Ratings of 4 reflect evidence of attachment behavioral organization and the presence of extreme or pervasive behavioral anomalies beyond the scope of traditional disorganization coding. Ratings of 3, 2, and 1 were assigned for behavioral displays that indicated fragmented or incomplete sequences of attachment behavior differentially directed toward the caregiver, isolated attachment signals and responses, or no evidence of attachment behavior.
The authors considered categorical attachment classifications ABCD only meaningful in the traditional sense for children receiving ratings of 4 or 5. The difference between institutionalized and family-reared children was impressive. Every community child living with parents in their study had an attachment rating of 5, whereas only 3 out of 95 children living in institutions had such a rating. Furthermore, except for one child rated as securely attached, all of the other organized attachment classifications in the institutionalized group received ratings lower than 5 Zeanah et al.
The attachment rating scale was also applied to SSPs of institutionalized and family-reared children in Ukraine. Of 35 family-reared children, 34 children received a rating of 5, one child was rated a 4.
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None of the family-reared children received a score lower than 4. However, of 29 institutionalized children, 12 were rated lower than 4 and only 7 children received a five Dobrova-Krol et al.
These numbers clearly favor family-reared children, although the contrast is less striking than in the BEIP study. The caregiving situation in institutions in Ukraine may be somewhat better compared to Romanian institutions some years ago, at least with regard to the ratio of caregivers to children, which is 1: Quality of caregiving was related to the continuous attachment ratings in both studies: More sensitive caregiving was associated with higher ratings on the 5-point attachment rating scale.
The attachment rating scale thus provides an important additional measure of attachment, reflecting the degree of attachment formation that is not self-evidently complete in institutionalized children. Moreover, it places attachment classifications assigned to children with low scores on the attachment formation rating scale in a more provisional context than those of children with a high rating on the attachment rating scale, where reliably rated attachment behavior has been observed, e.
It is often difficult to decide whether these children have formed any attachment relationship at all or are overwhelmed by the observation procedure, as might be the case with children with cognitive impairments. Unclassifiable children may either reflect the absence of attachment formation in the neglectful environment of an institution or result from the cognitive requirements of the SSP that was developed for typically developing children. An important issue for further discussion is how we can assess whether children have formed any attachment relationship at all.
Situations beyond the SSP with more naturalistic observations e. Differential patterns of child behavior in the two procedures would support the validity of the attachment assessment. To our knowledge no such study has done this but see The St. Petersburg—USA Orphanage Research Team, , who tested whether classifications differed as a function of whether the children were observed in the SSP with their most consistent caregiver or an alternative caregiverit made no difference.
Collectively, studies on attachment in institutionalized settings raise questions about whether the SSP measures the same construct in institutionalized and home-reared children. We would argue that the construct of attachment is more complicated among institutionalized children and their caregivers than has so far been appreciated.
The issue is that these children have attachments that are incompletely developed even though they may show characteristics of one the four major types or patterns of attachment. A study on attachment formation in foster children may be illustrative in this respect. These behaviors became evident within days to weeks, suggesting that there is a quantitative dimension when attachments are first created. Once attachments are well established, as they are with almost all home-reared infants, the quantitative aspect is no longer relevant because the attachments are fully developed.
Perhaps children raised in settings such as institutions do not have sufficient contact with caregivers to develop fully formed attachments indicative of a selective organized relationship relied upon for safety and encouragement to explore. The question that these results raise extends beyond studies of institutionalized children to all circumstances where care is intermittent, chaotic, and otherwise radically different from the average expectable environment.
That is, do some very high-risk home-reared children e. If so, then a quantitative dimension of attachment should perhaps be explored in studies of these children as well Zeanah et al. Furthermore, Muhamedrahimov and Palmov have suggested that institutionalized children often show behavior that is coded as disorganized attachment using the Main and Solomon scheme but that may reflect a strategy of coping with stress when the caregiver is emotionally unavailable even while providing adequate physical care for the child. The child may then suppress his or her need for care, comfort, and safety to maintain a relationship with the caregiver or may alternate avoidant and ambivalent patterns in stress situations, reflecting the insensitive, unpredictable, unstable, and inconsistent caregiving environment in the institution.
