Birth to three really does matter: in search of security

This blog reviews some attachment and care related issues I have covered in recent presentations, considering the origins, further development and implications of attachment theory, and how this might inform national policy creation for children under three and their families.

‘Classic’ attachment theory

Attachment theory was created by the British psychologist John Bowlby over the period directly following the Second World War (1939–45). Bowlby had built up the theory from his psychoanalytic work with children who had been evacuated from the cities during the war, separating them from home and family at very young ages. His central proposal was that human mothers and babies have a natural, evolved instinct to form a strong emotional bond, which if never made, or if broken in the first three years, created life-long emotional problems for the child. While this exclusive focus on mothers was later found to be highly problematic, Bowlby’s concept of the ‘Internal Working Model’ is still at the centre of modern attachment theory. He proposed that, based on their earliest relationships, infants construct an Internal Working Model (IWM) of what to expect from other people, and of their own level of ‘lovability’. Bowlby proposed that stable and loving relationships create an ‘other people are nice and I am lovable’ IWM, whereas troubled and fragmented relationships create an ‘other people are unkind and I am not lovable’ IWM. This basic belief, he proposed, was the basis of all subsequent emotional interactions with others, both in childhood and in later life.

Schaffer and Emerson (1964) later found, in a longitudinal study of babies aged 0–2, that several bonds with adults were formed in the first months. The babies tended to have one primary attachment and several secondary attachments, being content to be cared for by any of these ‘bonded’ adults. Only approximately 50 per cent of these babies had the primary attachment to the mother; the other 50 per cent had formed a primary attachment to another member of the family (most commonly the father or grandmother). The primary attachment tended to be the person in the family who showed the most ‘sensitive responsiveness’ to the baby.

The flexible human being

Bowlby had also drawn from ethology to create his ‘maternal deprivation’ theory, basing it partially on the phenomenon of imprinting in birds. What Schaffer and Emerson’s work indicates is that human beings are unsurprisingly rather more flexible than birds in the way in which they construct their early relationships, but that nevertheless, these relationships are have implications for lifelong mental health.  

D W Winnicott (1951) also shed light on this element of human flexibility when he studied what he came to call ‘transitional objects’- familiar toys and everyday objects (e.g., a teddy bear or a blanket) that small children use to bolster feelings of security in stressful situations. This again is unsurprising when we consider the human being as a symbolic primate. People operate via symbols- it is what makes us evolutionarily ‘special’. Words are the most obvious symbols, standing for the object in a sound or in a squiggle on the page. Children explore the more complex elements of symbolism in learning to speak, and later to read, but in very early development, they can create such a symbol subconsciously/ emotionally in a concrete object that can then temporarily stand for an attachment figure in stressful situations; a phenomenon that had been previously intuited in the early 20^th century children’s book The Velveteen Rabbit:

"Real isn't how you are made," said the Skin Horse. “It's a thing that happens to you. When a child loves you for a long, long time, not just to play with, but REALLY loves you, then you become Real”

(Williams 1922, online).

The studies of Mary Ainsworth (e.g., Ainsworth and Bell 1970) indicated that the quality of attachment that an infant had to bonded carers had a lasting effect on the IWM. Ainsworth proposed that where children’s experience was of bonded carers readily available to provide emotional support, they developed confidence to independently explore beyond the vicinity of the carer in an ever-widening arena, in the knowledge that they would be able to access emotional support when required. But where children learned that such support was never available, or that it was only available sporadically, they developed a reluctance to explore. Children who lacked emotional support altogether demonstrated a learned helplessness, developing a defence mechanism of responding dismissively to other people’s attempts to help; those who had learned that emotional support was only sporadically and unpredictably available developed a preoccupied/fearful style, developing a defence mechanism of constantly seeking reassurance from others due to an underlying concern that it might not be forthcoming when needed. In the mid-20^th century, therefore, building strong bonds of attachment in childhood was emphatically proposed by developmental psychologists to be crucial for lifelong individual mental health, and for cohesion and mutual trust in society in general.

The Cortisol Studies

With the growth of developmental neuro-biology in the early 21^st century, additional neurophysiological evidence emerged to support the importance of secure relationships in infancy. A range of studies discovered abnormally raised levels of the stress hormone cortisol in young children placed in situations where they did not feel secure in the care that they received. This was found in a range of studies of under threes spending full days in collective daycare, while comparison groups cared for in their family home showed normal cortisol levels (e.g., Badanes and Watamura 2012, Dettling, Gunnar and Donzella, 1999; Dettling, Parker, Lane, Sebanc and Gunnar, 2000; Watamura et al., 2003; Watamura, Kryzer, and Robertson, 2009).

