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Attachment: The Foundation of Relationships and the Impact of Trauma in the Lives of Children

By Angela Wheeler

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Rebecca, a healthy 35-year-old female, received prenatal care throughout her pregnancy and chose an adoptive family for her baby. She is a successful and independent person who chose not to raise her child as the father was not involved. At 40 weeks, she delivered a healthy baby boy, who was immediately held and loved on by his soon-to-be adoptive mother and father. They named the baby Sam. Sam is a child of trauma.

Alex and Beth lived with their mother and father until recently when, after months of fighting and arguing, their parents decided to file for divorce. Both children love their parents and are torn about where they wish to live. Both parents reassure the children that they are loved, assuring them this decision has nothing to do with them, and they will never have to choose sides. Alex and Beth grieve the loss of their family and are now, if not before, children of trauma.

Jennifer is a young, 36 weeks pregnant female. She received no prenatal care and is currently involved in a domestic violence relationship. She admitted to using drugs and alcohol during the first half of the pregnancy, as she was unaware that she was carrying a child. Jennifer gave birth to a baby girl who was immediately taken to the NICU, where she received care for two weeks. The newborn was then placed with her soon-to-be adoptive mother and father. They named the baby Jillian. Jillian is a child of trauma.

Macy is a 3-year-old girl living in a foster home. She has been placed in five different homes since birth. She has had weekly visitation with her biological parents but is still unable to live with them. Macy is a child of trauma.

Joseph is a happy-go-lucky 5-year-old who enjoys kindergarten. He was taken home from the hospital by an adoptive family at 2 days old. He has been nurtured and cared for, lacking for nothing. His adoptive parents are highly intelligent, well-respected members of their community. This kindergartner has been afforded the opportunities of great preschool programs, quality medical care and a stable family environment. As the school year unfolds, Joseph begins to show signs of anger, anxiety and behaviors not exhibited before. His parents are confused and concerned, unsure of what is happening. Joseph is a child of trauma.

Each of these stories is different and yet still the same: a child that has experienced early childhood trauma, which can be defined as “a psychological, emotional response to an event or an experience that is deeply distressing or disturbing.”1

Professionals within the mental health field find themselves managing the effects of trauma daily, but for those within the legal community: paralegals, attorneys and judges, as well as investigators and court-appointed advocates, there is often little training provided to assist in identifying or managing trauma. To best serve our clients, it is imperative that we place importance on the ways in which life begins, and the trauma and experiences occurred both in utero and the early stages of development.

For those in the judicial realm to best advocate for the youngest of clients, there needs to be an understanding that babies, while resilient, still suffer trauma that can potentially stay with them for life; children carry within them stories that need to be heard and understood. Whether advocating for the children within the deprived docket, children of divorce or babies caught in an adoption battle, the ways in which these cases are managed legally, have a huge impact on development and attachment. Having an understanding that trauma begins early, and carries with it a lifelong sentence, can assist in the legal strategy of cases.

When we think of childhood trauma, we often find ourselves assuming the worst: heinous abuse, neglect, violence. The understanding of trauma and its impact is constantly evolving. For example, trauma can begin in utero, carried throughout the pregnancy and continue through the early months of a child’s life.2 To a developing fetus, the mother’s womb provides everything needed for growth and development. The foundation for healthy brain development is crucial throughout this time. How a mother feels about being pregnant, and how she cares for herself throughout the pregnancy can affect the child. For example, “If the mother has a healthful lifestyle, her uterus will share that with the growing child. But if the mom suffers from chronic stress, consumes toxins such as alcohol and drugs or doesn’t eat properly, the fetus is exposed to those dangers right along with the mother. An infant’s neurochemistry reflects his or her very first home – the uterus.”3

Co-author of The Connected Child and founder of the methodology referred to as Trust Based Relational Intervention (TBRI), Dr. Karyn Purvis discusses a study that discovered 1-month-old infants born to mothers who suffered from high stress throughout pregnancy had imbalanced neurochemistry. Birth mothers who experienced depression and anxiety during the last trimester had children showing abnormal brain activity.4 During this optimal developmental period, if a child’s brain misses key opportunities, some deficits may occur, such as critical thinking skills, ability to process information and focus issues. These impairments can then become hardwired, predisposing the child to possible developmental delays and/or behavior problems later in life.5 If a child in utero experiences trauma and is placed in a home where they are not stimulated, curiosity and learning are not encouraged and there is a lack of nurturing, this child may continue to show deficits and struggle both academically and socially.

