Friday, June 14, 2013

Attachment in Autism

In the psychoanalytic view, autistic kids were considered unattached. This was presumed to be due to having a cold, distant, 'refrigerator mother', who did not present the child with the possibility of forming an attachment.

It is now known that autism is not caused by parenting, but is rather a neurobiological condition with a substantial genetic component. However, some people still think autism inherently impairs attachment. See, for example, the following comment, posted over a year ago as a response to this blog post:

"I can't speak directly to CP or other congenital anomalies but I do know for certain that children with autism fail to form appropriate attachments to their caregivers because that is one of the core features of autism - not because their parents didn't accept their autism."

So, do autistic kids attach? Moreover, do they form secure attachments? Yes, in fact, they do. But they don't always show them the same way.
I recently came across an excellent illustration of an autistic child with a secure attachment style, in this paper:

"Tommy, a 36-month-old boy with ASD and very little language, was observed together with his mother in the SSP. In the first episode of the SSP, in which only he and his mother were in the room, he seemed oblivious to his mother’s presence and to the toys in the room and was running around the room in circles, humming to himself, appearing self-absorbed and content. 

Upon receiving a cue from the observer, Tommy’s mother exited the room. Tommy immediately stopped his running around. He lay on the floor, appearing somewhat distressed and called softly, “Mama. . . .” When the stranger entered the room, she tried to soothe Tommy and engage him with toys, but he remained lying on the floor and looked at the door. 

Finally, Tommy’s mother entered the room. He immediately stood up, briefly looked at her, and resumed running around the room as he had done initially, before his mother had left."

Now, many parents might assume, if their child does not greet them or show overt pleasure at their return, that the child doesn't care for them. And indeed most neurotypical children would greet the parent. Depending on their distress level, they might run up and initiate physical contact, or they might simply smile and make a greeting gesture or sound from afar. Tommy did neither of those. The only overt social signal directed at his mother upon reunion was a brief glance, which she might easily have overlooked.

However, he is still a securely attached child, despite expressing it in a much less sociable manner. To illustrate this, you need to understand the two main functions of attachment - to support exploration and to provide comfort when distressed.

In the Strange Situation, toddlers and preschoolers are more playful when their caregiver is in the room. They are especially playful before the first separation episode. The security that the caregiver provides merely by being present gives the child the confidence to explore.
In contrast, when the caregiver leaves, the child loses that security. Play typically decreases greatly or stops altogether, and the child expresses distress. Some kids are more reactive than others, for reasons relating more to temperament than attachment. A less reactive child might just get quiet and subdued, and be relatively inactive. If they're somewhat more reactive, they might whimper or whine, or call for the caregiver if they have the language skills. And if they're highly reactive, they might burst out with a full-blown cry.
However, among securely attached kids, this distress is resolved by the caregiver's return. Their response to the caregiver varies based on how distressed they got, but they are capable of seeking out and receiving just as much comfort as they need to return to play. In contrast, some insecurely attached kids cling to the caregiver but are not comforted by this contact, or may even alternate clinging with aggression. And others seem to bottle up their feelings, refusing to seek contact even though they were clearly upset by the separation. A few seem to fall apart altogether, and can't seem to decide whether to approach the caregiver or run away, or might even show signs of dissociation.
So, compare Tommy here. He didn't play with the toys, but he engaged in his own style of play by running in circles and humming. When his mother left, he stopped this behavior and showed mild but obvious distress. And then when his mother returned, her presence comforted him enough for him to resume his previous behavior.
That's secure attachment. Even though he didn't greet her or initiate interaction with her, Tommy clearly needs his mother and derives an emotional benefit from her presence.


Blogger Rivka said...

I cared for a one year old child that I am pretty certain had Aspergers. He was passionately attached to his parents and to me. He didn't care to interact much with other children his age. But he obviously really really cared about us, his parents and me.

7:58 PM  

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