Reducing Separation Trauma:

A Resource Manual for Foster Parents, Social Workers, and Community Members who Care for Children and Youth

 

 

Chapter 1: Introduction

 

 

 

At some point in our lives, we will all experience a loss or separation from someone or something dear to us. Significant losses are always painful and are sometimes frightening and even life-changing. Whether due to death, relocation, the breakup of a close friendship or partnership, or a child leaving home, many people react to losses in predictable ways. Sadness, depression or despair, accompanied by anger, anxiety, fear, and loneliness, and sometimes, loss of self-esteem or direction in life, are typical reactions to loss and separation (Bloom, 1980; Bowlby, 1961, 1973; Fahlberg, 1979; Kubler-Ross, 1972; Parkes, 1972; Rycus and Hughes, 1998).

Children who are removed from their homes and placed in substitute care are all too familiar with the pain and uncertainty of losing important people, places, and things in their lives. They often experience many, repeated, and often sudden, losses, which can make their adjustment very difficult. They lose their parents, siblings, grandparents and extended family members, friends, neighbors, teachers…the list of important people goes on. In addition, they lose their familiar surroundings, their toys, clothes, pets, and other meaningful objects. Their losses are often compounded by damaging home lives that have left them emotionally scarred and behaviorally troubled.

In 2002, Child Welfare investigated nearly 3 million of claims of child abuse and neglect. Of those, 926,259 were substantiated (Child Welfare League of America, 2002b). Many of these children found their way into the foster care system. Foster children with backgrounds of neglect and abuse suffer three to seven times as many acute and chronic emotional problems as other children (Rosenfeld et al., 1997) and often experience compromised development that leads to disproportionately high involvement in the mental health, juvenile justice, and adult criminal justice systems (Briere, 1992; Cahill, Kaminer, & Johnson, 1999; Finzi et al., 2001). This increased risk is partly due to difficulties in attachment created by the abusive and/or neglectful situations that characterize their developmental years, as well as trauma caused by repeated separations from caregivers as they move from home to home (Kates, Johnson, Rader, & Strieder, 1991).

But do not despair! Not all separations are equally distressing, and there is hope even for children who have experienced repeated separation traumas. Research studies, clinical case studies, and reports from foster children themselves echo the sentiment of hope for foster children who receive appropriate care from alternative caregivers (e.g., Dozier, Stovall, Albus, & Bates, 2001; Festinger, 1983; Holmes, 1993, Hopkins, 2000; Kenrick, 2002; Lopez & Dworkin, 1996; Parkes, Stevenson-Hinde, & Maris, 1991). Although problems associated with traumatic separation from attachment figures can contribute to emotional and behavioral troubles and difficulty in future relationships, children who experience a caring relationship with an adult who is knowledgeable of the special needs of these children can form healthy relationships and expect to go on to lead healthy and fulfilling lives (ex., Lopez & Dworkin, 1996; Kenrick, 2002)If care givers are aware of the factors that lead to traumatic separation, they can better understand the impact on a child of separation from his or her family and be better equipped to limit the damage done by the separation and repair some of the damage caused by early abuse.

This manual will present theory and research on issues of attachment, separation, grief, and development for children in foster care and ideas and resources to help care givers ease their children’s transition into placement. Attachment theory (see Ainsworth, 1967; Ainsworth & Witting, 1969, Bowlby, 1969, and Bretheron, 1992) is presented as a framework to help care givers understand the emotional and psychological world of the children they look after, helping them recognize typical reactions to removal from the home and behaviors that may indicate a more serious problem.

The goal of this manual is to illuminate the experience of children in care so that foster parents, social workers, and other people involved with the children can understand the reasons for their behavior and the emotional turmoil behind them. This manual also includes specific steps that can be taken to minimize the impact of separation and placement and reduce separation trauma. This information is intended to ensure that caregivers are equipped with the knowledge to understand and effectively deal with a child who is transitioning to a different home.

