8

The Hand That Rocks
THE IMPACT OF EARLY
EMOTIONAL DEPRIVATION

Piglet sidled up to Pooh from behind.
“Pooh,” he whispered.
“Yes, Piglet?”
“Nothing,” said Piglet, taking Pooh’s paw.
“I just wanted to be sure of you.”

—A. A. MILNE,
Winnie-the-Pooh

[Jeffrey’s mother] was walking down the center of the highway toward on-coming cars causing traffic problems, as the cars were having to swerve around her. She said she wanted to die . . . and she was attempting to throw herself in front of cars. She had no smell of alcohol and was very depressed and despondent.

—EYEWITNESS ACCOUNT IN JEFFREY’S CHILD WELFARE CASE FILE

After I came home from the hospital, I couldn’t hold nothing down. I had a problem with retaining any kind of food . . . and [Mother] said she would feed me and I would just vomit it right back up. And she said that she was real scared. She took me to my grandma and grandpa’s house. And she was crying. She didn’t know what to do. She was scared that I was going to die. . . . I don’t think she had the money to take me to the hospital . . . so she went to her dad for advice. And her stepmom told her she should leave the baby with her and get out of here and don’t come back for two weeks. So that’s what happened. . . .

When my brother was only two and three years old himself, he says he got up and used the cooking stove to heat water and did things like changing my diapers. My mom would go into bouts of depression and sleep forever. The house would be like just sick, and John fixed bottles by himself. . . . My earliest recollection was the ambulance coming to take her away. . . . I remember my brother and me sitting on the porch. I was still wearing a diaper, that’s how young I was. . . . I remember my brother wrapping his arms around me and holding me tight. And a police woman told us our mom had to go to the hospital. We didn’t know what for. We thought she was dead.

—JEFFREY, AUGUST 1996

When we arrived at the home, John and Jeffrey were observed outside with nothing on but their underpants. The temperature was 53 degrees. It had been raining earlier, and the ground was still wet. . . . The condition of the family’s trailer was deplorable. Clothing was scattered throughout the floor. Dog feces was observed on the floor and clothing. Moldy dishes and baby bottles were on the kitchen counters. Dirty diapers, tin cans and a collection of garbage was on the kitchen floor. . . . The only food in the house was milk and cereal.

—CHILD PROTECTIVE SERVICES
CASEWORKER REPORT, OCTOBER 23, 1979

They were so much alike—my grandma and my mom—in so many ways. When my grandma was younger, she had her kids taken away from her. And then there’s my mom not doing the things she should be doing, so my grandma figures she should take us away from her. Well, my mom was of course no angel. She was doing a lot of drugs. My grandma decided we shouldn’t be living with her. . . . So we went from bad to worse—back and forth until at least the third grade, plus at least six foster homes by the time I was six years old. Yeah, we went back and forth between my grandma and my grandpa ’cause my mom was young and she wanted to party and stuff like that. She left us at times. Official foster care began later. I must have been two or three years old when I went to my first foster home, and I don’t even remember why. . . .

Walt and Bev are the reason I turned out the way I am. . . . We had a lot of structure. I remember every night we went to bed at the same time. Every night, no if, ands, or buts about it. There was an older boy—he was in high school, every night he stayed up and watched the 10:00 news, and we always wanted to stay up and watch the 10:00 news, too. . . . One night we got to stay up and watch the news with them. . . . And like, I remember going to preschool or kindergarten. I’d never gone to school before. . . . And every day Bev would wash my pants. I had to wear corduroys, and I loved those corduroys ’cause they made the neatest sound. I just loved them. I thought they were the coolest things in the world. . . . They always told us that they loved us. They always told us, every time we went anywhere. From the very beginning, they expected a kiss and a hug. And it was always funny to me. I was like, “I don’t want to kiss you! I mean, I hardly ever kissed my mom, why would I want to kiss you?” And it was hard for me to get over for a little bit, but after a couple of weeks it was like, “Yeah, I’m going to kiss them.” So, you know, I’d give them a hug and a kiss and we’d get out of the car and go do our thing. I remember every time, I mean, this is how much love they had in this house. . . .

I know half the time [going to foster homes] was because we were getting beat up by either my mom or one of her boyfriends or actually sometimes even her friends, her lady friends that would be living with us. . . . I don’t know if they found drugs . . . or just plain neglect, like not having food in the house or, you know, having clean clothes. I mean, we lived in this one house this one time, and when you’d walk into our room, you’d literally walk through a pile of clothes. . . . We had a bunk bed and it would actually go from the door—you couldn’t open the door because the clothes were all the way up to the top of the thing, and Mom never washed them. . . . She was too busy. She was out doing her drugs. . . . Sometimes she’d be with her friends. You know, this one lady, Bobbie, I remember when she lived with us. She and Bobbie were always going out, and this is a biker lady. I mean, she had four kids of her own. So you can imagine us three kids plus her four all in this one room. . . . And their little baby always screaming, and some of the little girls and boys wetting their beds and never getting it cleaned up. You know, sleeping in wet sheets and different things like that. It was just gross. It was disgusting. I remember times, you know, there was garbage all over the floor in the kitchen. You would try to walk through the kitchen, and you could not, no matter how hard you tried. It was literally piled on the floor with garbage and stuff. I mean, you couldn’t hit the linoleum. . . .