Let us consider Eli, a 10-month-old male who has lived with his biological mother since birth. She loves her baby and minimally meets his basic needs of food, clothing and shelter but is unable to provide stability, consistency and nurturing with attachment opportunities. Due to this, he is removed from his birth mother by the state agency and placed with a loving family that has educated themselves in trauma. They understand that Eli needs to experience a healthy attachment. Consequently, the foster or adoptive mother must spend weeks treating this young toddler as a newborn in an attempt to retrain his brain into developing appropriate attachment and healthy coping skills. Eli grows up loving his adoptive parents but demonstrates signs of anxiety, does not like to be left alone and has sleeping issues. At the age of 4, he is often angry, yelling at his adoptive parents that he hates them, and they are not his real parents. He asks questions about his first 10 months, inserting memories with what he has been told, and filling in the blanks with what he believes to be true. Dr. Bessel Van der Kolk revealed, “Being traumatized is not just an issue of being stuck in the past; it is just as much a problem of not being fully alive in the present.”6 Eli is a child of trauma.

With the emergence of the infant mental health field, we now know that early childhood experiences impact child development and that just nurturing a child does not make the trauma go away. In his book, The Body Keeps the Score, Van der Kolk theorizes although a child may not be able to remember or describe early experiences, their body does not forget, stating, “The job of the brain is to constantly monitor and evaluate what is going on within and around us.”7 Smells, sounds and environments help our bodies create memories of events, and it is those same senses that trigger memories as well. For example, Michael, a 47-year old male, has an aversion to the smell and taste of apple pie but does not have any reason as to why. In therapy, he recalls that his mother baked apple pies every Sunday throughout his early childhood. Sundays were the days that his father was home from work and would consume large amounts of alcohol, followed by angry outbursts where he would yell and lash out physically at child and mother. Michael’s brain was unable to physically tell him why the smell of apple pie left him feeling anxious and angry, but his body “kept score” and he avoided apple pie. Trauma impacts brain development and can cause long-term issues for children and adults. Children may appear outwardly that they are fine, but cognitively and emotionally, there may be impairments that cannot be seen.

An example of all that appears well on the outside are drugs consumed in utero that are now impacting early education for the child. In utero, the baby was exposed to the sounds of screaming and now presents as an overly anxious and easily frightened child. The child that moves from home to home, unable to develop trust that the same person is going to meet their needs, is now a child of a ruptured relationship. These ruptures tend to impact a child’s ability to develop adequate attachment. When a child experiences trauma or a break-down of attachment, research tells us that brain development and critical thinking skills are impaired.8

“Twenty years of medical research has shown that childhood adversity literally gets under our skin, changing people in ways that can endure in their bodies for decades. It can tip a child’s developmental trajectory and affect physiology.”9 Dr. Burke Harris writes that when a child’s stress response is activated too frequently, they lose the ability to self-regulate, and much like a broken thermostat that allows heat to blast continuously, their bodies become flooded with cortisol as their stress thermostat fails. The basic skills (i.e. breathing, temperature regulation, the fear-flight-freeze response) all originate in the lower brain, or what is commonly referred to as the downstairs brain.10 When a child experiences trauma, Dr. Bruce Perry’s sequence of engagement and processing tells us that the child does not have access to and is unable to develop their upper brain, which is where higher functions of learning occur. It is also in this limbic system that attachment occurs, and yet this cannot happen if the child constantly lives in their downstairs brain simply trying to survive.

The theory of attachment is credited to John Bowlby and Mary Ainsworth.11 Throughout his work, Bowlby began to believe that attachment was more an evolutionary process with the child having an innate drive to form an attachment.12 “The central theme of attachment theory is that primary caregivers who are available and responsive to an infant's needs allow the child to develop a sense of security.”13 Attachment begins as a dance between caregiver and infant. Primary caregivers are most often the mothers, and the process of attachment begins at birth. When a mother holds her infant, gazing into their eyes, providing food, nurturing and responding to the child’s needs, the attachment dance continues. The amount of trust a child has in a caregiver begins when the child’s needs are met. The child is put down; the child cries because they are hungry; the mother returns and meets the physical and emotional needs of the child. This is how trust is built.