However, it would be naïve to propose that every family home is more emotionally supportive than every daycare setting, and Australian researchers Sims, Guilfoyle and Parry (2006) clearly demonstrated this when they compared the cortisol levels of children in daycare settings judged as ‘high quality’ against the cortisol levels of children in daycare settings judged as ‘satisfactory’. Their findings indicated while children in the satisfactory settings typically showed the raised cortisol levels discovered by the previous research, children in the ‘high quality’ daycare typically showed no signs of a cortisol-elevated stress response. Sims et al suggested that the defining features of ‘high quality’ daycare were as follows:

• Protective care: staff provide careful, individualised care for all children at all times, and individual needs for safety, rest and comfort are met. Staffing policies and practices facilitate continuity of care for each child. Children are appropriately dressed for indoor and outdoor play. Toileting and nappy procedures are calm, positive experiences.
• Staff Relationships: happy engaging atmosphere, with staff positively guiding children’s behaviour; Staff communicate effectively and function as a team
• Partnership: Staff and families effectively exchange both verbal and written information about the children, and about the centre’s routines and expectations
• Respect: staff initiate and maintain communication with children, accommodating their individual needs including the recognition of social and cultural difference
• Planning, Learning and Evaluation: the centre programmes reflect a clear centre philosophy and shared goals, which cater for the needs, interests and abilities of all the children, and all the children are helped towards successful learning. The centre programmes encourage and support children to make confident choices and take on new challenges

The indications of Sims et al’s findings were therefore that the children in the high quality settings had fully accepted the daycare workers as into their circle of bonded adults, and felt secure in their care.

How should we care for under threes?

The key point emerging from attachment research carried out over half a century is therefore that children under three need affectionate, trusting relationships with a small group of adults who care for them in a calm, attentive fashion. With respect to home-based care, the chances that secure, bonded relationships will be cemented is greatly optimised by ensuring that parents have sufficient financial and social support, and are not placed under unmanageable stress during their child’s first three years of life. Tharner et al (2011, p.162) explain that ‘parenting stress explained the most variance in child emotional and behaviour problems’ but that ‘in families with high parenting stress, securely attached children had fewer socio-emotional problems than insecurely attached children’.

The role that well-trained professional adults can play in supporting children at risk of insecure family relationships has been further highlighted by Shonkoff et al (2015) who found that supportive adult-child relationships outside the immediate family circle could blunt the impact of insecure family relationships in early childhood, and that emotional resilience could be strengthened to some extent by supportive relationships with non-familial adults at any point in childhood. They list the important factors in such relationships as follows:

• That the relationship is long-standing, stable, caring and supportive
• The adult provides support for the child to believe that s/he can overcome adversity
• The adult supports the child to develop self-regulation skills (the ability to manage one’s own behaviour, emotions and attention focus). This is not an imposition of draconian external discipline, but gentle support for the child to learn how to regulate his/her own responses in situations that are experienced as stressful
• The adult is careful to support and affirm the social and cultural traditions to which the child and his/her family are affiliated

 Daycare is thus not precluded as an option for providing care for under threes, but the emotional support requirements of such young children put very high professional and financial demands upon it. These are principally that children have secure relationships with both the staff in the setting and with those who care for them at home, and that all bonded attachments are supported by both sets of adults, who interact respectfully and proactively. It also requires that adult-child ratios in professional settings are very high, that staff turnover is very low, and that the adults within the settings are properly trained to deal with the needs of very young children. Such staff would necessarily be well paid, to reflect the education and training required, and to be provided with further continuing professional development and a secure career structure to retain a stable staff cohort within the setting.

Children experiencing continuous stress due to early and ongoing insecure relationships typically have higher resting levels of cortisol and take longer to return to baseline after individual stressful experiences; a process that becomes ‘toxic’. A simplified comparison can be made between a continually stressed brain and a computer constantly running a program that takes up a significant amount of its processing capacity. Implications for such a child as time goes by include:

•        Fight or flight response always on stand-by

•        Quick to anger, to sadness and ‘learned helplessness’

•        Short attention span

•        Problems concentrating at school

•        View the world as a dangerous place

•        Mistrustful of adults and other children

•        Feeling of inadequacy/ lacks confidence

•        Lack of self-belief/ lack of self-motivation

•        May be over-dependent upon opinion/ support of others (preoccupied)

•        May reject support from others (dismissive)

This ongoing ‘fall out’ is emergent from the subconscious IWM they carry of the world within their emotional cognitions, i.e., that other people are not or may not be friendly and helpful, and that they themselves are not, or may not be worthy of affection. Insecurity in this fundamental construction of the self and other people’s responses to the self inevitably compromises mental well-being on a lifelong basis.

So what does this mean for policy?

Where we are constructing a national policy for care for under threes, we therefore have several choices. We may choose to rely on kin and neighbourhood to provide a bonded circle of adults, or we may set up high quality professional daycare facilities to reproduce such relationships. European nations offer models of both patterns of care, for example, the Netherlands principally relies upon kin and neighbourhood in a culture where adequate social welfare provision is made for families, and part-time working is commonplace, while the Scandinavian nations dedicate a significant proportion of their Gross Domestic Product to the provision of very high-quality daycare (Naumann et al 2013). Issues are likely to arise, however, in nations such as the UK where nearly one in three children live in families that are officially designated poor (Child Poverty Action Group 2019); where there is little financial or social support specifically targeted at families with children under three, and where funding mechanisms for daycare have been so badly managed by the government that a significant number of daycare providers closed down over the year following a funding policy change (Morton 2018), while those left are barely managing to meet their staff payroll (Ferguson 2019).

