adoption. Adoption of late-placed children could be considered the most radical and powerful intervention for abandoned and troubled children with respect to other kinds of social interventions (Van IJzendoorn & Juffer 2006; Rutter et al. 2007). All the children with enhanced attachment security were adopted by mothers with secure Adult Attachment Interview classifications, whereas children with insecure mothers remained mostly insecure. These results indicate that secure attachment internal working models of adoptive mothers, who reinforce positive interactions with their children and value attachment experiences, could enable insecure late-adopted children to revitalize affect in the parent-child relationships and positively reactivate their attachment-related needs, feelings and behaviours (Steele et al. 2003, 2007). There was no significant correspondence of secure/insecure models of attachment between adoptive mothers and their late-placed children (Dozier & Sepulveda 2004; Verissimo & Salvaterra 2006); however there was a significant increase in the degree of connection. This denotes that the link between patterns of attachment among adoptive mothers and their late-adopted children increases progressively even though it cannot be clearly outlined soon after placement.
Further, Stansfeld, S. et al., found that attachment style displayed little disparity among adult social position. Secured attachment style was more recurrent in advanced employment grade men and lesser employment grade women. Also childhood substantial deprivation was related with bigger risk of anxious and avoidant attachment in men. Also it was found that there was no link between sex, attachment styles and depressive symptoms. Anxious, avoidant or dreadful attachment and discharging style were allied with increased threat of depressive symptoms. This meant that the insecure attachment style was serving as a risk factor for depression and also lays a basis for understanding the origins of insecure attachment. It was also found that attachment style was not very much linked to either adult or parental social class. Thus, less socially privileged parental social position was related to an increased danger of both childhood emotional and material deprivation. It further states that deprivation was linked to low parental warmth that was allied with bigger risk of insecure attachment that was also associated with higher risk of depressive symptoms.
Feeney, J. A. and his colleagues proposed that insecure attachment was more prevalent among adoptees than among non-adoptees. Adoptees counted higher when compared with the participants on avoidance and anxiety, and have reliably emerged as the two key dimensions as the causal measures of adult attachment (Brennan, Clark, & Shaver, 1998). Adoptees were also overrepresented in the insecure attachment categories, particularly the fearful style.
Steele, M. et al., concluded that when a child enters an adoptive placement with fear, aggression and a disturbed internal working model, his or her model can be revised only and only if the new parent is available and understanding, following which the new model will then gain precedence over the old, fantasied, wished-for-relationships model. The child will then acquire an organized and secure self – representation, will be capable of sustaining hope and diminishing the negative disturbing forces.
Niemann, S. & Weiss, S. research findings identified a difference between the low and high secure groups. High secure children showed affective sharing and empathetic behaviour. They were also found to be emotionally attuned to their caregivers. On the contrary, low secure children displayed passive behaviours and refrained from physical contact. These children are still in the process of developing an attachment system with their care giver. Furthermore, with reference to the time, six months is too less a period to assess the development of attachment between the adoptee and the new parent. Six months post-adoption, children are still in the process of forming a bond and getting attached to their new parents. As a result, the researchers suggest that attachment behaviour should be assessed longitudinally, throughout the first year to see how the behaviour continues to develop and pre-adoption care tends to diminish.
Rutter, M., et al., conclude that the pattern of disinhibited attachment in children institutionalized for a minimum of 6 months, is indicative of a clinically significant disorder.
Smyke, A. T. et al., study reports that children in foster care were more secure than those who remained in institutions. Another important finding was that the age at which the child was placed in foster was directly proportional to his or her recovery of attachment. The younger the child was placed, the more likely he or she was to develop an organized attachment. This is due to the decreasing plasticity of attachment with increasing age. Children placed in foster care younger than 12 months were able to develop trusting relationships with new caregivers more quickly than older infants and toddlers (Dozier & Bick, 2007).
Proctor, C. and colleagues suggest that Indian adoptive parents were more homogenous and reported higher scores for clinical behaviour of their children in comparison to their Norwegian counterparts. Some parenting skills and some children’s behaviour are significantly associated with each other.
Taking together, the development of attachment patterns in adopted children and their new set of parents is said to be majorly influenced by a lot of variables ranging from the age at which the child is adopted, to the pre-adoption care and the environment in which the child was reared prior to adoption, the parenting skills and the style of parenting employed by the parents, parents’ existing attachment patterns, gender of the child and family dynamics. These attachment patterns developed at an early age also impact the relationships that an adoptee forms in adulthood. Cultural background of the parents (as well as the child in case of late-adoption) is another important factor that influences the formation of attachment between the child and the caregiver i.e. the mother. Majority of the research till date has focused on attachment as a construct within an individual. However, it is also important to assess attachment between individuals which will only help in studying the development of this connection in a holistic manner.
Strong empirical evidence shows that the attachment system in humans develops and functions essentially as it has been theorized by Bowlby and Ainsworth. The attachment theory is now used to explain related behaviours such as feeling of homesickness, the process of infatuation, and the shifts in relationships in case of unsuccessful relationships. There is increasing evidence for the long-term positive and negative effects of secure and insecure first attachments. It also places major emphasis on the role of maternal responsiveness. One of the main reasons that maternal responsiveness is important is that responding to the child’s signals sensitively and consistently creates trust, which is one of the major outcomes of attachment. Responsive mothers learn to read the child’s cues, learn to think like the child or – speak for the child (Juffer, Bakermans-Kranenburg, Van IJzendoorn, 2008). Further, the theory has also proved to be helpful in revising policies by placing new-borns with their mothers, right after