It will take knowledge, patience, and dedication to care for a child with a background of abuse and the difficult task of moving to a new home. But with patience, care, training, and support, caregivers can make a life-long difference in the quality of a child’s life.

 

 

 

Notes about Language in this Manual

 

This resource contains much discussion of the relationships between children and the adults who provide care for them. Research reflects cultural biases, such as considering the mother to be the primary source of nurturance and support for an infant. With fathers, grandparents, and many others filling this role in current times, this book attempts to demonstrate sensitivity to the many possible relationships and family configurations by using language that is more inclusive. Particularly in the chapter on attachment, terms such as “primary caregiver” or “primary attachment figure” are used in place of “mother” of “father”.

Certain other terms are used to describe persons involved with children in the child welfare system. The term “caregiver” is used here to describe parents, foster parents, family foster caregivers, adoptive parents, intimately involved clergy or other community members, and others who take on the role of providing for a child’s needs.

Finally, an attempt to remove gender bias has been made by including both the masculine and feminine pronouns when referring to a child in care (for example, his/hers; (s)he). It is acknowledged that this can at times reduce clarity and readability, but this is a necessary compromise in balancing the language in this manual to reflect the fact that foster placements, attachment disorders, and other problems described in this manual effect both genders equally (Thomas, 1997).

 

 

Chapter 2: Attachment

 

 

Intimate attachments to other human beings are the hub around which a person’s life revolves, not only when he [or she] is an infant or a toddler or a schoolchild but throughout his [or her] adolescence and in his [or her] years of maturity as well, and on into old age. Form these intimate attachments a person draws his [or her] strength and enjoyment of life and, through what he [or she] contributes, he [or she] gives strength and enjoyment to others. These are matters about which current science and traditional wisdom are one.

-John Bowlby (1980, p. 441)

 

 

 

Attachment is a complex process. The ways in which humans form relationships and how those relationships influence all aspects of development, are highly studied subjects; the base of knowledge about the complexities of how people’s attachments form and function continues to grow. It is imperative that people involved in making major life decisions for children have a basic understanding of attachment theory and what is currently known about how human relationships work. This knowledge is especially important for people who look after children in the child welfare system, for “attachment and separation are the heart of child welfare work” (Fahlberg, 1991. p. 19).

The bond between an infant and his or her primary caregiver serves several important purposes. Attachment figures are a source of safety, and they satisfy an infant’s physical needs for nourishment and protection. In addition, the attachment bond provides socialization and promotes connection with others, stimulates intellectual development, and is essential for the development of a sense of one’s self. Research on the effects of inadequate interpersonal relationships reveals a variety of emotional, behavioral, social, and even neurological and physical problems for children who do not have stable ties with supportive parent figures (e.g., Greenberg, 1999). Many of these problems can be long term. A child’s style of attachment can also give insights into the functioning of his or her family and the environment into which he or she was born. In light of the far-reaching implications of attachment, “the significance of intimate interpersonal relationships and the importance of early caretaking in learning how to make such attachments have become the canons of the child welfare and mental health professions.” (Watson, 1997, p. 160). An understanding of how attachment normally develops is critical for social workers and caregivers.

 

The Importance of Attachment

Foster children have often come from homes in which circumstances have severely limited the formation of healthy, nurturing, parent-child relationships. The emotional and physical bond that forms between an infant or young child and his or her primary caregiver through their relationship is known as attachment. Infants and young children who have been abused and neglected are at high risk for developing problems with attachment, as are children who have survived early, prolonged, or traumatic separations from their primary caregiver (Levy & Orlans 1998; Bowlby 1973).

