Keith E Rice's Integrated SocioPsychology Blog & Pages

Updated: 13 March 2021

In considering problems to do with failed attachment or lack of attachment, developmental psychologists usually use 3 categorisations:-

1. Separation:  this is where the young child has been temporarily separated from the mother/caregiver for a period of days or even weeks, with the result that the bond between them has been weakened and/or damaged
2. Maternal deprivation: the child and the mother/caregiver have been separated substantially, with the result that the bond is seriously damaged or even destroyed
3. Privation: the child has never formed a real bond with their mother or any other caregiver

As we shall see, it is not always easy to determine whether a child is suffering from separation or, more, maternal deprivation; neither is it always easy tell whether  a child is suffering from severe deprivation or is truly privated. However, all 3 categorisations are associated with emotional and behavioural difficulties, usually mildest in cases of separation and worst in those where the child is truly privated. This can be seen as the PURPLE vMEME not having its safety-in-belonging needs met, leading to the emergence and dominance of unhealthy RED in the child’s vMEME stack, with the consequence of Id-like thinking and beh&aviour.

It is important to note that in all 3 categorisations the child usually has the potential to ‘recover’ – though this potential seems to decrease with age and the severity of their experiences.

The towering figure in early psychological research into the emotional wellbeing of children is John Bowlby. While working at the London Child Guidance Clinic in the 1930s, Bowlby trained and qualified as a psychoanalyst. He further studied under Anna Freud and was at the Hampstead War Nursery when she (Anna Freud & Dorothy Burlingham, 1942; 1944) conducted their ground-breaking work into the effects of loss on child war refugees and orphans. From his time with Freud and from his own childhood experiences, he was determined to investigate the effects of separation and maternal deprivation on children’s wellbeing.

SEPARATION
From Bowlby’s Attachment Theory (1951) and his theory of Maternal Deprivation (1944), it could be expected that young children might suffer severe emotional effects as a result of even a short-term separation from their mother/primary  caregiver.

Bowlby first studied children who were separated from their mother for some time, often by the parent’s hospitalisation. He used naturalistic observation of children (aged 1 to 4) placed in residential nurseries. The children were filmed by Bowlby’s assistant John Robertson. Initially a boilerman at the Hampstead War Nursery, Robertson was trained by Anna Freud in making detailed notes on children’s behaviour. He also filmed the children, using scheduled time-sampling methods to avoid accusations of observer bias. Both Mary Ainsworth and Rudolph Schaffer assisted Bowlby & Robertson on this project. What they established from this research was that children tended to go through a 3-stage syndrome:-

1. Protest
   The immediate reaction to separation involves crying, screaming, kicking and generally struggling to escape. The child’s behaviours are then directed towards trying to get the mother/caregiver figure back – for example, the child may cry loudly and at length. Some children may reject the attentions of a substitute caregiver while others cling desperately. This phase may last a few hours or even a few weeks.
   
2. Despair
   The child becomes less active, seems apathetic and has little or no interest in their surroundings. They may cry quietly and generally appear to be in mourning. To some, it may appear the child has accepted the situation; but, in fact, the child has given up hope – a sort of learned helplessness. They may no longer expect the mother to return. The child hardly reacts to other people’s offers of comfort. Instead they prefer to comfort themselves by rocking and/or thumb-sucking.
   The extent of despair experienced varies according to how securely attached the child is and where they are on the Dimensions of Temperament. Using Strange Situation classifications, securely attached appear to cope better than insecure-avoidant or insecure-resistant. (In 1997 Helen Barrett re-examined the original films and felt not enough was made of individual differences, emphasising that securely attached children appeared to cope relatively well whereas insecurely-attached children were more distressed. She also noted that it was dangerous to generalise from what were effectively a series of case studies.)
3.  Detachment
   The child may now welcome the attentions of others and may even smile and seem sociable. However, this may be only an apparent state of wellbeing as the child may be in inner turmoil. When the child’s mother returns, they do not demonstrate a normal greeting. The child may be indifferent to the mother or even find her presence aversive. Effectively the child may have to relearn their relationship with the mother.

