ASD as a Risk Factor for Disrupted Attachment

 

When people hear ACES, or, adverse childhood experiences, it is likely that their mind goes to the more obvious types of adverse experiences such as physical abuse, sexual abuse, loss of a parent, or being removed from the home. But what about the less obvious adverse experiences? Those that are small, yet have a cumulative impact on a child’s sense of safety and security. Those that interfere with the essential bonding between child and caregiver. Those that risk or contribute to disrupted attachment. Experiences such as not having an attuned caregiver or, having a caregiver who struggles to understand and meet the child’s emotional and biological needs. Being on the Autism Spectrum can place a child at increased risk for such experiences.

Being on the spectrum comes with unique neurobiology that can present relational and developmental challenges, both of which impact experiences of co-regulation. Co-regulation is a fundamental component of a secure attachment, in which the caregiver supports the child in regulating emotional and biological needs. Co-regulation is achieved through a delicate dance between the child and caregiver, during which the child expresses a need, the caregiver attunes to the child, and then works with the child to meet the need in order to return to a calm and regulated state. As this process is repeated, the child learns that the world is responsive and safe. However, for a child on the spectrum and her caregiver, the dance of co-regulation can be exceptionally challenging. 

Depending on the child’s neurobiological differences there may be breakdowns at one or more stages of the co-regulation process. The child may have difficulty expressing his needs in a way that can be understood by others, and/or the caregiver may struggle to help the child regulate in a way that works with the child’s neurobiological differences. For example, a child may cry due to difficulty falling asleep and, in response, a caregiver may rock the child. However, if the child has an over or under sensitive vestibular system, the caregivers rocking may either be ineffective or exacerbate the child’s discomfort.

Each time the caregiver and child are unable to co-regulate a mini-attachment trauma occurs and, without a repair (such as successful co-regulation in other moments) these mini-traumas can accumulate to create a disrupted attachment. 

However, despite these challenges, co-regulation is absolutely possible. All that is needed is the knowledge and tools to get there. The most important knowledge for the caregiver to have is an understanding of his child’s unique neurobiology. Armed with this information, the caregiver can better attune and respond to his child and then, they are on their way to increased co-regulation and a more secure attachment. 

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Hi Nora,

I am with you in your frustration that neurodiverse girls and women are, for a variety of reasons, often missed; therefore, ending up misunderstood and misinterpreted. As more and more literature emerges discussing the nuanced ways neurodiversity presents in females, I am hopeful that this problem will be solved. And, you're right, it will not be a quick fix but we are slowly moving in a better direction. 

Thank you for your comment!

Erica

Does this mean that girls and women will be assessed for ASD? Our inability to recognize autism in female humans makes everyone's life difficult.  Both from the viewpoint of all parent and child, it is a shame that so many girls are labelled as bad or mentally ill when they are just different.  ADHD females also have problems that cant be addressed without a solid diagnosis.  While these diagnoses seem tragic they are really good news because it gives us tools to help us be happier. It's not a quick fix but it gets better. 

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I have learned a tremendous amount over the past year reading every bit of information that I can get my hands on from folks who have been presenters at BVK's trauma conference,   Ed Tronick's Infant Mental Health Program, Peter Fonagy, all the researchers on personality disorders,  family systems, intergeneration transmission (those personality disordered families), attachment--- Those people at the Anna Freud center in London....Psychodynamic psychotherapy..... Intersubjective Space and object relations....Anything I think that might help me understand what happens to the mind and the body after we have been traumatized at the hands of our parents starting in early infancy.   Not really all that important but one of the really great people who I have learned a tremendous amount from is Allan Schore..... He is called by some "The American John Bolby". 

This book is amazing and the information contained in this work is what the average person who cares about making sure that every baby has a shot in life needs to know..... 

 

Chapter 2: Modern Attachment Theory and 

Chapter 3: Early Interpersonal Neurobiological Assessment of Attachment and Autistic Spectrum Disorders 

These two chapters should be a Must Read by everyone who cares about the welfare of Children....Everyone!

Some Concepts from Chaprter 3

1. The primacy of  Right Brain development in the first year of life in interaction with the Infant's Attachment figure (Mother) which for the rest of the life span is dominant for the nonverbal, holistic, spontaneous (unconscious) processing of emotional information and social interactions - to regulate "affect" and cope with stresses and challenges and thereby for emotional resilience and emotional well-being.  (Text from Schore) 

2. Emotional Regulation. is essential for the development of a healthy sense of self. 

3. The structure and function of the mind and the brain are shaped by social experiences in emotional relationship.   ---- The developing infant's capacity for Intersubjectivity ----

4. The right hemisphere is undergoing a growth spurt in the womb /third trimester and so it is affected by maternal stress at this time.  

5.  "Studies on the adult brain are now shifting the classical "single brain" paradigm to a "dual-brain" paradigm and exploring precisely how the two cerebral hemispheres meditate different modes of experiencing and coping with the external world."  

Clinical Implications of Regulation Theory for Early Attachment Assessments: 

6. "Visual-facial attachment communications, it is now established that mutual gaze is critical to early social development."  The emergence fo the capacity to efficiently process information from faces requires visual input to he right (and not the left) hemisphere during infancy.   At 2 months of age, the onset of a critical period during which synaptic connections in the developing occipital cortex are modified by visual experience, infants show right hemispheric activation when exposed to a woman's face.  Using EEG ......

 

I am going to take a brake... But Chapter 2 first and then chapter 3 are essential reading here---If the infant doesn't get the sensory input that he or she needs in the form of visual -facial, auditory-prosodic, and tactile - gestural sensory communications,  synapses that would normally be developing, don't develop and the brain cells in those brain regions undergo Apoptosis (programmed cell death).   Then critical brain functions are lost.  

Pediatricians should know this - and we should be discussing how accurate everything he is presenting is because if it is all accurate - we are letting down kids in a massive way.  

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Hi Laura, 

Thank you for your comment! I agree with you and have even used the serve/return model within training material. Child development, and human relationships, are bi-directional in nature, with each individual impacting the other in return. As the child and caregiver are inextricably intertwined with one another, it does become a chicken/egg discussion. And, the way I see it, we can't have one without the other. 

Erica

I think the dynamic you describe might also be a chicken/egg problem.  Caregivers who can't attune might discourage attachment and connection in vulnerable babies,  and cause, or exacerbate, ASD spectrum problems.  

Children need adults to invite them into a mind-to-mind connection.  They need to be a safe person with a safe mind the child can "visit" and rely on.  Without an attuning parent, a child has to stay inside their own mind/feelings/etc all the time, which may feel intense and painful.  With an externally co-regulating "other" the child can get help with self regulation until they acquire the skill.

A really simple way of putting it that Bessel Van Der Kolk talks about is "serve/return."  Children need responses.  When they make a bid for attention, it is a "serve"-- and they want and expect a "return."   After many rebuffs, an ignored baby will have a very hard time continuing to try to connect.

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