Attachment

Question 1

What is the most important predictor of a child’s future personality development?

Answer 1

The child’s early development with the primary caregiver

Question 2

What are infants evolutionarily primed to do?

Answer 2

Form a close enduring dependent bond on a primary caregiver beginning in the first moments of life

Question 3

What does the vulnerability of the infant require?

Answer 3

That care be provided by the adult and the infants behaviour and inherent faculties ensure that a bond will be created

Question 4

How do infants respond to other people to form bonds?

Answer 4

Attend to human voices, recognise human faces and gaze into parent’s eyes when being fed

Question 5

What are the different attachment styles?

Answer 5

Secure (70%), insecure avoidant, insecure ambivalent/resistant, disorganised

Question 6

What was the “strange situation” study?

Answer 6

An observational study of attachment in infants aged 12-18 months?

Question 7

What are the stages of the “strange situation” study?

Answer 7

Mother, infant and experimenter
Mother and infant alone
Stanger joins mother and infant
Mother leaves baby and stranger alone
Mother returns and stranger leaves
Mother leaves, infant is alone
Stanger returns
Mother returns and stranger leaves

Question 8

How do adolescents with insecure avoidant attachment view themselves and other?

Answer 8

See self as unloved, self reliant

See others as rejecting, controlling and intrusive

Question 9

What are some characteristics of adolescents who are insecure avoidant attached?

Answer 9

Avoid intimacy, dependence and disclosure
Hard to engage, seen as cold
View relationships as unimportant
Don't feel huge need for other people
Indifferent to other's views

Question 10

What has insecure avoidant attachment been linked with in adolescents?

Answer 10

Higher incidence of physical illness (somatising) and hard drug use

Question 11

How do adolescents who are ambivalent attached view themselves and others?

Answer 11

Have low value of self, see self as ineffective and dependent
See others as insensitive, unpredictable and unreliable

Question 12

What are some characteristics of adolescents with ambivalent attachment?

Answer 12

Disruptive, attention seeking and difficult to manage
Alternate between friendly charm and hostile aggression, dysregulated emotions
Display antisocial behaviour, impulsivity and poor concentration

Question 13

What is a secure base?

Answer 13

Attachment figure/relationship provides a safe space from which to explore the world

Question 14

What is a safe haven?

Answer 14

Attachment figure/relationship is a safe place to retreat to at times of danger or anxiety

Question 15

How do infants begin to develop beliefs about themselves, others and the world?

Answer 15

Through their attachment relationship and how effective they experience themselves as being

Question 16

What happens if a child has mainly adverse and frightening experiences?

Answer 16

They develop a distressful and negative working model of the world around them

Question 17

What is attunement?

Answer 17

Process between caregiver and infant in which they are able to tune in to each others physical and emotional states

Question 18

What are the different attachment perspectives?

Answer 18

Developmental psychology and neuropsychoanalytic

Question 19

What is the developmental psychology approach to attachment?

Answer 19

Early relationships with the attachment objects causes an infant to form internal working models for relationships

Question 20

What is the neuropsychoanalytic approach to attachment?

Answer 20

Affective exchanges between infant and caregiver provide a foundation for neurological development

Question 21

Why is it difficult to reverse attachment disorders after the age of four?

Answer 21

Difficult to reverse damage as brain pathways have been laid down = brain 25% of adult weight at birth and 90% by age 3

Question 22

What are some behavioural signs of disordered attachment?

Answer 22

Lack of self control and normal fear
Self destructive behaviour and destruction of property
Aggression towards others and animals
Consistently irresponsible, difficulties with change
Stealing, lying, hoarding, inappropriate sexual behaviour
Sleep disturbances, abnormal eating habits
Enuresis and encopresis, poor hygiene

Question 23

How may cognitive functioning be impaired in children with disordered attachment?

Answer 23

Lack of cause and effect thinking
Learning and language disorders
Distorted self image, grandiose sense of self importance
All or nothing sense of thinking

Question 24

How is social functioning impacted by disordered attachment?

Answer 24

Superficially engaging, lacks trust in others
Lack of eye contact and peer relationships
Indiscriminately affectionate with strangers
Victimises others/blames others, cant tolerate limits

Question 25

How is emotional functioning altered in children with disordered attachment?

Answer 25

Core emotions are intense = anger, pain, fear, shame
Often appear disheartened or depressed with mood swings
Struggle to express emotions

Question 26

What are some physical aspects of disordered attachment?

Answer 26

Poor hygiene, chronic body tension, accident prone, high/low pain tolerance, tactilely defensive

Question 27

What are some causes of disordered attachment?

Answer 27

Unplanned pregnancy, postnatal depression/psychosis
Neglect or abuse, separation from primary caregiver
Maternal substance abuse, traumatic experiences
Frequent moves, undiagnosed painful illnesses
Poor parenting skills, parental attachment difficulties

Question 28

What can working with young people with disordered attachment cause?

Answer 28

Counter-transference issues (ie anger, sadness, fear etc)

Question 29

Why may interactions with these patients prove frustrating for health care professionals?

Answer 29

Staff may find it difficult to accept that these children respond in a non-therapeutic manner

Question 30

What are some differing approaches that the MDT may use when trying to manage a child with disordered attachment?

Answer 30

More/less punitive, more/less restrictions, more immediate rewards, change medication when not needed, more one on one time, early discharge

Question 31

How should disordered attachment be managed?

Answer 31

Clear assessment of both attachment and family system, and how these have causes the current difficulties

Question 32

What must young people with disordered attachment be able to make sense of?

Answer 32

Their history and current functioning

Question 33

How should professionals act when engaging with patients suffering from disordered attachment?

Answer 33

Develop trust = eye contact, voice tone, never threaten
Be consistent, calm and a good role model
Be available, responsive and caring

Question 34

How should health professionals approach managing a patient with disordered attachment?

Answer 34

Be curious and empathetic regarding the young person’s resistance to treatment intervention
Have realistic expectations

Question 35

What should be instilled and improved in patients with disordered attachment in their management of their condition?

Answer 35

Develop a balance between autonomy and dependency
Restore self esteem
Allow young person to express their feelings

Question 36

How do infants with secure attachment react during the “strange situation” study?

Answer 36

Distressed when mother leaves, avoids stranger when alone but friendly with mother present, positive and happy when mother returns, uses mother as safe base to explore environment

Question 37

How do infants with ambivalent attachment react during the “strange situation” study?

Answer 37

Show signs of distress when mother leaves, avoids stranger and shows fear, approaches mother when she comes back but resists contact, cries more and explores less than other types of attachment

Question 38

How do infants with insecure avoidance attachment react during the “strange situation” study?

Answer 38

Show no signs of distress when mother leaves, OK with stranger and play normally with stranger present, show little interest when mother returns, mother and stranger equally able to comfort child