I had a friend when I was in the fourth grade, and his family was perfect. I always wanted to go over to his house. Always. Every weekend I would actually ask him if I could stay the night. . . . He had his own room, and his parents were super nice. They always made sure he had breakfast. They always made sure he had his lunch and dinner, you know, three meals. They always told him that they loved him and all this stuff. They all could talk. They could all sit down and actually have a conversation together without having an argument. You know, just talk about fun things.

—JOHN, AUGUST 1996

Eleven-year-old Ray DeFord lived in a dingy apartment house in Aloha, Oregon, with his six pet rats, a python called Satan, and a knife he called “protection.” Neighbors described him as a strange and disruptive child, referring to him as a “junior Charles Manson,” and ordered their kids not to play with him. “He would throw rocks at my children,” one neighbor said. “One time he punched my son badly, and I complained to his mother. She wouldn’t say anything. She laughed.”1

Based on neighbors’ complaints, the deputy sheriff went several times to the DeFords’ home prior to July 2, 1996, to talk to Ray and his parents. Ray beat up two neighbor children ages five and nine, packed rocks in socks to sling at children, and kicked kids in their backs as they got off the school bus. He was never referred for services or taken into custody, however, until July 3, 1996, when he became the youngest child in Oregon history to be charged with murder the day after he set fire to the apartment complex where he had lived for five years. The fire killed eight neighbors—five children and three adults—all from the same small village in Mexico. Fourteen more people were taken to the hospital with injuries, and dozens of people were displaced by the fire.

Ray was an only child, born three years after the marriage of his parents. His mother was mentally retarded and unable to read or write. His father, while more mentally capable, had been a fugitive from a New Mexico prison for fifteen years at the time of the fire. He was partially paralyzed from a stroke that occurred two years before Ray was born. The neighbors described Ray as both abused and neglected, with parents who alternated between letting him do anything he wanted and sudden brutal punishment. “He was born, fed and unloved,” a neighbor told reporters. He wore tattered and ripped bell-bottoms and T-shirts. He was dirty and unkempt and had frequently been shunned in school by children who refused to sit near him for fear of catching “Ray germs.” The neighbor children often ridiculed him when his parents, both without jobs, searched through the apartment garbage-collection site for redeemable bottles and cans to supplement their disability checks.

Ray was not at his age level in reading. He failed the first grade and was in special classes for slow learners, where he reportedly fidgeted at his desk and stared into the distance. Ray was diagnosed as slightly mentally retarded with ADHD. He read at a first-grade level, was unable to do any math except for counting his fingers, and didn’t know how to respond socially. According to expert testimony given in court, Ray was injured on the head at eighteen months of age “before the soft spot had hardened” when his father beat him with a clipboard for crying. He also weaned his son by placing Ray’s baby bottle in a pan of rubbing alcohol and setting it on fire.

Those who knew Ray said that he learned not to cry and that his father continued to abuse him. Ray’s thirteen-year-old friend Jed told reporters from the Oregonian that once Ray’s father, Tom, invited Jed and a few other boys to Ray’s home when Ray was eight. While the boys were there, Tom smoked marijuana and then began shooting Ray in the legs with a BB gun for laughs. “Look at his parents and you’ll get the whole story,” Jed told reporters. Tom encouraged Ray to drink beer and whiskey and to smoke marijuana. He often allowed Ray to play with flammable liquids and fire in his presence and taught his son how to make cyanide out of bleach, detergent, and Coca-Cola. By the time he was five, Ray was threatening children who teased him about his clothes and hair with sharpened Popsicle sticks and with knives he took from his kitchen. Detective Michael O’Connor, who interviewed Ray after his arrest and who arrested Tom eight months later, said that Ray talked about the people who had died but showed no remorse during the several hours he was questioned.2

Even the casual reader of Ray’s story in the newspaper can see the painful reality of abuse and neglect that constituted Ray’s daily life. We have grown accustomed to such children acting out the fury they have absorbed. But questions remain: Why did this particular boy and not another who experienced equal pain wreak such havoc on innocent people? What keeps other children in similar circumstances from committing such crimes? The answers lie not only in understanding the separate factors involved in creating or preventing the creation of a Ray, but also in understanding the ways in which biological and social factors work together from infancy to set a course that may be lethal.

