Attachment and the child with special needs. (national perinatal association).

The annual conference of the National Perinatal Association, "Improving Outcomes for Mothers and Infants: Preconceptional Care and Beyond" will be held in San Antonio, TX, from November 29 through December 2, 2001. Dianne I. Maroney, RN, will be presenting on attachment theory at the conference; this article is adapted from her presentation.

Attachment is often defined as the theory of love. It is the special emotion and commitment we feel for another person. We begin to learn about the theory of love from the moment we are born and continue throughout our lifetime. Much has been written about how attachment develops between infants and their parents and how secure attachments result in confident, well-adjusted children and then adults. Attachment begins and grows as parent and child strengthen their love for one another by "dancing together," synchronizing their communication through touching, smiling, and playing. But what if the child's ability to respond is altered by developmental delays or mental or physical problems? A parent will face many challenges in creating a secure attachment and must work even harder to help the child develop a secure sense of self.

Pioneer researchers began examining the relationship between parent and child decades ago. In the 1920s Arnold Gesell, a famous pediatrician, and John B. Watson, a well-known psychologist, had conflicting theories about the treatment of children. Gesell suggested that children were what they were the minute they were born, and it didn't matter what parents did to change or shape them. Watson, on the other hand, contended that children were completely a product of their environment, and that too much spoiling by parents--usually mothers--could be dangerous. Watson's theory became well recognized and generally accepted in the US. Children were often told to keep quiet and left alone so as not to spoil them. Almost two decades later John Bowlby, who is now considered the father of the attachment theory, introduced the idea that the relationship between the mother and infant in the first years of life is the key to determining who we are, our ability to develop quality relationships, and our overall future well-being. Bowlby's research has since been extensively studied by others and his ideas and beliefs have been confirmed.

In an ideal home, an infant will cry, smile, laugh, and even move his body certain ways to communicate his needs to a parent, generally his mother. She responds to the infant's needs and the dance between mother and infant is repeated over and over. Of course, a father can also create this dance. As the parent consistently meets the needs of the infant and then the child, he begins to feel secure in his surroundings and grows to feel confident, positive, and comfortable with himself.

When a child has developmental delays, the dance between parent and child may not be as easy to achieve. For example, a premature infant who has developmental delays may not smile at the typical four to six weeks corrected age; she may not be able to coo, clap her hands, or even sit on the floor and play with mom and dad as a term child can. She may not give clear messages when she is hungry, tired, or overstimulated. If the parent has a difficult time understanding the baby's cues, or the baby does not respond as expected, the "dance" is interrupted and the synchronicity between them can be broken. Also, when a child is dependent on her mother for needs beyond the routine feeding, holding, and playing each day, the dynamics of love between them can change. The mom may have to switch back and forth between the roles of nurse and mother, which can confuse both her and the child.

Because attachment is so critical to a child's well-being, and attachment can be more difficult when a child has special needs, parents need to take extra effort to understand their special child. From the moment the child arrives home, parents must watch carefully and learn what each behavior means through patterns, body and verbal language, and how he tolerates interactions. He may be saying that he's ready for more touching, talking, or playing, or that he's had enough. As he grows he will be able to communicate more and more in his own special way. What's important is that parents respond appropriately. Kangaroo care, infant/child massage, and even yoga for kids are excellent tools for creating a bond between parent and child. The absolute key to developing a securely attached child is to make him feel as if he is the center of the universe, and that his parents understand and believe in him no matter what obstacles he may face.

Although the dance between parent and child may be more difficult to achieve when the child has special needs, it is equally--probably more--important. A securely attached child, and then adult, will have an optimistic and balanced life, and will most often contribute positively to the world.

Dianne I. Maroney is a former NICU nurse and the mother of a 26-week "preemie." She co-authored "Your Premature Baby and Child" (Berkley, 1999), a handbook for parents after the NICU.