It is in forming this connection that fosters a child’s development of self-regulation; the understanding that they can experience the dysregulation of being hungry, needing a diaper change or the necessity of other primary needs to be met, and then comes the person to meet these needs, reassuring them they are safe. This creates a feeling of “felt-safety,”14 and over time, a child develops the ability to self-regulate due to the notion of felt-safety even in the dysregulated state, knowing at some point, their person is coming. This is an example of a securely attached child. Because the child is securely attached to their primary caregiver, they can then expand their attachment to secondary caregivers and other family members. The foundation for healthy relationships has thus successfully been established.

There are four styles of attachment: ambivalent, avoidant, disorganized and secure.15 An ambivalent child might demonstrate characteristics of anxiety, clinginess and an inability to easily soothe. These children often seek relationships, only to then push people away, or they may be too overwhelmed with their emotions to seek out others. With avoidant attachment, a child may present as emotionally distant, unable to recognize emotions and choosing autonomy over being with others. The third style of attachment, disorganized, often lacks empathy, is aggressive with others and has little to no regard for rules. These children struggle with emotional closeness in relationships. A child that demonstrates a secure attachment is trusting and open to relationships with others. They manage emotions well, are empathetic and loving.

These attachment styles develop throughout the first three years of life16 and are attributed to the behaviors and interactions between child and caregiver responses. When the attachment style is one of the first three listed, we find children with an inability to trust or believe they are important or loved. They demonstrate higher anxiety, anger and disinterest in forming relationships. In his book, The Boy Who Was Raised as a Dog, Perry states, “The truth is, you cannot love yourself unless you have been loved and are loved. The capacity to love cannot be built in isolation.”17 When a child is afforded the opportunity of a securely attached relationship cycle, they understand their caregiver loves them and can leave, but will return; they can self-regulate and feel loved. Overall, these children have developed a higher level of trust. The first three years of a child’s life, and the style of attachment to which they are exposed, is a great indicator of future behavior and relationship patterns. Perry also states, “Connectedness is the key. Your history of connectedness is a better predictor of your health than your history of adversity.”18

As judges, attorneys and mental health professionals, the children we most frequently encounter have experienced ruptured relationships or may not have been afforded the opportunity to develop securely attached relationships. Parents with their own broken attachments, mental health issues and substance abuse addictions often cannot provide the necessary environment to care for and nurture their infants and young children. This requires child protective services to intervene, removing the child(ren) from what they know, even if what they know has been unhealthy. This creates trauma.

When parents get divorced, and what was once routine for the child(ren) is now unstable and unpredictable, we see signs of trauma. Trauma occurs with the child placed in an adoptive home appears well attached, but their biological parents have reversed consent for adoption. The child is now required to have visitation with “strangers,” resulting in uncertainties of scheduling and care providers, as lengthy court battles ensue, leaving the child struggling to manage emotions. This is trauma.

Addressing broken attachments and ruptured relationships requires a multi-disciplinary team approach. Judges, attorneys, mental health professionals and human services professionals all play a vital role in this process. Factors that influence outcomes include the length of time a child is in custody, custodial schedules within divorce agreements, parenting styles and willingness to work with children of trauma, as well as the timing and severity of the child’s trauma. In an effort to minimize the effects of trauma or to provide the optimal situations for attachment to occur, it is important to have open lines of communication between foster parents, court systems and mental health professionals. Early intervention with therapeutic services, providing skills and resources to promote healthy relationships is imperative.

Children in state custody deserve permanency, which in turn fosters stability and security, allowing a child to begin healing from their trauma. Oklahoma, at the end of the 2019 fiscal year, had 8,631 children in custody, with less than 1,400 in trial adoption or trial reunification status, leaving over 4,000 children without permanency.19 Establishing higher expectations of treatment plans by the biological parents and more expedient termination of rights should these expectations not be met, provides the children in care the opportunity to move forward.

