The Impact of Attachment on Child Symptomology and Treatment Outcomes after Trauma

Background:  The attachment relationship between parent and child predicts positive outcomes for children in a number of spheres of development, including academic, socio-emotional, and behavioral.  But what happens when a child is experiencing trauma at the hands of the parent, who is supposed to protect the child?  Our objective was to better understand the impact of trauma on children’s behavioral and emotional functioning and the impact of attachment on treatment outcomes for children who had experienced traumatic events at the hands of their caregivers.

Method:  This study addressed the following research questions: Does attachment provide a buffer for children who have experienced trauma at the hands of their caregiver?  Does attachment predict children’s recovery in therapy?  This descriptive evaluation of families receiving therapy as a result of trauma included 333 children aged 2-8 (mean age 5.53 years) who experienced an average of 3.89 traumatic events.  The most common events were:  exposure to domestic violence (n=174, 52.3% of sample); separation from an important family member (n=132; 39.6%); witnessed a parent being arrested (n = 107, 32.1%); physical maltreatment (n=99, 29.7%); sexual maltreatment/abuse (n= 4, 22.2%); removed from home due to known or suspected neglect (n=59, 17.7%); and incarceration of caregiver (n=58, 17.4%).  Data were collected in family homes three times, every 3 months.  Measures completed by parents included: Devereux Early Childhood Assessment (LeBuffe & Naglieri, 2003), Parenting Stress Inventory (Abidin, 1995), Trauma Symptom Checklist for Young Children (Briere, 2005), Traumatic Experiences Questionnaire (unpublished). 

Results:  Repeated measures ANOVAs with attachment and time as main outcomes indicated that children with normal attachment (as measured by the attachment subscale of the DECA) had fewer symptoms of distress at baseline than children with lower levels of attachment on the behavioral concerns subscale of the DECA (p<.005) and the child domain of the PSI (p<.001).  Children with normal attachment had higher protective factors of initiative (p<.001) and self-control (p<.001) at baseline and over time (initiative p<.05; self-control p<.001).  In addition, children with secure attachment had fewer symptoms of distress over time, as measured by the behavioral concerns scale of the DECA (p<.005), the child domain of the PSI (p<.01), and the post-traumatic scale total of the TSCYC (p<.005).  There was no significant interaction in any analysis.  Children with low attachment scores and low levels of trauma had more symptomology than children with normal attachment scores who experienced high levels of traumatic events; in most cases, after 6 months of therapy, children with low levels of attachment still had higher levels of symptomology than children with normal levels of attachment did at baseline.

Conclusion: Children with normal attachment as measured by the DECA appeared to be less impacted and have more signs of resilience despite trauma than children with low levels of attachment. The implication of this work is that social workers working with parents and young children with trauma experiences should support the parent-child relationship to buffer the impact of trauma.