As children progress from the complete dependence of infancy to increasing independence, they need stable and secure family relationships to provide emotional warmth, responsiveness, and constructive discipline. In infancy, much attention has centred on the development of attachment relationships. The influential work of Bowlby(6) and others has shown that infants are social beings from very early in development, and that a child's need to be attached to others is a basic part of our biological heritage. Infants become increasingly socially responsive over the first 6 months of life. At 6 to 8 months of age they begin to form selective attachments to particular individuals; they seek proximity to these attachment figures if distressed or frightened, and protest if the person they are attached to leaves. In evolutionary terms, these behaviours function to provide protection for the infant, and to reduce anxiety and distress.
Almost all infants—even those neglected or maltreated by their carers—develop attachment relationships of this kind. Their quality varies, however, depending on characteristics of the parent, the child, and the mesh between the two. Infants who have received sensitive and responsive care tend to show secure attachment patterns; they use caregivers as a base for exploration, and, although distressed by brief separations, greet caregivers positively on reunion and can be quickly comforted. Insecure attachments are more likely to develop when parents themselves are stressed or unsupported, and are unresponsive to their children. Two main types of insecure attachment have been identified: avoidant attachments (associated with rejecting or highly intrusive parental care) and resistant-ambivalent patterns (associated with inconsistent or unresponsive parenting). More recently, a third disorganized category has been described. This seems especially associated with parental behaviours that are frightening, unpredictable, or abusive. When infants' presumed source of safety is also a source of fear, they show a variety of contradictory behaviours after brief separations, and often appear confused, depressed, or apprehensive.
Attachment theorists argue that the quality of these early relationships may have long-term implications. Though not entirely resistant to change, infants' attachment patterns do tend to be stable over time. Some of this stability may reflect continuity in the quality of family care. In addition, attachment theory proposes that early attachment experiences are internalized in internal working models of self and others, that function as templates for future relationship formation. Children who have experienced responsive early care come to expect others to be caring and reliable; those who have been ignored or rejected develop less positive expectancies of others, of relationships, and of themselves. Later in development, new relationships may be created in line with these expectancies. Although many aspects of these models await confirmation, securely attached infants are known to go on to be more sociable and co-operative in their social relationships, and to show more positive affect and self-esteem. Insecurely attached infants show less positive relationships, and are at some increased risk for psychopathology. In addition, both ICD-10 and DSM-IV recognize two varieties of attachment disorders: non-attachment with emotional withdrawal, typically associated with abuse, and non-attachment with indiscriminate sociability, most usually observed when children have been exposed to repeated changes of caretaker. Although as many as 40 per cent of infants receive insecure attachment classifications, these more severe forms of attachment disorder are rare.
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