In the family court system, where Oklahoma ranks in the top five for highest divorce rates,20 it is imperative that parenting classes are encouraged with the filing of separation and that custody arrangements are looked at by multiple factors, such as the age of the child and who has been the primary caregiver, as a cookie-cutter approach is not always in the best interest of the children. Early education for parents on the trauma of divorce and the benefits of co-parenting could bring relief to many families as they endure this highly stressful and emotional time. It is the youngest members of society that suffer the greatest traumas as they experience broken attachments, abuse and neglect.

At Kaiser Permanente, the Adverse Childhood Experiences (ACE) Study determined there is a direct correlation between divorce, abuse, neglect, household dysfunction, incarceration of relatives and the overall well-being of adults. Having an ACE score of two or more doubles someone’s likelihood of developing an autoimmune disease.21 In her practice, Harris also found patients with four or more ACEs were twice as likely to be overweight or obese and 32.6 times as likely to have been diagnosed with learning and behavioral problems.22 While there are the Cinderella stories in which people overcome great adversity, childhood trauma leaves a long-lasting impact that is carried into adulthood.

It is not necessarily our circumstances that determine if an event is traumatic, but more so the ways in which our body reacts to the experience. In the ACE study, we learn that the higher number of adverse traumatic experiences a child has, the more likely they are to have an increase of depression, anxiety, suicidal tendencies – even obesity, heart disease and diabetes. Being able to minimize the trauma a young child experiences can result in an overall increase of emotional, physical and mental well-being.

For all who choose to work with children and families, it should be the utmost priority to understand trauma and attachment and how it affects the littlest people of society. Judges and attorneys are required to make recommendations and decisions daily that affect the future of these children before them. Look: see the trauma through the lens of the child who deserves our best. Listen: hear the stories that cannot be spoken. Speak: be their voice of protection and in rewriting their future. “If we can communicate to our children: It’s you and me against your history we have a strong place to begin.”23

ABOUT THE AUTHOR

Angela Wheeler is a licensed professional counselor, a registered play therapist and TBRI practitioner. Her practice, Connections, focuses on trauma, attachment and reunification. She works with families in litigation, assisting children and parents with reunification and is frequently asked to testify as an expert in adoption/trauma cases.


Endnotes

  1. centerforanxietydisorders.com/what-is-trauma/.
  2. K. Purvis, D. Cross and W. Lyons Sunshine, “The Connected Child,” (2007), New York: McGraw Hill.
  3. Id.
  4. Id.
  5. Id.
  6. B. Van der Kolk, “The Body Keeps the Score,” (2014), New York: Penguin Books.
  7. Id.
  8. B.D. Perry, “Bonding and Attachment in Maltreated Children: Consequences of Emotional Neglect in Childhood” (1991), CTA Parent and Caregiver Education Series, Volume 1: Issue 3, Child Trauma Academy Press.
  9. N. Burke Harris, “The Deepest Well,” (2018), New York: Houghton Mifflin Harcourt.
  10. B.D. Perry, “Bridges to Hope: Teaching in the Shadow of Trauma,” (Feb. 17, 2020), Presentation, Cox Convention Center, Oklahoma City, OK.
  11. M.D.S. Ainsworth and J. Bowlby, “An Ethological Approach to Personality Development,” American Psychologist, (1991), 46, 331-341.
  12. www.verywellmind.com/what-is-attachment-theory-2795337.
  13. Id.
  14. Purvis, Cross and Lyons Sunshine, “The Connected Child.”
  15. Ainsworth and Bowlby, “An Ethological Approach to Personality Development.”
  16. www.zerotothree.org.
  17. B.D. Perry, “The Boy Who Was Raised as a Dog,” (2007), New York: Basic Books.
  18. Perry, “Bridges to Hope: Teaching in the Shadow of Trauma.”
  19. www.okdhs.org/library/rpts/Pages/s19_dhsannualreport_tables.aspx.
  20. www.cdc.gov/nchs/nvss/marriage-divorce.htm?DC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fnchs%2Fmardiv.htm.
  21. Burke Harris, “The Deepest Well.”
  22. Id.
  23. Purvis, Cross and Lyons Sunshine, “The Connected Child.”

Originally published in the Oklahoma Bar Journal -- OBJ 91 No. 6 (August 2020)