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Attachment, a Neurodevelopmental Perspective. Dr Bruce Chenoweth Consultant Psychiatrist Senior Staff Specialist, D.A.S. Division. of Women and Children’s Health, St. George Hospital Conjoint Senior Lecturer, School of Psychiatry, U.N.S.W. Psychiatry—Then and Now!. Brain Stuff and Attachment.

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attachment a neurodevelopmental perspective
Attachment, a Neurodevelopmental Perspective
  • Dr Bruce Chenoweth
  • Consultant Psychiatrist
  • Senior Staff Specialist, D.A.S. Division. of Women and Children’s Health, St. George Hospital
  • Conjoint Senior Lecturer, School of Psychiatry, U.N.S.W.
brain stuff and attachment
Brain Stuff and Attachment
  • Walking upright needed bigger prefrontal cortex
  • Sophisticated ability then possible to focus, plan, control actions, reflect and anticipate, and manage social relations.
  • Babies needed to be born prematurely and nurtured outside the womb
neurobiology of secure attachments
Neurobiology of secure attachments
  • When a baby is born-------!
  • Brain development before age of 1 yr is much more extensive than realized
  • Brain development is much more vulnerable than previously suspected
  • Neural genesis and apoptosis
  • Empathic attunement directly influences the maturation of regulatory mechanisms
  • Stress = asynchrony which is reflected permanently and architecturally
dyadic interaction and brain development
Dyadic interaction and brain development
  • From outset, reciprocal stimulation occurs
  • Mother is an external CNS regulator of emotion and hence development of the infant PFC
  • Facial expressions, gaze, touch, body movements and vocalizations generate a symbiotic state
  • Conversely, lack of +ve interaction causes withdrawal and failure to develop affect self-regulation and to co-regulate social interactions.
physiology of regulation
Physiology of regulation
  • New neural pathways permit subtle sensory discrimination
  • Enhanced signaling systems enables the child to construct patterns and take on meaning
  • This leads to less stress-induced autonomic arousal [which can damage irreparably the formation of sophisticated regulatory pathways]
  • The full expression of emotional dysregulation may not be apparent until teenage years
not just unhappy kids
Not just unhappy kids!
  • Maternal absence in the first year of life is negatively linked to physiological regulation
  • Symbiotic “Mind-reading” is only achieved through countless hours of contact. Not innate.
  • Neural deficits are apparent in children not exposed to good and consistent empathic attunement.
  • Stress levels are measurable
neural structures 1
Neural Structures 1
  • Brain overview
biochemistry of attachment failure
Biochemistry of attachment failure
  • Chronic stress--<corticotrophin releasing factor and loss of diurnal variation in cortisol level.
  • High concentration of cortisol receptors in parts of brain responsible for arousal and ability to learn
  • Rapid increase, adrenalin, nor adrenalin, dopamine
  • Hyper metabolism in some parts of brain
  • High thyroid activity-active in brain differentiation and regulation
biochemistry of good empathic attunement
Biochemistry of Good Empathic Attunement
  • Low stress, low cortisol and low proinflammatory cytokines
  • High oxytocin leading to down-regulation of primitive fight or flight responses
  • Hippocampal generation and regeneration after stress.
  • Improved cortical activity improving executive functioning and affect regulation
impact of disruption of bonding on infant r brain development
Impact of Disruption of Bonding on Infant R. Brain Development
  • Time of most rapid R. brain growth spurt
  • Neuronal overproduction vs. apoptosis
  • Semi-permanent arrest of development
  • Stressful growth inhibitors: excito-toxicity pruning of R. brain cortical circuits
  • Regulatory failure of emotional homeostasis and attachment
  • Up-regulation of primitive survival pathways
  • Vestigial switch-gear, readily triggers emotional dysregulation
critical role of the caregiver in the first three months
Critical role of the Caregiver in the first three months
  • Continuity of interaction crucial
  • Caregiver imparts ability to self-sooth
  • Baby differentiates global states-calmness. Distress and pleasure
  • Physical sensation and the emotional are bound together-motor responses move from reflexive to volitional mediated by affect.
two to five months
Two to five months
  • Withwarm nurturing, investment in and from caregivers increases—differentiation from other adults
  • Gaze, listening and movement become synchronized
  • Patterns discerned in caregivers voices
  • Discrimination occurs between joy, indifference and annoyance
  • Emotional significance of facial expression and vocalization
infant development
Infant Development
  • Baby at 3 months
four to ten months
Four to ten months
  • Purposeful 2-way interaction
  • Constant carers need to read and respond to emotional signals and challenge to reciprocate
  • Signaling through facial gestures, gestures, vocalization—broad range of emotions and sensations
  • By eight months, integrated sequencing of responses and adoption of social patterns
infant development1
Infant Development
  • Baby at 6 months
infant development2
Infant Development
  • Baby at 9 months
nine to eighteen months
Nine to eighteen months
  • Continuous flow of to-and fro communication
  • Complex interactions
  • Language acquisition
science into action
Science into Action
  • Immediate contact following birth
  • Biological parents preferred over extended family or other care givers
  • Empathic attunement with baby the critical factor
  • This requires extended time together with baby
  • The younger the baby, the more essential is continuity of empathic attunement
  • Transitions between environments can be stressful for young babies
special needs children
Special Needs Children
  • Attachments difficult
  • Reciprocity limited
  • Dysmorphia
  • Additional demands
  • Relationship stress
  • Maternal guilt/depression
  • Challenging behaviour
autistic children
Autistic Children
  • Difficulty with communication, socialization, lack of awareness of others, inability to play, or to copy, and will not seek comfort.
  • Marked abnormal nonverbal communication
  • Lack of imaginal world
  • Abnormal speech, no reciprocal responses
  • Restricted and stereotyped interests
  • Extreme distress on transitions
family court issues
Family Court Issues
  • “Marriage on Rocks” common
  • Changes very difficult
  • Consistency essential, transitions difficult
  • Independent Legal Advisors sometimes don’t understand
  • Need to work outside established shared-care precedents
take home message
Take-home message
  • The brain is plastic—whatever you put in changes the architecture
  • There are critical times in the developmental trajectory for the establishment of stable patterns which are enduring
  • The first 18 months are critical times for the genesis of emotional and cognitive regulation
  • Empathic attunement is critical for this to happen