Bowlby noted that the effects of the separation lasted for months afterwards, children aged between 7 months and 3 years (the sensitive period) being the most vulnerable. Following the separation, children were more likely to experience separation anxiety, worrying about future separations. Eleanor Maccoby (1980) refined the age of especial vulnerability to between the ages of 12 and 18 months. One of the crucial variables associated with age, she argues, is the ability to hold in the mind an image of the absent parent. She explains older children coping better, probably because they have learned that separation is followed by reunion. Also their language skills have developed enough for parents to explain that the separation will be short.

Bowlby also noted that many new widows and widowers showed the same 3 phases in face of their loss.

‘A 2-Year-Old goes to Hospital’ (1952)
From looking at young children having extended stays in residential nurseries. Bowlby & Robertson moved on to look at how young children were treated in hospital.

At the time, when children had to be treated in hospital, it was the norm for them to spend weeks with only minimal contact with their parents. Ostensibly this was on the grounds of sanitation. Visiting was usually restricted to one hour a day and even that was sometimes discouraged. A 1952 Nursing Times survey found that only 300 out of 1,300 hospitals allowed daily visiting and 150 allowed no visiting whatsoever. Amongst the Nursing Times’ findings…

• Guy’s Hospital only allowed parents to visit 2-4 PM on Sundays
• St Thomas’ Hospital prohibited parental visits for the first month but they were then allowed to see their children sleeping between 7- 8 PM
• Parents of children under 3 years were not allowed to visit at all by the London Hospital; for children over 3, their parents could visit twice weekly
• The West London Hospital allowed no visiting at any time.

Although a number of psychologists believed that children experienced anxiety when separated from their primary caregiver, the meme most medical professionals usually subscribed to at the time was that high standards of physical care were all that was needed. Many also stated that parental visits often just led to the children becoming distressed again when the parents left.

Bowlby & Robertson were alarmed by the despair they observed in hospitalised children – but found the medical profession were reluctant to acknowledge this. Robertson declared to Bowlby that he could not go on unless they did something for the children they were observing. So they filmed ‘Laura’, a 2-year-old selected at random, who was admitted to hospital for 8 days to undergo a minor operation. They had almost no budget, no artificial lighting and only a handheld cinecamera. To avoid accusations that he had filmed only at times when Laura was distressed, Robertson used an unbiased time-sampling technique, filming Laura for 2 x 40-minute sessions at the same time each day. The hospital clock on the wall was filmed to show the length of the sessions at the same time each day.

In the film, Laura alternates between periods of calm and distress. Her parents visit occasionally and she begs to go home. She clearly struggles to control her feelings. As her mother is not there and the nurses change frequently, she has to face the fears, frights and hurts of the hospital stay with no familiar person to cling to. She is extremely upset by a rectal anaesthetic. Then she becomes quiet and ‘settles’. But at the end of her stay she is withdrawn from her mother, apparently shaken in her trust.

Bowlby & Robertson’s film captures Laura going through the Protest Despair Detachment (PDD) syndrome. It confirmed what had been common knowledge in many communities: that young children could be ‘changed’ by a spell in hospital. The film created a scandal about the way children were treated in hospital.

In 1989 Robertson (James Robertson & Joyce Robertson, 1989) wrote: “It should be borne in mind that the 1951 ward was typical of the times. The nurses were hard-working, busy keeping order, giving medication, making beds, feeding and cleaning the children. They were cheerful and friendly, with ready smiles for the younger patients as they went about their work. But they were not allowed to stop and play with them or give them comfort. They interacted freely with the older children, but went to the younger ones only when there was a physical need to be dealt with.”

One doctor, quoted in Robertson & Robertson, was very angered by the film, feeling his profession had been slandered. However, the next time, he walked down his children’s ward, he saw things differently – “I really heard the children crying for the first time.” The doctor immediately introduced unrestricted visiting and encouraged parents of under-5s to stay.

The film forced the medical profession to acknowledge the need to look after the emotional wellbeing of the young children in their care. It was the start of the culture shift that led to parents being able to stay with their children in hospital – overnight and for days on end, if appropriate.

