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Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Friday, July 20, 2012

Attachment and Day Care, Part 3

In the last two posts, I’ve been discussing some issues brought up by Elisa B., the mother of a two-year-old who has been having difficulty in his day care since he was separated from a favorite teacher. Elisa has found that the separation was intentional and that the day care staff believes that Billy should be developing more casual affectionate relationships with more child care providers rather than having a strong relationship with one. She also found that the plan is to move Billy to yet another classroom in about 6 weeks.

I mentioned in the last post that Developmentally Appropriate Practice requires attention to the needs and abilities characteristic of a particular age group (and I might point out that children are generally thought to do better with a small number of familiar people until at least 36 months of age, so I don’t think the day care center is aware of relevant appropriate practice). In addition, because children do not all develop along exactly the same schedule, or even develop all their abilities at the same rate, individually appropriate practice is also needed.

An essential part of individualization is attention to temperament. This term refers to the biological, constitutional characteristics unique to each person, which determine the ways each of us reacts to the world. There are several ways of looking at temperament, but they all assume that people have characteristics at birth which continue to be expressed throughout their lives. Naturally, because each person changes with age, the behaviors that express temperamental characteristics change over time, but the temperament remains the same. For example, the 6-month-old who eagerly tries new foods may become the ten-year-old who likes some foods much better than others but is enthusiastic about new games or people. All temperamental differences are by definition within the normal range of development, but some temperamental patterns take more support and guidance than others.  

Elisa  describes Billy as always having cried a lot, being shy around other people even if his mother and father were there, and having a lot of trouble adjusting when he first attended day care at 13 months.  Without having any other information, I’m guessing that Billy has three important temperamental characteristics. He has negative mood quality, so that even if there is nothing much happening his tendency is to be sad rather than cheerful. He withdraws  from new events and people rather than approaching them eagerly. And he is slow to adapt to situations.

These “difficult” temperamental characteristics have their advantages. A child like this does not wander off with strangers, drink liquids the painters left sitting around, or approach stray dogs. At the beach, he won’t go into the water when his mother isn’t watching (in fact, lots of luck getting him in there before Labor Day). But, in modern life, adults are not likely to see this as an ideal temperament. Families are all scheduled up and feel they should be able to rush hither and thither without pausing for adjustment. However, a child with this sort of “difficult” temperament just can’t be forced to accept rapid changes without responding with many tears and fears.

“Difficult” children can do very well if they are given plenty of affectionate guidance and if their reactions are anticipated. It would certainly be a big surprise if a child like Billy took happily to day care at 13 months. What he needed, and still needs, is plenty of time for adjustment to any new person or situation. What--  does somebody say he’ll have to do better eventually, so why not make him do it now? First of all, he can’t do it now. He doesn’t have the skills. Second, he will be able to do a good job later, and be his best mental and emotional self, if he now learns from adults how to cope. Doing new things a little at a time, having a chance to watch other children do them, and knowing that a familiar adult is nearby--  these are all factors that can make a new situation be, as one of my sons used to say, “funner than I thought!” Interestingly, we have no problem with letting adults or even older children handle their introduction to new things as they see fit, but some of us still believe that to allow  “difficult” toddlers to take their time is spoiling or babying them. On the contrary, it’s providing what teachers call scaffolding to help them master the situation.

Although it’s not well understood how temperament is determined, it probably has at least some genetic causes. One of the things Elisa B. said about herself was that she tended to be anxious and depressed. This makes me wonder whether she shares Billy’s temperament to some extent, which may help her have some insight into his feelings. Whatever day care arrangement Elisa finally makes, I hope it will be one where the caregivers are able to recognize the accuracy of her statements about Billy.

One more issue needs to be discussed. Elisa has asked me whether it would be good to have Billy tested for his attachment to her and to seek treatment for any problems that showed up. I have to say that I would see no point to doing this. First of all, the major way of evaluating attachment, the Strange Situation, was developed as a way of looking at differences between groups, not differences between individuals. The Strange Situation does not offer a clear assessment of individual attachment, and although it might provide guidance for clinical work with a family, very few clinicians are trained to do it or have in their offices the physical arrangements it requires. In any case, there is no question in my mind that the reported behavior shows that Billy is much attached to his mother and also quite able to form attachments to other caregivers when given time and opportunity. He does not need help or guidance in attachment--  just a chance to do it. However, if Elisa feels that the situation is too difficult to deal with, she and Billy might benefit from one of the treatments (like DIR) that works with parents and children together to improve their emotional communication.

A while ago, I came across a parent education pamphlet, put out by a major infant mental health group, that made a remarkable error about attachment. It stated that if children are securely attached, they will not cry when left at day care. This is absolute nonsense, and I hope that Elisa has not been thinking that it’s true. Secure attachment means that when the young child is distressed, he or she can be comforted by a familiar caregiver, and that the child can use that caregiver as a secure base for exploration. Infants over about 8 months of age, toddlers, and even young preschoolers are quite likely to cry at least briefly when left by a familiar person--  unless another familiar attachment figure has received them and begun to talk to and hold them. Young children who do not react to separation are much more likely to need some form of intervention, convenient though their behavior may seem to parents and caregivers.

I hope Elisa and Billy are able to find a day care arrangement where caregivers understand some of the points I’ve been making and are aware of appropriate practice with different developmental stages and different personalities. Finding such a place would make the next few years of Billy’s life far more pleasant for the whole family.


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