In this article I detail the neurobiology of a secure attachment, an exemplar of adaptive infant mental health, and focus upon the primary caregiver's psychobiological regulation of the infant's maturing limbic system, the brain areas specialized for adapting to a rapidly. CiteSeerX - Document Details (Isaac Councill, Lee Giles, Pradeep Teregowda): Over the last ten years the basic knowledge of brain structure and function has. The right brain is involved in the regulation of emotion and arousal states, and in the Secure attachment leads to a background state of emotional wellbeing, and relationships between genes and social experience have direct effects on.
A number of anatomical and imaging studies now document earlier maturation of the right hemisphere in prenatal and postnatal stages of human development Gupta et al. In his monumental overview of current brain asymmetry research, neuropsychiatrist Iain McGilchrist puts forth the argument that the difference between the two brain hemispheres is profound. The right and left hemispheres create coherent, utterly different, and often incompatible versions of the world with competing priorities and values, and indeed two modes of being.
Hecht cites even more recent lateralization research which indicates that the right hemisphere is the primary driver of the innate psychobiological need for affiliation and social connection, and thereby for emotion regulation and personal growth. The essential adaptive right brain functions of interdependence, social connection, and emotion regulation emerge out of early attachment experiences, and they need to be assessed during the critical period. Third, on the basis of the principle of hierarchical brain organization I have offered a model of the ontogeny of the emotion processing limbic system, which is shaped by the mother—infant attachment relationship Schore, It is well-established that the right cortical hemisphere, more so than the left, is particularly well reciprocally connected with limbic and subcortical regions, and that the functional maturation of cortical-limbic circuits is significantly influenced by early socio-emotional experience.
In line with the morphogenetic principle of caudal to rostral brain development, regulation theory proscribes a maturational sequence over prenatal to postnatal stages of more complex right-lateralized control regulatory systems in the amygdala, then anterior cingulate, then orbitofrontal cortex.
This hierarchical circuit of emotion regulation is imprinted in affective attachment transactions over the course of first year, bottom-up, that is, subcortical to cortical, amygdala at the beginning of the first year to orbital prefrontal cortical at the end of infancy. Research now demonstrates subcortical components of the limbic system e. It is often overlooked that the first year is a time of tremendous expansion of subcortical brain areas. Early assessments need to shift from later maturing cortical executive functions to earlier-developing subcortical functions.
Integrating the preceding three developmental organizing principles of interpersonal neurobiology, right brain lateralization, and ontogenetic progression of hierarchical regulatory systems, I offer a psychoneurobiological model that can be used to evaluate the burgeoning attachment system, as it is evolving in real developmental time.
Modern attachment theory also offers an heuristic model of both optimal and less than optimal early right brain development. The model suggests that optimal development in infancy reflects a growth-facilitating relational context that promotes the progression of more complex limbic control systems in the right brain that support a foundation of later emotional-wellbeing.
On the other hand, less than optimal right brain development is associated with various growth-inhibiting relational contexts that generate altered subcortical-cortical patterns of limbic—autonomic connectivity, or even structural and neuropathological alterations within the regulatory hubs themselves, and thereby inefficient control functions.
In light of the longstanding gap, indeed disconnect between the attachment and autism worlds, it may seem surprising that attachment theory can make important contributions to a deeper understanding of autism.
Early interpersonal neurobiological assessment of attachment and autistic spectrum disorders
The fact that both fields are intensely focused on social-emotional development in the prenatal, perinatal, and postnatal stages of human infancy highlights the problem of the early differential diagnosis of these developmental disorders. In classic writings on childhood autism Rutterpp. That said, both fields have now embraced an epigenetic perspective, which suggests that they may share at least some common psychoneurobiological etiological factors.
In the second section I offer an overview of current research from developmental neuroscience on the early stages of autism. I also report recent studies on alterations of right brain limbic structures in developing autistic brains, as well as a growing body of research demonstrating early appearing deficits in intersubjective behavior in autistic mother-infant dyads.