A review of the research on violent and homicidal children reveals that the majority of children like Ray have neurological impairments or diagnosable psychological illnesses. The majority of violent adolescents also have substance abuse disorders. Few have received treatment for these problems.3 In one study, 96 percent of homicidal children had come from chaotic family backgrounds, usually including family violence (81 percent). Ninety percent had been abused by a family member as a child. One hundred percent had a history of serious school problems, including 86 percent who had failed at least one grade and 76 percent with documented learning disabilities.4

As reviewed in earlier chapters, many children who become impulsively violent had, as babies, subtle neurological abnormalities. They began life with “difficult” or extremely sensitive temperaments or showed early signs of attention-deficit/hyperactivity disorder, which progressed to more serious behavioral disorders. They may have been exposed to extreme trauma. But these beginnings are not in themselves causal. Neurological differences only render a child more vulnerable to negative environmental circumstances. Whether children become poets or ax murderers depends on the interaction of biological and social factors—the complex interweaving of risks and protective qualities in a child’s life.

One way to picture the interaction between the biological (particularly neurological) traits of the child and familial or social factors creating violence is to imagine each individual as a small lake. Each lake is different; the size and depth and breadth of our lakes vary. Each is unique in its dimensions since birth. The parameters of our lakes are determined by biological and genetic factors. The water in each lake is the fluid force of potential, the basic competence and confidence we each bring to life. Positive experiences in our environments serve as the wind and rain that enlarge the size of our lakes—we may grow deeper or broader and develop our potential capacities. The water in our lakes increases from these experiences. But negative familial or social factors are like rocks in our lakes. Some rocks, such as multiple family moves, are small; most of us have several of these. Others, such as early physical or sexual abuse, are huge rocks that may rise above the surface of the water. Numerous large boulders in a very small or shallow lake have a far greater impact in reducing the total volume of water than the same number of large rocks in a large and deep lake. A child who begins life with an expansive lake will be less likely to experience immediate overflow from a huge rock outcropping (e.g., loss of a parent) than a child who starts with a lake rendered small and shallow by negative biological factors such as neurological impairment. All lakes will be affected by boulders, and if there are several, the water can become dammed or overflow, leaving the lake nearly empty. Those children with small and shallow lakes from the beginning are most at risk.

Biological and social factors are highly interactive in human development, particularly in earliest development. Biology is one strand of influence on human behavior, affected both by heritable genetics and by environmentally imposed factors such as the prenatal impact of alcohol or drugs, birth trauma, or later head injury. Social factors, particularly the sensitive nurturing of a committed caregiver, interact with and actually alter biological elements such as brain chemistry and brain tissue. Reducing the relationship between biology, experience, and behavior to its most basic form: Children reflect what they have absorbed biologically and socially. Though the processes are complex and often the injuries are unintended, when it comes to our babies, we reap what we sow. Never is the opportunity so great to make so much difference for our children. And never is it so potentially damaging to our communities and to our nation to be unaware of this reality.5

FIRST LOVE

The interactive process most protective against later violent behavior begins in the first year after birth: the formation of a secure attachment relationship with a primary caregiver. Here in one relationship lies the foundation of three key protective factors that mitigate against later aggression:6 the learning of empathy or emotional attachment to others;7 the opportunity to learn to control and balance feelings, especially those that can be destructive;8 and the opportunity to develop capacities for higher levels of cognitive processing.9

In the 1960s, John Bowlby theorized that children form models or templates of themselves and relationships with others based on their experiences with first caregivers, most often mothers.10 These templates form the organizational core of children’s beliefs, expectations, and motivations, which continue to guide and shape the child’s sense of himself and of his role in subsequent relationships. Bowlby recognized that the emotional dance we go about creating in intimate relationships as adults has a strange way of echoing our first relationship. Americans spend untold fortunes and countless hours in therapy trying to figure out why they have continued to seek and then how to avoid marrying the ghost of their mother or father. As the result of early emotional learning, we tend to replicate familiar relationship patterns and confirm the view we formed early of how relationships work. In the same way, generally without awareness, we bring our own histories as infants to our roles as parents.

Bowlby’s theories were a blending of views adapted from psychoanalysis and ethology, or the study of animal behavior. Bowlby had been particularly impressed with the work of Konrad Lorenz, who noted that ducklings and goslings “imprint” or attach to the first moving object they see after hatching (human, goose, or whatever). Early interpretations of Bowlby’s work were applied very simplistically to human children, resulting in the popular but poorly validated concept of “bonding.” This is the notion that, immediately after birth, babies, like goslings, imprint or bond in gluelike fashion to their caregiver, presumably the mother, and that birth bonding is critical. In fact, we now know that for human babies attachment does not occur all at once and does not happen just at birth. It is a cumulative process of minute interchanges between a child and a caregiver over a period of many months, perhaps even years. Even the traditional emphasis on mothers is misleading. Key to attachment is the child’s ability to secure a close and trusting reciprocal relationship with one caretaker, male or female. The failure to achieve this at all is even more devastating than suffering a disruption in an existing relationship. The first months of life are especially important to this process.