In Gravesian terms, the medical professionals could be said to be operating from the BLUE vMEME; they were focused on doing what they believed/were told was right. Bowlby & Robertson, coming off GREEN – if not  2nd Tier – saw that the BLUE-driven regimes of the hospitals were not meeting the PURPLE attachment needs of the children in their care. For the doctor who ordered unrestricted visiting,  ‘A 2-Year-Old goes to Hospital’ served to induce what Gregory Bateson (1972) would have termed ‘Level 3 Deep Change’ – a complete revolution in thinking. See: The Process of Change.

While psychological care of children and their parents has improved exponentially over the last half-century or so, hospitalisation can still have a negative effect on children. Robert Kirkby & Thomas Whelan (1996) cite the child’s age, the quality of the attachment to the parents, the seriousness of the condition and the severity of the medical intervention as being key variables in how children handle separation. Schaffer (1996) notes a gender difference mediated by age, in that young males tend to suffer more when separated from their mother/caregiver but females find it harder in adolescence. He also asserts that a ‘difficult’ temperament, a history of family conflict and the parents being ‘psychologically unavailable’ all add to the child’s vulnerability in separation. His assertion that repeated separations also add to this vulnerability is somewhat qualified by Margaret Stacey et al (1970). Stacey et al studied 4-year-olds in Wales spending 4 days in hospital to have their tonsils removed. Their parents were not able to stay overnight. Those who were used to staying away overnight – eg: with grandparents or friends – were less likely to find their hospitalisation distressing. From this the researchers concluded children with regular short separation experiences were less distressed by a stay in hospital.

Other factors affecting  the likely vulnerability of young children to separation include the environment being strange and unfamiliar (Gail Ross et al, 1975) and whether the mother accompanies the child into the hospital (Claire Fagin, 1966). Milton Kotelchuck (1976) emphasises the child having good multiple attachments helps them cope better. He found that, when fathers were actively involved as caregivers, children were more comfortable when left alone with strangers; he also found that the period when children protested strongly at separation was shorter if both parents were actively involved in caring. David Quinton & Michael Rutter (1976) state that separation is more stressful in low income families. The researchers suggest that conflict and insecurity are more likely in low income families and this magnifies the negative effects of separation.

5 films by James & Joyce Robertson (1967-1976)
James Robertson was not as convinced as Bowlby that the PDD syndrome was purely the result of separation from the mother – viz Bowlby (1969): “The subjects of various studies differ in many respects. For example, they differ in age, in the type of home from which they come, in the type of institution to which they go and the care they receive there, and in the length of time they are away. They differ, too, in whether they are healthy or sick. In spite of all these variations, however, and despite the different backgrounds and expectations of the observers, there is a remarkable uniformity in the findings. Once a child is over the age of six months he tends to respond to the event of separation from mother in certain typical ways.” Robertson was concerned that Bowlby wasn’t giving due consideration to variables such as quality of substitute care, multiple caregivers, age and level of maturity of the child at separation.

Robertson wanted a project to investigate these other variables but discussions with Bowlby about this led to a partial parting of the ways between the 2 men. However, Bowlby did agree for the Tavistock Institute, of which he was now a director, to put some funding into Robertson’s project.

To test whether other variables had an effect, Robertson and his social worker wife Joyce became foster parents for infants undergoing shortish separation for the duration their mothers were hospitalised. Each child’s stay in the Robertson household was filmed for around 20 minutes each day. Joyce kept a pad on which to make contemporaneous notes and also made use of a tape recorder. Edits of the movies were published as a series under the umbrella title of ‘Young Children in Brief Separation’. They followed the following general principles:-

• The children were introduced into Robertsons’ home before the mother’s hospitalisation
• They were cared for by a trained, fully-available substitute ‘mother’ (Joyce)
• The parents briefed the Robertsons who then followed similar routines to those in the child’s home and the child brought personal items – eg: toys and photographs – from home
• Contact with the father was maintained and the mother was discussed frequently in positive terms – in some of the cases, the children were taken to visit their mother in hospital

‘Kate’ (1967), aged 2 years 5 months, was their first foster child. In the film, for the first 3-4 days of the 27-day separation she is cheerful and seems relatively relaxed. She uses a family of dolls to recall life at home and to anticipate reunion with her parents. However, as the separation becomes extended, disillusion begins to set in and Kate starts to show anxiety. She is increasingly cool towards the visiting father, expressing anger towards her absent mother and begins to make a niche for herself in the foster family, attaching particularly to Joyce.