In this section I describe current developmental neuroscience findings on the infant and maternal processing of these sensoriaffective communications. These studies are organized as a temporal sequence over the course of the first year. I also offer clinical implications of the research studies for assessments of social-emotional development.
Due to space limitations I refer the reader to Schore afor specific references to the following. With respect to visual-facial attachment communications, it is now established that mutual gaze is critical to early social development. The emergence of the capacity to efficiently process information from faces requires visual input to the right and not left hemisphere during infancy.
Using electroencephalography EEG methodology, Grossmann et al. Note the developmental progression over the first year to more complex visual-affective functions. These research data indicate that the future capacity to process the essential social information expressed in face-to-face communications, a central aspect of all later intimate relationships, is dependent upon caregiver-infant eye contact and visual gazing during early critical periods.
Ongoing studies of prenatal, perinatal, and postnatal auditory-prosodic attachment communications also highlight the role of the right brain.
In an EEG study of auditory pitch processing in preterm infants born at 30 gestational weeks, Mento et al. A functional magnetic resonance imaging MRI study of 1- to 3-day-old newborns reports that music evokes right hemispheric activation in the auditory cortex. This same optical brain imaging technology reveals that prosodic processing of emotional voices in 3-month-old and 4-month-old infants activates the right temporoparietal region.
Independent of culture infant-directed speech is preferred over adult-directed speech as early as a few weeks after birth. Compared to adult-directed speech, motherese, the vocal expression of emotion to infants, is higher in pitch, has a wider pitch range, and exhibits exaggerated pitch contours.
In addition, it is shorter, slower, and separated by longer pauses than adult speech. Developmental neurobiological research demonstrates that maternal infant directed speech activates the right temporal area of 4- to 6-month-old infants, and that this activation is even greater in 7- to 9-month-old infants.
Again, note the developmental progression of auditory affective functions that allow for more complex communication. The emotional quality of what infants hear in the early stages of infancy affects the development of the voice processing areas of the right hemisphere, especially the temporal voice areas in the upper banks of the right superior temporal sulcus.
Other studies report high levels of tactile stimulation and mutual touch occur in breastfeeding, and an increase in EEG amplitude in right posterior cortical areas in 6-month-old infants during the intense somatosensory tactile contact of breastfeeding.
Clinicians need to appraise not only the quality and amount of spontaneous caregiver-infant direct pupil-focused eye gazing and auditory communications but also the quality and amount of sensitive interpersonal touch the infant is receiving and expressing. Left versus right sided cradling should be assessed, since right cradling has been associated with maternal depression and maternal stress. The finding that adults who cradle on the right are more detached and less responsive to their infants than those who cradle on the left can also be used diagnostically see Schore, As the securely attached infant enters toddlerhood, his or her interactively regulated right brain visual-facial, auditory-prosodic, and tactile—gestural communications become holistically integrated, allowing for the emergence of a coherent right brain emotional and corporeal subjective sense of self.
Studying structural connectivity asymmetry in the perinatal brain with newborn infants at the beginning of the first year, Michael Meaney and his colleagues conclude, [I]n early life the right cerebral hemisphere could be better able to process … emotion Wada and Davis, ; Schore, This idea appears consistent with our findings of rightward asymmetry in … limbic structures … These neural substrates function as hubs in the right hemisphere for emotion processes and mother and child interaction Ratnarajah et al.
Bowlbyp. Each hierarchical level of the three tiered limbic system processes and imprints a positive or negative hedonic charge on current exteroceptive information about changes in the external social environment and then integrates it with interoceptive information about concurrent alterations in internal bodily states.
Although all process exteroceptive and interoceptive information, the later maturing systems in the cortex process this information in a more complex fashion than the earlier subcortical components.
The output of the lowest level limbic levels is expressed as automatic innate reflexes, while higher processing produces more flexible intuitive responses that allow fine adjustment to environmental circumstances.
In three dimensions, the attachment control system is hierarchically structured as an outer-later developing orbitofrontal-limbic regulated core, an inner earlier-developing cingulate-limbic regulating core, and an earliest evolving amygdala-regulated core, like nested Russian dolls.