Towards the end of his life, Bowlby accepted that he may have put too much emphasis on the exclusive role of the mother, but further reflected:

Man and woman power devoted to the production of material goods counts a plus in all our economic indices. Man and woman power devoted to the production of happy, healthy and self-reliant children in their own homes does not count at all. We have created a topsy-turvy world’

(Bowlby 1988, p.2).

This point is just as relevant today. The birth to three period of a human life matters intensely in terms of nurturing an emotionally secure individual, but we give this so very little thought in contemporary policy creation. When we piece our society back together after the current Brexit crisis, this consideration must be placed at the very top of the national policy agenda.

References

Ainsworth, M.D.S. and Bell, S.M. (1970) ‘Attachment, exploration, and separation: Illustrated by the behavior of one-year-olds in a strange situation’. Child Development, 41, pp.49–67.

Badanes, L., Dmitrieva, J. and Watamura, S. (2012) ‘Understanding cortisol reactivity across the day at child care: The potential buffering role of secure attachments to caregivers’, Early Childhood Research Quarterly 27, pp.156– 165.

Bowlby, J. (1988) A Secure Base. London: Routledge.

Bowlby, J. (1952) Maternal Care and Mental Health. Geneva: The World Health Organisation. Retrieved from http://whqlibdoc.who.int/publications/9241400021_part1.pdf

Child Poverty Action Group (2019) Child Poverty Facts and Figures. Available at: http://www.cpag.org.uk/content/child-poverty-facts-and-figures

Dettling, A.C., Parker, S.W., Lane, S., Sebanc, A. and Gunnar, M.R. (2000) ‘Quality of care and temperament determine changes in cortisol concentrations over the day for young children in childcare’, Psychoneuroendocrinology 25, pp.819–836.

Dettling, A.C., Gunnar, M.R. and Donzella, B. (1999) ‘Cortisol levels of young children in full-day childcare centers: Relations with age and temperament’, Psychoneuroendocrinology, 24, pp.519–536.

Ferguson, D. (2019) Parents in England face shock rise in childcare costs as government cuts bite. The Observer online. Available at: https://www.theguardian.com/money/2019/mar/31/childcare-fees-rocket-lack-of-early-years-funding-nurseries-close

Morton, K. (2018) Nursery closures rise 66 per cent since 30 hours began. Nursery World Online. Available at: https://www.nurseryworld.co.uk/nursery-world/news/1165551/nursery-closures-rise-66-per-cent-since-30-hours-began

Naumann I., McLean, C., Koslowski, A., Tisdall, K., and Lloyd, E. (2013) Early Childhood Education and Care Provision: International Review of Policy, Delivery and Funding. Edinburgh. Centre for Research on Families and Relationships (University of Edinburgh). Available at: https://www.nls.uk/scotgov/2013/9781782564164.pdf

Schaffer, H.R. and Emerson, P.F. (1964) ‘The development of social attachments in infancy’. Monographs of the Society for Research in Child Development, 29 (Serial No. 94).

Shonkoff, J., Levitt, P., Bunge, S., Cameron, J., Duncan, G., Fisher, P., Fox, N., Gunnar, M., Hensch, T., Martinez, F., Mayes, L., McEwen, B. and Nelson, C. (2015) Supportive relationships and active skill building strengthen the foundations of resilience. National Scientific Council on the Developing Child. Harvard: Center for the Developing Child, Harvard University. Available at: https://developingchild.harvard.edu/wp-content/uploads/2015/05/The-Science-of-Resilience.pdf

Sims, M., Guilfoyle, A. and Parry, T. (2006) ‘Child care for infants and toddlers: where in the world are we going? The First Years – Nga Tau Tuatahi’. New Zealand Journal of Infant and Toddler Education, 8(1), pp.12–19.

Tharner, A. (2011) Parents and Infants: determinants of attachment in a longitudinal population-based study. Amsterdam: Erasmus Medical Centre​

Watamura, S.E., Donzella, B., Alwin, J. and Gunnar, M.R. (2003) ‘Morning-to-afternoon increases in cortisol concentrations for infants and toddlers at child care: Age differences and behavioral correlates’, Child Development 74, pp.1006–1020.

Watamura, S.E., Kryzer, E.M. and Robertson, S.S. (2009) Cortisol patterns at homeand child care: Afternoon differences and evening recovery in children attending very high quality full-day center-based child care. Journal of Applied Developmental Psychology 30, pp.475–485.

Williams, M. (1922) The Velveteen Rabbit. Available at: https://digital.library.upenn.edu/women/williams/rabbit/rabbit.html

Winnicott, D.W. (1951) ‘Transitional objects and transitional phenomena. A study of the first not-me possession’. International Journal of Psycho-Analysis, 34, pp.89–97.