It has been argued that over time institutionalized children learned to suppress the display of negative emotions and to favor positive display emotions as a somewhat organized strategy of behavior that is adaptive to the context of the institution e. One of the behaviors that seems to be typical of institutionalized children is disinhibited or indiscriminately friendly behavior, characterized as affectionate and friendly behavior toward all adults, including strangers, without the fear or caution that is characteristic of typically developing children Tizard, The DSM-IV description of a reactive attachment disorder RAD differentiates between inhibited and disinhibited attachment disorders, and the disinhibited type is characterized by, seeking comfort with others, including relatively unfamiliar adults, without a preference for the attachment figure.
In addition, these behaviors must arise in the context of pathogenic care, which is believed to be responsible for the disorder. Although indiscriminate friendliness is equivalent to disinhibited RAD, the relation between the latter and classifications of attachment appears to be quite complex.
RAD disinhibited may be present with any classification of attachment, including secure, though it is more prevalent with aberrant patterns such as disorganized and insecure other. Furthermore, enhanced caregiving quality alone is insufficient to diminish indiscriminate behavior, at least in some children, as evidenced by the persistence of indiscriminate behavior in children adopted out of institutions into advantaged middle-class homes Rutter et al.
Caregivers are asked whether the child wanders off without distress; whether their child is willing to go off with a stranger; how friendly the child is with new adults; whether the child is shy with new adults; what the child typically did upon meeting new adults Chisholm, Studies involving children after adoption from institutionalized settings e. In both types of studies the comparison groups were never institutionalized children, most often from biological families except for the study of the English and Romanian Adoptees Study Team, in which the comparison group consisted of never institutionalized domestically adopted children.
Nevertheless, the distinction between the two sets of studies is important, not only when associations of indiscriminate behavior with other variables are considered, but also for the interpretation of the behavior itself. Chisholm suggested that indiscriminate behavior may well be adaptive in the institutional setting, where friendly children may receive what little attention caregivers are able to give.
In her study, children scoring higher on measures of indiscriminate friendliness after adoption were more likely to have been favorites in the institution according to their adoptive parents. However, the function of indiscriminate behavior after adoption is less clear. Below we consider the possibility that indiscriminate friendliness may the result of biological programming by the neglectful environment mainly in the area of capacity for focused attention and effortful control. This argument suggests that the core difficulty for children with indiscriminate friendliness is a lack of self control.
Who would not want to believe that the child they are adopting was probably favored in the institution, and is therefore used to affection and attention and thus able to show it so fully? However, this perception is only rarely grounded in reality and serves much of the time to create a honeymoon that cannot last. As soon as the adopted child speaks intimate requests e. Bruce, Tarullo, and Gunnar also examined indiscriminate friendliness using the interview and observation of indiscriminate behavior and found it associated with attention regulation as assessed with both parent report and neuropsychological tasks e.
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These results suggest problems in effortful regulation of attention as possibly underlying indiscriminate friendliness. Specifically, it may be that the inability to appropriately inhibit either verbal or physical approaches to strangers might be a broader reflection of attention and behavior regulatory problems and not necessarily issues in forming attachment relationships. This is supported by the finding that associations between attachment and indiscriminate behavior appear to be equivocal.
In general, indiscriminate friendliness does not seem incompatible with secure attachment to the adoptive parent, and it was found to be unrelated to the quality of care in the adoptive families Rutter et al. Remarkably, indiscriminate behavior was associated with cognitive impairment and peer relationship problems in formerly institutionalized adopted children, but such a relation was not found in never institutionalized children Rutter et al.
