Attachment, a Neurodevelopmental Perspective

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Attachment, a Neurodevelopmental Perspective

• Dr Bruce Chenoweth
• Consultant Psychiatrist
• Senior Staff Specialist, D.A.S. Division. of
  Women and Childrens Health, St. George Hospital
• Conjoint Senior Lecturer, School of Psychiatry,
  U.N.S.W.

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PsychiatryThen and Now!
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Brain Stuff and Attachment

• Walking upright needed bigger prefrontal cortex
• Sophisticated ability then possible to focus,
  plan, control actions, reflect and anticipate,
  and manage social relations.
• Babies needed to be born prematurely and nurtured
  outside the womb

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Neurobiology of secure attachments

• When a baby is born-------!
• Brain development before age of 1 yr is much more
  extensive than realized
• Brain development is much more vulnerable than
  previously suspected
• Neural genesis and apoptosis
• Empathic attunement directly influences the
  maturation of regulatory mechanisms
• Stress asynchrony which is reflected
  permanently and architecturally

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Dyadic interaction and brain development

• From outset, reciprocal stimulation occurs
• Mother is an external CNS regulator of emotion
  and hence development of the infant PFC
• Facial expressions, gaze, touch, body movements
  and vocalizations generate a symbiotic state
• Conversely, lack of ve interaction causes
  withdrawal and failure to develop affect
  self-regulation and to co-regulate social
  interactions.

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Physiology of regulation

• New neural pathways permit subtle sensory
  discrimination
• Enhanced signaling systems enables the child to
  construct patterns and take on meaning
• This leads to less stress-induced autonomic
  arousal which can damage irreparably the
  formation of sophisticated regulatory pathways
• The full expression of emotional dysregulation
  may not be apparent until teenage years

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Not just unhappy kids!

• Maternal absence in the first year of life is
  negatively linked to physiological regulation
• Symbiotic Mind-reading is only achieved through
  countless hours of contact. Not innate.
• Neural deficits are apparent in children not
  exposed to good and consistent empathic
  attunement.
• Stress levels are measurable

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Neural Structures 1

• Brain overview

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Neural Structures 2

• Old brain

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Biochemistry of attachment failure

• Chronic stress--ltcorticotrophin releasing factor
  and loss of diurnal variation in cortisol level.
• High concentration of cortisol receptors in parts
  of brain responsible for arousal and ability to
  learn
• Rapid increase, adrenalin, nor adrenalin,
  dopamine
• Hyper metabolism in some parts of brain
• High thyroid activity-active in brain
  differentiation and regulation

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Biochemistry of Good Empathic Attunement

• Low stress, low cortisol and low proinflammatory
  cytokines
• High oxytocin leading to down-regulation of
  primitive fight or flight responses
• Hippocampal generation and regeneration after
  stress.
• Improved cortical activity improving executive
  functioning and affect regulation

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Attachment SwitchON!
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Oxytocin and Fight/Flight Response
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Impact of Disruption of Bonding on Infant R.
Brain Development

• Time of most rapid R. brain growth spurt
• Neuronal overproduction vs. apoptosis
• Semi-permanent arrest of development
• Stressful growth inhibitors excito-toxicity
  pruning of R. brain cortical circuits
• Regulatory failure of emotional homeostasis and
  attachment
• Up-regulation of primitive survival pathways
• Vestigial switch-gear, readily triggers emotional
  dysregulation

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Yiddisher Mommas!

• Before

• After

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Critical role of the Caregiver in the first three
months

• Continuity of interaction crucial
• Caregiver imparts ability to self-sooth
• Baby differentiates global states-calmness.
  Distress and pleasure
• Physical sensation and the emotional are bound
  together-motor responses move from reflexive to
  volitional mediated by affect.

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Two to five months

• With warm nurturing, investment in and from
  caregivers increasesdifferentiation from other
  adults
• Gaze, listening and movement become synchronized
• Patterns discerned in caregivers voices
• Discrimination occurs between joy, indifference
  and annoyance
• Emotional significance of facial expression and
  vocalization

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Infant Development

• Baby at 3 months

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Four to ten months

• Purposeful 2-way interaction
• Constant carers need to read and respond to
  emotional signals and challenge to reciprocate
• Signaling through facial gestures, gestures,
  vocalizationbroad range of emotions and
  sensations
• By eight months, integrated sequencing of
  responses and adoption of social patterns

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Infant Development

• Baby at 6 months

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Infant Development

• Baby at 9 months

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Nine to eighteen months

• Continuous flow of to-and fro communication
• Complex interactions
• Language acquisition

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Science into Action

• Immediate contact following birth
• Biological parents preferred over extended family
  or other care givers
• Empathic attunement with baby the critical factor
• This requires extended time together with baby
• The younger the baby, the more essential is
  continuity of empathic attunement
• Transitions between environments can be stressful
  for young babies

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Special Needs Children

• Attachments difficult
• Reciprocity limited
• Dysmorphia
• Additional demands
• Relationship stress
• Maternal guilt/depression
• Challenging behaviour

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Autistic Children

• Difficulty with communication, socialization,
  lack of awareness of others, inability to play,
  or to copy, and will not seek comfort.
• Marked abnormal nonverbal communication
• Lack of imaginal world
• Abnormal speech, no reciprocal responses
• Restricted and stereotyped interests
• Extreme distress on transitions

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Family Court Issues

• Marriage on Rocks common
• Changes very difficult
• Consistency essential, transitions difficult
• Independent Legal Advisors sometimes dont
  understand
• Need to work outside established shared-care
  precedents

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Take-home message

• The brain is plasticwhatever you put in changes
  the architecture
• There are critical times in the developmental
  trajectory for the establishment of stable
  patterns which are enduring
• The first 18 months are critical times for the
  genesis of emotional and cognitive regulation
• Empathic attunement is critical for this to happen