Attachment is important for all aspects of a child’s development. The emotional bond that forms between a child and his or her first primary caregiver* (see note in Introduction) sets the stage for all of the child’s future relationships and the ways in which the child interacts with the world (Bowlby, 1988). This first, and most important, relationship teaches the child how to view the world and how to respond to it. A child’s relationship with his or her first attachment figure creates a template for future relationships, a sort of lens through which all people are viewed. The attachment lens colors people and situations in a way that is similar to the child’s experiences with his or her primary caregiver, such that the child behaves, at an almost instinctual level, in the same way that he or she did with the first primary caregiver.

If a child’s first attachment figure responds to the child in a sensitive, consistent, and effective way, the child learns to trust the primary caregiver and seek her out in times of need, creating the building blocks for healthy relationships. At the same time, the child learns to be autonomous, exploring the environment with a sense of confidence that his or her caregiver will not allow anything bad to happen to the child (Ainsworth et al., 1978). This confidence will become a part of the child’s template, and (s)he will encounter new people and new situations with the capacity to interact in a way that is flexible and appropriate. These children are more able to cope with stress, form relationships, and experience the positive aspects of life (Fahlberg, 1991). Children who develop secure attachments are more able to:

• Attain full intellectual potential
• Sort out perceptions
• Think logically
• Develop social emotions
• Develop a conscience
• Trust others
• Be resilient
• Become self-reliant
• Cope better with stress and frustration
• Reduce feelings of jealousy
• Overcome common fears and worries
• Have increased feelings of self-worth

 

If the child does not experience a healthy attachment relationship with the primary caregiver, or if the attachment with the caregiver is disrupted, the child will not develop the same flexibility, and healthy development of social, psychological, behavioral, and even physical health are compromise. Children who do not maintain a healthy attachment will not learn to trust other people, themselves, or their environment. They will develop behaviors that protect them as well as possible in these undesirable circumstances. As these children grow and develop, these protective behaviors will no longer be sufficient to get their needs met; they will not learn how to interact with the world and people in it in an effective way.

Children who have problems with attachment may develop behaviors that seem extreme in order to cope with the inadequate conditions in their relationships with primary caregivers (see Lyons-Ruth for review of aggressive behavior problems associated with attachment). Many of the “problem behaviors” expressed by children in care are in fact survival skills they have learned in order to make their way in their troubled lives. Poor attachment and the behavior problems associated with it can seriously interfere with adjustment in foster placements, for the child and for the family, and can increase the risk of placement disruption (Fahlberg 1991; Levy & Orlans 1998; Pinderhughes & Rosenberg, 1990). It is important for caregivers to put these sometimes outrageous and incomprehensible behaviors into context, so that they can maintain their empathy and understanding for a troubled child and prevent further disruptions to the child’s attachment system through repeated moves. Later in this chapter, behaviors associated with attachment problems will be discussed, as well as the reasons for some undesirable behaviors and the purposes they have served for children.

Despite the many problems associated with attachment problems, some children who grow up in relatively deprived environments retain the capacity to overcome their beginnings and learn to trust and love (Cline 1992; Cournos, 2002; Egeland & Sroufe, 1981; Fahlberg 1991; Hughes, 1997; Kagan, 2004; Kenrick, 2000; Levy & Orlans 1995; Toth & Cicchetti, 1996). Researchers agree that a major factor in promoting this resiliency is the presence of a caring, committed, adult who can provide a stimulating and supportive environment. Even children with severe attachment disorders can be helped to develop trusting, intimate, meaningful relationships given the caring, dedicated, and patient support of caregivers who serve as attachment figures.

Attachment is an important concept in the development of children’s identities and their relationships with others, and it is among the most influential theories informing child welfare practice today (Rycus & Hughes, 1998). Knowledge of attachment issues is essential for people who care for foster children because this group is at increased risk for problems with attachment (Main, 1996), which can lead to serious disruptions in a child’s emotional and behavioral development and can cause problems that last a lifetime if not appropriately addressed. Caregivers who are aware of issues concerning attachment will be better equipped to understand the experiences of children involved with the child welfare system and to handle transitions in a way that inflict as little harm as possible on vulnerable children. This chapter attempts to provide the necessary information about attachment. It will 1) define attachment and describe the ways in which attachment normally develops; 2) identify the effects of weak attachment, including attachment disorder, and the ways in which weak attachment form; 3) describe the circumstances which often surround a foster child’s attachment development and the effects of unstable home environments; and 4) provide suggestions for strengthening weak attachments and promoting new ones for children in care.