Children who currently live in institutionalized settings show consistently more indiscriminately friendly behavior than comparison groups not living in institutions Dobrova-Krol et al. However, levels of indiscriminate friendliness appear unrelated to length of stay in the institution and to having a preferred attachment figure or not. Smyke and colleagues found that lower levels of indiscriminate friendliness were shown by children who were the favorites of a caregiver contrary to Chisholm, , who found higher levels of indiscriminate friendliness for adopted children who, according to their adoptive parents, had been favorites in the institution.
It may be that BEIP missed the window during which fostering would have reduced indiscriminate behavior; the youngest child was fostered at 7 months, with a mean age of around 22 months, and we already noted that indiscriminate behavior is more persistent when institutionalized rearing extends beyond the age of 6 months see Table 1. Thus, it would seem that the absence of consistent care early in life, typical of institutional life, elicits in some children a fervent search for care from whoever appears to be available.
And for the adult who is the target of this behavior, interest and warmth in return is difficult to inhibit! The etiology and function of indiscriminate friendly behavior may be different for institutionalized versus non-institutionalized children. In a study on institutionalized care in Ukraine, indiscriminate friendliness was positively related to more sensitive care for children in the institutional setting but not for the comparison group of family-reared children Dobrova-Krol et al.
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If this reasoning is sound, two important questions remain. First, why does indiscriminate friendly behavior appear to persist after adoption in a part of this group? Chisholm suggests that the behavior may be reinforced by adoptive parents and strangers after adoption; about one year after adoption most adoptive parents reported that they were pleased that their child was warm and loving and appeared to be fond of everyone Chisholm, , p. In that case, indiscriminate friendliness in institution-reared children is not adaptive — and indeed it may be questioned how much the child profits for the shallow contacts that result from their indiscriminate behavior.
Instead, it results from the lack of expected input in the form of contingent interactions with a stable caregiver that is needed to facilitate the development of a preference for familiar caregivers. The presumably experience-expectant process is shown in the transformation from a relatively indiscriminate response towards strangers, characteristic for the first months of life, to stranger anxiety occurring around 7 to 8 months Bowlby, This possibility relates to the construct of sensitive periods Chapter 6. That is, it appears that a normative period of indiscriminate behavior is present early in the first year of life.
Beginning about 2 to 3 months of age, infants are quite interested in engaging in social interaction with almost anyone. At months, this changes and for the first time they begin to exhibit wariness with strangers. This suggests inhibition of the affiliative motivational system described by Bowlby In children who experience serious neglect, however, the sensitive period for inhibition closes without the development of a selective or specific attachment in the context of a more-or-less continuous relationship, so that indiscriminate friendliness persists with potentially maladaptive consequences.
Thus, the etiology and function of indiscriminate friendliness may differ for family- and institution-reared children. In the first case it may reflect a distortion or disruption of early attachment relationships not uncommon in multiple-problem families. In the latter case it seems to result from the lack of expected input in the form of contingent interactions with a stable caregiver in early life, which is characteristic for institutional care and may be related to decreased emotional and behavioral regulation Dobrova-Krol et al. The second question pertains to the assessment of attachment with indiscriminately friendly institutionalized children.
In the classic Strange Situation Procedure with the inclusion of a stranger and a caregiver, close attention to whether preference is shown to the caregiver over the stranger provides valuable information to ascertain the existence of a specific attachment that is not the reflection of mere sociable or friendly behavior.
Specific secure, insecure, or disorganized attachments may or may not exist alongside indiscriminately friendly behavior. The inclusion of structured interviews e. As noted above, indiscriminate friendliness has most often been assessed on the basis of an interview with the caregiver. Although convergence among these somewhat varying interviews has been demonstrated Zeanah et al.