At the explosive event of birth, the normal newborn is wired to signal her mother with behaviors designed to draw her mother close. Expelled from an existence that maintained her comfort automatically, the baby cries and extends her arms in a primitive message designed to trigger her mother’s protective embrace. When the mother responds by reaching for her baby, bringing her infant to her breast, making comforting sounds, and patting or rocking, the baby’s temporarily alarmed nervous system is calmed. Inside the baby’s brain, the neurochemical responses to the mother’s soothing reestablishes the physiological equilibrium, and this new little person experiences a physical state similar to the one preceding birth. The baby quiets and relaxes. The mother in turn relaxes.

From this beginning, these exchanges, initially triggered by the baby’s biological needs, will be repeated in millions of tiny gestures and will evolve over time to complex readings of the respective emotions of both mother and baby. The differences between one mother-and-baby pair and another will occur at this moment-to-moment level. Behaviors of the baby trigger behaviors by the parent; crying, for example, can trigger the letting down of milk for nursing. Optimally, the behavior of the parent, such as holding and feeding, elicits predictable behaviors from the baby, such as nursing and calming, which in turn relieves the parent’s tension and results in a balanced, goal-directed partnership. These gestures passed back and forth—cries and agitated movements followed by smiles, caresses, pats, gentle words, warm nipples, dry clothes; or frowns, slaps, yells, cold food propped and left—all occur hundreds of times in the course of a week. Together they leave a cumulative imprint on the developing brain, which, over time, forms a template or pattern for anticipated behavior.11 Bowlby calls this the child’s “internal working model.” Bowlby observed the ways in which one generation transfers patterns of caretaking to the next through the working model. He also noted that these are “working” not static models. They can and do shift with education, therapy, and important life events such as marriage and close relationships. This is how child-rearing patterns, including child abuse, are transferred from one generation to the next.

Dr. T. Berry Brazelton documented this process of intergenerational transfer of basic caretaking behaviors on videotape. The beginning of the video shows a mother feeding, burping, and holding or playing with her baby. On the tape, Brazelton notes the feeding posture, the positioning of the baby by the mother to receive the bottle or breast, her timing, and the way she does or does not wait for the baby to show satiation before interrupting for a burp. Her positioning of her child over her shoulder, the way she pats or rubs the child’s back or holds her on her lap to burp, are all observed. Then the scene shifts to a different mother and baby. The second mother also feeds and burps her baby, using the same gestures, positioning, rhythms, and even facial expressions. After a while, Dr. Brazelton reveals that the second mother is the now grown-up baby seen in the first sequence. Though this woman has never seen the film of herself as an infant with her mother, her behaviors with her own infant are a shadow image of her mother’s behaviors with her. The somatically stored memories of her own experience as a baby were activated with the advent of her own child. To document the variations of parenting behaviors being transferred, Dr. Brazelton created several two-generation sequences, each different from the other and each graphically illustrating the transference of patterns stored and remembered from babyhood. It is through this subtle process of working models internalized quietly in the nursery that the hands that rock the cradles do in fact influence world outcomes.

MIRROR, MIRROR: THE ORIGIN OF EMPATHY

Twenty-three-month-old Jason was strapped into his car seat looking out the window as his mother slowed to a stop at a traffic signal. As the light turned from yellow to red, an old woman waiting at the corner stepped painfully from the curb and walked across the street directly in front of the car where Jason and his mother waited for the light to change. As the old woman hobbled across the street, bent over with the weight of two bulging shopping bags, Jason began to cry softly. His mother turned to ask him what was wrong. Tears flowing down his cheeks, he pointed at the old woman as she continued slowly toward the opposite curb. “Dat poor old lady,” he said.

Two-and-a-half-year-old Tray, short for Thomas, received national media attention and praise for his part in a serious domestic drama in February 1996. His mother wouldn’t wake up, apparently having succumbed to an undetected heart problem in her home in Vancouver, Washington. She had died in her bed with a book across her face, leaving Tray and his eighteen-month-old sister, Kiana, who was upstairs in her crib, alone in the apartment. Tray’s mother appeared to him to be sleeping. When he couldn’t rouse her, he knew what to do. He opened the kitchen cupboard and found dry cereal. For two days he fed himself and carried juice and handfuls of cereal and crackers to Kiana. He used wads of toilet paper to mop up his sister’s wet crib and to pad her diaper. When a scheduled but new babysitter came to the door two days after his mother’s death, he wouldn’t open the locked door. His mother had taught him not to open the door for people he didn’t know. When he grew sleepy, he lay down on the toddler bed near Kiana’s crib. Concerned at her inability to contact Tray’s mother by telephone, though she heard the children inside, the sitter returned the following day and persuaded Tray to let her inside the apartment.12

