Monday, January 19, 2015

When an Ideal Upbringing Isn't in the Cards

As a society, we generally agree that children need to have the best possible upbringing. And it's possible to look through the scientific literature to get a pretty good idea of what an ideal upbringing is like. A consistent caregiver present throughout the child's life, who has enough support to effectively manage the stress of child-rearing, is sensitive and responsive to their child's emotional needs and comforts them when they need comforting, and disciplines by rewarding good behaviour, explaining rules clearly and having consistent, logical consequences, which they administer while remaining calm.

But what if that's not an option?

Research has found a critical period for attachment, that seems to start between 9-12 months of age, and ends somewhere around 3-5 years. Experiences during this age range have a critical, lasting effect on the child's attachment, emotional regulation, and the neural architecture of their brain. Both inadequate caregiving (eg abuse or neglect) and separation from caregivers have the potential to cause lasting harm, especially in this age range. On the other hand, children in this age range are better able to respond to a change for the better than an older child would be.

So, imagine an 15 month old child, already well within this critical period. His mother has a serious drug addiction, which is making it very difficult for her to provide sensitive and responsive care to her child. In reaction, her child has developed a disorganized attachment style, which puts him at higher risk for both internalizing and externalizing psychological problems.

But he is attached to his mom. And his attachment is better than it could be - he shows no sign of reactive attachment disorder (RAD), the most severe end of attachment disturbance. He still gets some comfort from his mother's presence, still prefers her to a stranger, and feels safe enough with her watching over him that he's willing to play and explore. His attachment style is not optimal - he often seems to be in a double bind, wanting mom's comfort but also being afraid of her - but there's still room for it to get worse.

And this puts us in a tough situation. If we remove this child, we could put him into a foster home, with a foster parent who will probably provide him with sensitive and responsive care. However, since this child is attached to his mom, losing her will be traumatic for him. He might recover from his trauma and attach to his foster carer, potentially forming a better attachment style in the process, or he might not, and start sliding towards RAD. And if he does attach to his foster carer, how long will that relationship last? Foster homes aren't intended as permanent homes. Although some children stay in one foster home for years, and some are even adopted by foster parents, many foster children end up being moved from home to home. And if this little boy, who's already showing a disorganized attachment, gets moved several times during the critical period for attachment, then we can virtually guarantee that he will develop RAD.

Alternatively, we could try to get his mom to stop using. If she does go clean, her parenting will improve, and her baby is still young enough to respond to that - especially if we give her attachment-focused parent training as well. But what if she relapses? Or even gets worse? Her child may need to be removed anyway, months later, having missed out on several more months of good care in the critical period for attachment. We could end up back at square one, except with a 28 month old instead of a 15 month old. And now that he's two, it's that much harder for him to transfer his attachment from mom to a foster carer, and that much harder for the foster carer's parenting to sink in and change his view of relationships.

There is no one option that will put this child on the best road to life. All we have are different bad options, each of which could be putting the child at further risk, but if not, we might be able to make things a bit better. And the best outcome will still fall short of where this kid could have been, if he'd gotten sensitive and responsive care from birth.


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