Still, observational measures of indiscriminate friendliness may provide important information in addition to caregiver report of friendly behavior. The BEIP Stranger at the Door procedure may turn out to be an important breakthrough in the measurement of indiscriminate friendliness independent of caregiver report. Table 1 summarizes the studies looking at indiscriminate friendliness with reference to sample, measurement, and outcome and should be seen as a call for further work that incorporates a variety of sources of information concerning children, while living in the institution and after foster or adoptive placements.
In this way, we may draw closer to a refined understanding of the causes and consequences of indiscriminate friendliness. The causes of indiscriminate friendliness are to be found in those studies that involve careful observations of caregiver characteristics and behavior in institutions as well as child measures of effortful regulation of attention and behavior. Sensitive care also implies a relationship between infant and caregiver that is stable over time.
Caregivers managed to feed the infants and keep them clean but they did not have time for play and emotional and social exchanges. In a normal family setting, both caregiver and child negotiate in a cooperative way to ensure that the goals of both partners are achieved. In the study of Greek institutionalized children Vorria et al.
Under these circumstances, it is difficult to imagine how a pattern of attachment could develop, because normally such patterns are based on thousands of interactions between an individual infant and an individual devoted caregiver. A similar picture of too many children being cared for by too few caregivers grossly lacking in sensitivity has been suggested by Muhamderahimov The social-emotional environment of children in the Russian baby homes he studied was characterized by severe deficits in the sensitivity, responsivity, and stability of caregivers as well as neglect and maltreatment even in the context of obligatory caregiving duties feeding, changing, hygienic procedures, etc.
Observations showed that in the situation of the longest and the most intense interaction with adults i. In Metera, some of the caregivers, as a method of discipline, used behaviors e. This may be among the reasons for having many infants with a disorganized type of attachment Vorria et al. The stability of the caregivers is another serious problem related to institutional care. It should be realized that a 4: Taking shifts, vacations, and staff turnover into account, it is clear that children in institutions usually are cared for by many different caregivers; by the age of four some children have had as many as 50 different caregivers e.
Petersburg-USA Orphanage Research Team, , hampering the development of an attachment relationship with a stable caregiver. In the Metera Babies Center the caregivers usually remained the same for many years, often until they retired; however, the fact that they work in shifts in large groups hampers attachment formation. Moreover, caregivers are often untrained, or trained to look after the infants and take physical care of them but not to interact with the children. The micro-caregiving environment within which each child develops is thus more predictive of development than the mere fact of institutionalization.
Unfortunately, only a few studies have focused on the relation between quality of care on the level of the individual institutionalized children and their attachment pattern or indiscriminate behavior. In institutionalized children in Ukraine, more positive caregiving was related to higher scores on the continuous attachment rating scale as developed by Zeanah and colleagues , to increased attachment security, and to more indiscriminate friendly behavior.
Yet associations between indiscriminate friendliness and any specific pattern of attachment were absent Dobrova-Krol et al. Zeanah and colleagues, in contrast, found that indiscriminate friendliness was unrelated to continuous ratings of attachment.
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They also found, akin to the Ukraine work, that indiscriminate behavior was not linked to attachment disorganization, and neither was it related to quality of caregiving. Thus, although several studies on institutionalized care found associations between quality of care for the individual child and, in order, child attachment and indiscriminately friendly behavior, attachment and indiscriminate friendliness appear to be separate constructs that are not directly inversely related to each other. In spite of insufficient sensitive care in residential settings, it is important to mention that one in five of the Greek infants studied by Vorria and colleagues was securely attached with their caregiver Vorria et al.
This finding is interesting, because in the Zeanah et al. More similar to the Vorria et al. It is widely accepted that relationships between caregivers and infants are the result of the interplay of both caregiver and infant characteristics. Infants may elicit specific caregiving responses which, in turn, could influence the type of attachment insecurity. Other factors that ought to be examined are medical complications experienced by the infants, such as premature birth.