In my most recent articulation of this model of the ontogenetic progression of hierarchical limbic—autonomic regulatory centers, I offer evidence showing that the amygdala especially the central nucleusthe paraventricular areas of the hypothalamus that produce the stress reducing neuropeptide oxytocin and the stress intensifying neuropeptide corticotropin releasing factor, and the insula, involved in stress-responsive visceroautonomic functions, begin their maturation prenatally and are functional at birth and over the ensuing perinatal stage Schore, a.
In light of the fact that the emotional state of the mother influences the fetus, assessing the emotional well-being of the mother-to-be in pregnancy is critical. From 10 to 12 months of age the regulatory center in the orbitofrontal cortex, the attachment executive control system, begins its developmental growth period, which spans until the end of the second year Schore, With optimal relational attachment experiences, the vertical axis that connects the right orbitofrontal cortex with subcortical areas is well developed, allowing the right orbitofrontal cortex to regulate the right amygdala.
Indeed, developmental neurobiological research reveals that the most rapid change in brain maturation occurs in the first 3—6 months of life, followed by slower change until 24 months, and relative stability after 24 months Hermoye et al. Other studies demonstrate that amygdala function contributes to human attachment security Lemche et al. For the rest of the life span the right, and not left lateralized prefrontal regions are responsible for the most complex regulation of affect and stress Schore, ; Sullivan and Gratton, ; Cerqueira et al.
The right orbitofrontal cortex imprints internal representations of attachment experiences in implicit-procedural memory, thereby generating an internal working model that encodes non-conscious strategies of affect regulation. This regulatory system, the hierarchical the apex of the limbic system, is responsible for the adaptive capacities of emotional communication and regulation that is found in secure children.
On the other hand functional limitations of the orbitofrontal system are seen in insecure attachment and a wide variety of psychiatric disorders see Schore, aba. This ontogenetic hierarchical model suggests that right brain assessments need to be timed to crucial period transitions of the three regulatory systems 2—3, 10—12, 18—24 monthsperiods of complex reorganizations of the emotion processing limbic system.
As the securely attached infant moves through infancy and toddlerhood, his or her interactively regulated intersubjective right brain visual-facial, auditory-prosodic, and tactile—gestural attachment communications become holistically integrated, allowing for the emergence of a right brain coherent emotional and corporeal subjective sense of self and a background state of well-being.
Left hemispheric verbal explicit measures cannot tap into these implicit psychoneurobiological mechanisms. In addition to ongoing clinical intersubjective evaluations, clinicians should investigate the use of current research methodologies as a potential source of developmental neuropsychological assessment tools.
Autism is now viewed as a lifelong, complex neurodevelopmental disorder that severely impairs social interaction. Core symptoms include abnormal or unreciprocated interpersonal and emotional interactions, disordered social communication, and repetitive and stereotypic behaviors and restricted interests. At present it is thought that its onset most likely occurs in the latter part of the first year of life Hazlett et al. The field is presently poised to begin more comprehensive studies of the prenatal, perinatal and early postnatal periods.
Yirmaya and Charman observe, The window of this abnormal brain growth coincides with the period of synaptogenesis and subsequent pruning when cortical connections are developed, refined and stabilized. Studying children as young as 18 months Munson et al. Commenting on this amygdala enlargement in months-old toddlers Schumann et al. Initial signs of autism in toddlers include unusual affective behavior, reduced social interest, and poor eye contact, which are all suggestive of aberrant amygdalar function.
This body of research clearly implies that autistic infants and toddlers experience a chronic intense fear state in the first 2 years of infancy, and that this needs to be assessed. The finding that early developing right basolateral amygdalar enlargement, associated with amygdalar hyperreactivity and abnormal fear conditioning persists in 6-to 7-year old children Kim et al. In a subsequent study Guedeney et al. Other research reports hyporesponsivesness to social stimuli e.
Indeed in a case study Dawson et al. The right amygdala findings in autistic toddlers indicate that pathological dissociation needs to be recognized and studied by autism researchers. Developmental neuroscience also implicates another component of limbic circuitry, the right anterior cingulate that is strongly connected with the right amygdala in autism.