These stories of preschoolers, though unusual, are not rare. By the age of fourteen months, toddlers often show clear signs of empathy.13 Like violent behavior, empathic behavior does not emerge from a void. Unlike violence, it is built from the loving experience between a baby and a caring adult. Many believe that some form of empathy is inborn: the frequently cited example is of the newborn who begins to cry upon hearing another baby cry in the hospital nursery. But developmental research distinguishes this response from empathy, viewing it as a form of emotional contagion experienced prior to the baby’s capacity for empathy. The more sophisticated cognitive processes involved in empathy include the ability to discriminate oneself from another person, the ability to take the perspective of another person into account, and finally to respond to alleviate another person’s distress. The first of these functions—recognizing one’s physical separateness from others—is generally developed near a child’s first birthday. But at that young age, it is difficult for toddlers to discern that other people’s feelings are not the same as their own. A one-year-old will often cry at seeing a cut on Daddy’s knee or will examine his own fingers when he sees another child hurt his fingers. But as young as fourteen months, some children will move from showing signs of awareness of another’s pain to trying to do something about it, like summoning an adult to help. Between twenty and twenty-nine months, children begin to take steps to comfort others directly—patting, embracing, and taking things to the victim.14

Here lies the root of altruism—the core of moral behavior. Without this quality, human societies would fall apart. When the early sensitive exchange of emotional and physical caretaking between a child and a parent is continued and followed by the parent teaching the child about the impact of his or her behaviors on others, altruistic behavior like Tray’s is not uncommon by thirty months. Although individual differences in children’s temperaments, personalities, and other potentials certainly influence the ease with which these lessons are absorbed, given parental modeling and direct teaching, young children will reflect empathic and altruistic values.15

The foundation for empathy is laid from the beginning. When the early months of an infant’s experience include consistent, sensitive interactions in which the caregiver accurately assesses the child’s needs and responds quickly in a soothing manner, and when a child’s sadness or joy is mirrored in the face of the parent, the child experiences comfort and trust with the caregiver. But when the baby instead experiences unpredictable or dissonant emotions from a key adult, or no response, or a harsh or overwhelming response to efforts to engage the adult, the attachment to the caregiver may be characterized by distrust, fear, or a disorganized combination of conflicting feelings.

Observing the securely attached baby at four to six months of age, we can see and feel his sense of confidence at gaining and maintaining his closeness to his mother, his freedom to express a range of emotions and the expectation that he will be soothed and comforted. The relationship looks fluid and flexible like a waltz between mother and baby. This is the kind of relationship we all love to watch. The pair, like lovers, are enthralled with each other. They seem not to tire of mutual gaze, and even the subtlest gestures are appreciated. The baby’s delight at a toy or a funny sound is reflected in the mother’s smile. Conversely, her baby’s fear or pain evokes the mother’s immediate tension and triggers gestures to comfort her child. It is only a very few months before the infant becomes a toddler like Jason, Tray, or Rachel (introduced below), who reflect to the world the quality of the positive connections they have experienced. This emotional attunement is the cradle of human connection. Tiny interactions between each infant and his mother create threads of empathy that together form the warp and woof of the tapestry we call community, a tapestry that is weakened by each thread that is frayed or broken.

Not all mother-child relationships look like a waltz. Research on interrelationships, particularly parent-child relationships, was given strong impetus by Dr. Mary Ainsworth in the 1960s. Prior to Ainsworth, individual behaviors had been the primary focus of psychology’s lens. It has only been since her work that transactional, or interactive, dynamics have taken their place alongside individual measures in assessing young children. A student of Bowlby, Ains­worth created a well-known laboratory exercise involving mothers with babies who ranged in age from twelve to eighteen months.16 In brief sequences, researchers watched babies as they played with their mothers, as the baby was separated from the mother when she left the room, and as the mother returned. During two intervals a stranger was in the room. In one, the baby was alone. Ainsworth called this assessment the “strange situation.” It was used to determine the type of attachment relationship infants experienced with their mothers. Ainsworth classified the infants’ reactions into three distinct profiles. One group of babies cried when their mother left the room but when she returned reached up and greeted her with smiles and obvious signs of pleasure. They molded easily to their mothers’ bodies when their mothers picked them up and were easy to console. These infants, which Ainsworth called the “securely attached,” accounted for 70 percent of the total.

A second group of babies were clingy with their mothers and seemed afraid to explore the room independently. When their mothers left, these babies became agitated and anxious and cried frequently. When the mothers returned to the babies in this group, which Ains­worth called the “ambivalent” babies, they also reached to their mothers for contact, but then they arched away and resisted their mothers’ efforts to comfort them. This pattern is associated with erratic, inconsistent, and sometimes intrusive caregiving during the first year.

The third group, which Ainsworth called the “avoidant” babies, looked very independent while their mothers were with them. They explored the new environment and seemed not to look much to their mothers for reassurance. Having shown no preference for their mothers over the stranger, when left alone, these babies showed little response. And when mothers returned, the avoidant babies went their own way or avoided contact. This pattern is associated with parental insensitivity or emotional unavailability. The child’s avoidance is believed to be a defense against the parent’s lack of responsiveness.