 

 

 

What is Attachment?

 

To grow up healthy, an “infant and young child should experience a warm, intimate, and continuous relationship with his [or her] mother (or permanent mother substitute) in which both find satisfaction and enjoyment” (Bowlby, 1951, p. 13). Attachment has been defined as “an affectionate bond between two individuals that endures through space and time and serves to join them emotionally” (Klaus, 1976). Attachment represents the capacity for emotional security, closeness, and autonomy which develops in a child who has experienced a predictable pattern of warmth, sensitivity, responsiveness, and dependability from a significant caregiver (Karen, 1994). Briefly, attachment is an enduring emotional bond, first developed between an infant and a sensitive caregiver, that influences a child’s capacity to love and be loved.

Young child develop a healthy attachment when they consistently receive from their primary caregiver the basic necessities such as food, shelter, and clothing in addition to “the emotional essentials” such as touch, movement, eye contact, and smiles (Moss, 2005). Primary attachments are so important that the capacity to form attachments has become a criterion of healthy maturity, and “Reactive Attachment Disorder” appears in the clinician’s handbook of mental illness (American Psychiatric Association, 1994). The first attachment is “the hub around which a person’s life revolves.” (Bowlby, 1980, p. 441)

 

 

Attachment Development

 

What we know about human relationships is largely based on Bowlby’s (1969) concept of attachment. Bowlby’s influential theory of human development was inspired by his work with children and adolescents raised in institutions. While studying the relationships between these children and their mothers, Bowlby noticed that some of the children seemed unable to connect with others. This, he found, was due to disruptions in attachment during the first few years of life. From birth to about the fourth year, infants rely on their caregivers to satisfy all of their needs. This is an important time in a person’s development, when sensory and cognitive functions grow rapidly and babies learn the rules of human interaction from their caregivers. Bowlby built a career and a literary empire investigating the causes and consequences of attachment relationships and their effects on human development. His work has been the foundation of much of contemporary theory and research on relationships.

In his early work, Bowlby (1958) described the nature of a child’s ties to his mother (or primary caregiver) and the basics of attachment. Attachment behaviors are innate, instinctual, responses that are used to get basic needs for food and safety met. In infancy, these attachment behaviors include sucking, clinging, following, and signaling behaviors (i.e., crying when hungry).

A sensitive parent (or other caregiver) can recognize the meaning of her infant’s nonverbal cues and respond quickly to the young child’s physical and emotional needs. The sensitive caregiver feeds the infant when it is hungry; assures that the infant is warm, dry, and physically comfortable; and comforts and sooths the infant when it is distressed or frightened (Rycus & Hughes, 1998).

Attachment behaviors not only help a child satisfy needs, but also bond the child to the caregiver and the caregiver to the child. Children develop the strongest attachments with sensitive caregivers (Ainsworth, Blehar, Waters, & Wall, 1978) and form reciprocal relationships with them. For example, “the mother’s caregiving behaviors of feeding, holding, nurturing, smiling, cuddling, and talking to the infant reinforce the infant’s attachment to the mother; and the infant’s responses to its mother’s care, including cooing, smiling, cuddling, and becoming quiet when held, strengthen the mother’s attachment to the infant” (Rycus & Hughes, 1998).

As people mature, we continue to engage in attachment behaviors, although we generally modify them as our ability to communicate grows, our needs change, and we begin to recognize more people as important in our lives (Cassidy & Shaver, 1999). Even in adulthood, well-attached people seek closeness and reassurance from the most important attachment figures in their lives during times of distress (Hazan & Zeifman, 1999).