The Robertsons were excited as, despite there being some difficulties and  anxieties, Kate did not display anything like the full-scale PDD they might have expected from Bowlby’s conclusions. They attributed this partly to the excellent care given by Joyce, the familiar routines and environment and Kate being old enough to hold onto the memory of her mother.

Following a break in the project to secure additional funding, 17-month-old ‘Jane’ (1968) came to the Robertsons for a 10-day stay. Jane readily accepts Joyce  as substitute (foster) mother and her father visits daily, and the foster mother is fully available to meet Jane’s needs. She seems to be in a state of ‘manageable anxiety’. At reunion Jane returns to her mother with warmth and good expectations. But she is reluctant to give up the foster mother to whom she has become attached.

The Robertsons’ third foster child was ‘Thomas’ (1971), aged aged 2 years 4 months, who was with them for 10 days. Thomas is able to keep his absent mother in mind and talk and talk about her. This, and the daily visits of his father, help him understand the situation as a younger child cannot do. Although in need of mothering care, Thomas sometimes struggles to accept the affectionate exchanges with Joyce as he experiences conflict about loyalty to his mother. Thus, at times he attacks the foster mother when she gives him the very attention he seeks. At reunion with his mother, unlike Jane and, to some extent, Kate, Thomas has no problem about leaving the foster mother.

The impact of these films was huge as they demonstrated that PDD was not inevitable in the separation of young children from their mother/caregiver if high quality substitute mothering was provided, along with familiarity of the environment and the routines. Though it’s doubtful the Robertsons would have known of the work of Clare W Graves at the time these films were made, they would have been known about Abraham Maslow’s Hierarchy of Needs and the emphasis Maslow placed on safety and belonging as prerequisites for the development of self-esteem. The Robertsons worked hard to make their foster children feel safe and to encourage a degree of attachment to the foster mother.

In 1976 the Robertsons published a final film: ‘Lucy’, a 21-month-old who stayed with them for 19 days.  There had been a strain in the relationship between Lucy and her mother and she is undemonstrative on separation from her mother.  The film shows clearly how Lucy, despite anxiety and resistive behaviour, becomes attached to Joyce during her stay with the Robinsons. This seems to have  a ‘healing’ effect on Lucy as she responds immediately and positively to her mother upon reunion. However, Lucy then appears to have a conflict of loyalty to her mother and loyalty to her foster-mother. The film shows how, in the subsequent weeks, mother and foster mother co-operate in helping Lucy work successfully through her divided loyalties.

Bertram Raven (1981) criticised the ‘Young Children in Brief Separation’ project for having no control group for comparison purposes.

However, the Robertsons had filmed ‘John’ (1969) for comparison purposes. Aged 17 months he spent 9 days in a residential nursery, arranged by the family’s GP. In the nursery Joyce Robertson wore the same uniform as the other staff and assisted in background tasks but did not get directly involved in caring for John.

John and his mother had enjoyed a close and harmonious relationship. He was quiet – a little introverted – but ate and slept well.

For the first 2 days, the film shows John behaving much as normal, apparently confident the nurses would respond to his needs as his parents would. He becomes increasingly bewildered as this fails to happen but carries on trying to get the attention of the busy nurses. There are 9 rotating nurses, none of whom are assigned to individual children; so no nurse attends to John long enough to understand him and answer his needs. However, he finds he cannot not compete with the other, more assertive and extravert children in the nursery – some of whom pick on him. Eventually John stops trying to get the nurses’ attention and turns to an over-sized teddy bear for some kind of comfort. He stops eating, stops playing and spends a great deal of time crying.

John enthusiastically greets his father on his first visits but soon comes to reject him. When his mother comes to take him home, he starts throwing himself around and crying loudly. When she tries to put him on her lap, he struggles, screams and tries to run away from her. Although he does finally lie quietly on her lap, he never once looks at her. When his father arrives, he ‘escapes’ into his arms.