These authors state the strong and consistent predominance for the right hemisphere emerges postnatally, that this right hemisphere VEN predominance may be related to the right hemispheric specialization for the social-emotions and therefore important for normal functioning, and therefore deviations from this ratio could be dysfunctional.
Functionally this right anterior cingulate system is involved in the fast intuitive assessment of complex social situations. When the mother-baby dyad is in attunement, both will experience positive emotions. If out of sync, the baby will show signs of stress, such as crying, that indicate the need for re-attunement. Events that cause such painful emotions as fear, anxiety, and sadness create stress.
This includes everything from short, unwanted separations from the mother to the extreme of abuse. It is also important to note that stress to an infant is not limited to negatively charged events, but also includes anything new or different. New situations create stress for babies because they have no prior experience of them. Attunement of the mother-child pair in stressful situations creates the self-regulation that babies do not inherently possess.
When babies are in balance, they are emotionally regulated, and rely on the relationship with their mother to keep disregulation at bay. Without this assistance, the crying intensifies and leads to a chain of internal reactions that put the baby in a survival mode.
The Science of Attachment: The Biological Roots of Love - The Natural Child Project
In a survival mode, the baby operates at the most primary level, forced to dedicate all resources to the basic functions necessary for existence, thus forfeiting opportunity for potential growth.
This chain of events is a cycle of hyperarousal and dissociation that begins when the baby becomes distressed. This engages the sympathetic nervous system, which increases the heart rate, blood pressure, and respiration. Distress at this stage is usually expressed by crying, which will progress to screaming.
The brain attempts to mediate this by increasing levels of major stress hormones, elevating the brain's levels of adrenaline, noradrenaline, and dopamine.
This triggers a hypermetabolic state in the developing brain. Prolonged periods spent in this state are damaging. Additionally, prolonged exposure to stress induces increased levels of thyroid hormones and vasopressin.
At this point, the child disengages from the external world's stimuli and retreats to an internal world. This reaction involves numbing, avoidance, compliance, and lack of reaction. In biological and evolutionary terms, it is the same process that allows us to retreat from overwhelming situations to heal wounds and fill depleted resources.
However, as a response to dyadic misattunement, it is devastating, and the effects of even short periods of dissociation are profound. Blood pressure decreases, as does the heart rate, despite the still-circulating adrenaline. This means that all of their regulatory resources must be devoted to trying to reorganize and regain equilibrium.
In the infant, states become traits, so the effects of such early relational traumas become part of the structure of the forming personality. Contrary to popular cultural beliefs, close attachment to the mother remains crucially important to children through the toddler and early childhood years. While the needs shift, the attachment remains key. In toddlerhood, children make great strides in physical ability and locomotion but are still at an early point in the development of necessary self-protective skills.
As the child grows, he becomes more autonomous and self-reliant, but remains vulnerable to a wide range of dangers. Thus, attachment behaviors, such as seeking proximity to mother, evincing anxiety when mother moves away, and protesting separation are adaptive mechanisms, not regressive ones. This adaptive pattern is largely unappreciated by our Western culture and is unfortunately and wrongly labeled "controlling," "attention-seeking," or "spoiling.
As children continue to age and develop, their needs evolve but their reliance on the attachment system endures. Even adolescence, often viewed as the pinnacle of developmental challenges, has its focus in attachment. Adolescents struggle with the tension between their connection to family and their formation of independence.
The foundation built in the early years is the groundwork for this phase of life; if the attachment is secure and established, child and parents can negotiate the events of adolescence with little struggle.
What is also highlighted in the research is the importance of nonmaternal caregivers in the child's life.
Allan Schore - Google Scholar-sitater
While the mother-child dyad maintains primacy because of its psychobiological underpinnings in survival and optimal development, the child cultivates an array of "affectional bonds"3 that include, most important, the father or partner, as well as other members of the network of close family and friends.
