I just read an article written by a friend and user of the Keys to Interactive Parenting Scale (KIPS), which got me to thinking about the connection of parent-child interaction and secure attachment.  In the article by Robin Balbernie, titled The importance of secure attachment for infant mental health, I was particularly struck by how poetically he captured the role of parenting in attachment:

Secure attachment, which is built up by everyday sensitive and appropriately responsive parenting, means a child will be more likely to grow up in a way that will enable them to make the most of their life’s opportunities. On the other hand, very insecure attachment, which often is a marker for maltreatment, puts the child at a greatly increased risk for exhibiting a range of antisocial behaviour, as well as significant emotional and mental health difficulties in later life.  –Robin Balbernie

Attachment: Secure and Insecure

Many in our field are quite rightly deeply concerned about attachment.  John Bowlby coined the term in referring to a child’s emotional connection to an adult caregiver.  Attachment can be assessed by a child’s tendency to turn selectively to the attachment figure when needing comfort, support, nurturance or protection (for a brief video of Bowlby speaking on the subject, follow this link).  Attachment is formed during the first year of life through the myriad of daily interactions between caregiver and child.  The quality of attachment has profound impact on the psychological development of the child, for either good or ill.  Even in the absence of overt abuse, the Romanian orphanage studies show the devastating impact of lack of responsive caregiver-child interaction, and consequently insecure attachment, on children’s development and well being (for a review, see CH Zeanah, LJ.Berlin, and NW Boris (2011). Journal of Child Psychology and Psychiatry, 52:8, pp 819–833).  Given the profound consequences, it is concerning to see estimates of secure attachment in the general population of only between 55-65%.  Given the consequences, it is also concerning to the think that about 40% of children are insecurely attached. Insecure attachment can be as high as 90% in some impacted populations, and presents with several different behavioral classifications.  

Insecure attachment results in the inability to form quality relationships or have empathy for others, which can set off a negative series of events.   Balbernie stresses that we need to act early to build a strong bond between parent and child because repair becomes very difficult after the developmental window has closed.  Thus, prevention should be a major focus.  Another troubling point is that insecure attachment is intergenerational.  A parent who experienced insecure attachment as a child may have difficulty empathizing and responding sensitively to her child, which often results in her child becoming insecurely attached; so insecure attachment tends to perpetuate across generations.  The high prevalence and intergenerational transmission of insecure attachment provides a prime opportunity to prevent, as Balbernie refers to, the “emotional and mental health difficulties”  in the lives of families, throughout full lifetimes, and in future generations.  

In looking for prevention strategies that will boost the prevalence of secure attachment, we need to keep Cyr et al.’s words in the top in our minds:

Studies of nonmaltreated, typically developing children have demonstrated that sensitive, contingent, and responsive maternal caregiving behavior promotes the development of a secure attachment relationship. – Cyr et al. 2010

Prevention through Parenting

If we aim to prevent insecure attachment and build secure child-parent connections we need to act through the parent (or those acting in the parental role).  A number of evidenced-based interventions support parents in improving their parenting and strengthening attachment.  A few examples include Circle of Security, Attachment and Biobehavioral Catch-up, and Video Interactive Guidance for Parents.  All three examples 1) use video in the intervention and 2) require extensive training.  The use of video is key in assessing the parent-child interaction and providing personalized feedback and reflection with each parent to guide improvement, which leads to building the parent-child relationship.  

The high proportions of children showing insecure attachment calls for widespread prevention efforts.  This led the United Kingdom’s Department of Education to recommend universal screening of parent-child interactions with the aim of identifying those families needing support, so services can be provided early to increase the likelihood of achieving secure attachment.  With the recent development of practical parenting assessment tools, like KIPS, which require only a couple of days of training, widespread parenting assessment has become feasible.  Beyond identification of families at-risk due to parenting, the assessment information provides insights that can target services to the specific parenting needs of the family.  Furthermore, by repeatedly assessing parenting as children progress from one developmental stage to the next, we can continually provide parents with feedback, reflection and guidance for the next stage, and document parenting outcomes.  By aggregating results, programs can document the impact they have on parent-child interaction in the families they serve, which so delights boards and funders.

Research shows that intervening early makes the all important difference in developing secure attachment.  By assessing parenting while attachment is forming we can identify those at risk. With early intervention we can support parents during the vital early developmental stages to promote the development of secure attachment.  By identifying families needing support and providing targeted services to their needs, we can ensure that more children become securely attached.