Succeeding studies have added a fourth category, the “type D,” or disorganized type. These are children who have typically been abused. They seek closeness to their mothers but in disorganized or distorted ways. These babies may approach their mothers backward or suddenly freeze or sit and stare off into space. Upon reunion, they show conflicted, sad, or fearful behavior. Unlike the children in Ainsworth’s first three categories, who all have the ability to get their needs met in some organized if not ideal manner, type D children are at risk of serious relational conflicts. Type D relationships are characterized by parents who are both the primary source of protection and simultaneously the source of harm or failed protection. Researchers studying maltreated children estimate that 90 percent of abused and neglected children exhibit disorganized attachment.17 When seeking to prevent violence at its root, it is this group of babies and their caregivers that warrants intense intervention.18 As we look more deeply at what is going on for “disorganized” babies both behaviorally and biologically, this understanding becomes especially relevant to understanding the antecedents of violence. Over time we realize that far more is being exchanged between parents and babies than meets the eye. This is particularly true when neglect or abuse characterizes this relationship, as the following story of Rachel illustrates.

At age eleven, Rachel is a beautiful and intelligent child. But Rachel steals money from her adoptive mother’s purse, her brother’s wallet, her teacher’s pockets. She destroys her brother’s favorite things—most recently his prized autographed baseball card and his new mitt. Her mother found a darning needle pointed upright in her bed carefully lodged in the middle of the mattress pad and bottom sheet. At school Rachel fights physically with other kids. She’s bright but won’t accept the teachers’ authority. Even when she has completed her homework, Rachel won’t turn it in. Little things upset her, and when they do, she yells obscenities and pushes, shoves, or hits whoever happens to be there.

When Rachel was barely a year old and still living with her biological mother, a neighbor who was babysitting one afternoon found cigarette burns on Rachel’s bottom and reported it to authorities. Although she was not removed from her mother then, her case was monitored by the child welfare system. Almost a year after the first incident, Rachel was again reported with serious injuries when hospital staff at the emergency room discovered multiple bruises and more serious burns on her buttocks. Just before her second birthday, Rachel was removed from her home and placed in protective custody when her caseworker discovered that her mother’s boyfriend had set fire to Rachel’s diaper. Initially, Rachel’s mother was angry and demanded that she get her baby back. For the first few months after Rachel’s removal, her mother faithfully attended parenting sessions and came for weekly supervised visits in an effort to regain custody of her daughter. But after her mother met a new man, Rachel was left crying and disappointed as her mother failed to appear for several scheduled visits.

Rachel’s mother, herself a baby adopted and then relinquished to foster care, was unable to put Rachel’s needs ahead of her own. She said that Rachel had always been hard for her, a difficult baby with a bad temper. Rachel’s father had relinquished paternity shortly after she was born. After nearly a year of mostly missed visits by her biological mother, Rachel—then in a foster home—was placed in “permanent planning,” a child welfare term for the final phase of evaluation of biological parents prior to the state’s termination of parental rights. Rachel’s mother decided to relinquish her rights to Rachel. After two years of foster care, at age four, Rachel was adopted.

Rachel’s adoptive parents met a little girl who, the agency told them, had “lacked loving parenting.” The reality of Rachel’s multiple losses, moves, and disappointments—to say nothing of the physical traumas—was missing from the account. Rachel’s honeymoon with her new family was short-lived. Her temper was irrepressible. When she didn’t get what she wanted, she would scream and then hold her breath until she turned blue and passed out. She was irritable and loud in most situations, rarely allowing affection from her adoptive parents, let alone giving it. She was constantly aggressive with other children.

After seven years of failed efforts, Rachel’s adoptive parents are near the end of their rope. The school wants her in a more structured fifth-grade setting because she frequently becomes physically violent with other students with little provocation. Her parents intuitively feel that her behaviors are a misguided and now habituated response that Rachel exhibits in an effort to receive attention and to make an emotional connection with adults. But they have no idea of how to cope with her behaviors and fear that they may be forced by her escalating aggression into confirming what Rachel already believes and screams at them: that they will “dump her.”

From all we know about Rachel’s mother and the agency records of observations that began before her first birthday, the interactions between the infant Rachel and her mother were, from Rachel’s view, unpredictable and erratic. Her mother was only able to respond to Rachel when her own feelings were controlled and when her own needs were met. Her ability to comprehend or respond to Rachel’s signals was very limited. Rachel’s mother was physically available to Rachel sometimes, but her emotional availability and responses had little to do with Rachel’s cues. Her efforts to engage her mother as often as not likely resulted in frustration. Rachel was picked up, fed, and talked to sometimes—but often she was also handled with anger, or burned, or left to cry. Having tried and failed to engage her mother, Rachel, learning only that she couldn’t predict what would happen, felt angry, fearful, and ineffective. By age one, she would hold her breath and then erupt into explosive tantrums. Her mother was surprised by her baby’s fury, which she experienced, just as Rachel had experienced her mother’s anger, as “coming out of the blue.” Rachel’s rages, however, at least succeeded in attracting her mother’s attention. There were several visits to the emergency room before she was two with Rachel holding her breath and turning blue, sometimes fainting.