For many months afterwards he continued to have outbursts of anger towards his mother. Behavioural problems are reported to have continued throughout John’s childhood, including repeatedly running away from home.

The effects of John’s stay in residential nursery are clearly closer to Bowlby’s PDD.

Day care
Along with a number of other child-oriented Developmental psychologists, mostly of a Psychoanalytic persuasion – eg: Anna Freud, Melanie Klein – Bowlby and the Robertsons brought a much-needed focus on the emotional wellbeing of children and the psychological damage so easily caused when an infant is separated from their mother/caregiver.

As discussed in Bowlby’s influence, the popularisation of his work by the World Health Organisation from 1951 promulgated the meme that mothers should stay at home with their infant children as an essential means of developing  and maintaining secure attachment, thus satisfying the PURPLE vMEME’s need for safety-in-belonging. However, as the 1960s progressed into the 1970s and GREEN-driven Feminism grew more and more influential, ever larger numbers of women went out to work. By 1991 in the US 60+% of mothers of pre-school children had returned to work, compared with just 18% in 1960. In the UK day care places increased from 648,000 in 1987 to 998,000 in 1997. According to The Observer’s Gaby Hinscliff,  52% of women with children under 5 were working in 2004.

More and more mothers taking at least part-time jobs has led to an virtual explosion in day care in the West. In the light of Bowlby’s findings on separation, many commentators have expressed real concern at the effects of being placed in day care on the psychological wellbeing of children.

The majority of studies investigating the effects of day care on cognitive development have found the educational stimulation in the better day care facilities produces real and lasting advantages over homecare. Eg: Margaret Buchanal, Marvin Lee & Craig Ramey (1989) tested the IQ of children entering primary school and found those who had been in day care tended to score higher than those who had been at home pre-school. Not all research supports such findings. Eg: Barbara Tizard (1979) found evidence that, regardless of social class, mothers have more complex conversations with their child than do nursery teachers. Teachers also had fewer exchanges and elicited less from the children. (This may be due to the teacher having divided attention but teacher-child interaction would have an effect on cognitive development.) However, the benefits of day care for cognitive development amongst ‘disadvantaged’ children can be significant. Craig Ramey (1992) followed a group of 54 infants from disadvantaged backgrounds. They were randomly-assigned to either homecare or attendance at a day care centre offering supplementary social and medical care and educational opportunities. After one year there was no difference in IQ; but after 42 months the children in day care were superior in cognitive measures of  verbal language, perception and memory. At the start of the investigation, the youngest child was just 6 weeks while the majority were around 3 months. The benefits of day care can also be long lasting. Frances Campbell et al (2001) followed 104 poor African-American minority children from the Carolina Abecedarian Project. Started in 1972, this provided high-quality day care. Half the children in Campbell et al’s study were in the Abecedarian Project while the other half had a variety of child care arrangements. The researchers studied the participants 20 years later and found those who had received the high-quality day care were twice as likely to continue in school and scored significantly higher on reading and maths tests. They were also more likely to have a job.

Interestingly, Ramey found that day care also benefited his participants in terms of social measures – being socially confident, less aggressive, less selfish and more likely to be goal-directed. Likewise K Alison Clarke-Stewart, Christian Gruber & Linda May Fitzgerald (1994) found both cognitive and social benefits in day care. They looked at 500 infants from various social backgrounds and undergoing a range of different types of care from full homecare to full day care. They found the 150 ‘day carers’ not only benefited from the enhanced stimulation but learned earlier how to cope in social situations and how to negotiate with peers. Cindy Creps & Lynne Vernon-Feagans (1999) confirmed this. However, they also found children who started day care before the age of 6 months tended to be more sociable than those who started later. Altogether though, findings on the effects on social development have been far more mixed than with cognitive development. Eg: James Pennebaker et al (1981), in almost an echo of Robertson & Robertson’s ‘John’, found that, for shy and unsociable children, nursery can be threatening and damaging. Moreover, such damage can have lasting effects for the child’s later school career.