When separated from their caregivers, infants and children who have healthy attachments will respond with separation anxiety. Separation anxiety is the normal response to separation and includes 1) protest to the separation, 2) despair related to grief and mourning (when the child believes that the parent will not be returning), and 3) denial of detachment (Bowlby, 1958). The grief and mourning process is activated in children and adults whenever attachment behaviors are stimulated (when a person has a need for safety or security) but the attachment figure is unavailable. The grief reaction to separation is an important element in the experiences of children in foster care. We will explore the implications of grief in a later chapter.

Separation anxiety can become profound if the separation from the primary attachment figure is too long or too frequent (Bowlby, 1958). One of Bowlby’s original (1958) findings, which has been substantiated in decades of research with children in care (e.g., Greenberg, 1999; Kenrick, 2000; Paradek, 1984), is that an inability to form deep relationships with others may result when there are too frequent changes in caregivers. This has serious implications for children in care, who are often repeatedly separated from their primary caregivers and/or moved from placement to placement, disrupting any attachments that form in those placements.

 

 

Stages of Attachment Development

 

Researchers have distinguished between normal and disturbed attachment behaviors in young children (e.g., Ainsworth et al., 1978; Bowlby, 1969; Cicchetti, 1989; Crittenden, 1995; Greenspan,1988). Developmental attachment patterns emerge, in sequence, through the child’s relationship with the parent over the first 4 years of life. Significant disturbances in the child’s development result from disruptions in the child’s attachment to the primary parent figure during that time. The following table distinguishes normal attachment behaviors over the first four years of life (adapted from Rycus & Hughes, 1998 and Delaney, 1991).

 

 

 

Development of Normal Attachment Behaviors

 

Age	Stage	Description
Birth – 3 months  	Pre-attachment	Infant orients toward the sound of the caregiver’s voice; (s)he tracks visually. Infant smiles reflexively; increasingly responsive to interesting stimuli; relaxed and alert.
3-8 months  	Recognition/Discrimination	Infant differentiates between primary caregiver and others. Smiles are based on recognition; very interested in primary caregiver. Infant scans the caregiver’s face with excitement. Infant greets caregiver and vocalizes differently to the caregiver. Infant is especially responsive to smiles and touch with interest and pleasure. Infant has full range of emotions.
8-36 months  	Active Attachment	Stranger reaction emerges. Infant shows clear preference for the primary caregiver. Infant checks back to the caregiver’s face. Child crawls or walks away from caregiver and explores without anxiety. Child acts intermittently in dependent and then independent ways.
36 months-  	Partnership	Attachment solidifies. Child shows increased ability to communicate needs verbally and relates to others across a wide range of emotions. Child negotiates differences between self and others.

 

 

 

 

 

 

 

The Attachment Cycle

 

Attachment researchers and professionals illustrate healthy attachment as a cycle of need gratification, which, when disrupted, causes problems in a child’s development of sense of self and others (e.g., Hughes, 1997; Keck & Kupecky, 2002). They agree that a child’s first 18-36 months are vitally important to establishing attachment. In a healthy situation, the infant is exposed to love, nurturance, and appropriate care in which the following attachment is repeated over and over again.

 

 

The Attachment Cycle

• The child has a need
• The child expresses the need by fussing, crying, or otherwise raging
• The need is gratified by a caregiver, who provides movement, eye contact, speech, warmth, and/or feeding
• This gratification leads to the development of the child’s trust in others

 

 

 

 

 

 

 

NEED

TRUST

ANGER AROUSAL RAGE

GRATIFICATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Styles of Attachment

 

A good knowledge of attachment styles is helpful for foster parents and other caregivers because it helps provide an understanding of the early experiences that influenced a child’s development and can be used to predict certain behaviors. While the styles that will be described below apply primarily to infants and toddlers, similar styles have been found to endure throughout childhood (Grossman & Grossman, 1991; Main & Cassidy, 1988), adolescence (Urban, Carlson, Egeland, & Sroufe, 1991), and adulthood (Hazan & Zeifman, 1999; Main & Cassidy, 1988). Knowing about a child’s background and the likely influences on his or her attachment style will be useful information for every caregiver.