Rachel’s behavior at age eleven may be viewed by some therapists as an attempt to engage or connect with her adoptive parents and to release her anger at what she experiences as anticipated betrayal. Rachel—as all children do—developed a working model of what to expect in intimate relationships based on her first relationship with her mother in early infancy. Even in the best of circumstances, creating constructive patterns of relating will clearly be difficult for Rachel. She will require unusual structure, patience, and energy and remains at risk of losing her second primary caregiver. Her behavior, once adaptive to a negative pattern with her biological mother, is now re-creating her early formed belief about what happens when she is vulnerable to a caregiver: they hurt her and they leave her. Without intensive and expensive therapy, Rachel is well on her way to school failure, negative peer affiliations, and violent behavior.

While psychologists have long been aware of the concept of attachment in behavioral terms, it is only since the mid-1990s that neurobiology has provided the understanding that actual biological change accompanies the behaviors we see. The biology of attachment again points to the crucial period of the first two years when negative patterns are rooted in structural and neurochemical changes.

Dr. Allan Schore, at the UCLA School of Medicine, believes that there are neurochemical and structural processes in a specific area of the baby’s brain—the orbitofrontal cortex—that are designed to be receptive to and programmed by the interactive emotional relationship between the baby and the mother or primary caregiver. This area of the brain appears to link sensual input from the cortex (sight, smell, sound, etc.) with the child’s emotionally reactive limbic system and with his internal physical processes (the autonomic nervous system). When the caregiver is able to read the baby’s physical states and cues accurately and respond in a timely and sensitive way, this system of the baby’s brain associates the caregiver with positive and balanced internal physical feelings. By experiencing the joyful and soothing responses of the caregiver to basic needs, the baby experiences connection and pleasure and confidence in the presence of the caregiver. Over time, these feelings become associated with her presence and anticipated in future interactions with this person. In addition, the infant learns that strong emotional states can be entrusted to another and ultimately balanced or resolved, in the context of relationship. This reciprocal process of positive emotional exchanges is the foundation not only for attachment, but also for the development of empathy and the constructive ability for emotional sensitivity in intimate relationships. Dr. Schore explains:

The self is not present at birth. The self emerges over the course of infancy. And it emerges over the course of infancy only if it is part of a relationship with the caregiver. That is, the emergence of self requires more than just a genetically programmed or inborn tendency to organize experiences. It requires certain types of experiences that are presented and performed by an emotionally attuned caregiver. What this means is that the relationship is the crucible, the nurturing matrix out of which the child’s self is cultivated. . . . The mother is providing certain modulated emotional experiences that allow for the attachment bond between the two of them to form, this channel of emotional communication to be created. As a result of this, the child begins to master the central task of the first year of life—learning about his own or others’ internal states and how she or he can regulate these states with other human beings.

In an optimal scenario, the infant is an active participant in a relationship with an emotionally attuned primary caregiver who expands opportunities for positive emotion and minimizes states of negative emotion. . . . Experiencing the joy of being the gleam in the parents’ eye, and of having the secure feeling that one is under the watchful eye of the mother, directly support and nurture the infant’s burgeoning positive self-esteem.

At the end of the first year, these same attachment experiences directly influence the growth of the infant’s brain, especially the orbital prefrontal areas of the right brain that are involved in affect regulation and in coping with internal and external stress. Over time, the cumulative effects of these early interactions set up an internal sense of security and resilience that comes from the intuitive knowledge that one can regulate the flows and shifts of one’s emotional states either by one’s own coping capacities or within a relationship with caring others. The development of this prefrontal area is responsible for empathy, and therefore for that which makes up “human.”

So, a securely attached infant learns in the first two years of life that certain internal subjective states are shareable with others, that one is a human among other humans. This capacity for empathy gives him or her a sense of connectedness with others and therefore a human identity. To be a biological human and to be a psychological human are very different things. To have a human body is one thing, but to be able to feel that one’s needs are of value to self and others only emerges as a result of, at the beginning of life, experiencing an ongoing relationship with an emotionally attuned adult human. . . .19

In Rachel’s case, and in the case of children with type D attachment patterns, instead of a sensitive, “attuned” emotional exchange between the baby and parent, there is “misattunement.” Signals intended by the infant to elicit comfort have been met with pain or unpredictable responses that did not lead to pleasure and soothing for the child. Structural and biochemical processes that could have once supported feelings of relief and connection instead were set to handle erratic and stressful responses. By ten to twelve months of age, these patterns are internalized by the child, even in the absence of the caregiver. At the end of the first year, brain maturation allows for the baby to move from solely existential responses requiring the physical presence of the caregiver to the ability to store the memory of the caregiver’s face and to recall her emotional responses even when she is not present. At this point, Bowlby’s template is internalized, and expectations of future emotional encounters will be based on past interactions with the caregiver.