In the Greek study there was a higher proportion of prematurity among the group care infants The smallest sample and oldest study using a novel procedure for studying attachment suggested a possible genetic effect upon security versus insecurity of attachment. Yet the more recent reports on larger samples relying on the well-validated standard Strange Situation Procedure robustly support the suggestion that the development of attachment is mostly environmentally shaped.
However, it may be that a protective genetic lay-out can account for some resilience. In a small study of Ukrainian preschoolers reared in institutional settings or in their biological families a moderating role of 5HTTLPR for the association between rearing environment and attachment disorganization was found. Thus children may differ in their vulnerability to extremely adverse rearing experiences, depending on their genetic characteristics see Chapter 1. In the Greek study, an effort was undertaken to clarify what could account for the differences in attachment found in the infants growing up in residential group care Vorria et al.
Also, because of their social abilities, these infants may have been more rewarding to interact with, so their caregivers paid more and more sensitive attention to these infants, enabling the formation of secure attachment relationships. Other variables, such as caregiver characteristics, were not found to differentiate the group care infants who were securely attached to their primary caregivers and those who had a disorganized pattern of attachment.
Various temperamental characteristics may affect the infant-caregiver relationship. Infant sociability may help to increase the amount of caregiver attention, but fussy infants may achieve the same goal. They may attract more personal attention of the caregivers and so increase their chances of building a relationship with one or more of them. It might be that the group care infants who managed to develop secure attachment with their caregiver were more resilient; Rutter pointed out that even in the most disadvantaged environments some individuals manage to emerge unmarked.
Some of the best available evidence that suggests security of attachment may be increased among institutionalized children by re-organizing care within institutions comes from The St-Petersburg-USA Orphanage Research Team This team initiated an intervention program designed to improve the social-emotional relationship experience of Russian children birth to four years living in baby homes, which is also the first quasi-experimental attempt to change attachment classifications within an institution.
These interventions provided significant change in the social and emotional behavior of typically developing children and for children with disabilities, although the latter group needed longer exposure and the pattern of results was sometimes different. Specifically, the intervention improved the caregiver-child relationship during free-play and produced better quality of play, more positive affect, and more positive reciprocal engagement.
Also, intervention typically developing children displayed higher positive emotional tone during free play and reunions and more negative emotional tone during separations and reunions. Similarly, intervention caregivers increased in positive and negative emotional tone and the number of different emotions that they displayed. Presumably, children living in the new caregiving environment after training and structural changes had the opportunity to develop a relationship with a more sensitive and responsive primary caregiver. Indeed, the rate of attachment disorganization was lower after the intervention Outdoors they stayed closer to their primary caregiver.
The authors assumed that indiscriminately friendly behavior decreased when children experienced a more sensitive and stable caregiving environment. In sum, although child characteristics may be related to attachment quality, the observational and quasi-experimental evidence supports the idea that it is the qualities of the caregiver that are of overriding importance for attachment security and social-emotional development similar to studies on non-institutionalized children as well Van IJzendoorn et al.
There is diverse evidence to suggest that when adoptive placements are sensitive and well-organized then previously institutionalized children may develop secure attachments with their adoptive parents e. At the age of four years, adopted children still showed less secure attachment representations as assessed with the ASCT compared to the comparison children. On the ASCT, adopted children constructed narratives that contained fewer prosocial interactions between parent and child figures, were incoherent and avoidant during story-telling, and were less likely to produce adequate story resolutions to the central conflict of each story-stem, which might indicate that they had internalized less secure internal working models of attachment.
Significant between-group differences regarding attachment were still found between the adopted children and the comparison group. Furthermore, some formerly institutionalized disorganized children were found to be securely attached to their adoptive mother, suggestive of a rebound effect in which the extreme sensitivity of the infant to deficient institutional care perhaps helped the formerly disorganized infant become secure in the context of more optimal care provided by the adoptive mother.