Attunement in each of these relationships is intensely important because the child is always taking in new information and being shaped by the world. While attachment theory centers on a primary figure, typically the mother, as the bedrock of the child's health and wellbeing, this does not occur in a vacuum, nor to the exclusion of fathers and partners.
Often, in the progression of infant development, the initial role of fathers focuses on support of the mother in her attempt to care for their baby. But it does not stop there. As the baby gains in abilities, the father becomes more central, and his role often evolves into the safe launching point for the child's accelerated forays into the external world.
In the implementation of attachment theory, the baby is connected to the mother and embraced by the support of many people who influence growth and development differently at each unique stage. What does all this mean? Healthy attachment via healthy attunement is the key to healthy babies, and healthy babies are the key to healthy adults. However, while the research may be illuminating, it can also sound frightening.
It is crucial to remember that the mother-baby dyad is a mutual system. No system functions flawlessly all of the time; each of us will be faced with times when we are out of sync, or in emotional disregulation, with our babies. The good news is that these periods of misattunement, as long as they are brief and not chronic, appear to be a positive thing.
Because the baby is learning self-regulation, short periods of misattunement followed by re-attunement have the effect of teaching resilience.Dr. Allan Schore on attachment trauma and the effects of neglect and abuse on the brain
Further, it is speculated that such interactive repair may also be the underpinning of empathy. Long periods of disequilibrium, or consistent and repeated short exposures, however, are not beneficial.
The long-term effects of such environments are as disheartening as the short-term stress reaction. Research now directly links the early experiences discussed with a predisposition to mental illness of all kinds and impaired functioning over a lifespan. Yet another body of hopeful research also exists. There is expanding and exciting study on the impact of positive emotional and play states in the mother-child relationship. This research shows that the capacity to create joy, elation, interest, and excitement together with your baby is a key to early healthy development and lifelong physical and mental health.
Thus, the focus is not just on the negative impact of stress and the importance of stress avoidance, but also recognizes the central importance of happiness and joy. The child attaches to the regulating mother, who helps maximize opportunity for positive emotions and minimize opportunity for negative emotions, thus creating optimal health.
We need cultural changes - changes in expectation, in our view of parents, in our definitions of feminism and masculinity, in our economic systems and medical understandings.
In its broader applications, attachment theory requires us to rethink most of what our society has taught us. We must let go of old learning and erroneous information in order to re-attune to our own connective instincts. While this cannot be accomplished quickly, what we can do is apply this new knowledge to our own lives. Sources that advise the use of formula, bottles, and feeding schedules when on-cue breastfeeding is possible can be dismissed.
The understanding of breastfeeding as an attachment behavior that not only meets the nutritional and emotional needs of children but helps to fortify the mother-baby dyad is clear.
Bowlby himself saw the dual purpose of breastfeeding and viewed the attachment as primary. At about eight weeks of age, a baby's vision improves, and these early visual experiences play an important role in development.
The mother's emotionally expressive face is the most potent visual stimulus a baby encounters. This emotional circuit causes the mother's endorphin levels to rise in turn, resulting in an emotional synchronization.
Cosleeping is another important extension of attachment theory. Because of mother-baby proximity, cosleeping allows for a quick response to disequilibrium. Firmly established regulatory aspects of bed-sharing parallel and echo the self-regulatory learning taking place within the attachment framework.
As the work of Dr. James McKenna illustrates see Mothering, no. Perhaps most important, behavior-based techniques of child raising, such as sleep training, must be shunned. Given the new body of sophisticated, cross-discipline research on attachment and brain development outlined in this article, it is clear that a baby's willingness to accept sleep training after reportedly brief periods of protest is no less than a cycle of hyperarousal and dissociation responses that is damaging to its development.
To think that since the infant has passively accepted the new sleep system, the sleep training is thus "successful," is to misunderstand the workings of the infant brain.
No longer can we accept the conventional wisdom that babies are merely "exercising their lungs" when they cry; nor can we tolerate interpretations of babies' cries as "manipulation. It is an attempt at communication, not manipulation.
Their goals are survival and optimal development. This is achieved through secure attachment. Perhaps the most difficult application of attachment theory lies in our own childhoods.