Those who care for children in the pre-school or school-age years, or adolescents, will benefit from understanding how children develop their relational patterns; and those who care for very young children will be better equipped to identify behaviors that indicate problems in the relationship between a child and his or her primary caregiver, and which will likely contribute to problems in the child’s ability to form relationships.

 

 

Secure Attachment

Sensitive, responsive parents have children who are securely attached. The attachment cycle described above has been successfully completed many times throughout the child’s young life. A secure attachment style in infancy predicts many positive outcomes as a child develops, including greater curiosity and persistence as a toddler, positive peer relationships in preschoolers, advanced cognitive functioning during middle childhood (Webster, 1999); the development of a social conscience and positive self-concept in adolescence (Allen & Land, 1999); and healthy, reciprocal relationships in adulthood (Feeney, 2000). Secure attachments lead to flexible thinking, emotional resilience, ability to modulate emotion, and openness to new learning (Kagan, 2004). Securely attached children look to their parents to be comforted in times of stress and are able to be soothed by their parents’ care.

 

Indicators of a secure attachment style in infants and toddlers include:

• Seeks interaction, closeness, and/or physical contact with parent after being separated for any length of time, then returns to play after briefly maintaining contact
• Greets parent actively after a separation; for example, creeping to parent
• Is readily soothed by parent when distressed
• Openly explores and plays in environment

 

 

Insecure Attachment

Infants whose parents do not respond sensitively to their needs are less likely to form secure attachments. Repeated breaks in the attachment cycle (shown above) do not allow for the creation of the nurturing relationship necessary to promote healthy growth. Following are the common causes of disruption in the attachment cycle (Hughes, 1997; Moss, 2005).

 

Common Causes of Attachment Disruption (Highest risk if these occur in first two years of life.)*

• Sudden or traumatic separation from primary caregiver (through death, illness, hospitalization of caregiver, or removal of child)
• Physical, emotional, or sexual abuse
• Neglect (of physical or emotional needs)
• Illness or pain which cannot be alleviated by caregiver
• Frequent moves and/or placements
• Inconsistent or inadequate care at home or in day care (care must include holding, talking, nurturing, as well as meeting basic physical needs)
• Chronic depression of primary caregiver
• Neurological problem in child which interferes with perception of or ability to receive nurturing (i.e. babies exposed to crack cocaine in utero; Moss, 2005)

 

 

 

Insecure attachments result from disruptions in the attachment cycle and may take the form of any of three different attachment styles: avoidant, ambivalent, or disorganized. The first two categories (as well as the secure category described above) were first discovered by the early attachment researcher Mary Ainsworth and her colleagues (1978) when they observed the reactions of 12-month-old children when they were separated from, and then reunited with their mothers. The third category, disorganized, was discovered by later researchers Mary Main and Judith Solomon (1990) in a similar situation.

Based on their reactions to their primary caregivers, insecurely attached infants will either 1) act distant, as if they have no need for emotional connection (an avoidant attachment style); 2) constantly clamor for attention and nurturance, never being able to be comforted (ambivalent attachment style); or 3) show signs of contradictory behavior with the caregiver, being unsure whether to seek physical and emotional closeness with the caregiver or try to maintain distance (disorganized attachment style). A brief description of the insecure attachment styles will follow. For further reading on attachment behaviors in infants and toddlers in foster care, see Fish & Chapman (2004; vignettes to follow are adapted from Fish & Chapman, 2004).
 

Insecure-Avoidant Attachment

Avoidantly attached infants and toddlers appear to snub caregivers and act as if they are not distressed by the separation, when in reality, they are experiencing distress. Ainsworth found