Alternatively, children with firmly established secure attachments within the institution might experience a more severe loss in the transition to the adoptive family and have more difficulty in regaining trust in a new attachment figure. These children may need more time to get over the loss of their attachment figure in the institution and to form a secure attachment relationship with their adoptive parents. Without information on the attachment state of mind of the adoptive parents it is difficult to draw firm conclusions.
It should also be noted that the average AQS score for the Greek preschoolers was significantly higher than the average security score found worldwide see Van IJzendoorn et al. Steele and colleagues observed that formerly disorganized insecure children quickly showed signs of security but only if they were placed with an adoptive parent with a secure and organized state of mind in response to the Adult Attachment Interview or AAI.
This finding echoes the report of Dozier, Stovall, Albus, and Bates showing that babies removed from neglectful circumstances at months of age began to show signs of secure attachment proximity seeking and contact maintenance but only if they were placed with a foster mother who provided a secure and organized response to the AAI. Meta-analytic results showed that age at adoption was a significant moderator of attachment security of the child in the adoptive family. At the same time, given the widespread growth in orphan populations worldwide and the diminishing interest many countries show in adoption outside their borders, a high priority for researchers and policy advocates must be that of improving the quality of care either within family environments or within institutional settings.
The knowledge base is firmly established as to what can and should be done to facilitate secure attachments among institutionalized children, a process likely to have long-term efficacious consequences for children, families and society. CHZ was supported by the John D. National Center for Biotechnology Information , U. Monogr Soc Res Child Dev. Author manuscript; available in PMC Sep Zeanah , Rifkat J. Muhamedrahimov , Panayiota Vorria , Natasha A.
See other articles in PMC that cite the published article. Abstract Attachment has been assessed in the extreme environment of orphanages, but an important issue to be addressed in this chapter is whether in addition to standard assessment procedures, such as the Strange Situation, the lack of a specific attachment in some institutionalized children should be taken into account given the limits to the development of stable relationships in institutionalized care.
This chapter is organized around three conceptual and methodological issues: What is the role of attachment and indiscriminate friendliness in adapting to the institutional environment of structural neglect? Specifically, what components in institutional care are responsible for attachment insecurity and disorganization? What caregiver and child characteristics are associated with secure attachment? How can institutional care be enhanced to promote more secure attachments?
How fast do attachments develop after adoption or fostering, how can we assess progress and problems in the development of attachments, and what can parents and professionals do to facilitate post-institutionalized children in creating their secure base and regulating their emotions in acceptable ways? How might attachments emerging in the institutional setting help or hinder the adaptation of post-institutionalized children to a life in adoptive families or foster care?
And last but not least, is complete recovery of attachment and emotion regulation possible, or do scars remain that limit recovery? An obvious critical variable is the age at which a child enters and leaves institutional care. Child-Caregiver Attachments in Institutions Assessing attachment in institutionalized children: Background considerations Bowlby was highly suspicious that a residential rearing environment could approximate a normal home life for a child, yet institutions continue to exist throughout the world more than a half-century after strong concerns were expressed e.
Attachment and Indiscriminate Friendliness Indiscriminate friendliness in adoptees and institutionalized children One of the behaviors that seems to be typical of institutionalized children is disinhibited or indiscriminately friendly behavior, characterized as affectionate and friendly behavior toward all adults, including strangers, without the fear or caution that is characteristic of typically developing children Tizard, IF related to length of stay in inst 2. IF related to having been favorite in inst 3. IF unrelated to attachment Sabbagh, in Chisholm, a? IF related to insecure-other 3.
IF stable 6 — 11 yrs 4. IF unrelated to quality adoptive home 5. IF related to length of stay in inst 3. IF measures convergent 2. IF weakly related to aggression. Being favorite less IF Roy et al. Romanian orphanage; foster care; comparison group SSP 3- item interview 1. IF unrelated to length of stay inst 3.
IF unrelated to attachment organization Dobrova-Krol et al.
Child-Caregiver Attachments in Institutions
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