It is when investigating the effects of day care on young children’s emotional development that findings tend to become rather concerning. In their classic 1988 study Jay Belsky & Michael Rovine found an increased risk of insecure attachment if  a child was placed in day care for at least 4 months starting before their first birthday. 149 12-13-month babies (90 male, 59 female) with 2 married heterosexual parents were assessed for attachment to both their mothers and fathers using the Strange Situation. Special attention was paid to Stage 8 – the child’s final reunion with their carer. Additionally mothers were interviewed about their work and classified according to whether they worked and used day care and, if so, for how many hours per week. Rates of insecure attachment to mothers and fathers were calculated in relation to mother’s working hours.
There were higher rates of insecure attachment in children whose mothers worked 20 hours a week or more – 43% chance of insecure attachment compared to 26% for those whose who were in day care less than 20 hours. These children experiencing more than 20 hours especially showed resistance to being reunited at Stage 8. Infants whose mothers worked more than 35 hours a week were more likely to have an insecure attachment to their father. K Alison Clarke-Stewart (1989) criticised Belksy & Rovine’s  use of the Strange Situation as an instrument to measure attachment in children who experience extensive day care. This was on the basis that some children become so familiar with being left by their parents with strange people that they would not respond with the same stress as a child not in day care. She argued that children in day care tend to be more independent which could be interpreted as avoidant behaviour. Yet Belsky’s 1990 meta- analysis, collating the results of a number of previously-published studies and involving 464 children in total, further convinced him that 20 hours a week in day care was a critical threshold for secure/insecure attachment, especially where the child was under one-year-old. This view was supported by C Violata & C Russell (1994). They carried out a meta-analysis of 88 studies and concluded that regular day care for more than 20 hours per week had an unmistakably negative effect on socio-emotional development, behaviour and attachment of young children.
However, Peter Barnes (1995) notes that these differences in attachment type may be due to other factors, such as the type of substitute care and the reasons for mothers needing to work longer hours. Michael Lamb (1992), from a meta-analysis, backed Belsky & Rovine’s threshold of 20 hours in day care as being a key factor in whether day care had a negative effect on a child’s emotional health. Yet Lamb also illustrated the complexity of the issue by citing the quality of the parenting. This, for Lamb, is a fourth key factor, the others being the quality of the day care provision, the age of the child when first entering day care and the amount of day care the child experiences during the week.

Just how complex the interaction of these variables can be is illustrated by Clarke-Stewart, Gruber & Fitzgerald’s finding that there was no comparative negative effect on attachment for children in their sample spending a minimum of 30 hours per week in day care from 3 months old. Bengt-Erik Andersson (1992) also found no ill effects when infants were placed in day care under the age of one and for more than 20 hours. Sandra Scarr & William Thompson (1994) had similar findings to Andersson.

Behavioural scientists have sought to build on the work of the Robertson & Robertson to ‘develop’ best practice in day care. 3 key elements tend to show in research as being:-

1. High staff-to-child ratio.
   The NICHD Early Child Care Research Network (1999) stated that the minimum should be 1:3 and that high quality care cannot be provided consistently with any less. Even at that level, there is a risk care staff can become overwhelmed at times and not able to care consistently for their named children. A good ratio also enables the care staff to spend time with the children, both for emotional development and cognitive stimulation.
2. Minimal staff turnover
   Scahffer (1998) stated consistency of care staff in the child’s life is essential. This allows the formation of attachment between care staff and child, nourishing the child’s PURPLE vMEME.
3. Trained and experienced staff
   Kathy Silva et al (2003) found that the quality of care was correlated positively with the qualification levels of the care staff. The higher the qualifications of the staff – especially the nursery manager – the better the social and development of the children in their care.

Research on the effects of day care on infants’ development has demonstrated many effects that show Belsky’s 20-hours-per-week critical threshold for it being detrimental to children’s emotional development to be overly simplistic. Yet clearly separation from the mother/caregiver is a potentially dangerous experience and needs to be managed carefully, taking into account a wide variety of factors. The quality of attachment to the parents and the child’s temperament are vital factors to be considered.

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