When all has gone well, the mother’s role in the baby’s first year has been one of primarily nurturing and approval, coaching and cheering. This is what the baby thrives on, expecting it to last. But sometime early in the child’s second year, generally around fourteen months, the necessary role for the mother shifts to that of a socializing agent for the child. Where the circuitry being built in the first year in the orbitofrontal area has been predominantly what Schore calls the “excitatory” circuit, now it becomes essential to build certain “inhibitory” mechanisms. In this new stage it is essential for the mother to provide guidance and discipline; her child’s safety becomes dependent on restriction. The caregiver’s verbalizations change from the gentle encouragement and coaching of infancy (“There you are. You can do it. Look at you! Good job—what a big boy!”) to include moments of disapproval (“Stop! No, No.”). When this shift occurs, the baby, expecting his mother’s consistent approval, is faced with a misattune­ment between the pleasure experienced from his own explorations and the disapproval that the mother now delivers.

Resolving this misattunement and achieving a balance between excitatory and inhibitory processes is a major task for the parent and child, which is only beginning during the second year. It is an essential and normal process for a mother to give inhibitory commands. But when the parent of the toddler is excessively disapproving (“Bad boy! You are so stupid! You can’t do anything right!”) and allows the child to experience shame for long periods of time, then the child’s ability to connect intimately with others can be damaged. This is especially true when the first year’s task of achieving attunement has not occurred. Schore believes that these effects often continue throughout life:

I suggest that the orbitofrontal system is an essential component of the affective core. This prefrontal-limbic region comes to act in the capacity of an executive control function for the entire right cortex, the hemisphere that modulates affect, nonverbal communication, and unconscious processes for the rest of life.20

Excessive shame results in the child experiencing “hypo-­arousal” (underarousal)—the opposite of excitement and playfulness—a dampening of pleasure. This is conveyed to the rest of the child’s physical system through the inhibitory circuitry to the autonomic nervous system, affecting all the nonvoluntary functions, such as heart rate. Schore believes that when prolonged cold and shameful experiences with the primary caregiver are experienced too early during the child’s first year of life, particularly when playful and warm interactions have been infrequent, these events foster low self-esteem. Not only does the child experience a lack of excitement, closeness, and warmth in this early relationship, but the child’s basic brain biology shifts for self-preservation to a dampened level. Now little comfort or sensitivity is expected from other people. Over time, these children become individuals who may show little concern for relationships. Schore asserts that early unregulated humiliation may be a common source of transmission of severe emotional disorders associated with the underregulation of aggression and an impaired ability to empathetically experience the emotional states of others. Schore sees strong clinical evidence that shame-humiliation dynamics always accompany child abuse, and that the loss of the ability to regulate the intensity of feelings is the most far-reaching effect of early trauma and neglect.

In extreme instances of misattunement, scientists like Antonio Damasio, author of Descartes’ Error, believe that the result is developmental sociopathy.21 If the synapses in this area of the brain are never built due to neglect or are destroyed by neurochemicals resulting from chronic stress, the individual may be left without the ability to connect, to trust, and ultimately to experience empathy. Developmental sociopathy renders the individual unresponsive to the pain or endangerment of others. In laboratory settings, when scenes of horrific violence are shown to such individuals, their autonomic nervous systems do not register the normal physiological responses such as increased heart rates or increased skin moisture. In describing a child who cold-bloodedly murders, Bruce Perry says:

The part of his brain which would have allowed him to feel connected to other human beings—empathy—simply does not develop. He has affective blindness. Just as the retarded child lacks the capacity to understand abstract cognitive concepts, the young murderer lacks the capacity to be connected to other human beings in a healthy way. Experience or rather lack of critical experiences resulted in his affective blindness—this emotional retardation. . . . If a child feels no emotional attachment to any human being, then we cannot expect any more remorse from him after killing a human than one would expect from someone who ran over a squirrel.22

While the prognosis for Rachel is still unknown, her story is, unfortunately, no longer an unusual one, especially not for teachers or foster parents. Nor is this an unfamiliar story for therapists who specialize in working with adopted and foster children or children who have had multiple “breaks” or separations from their biological parents, who themselves have serious problems such as mental illness or drug addiction. There is something very fundamental in our first relationship with our parents that reverberates throughout our ensuing relationships—often for a lifetime. When we are at our most vulnerable, when care is a matter of physical and emotional survival, parenting behaviors have a more pervasive impact on both our behavior and our biology than we might want to consider.

THAT OLD FAMILIAR FEELING:
LEARNING TO REGULATE EMOTIONS

Besides meeting the baby’s basic physical needs for food, shelter, and warmth, early caregiving behavior sends subtle messages of emotional comfort—or not—to the infant’s brain. Not only are physical systems such as digestion being regulated by the mother’s proximity and her provision of food, touch, etc., but the child’s neurologically based emotional systems are also setting their balance points. A mother’s ability to accurately interpret her baby’s cues and her response to those cues has immediate repercussions on the modulation of the stress-related neurotransmitters (e.g., norepinephrine) and on key centers of emotion such as the limbic system in the baby’s brain. The baby left to cry for long intervals or the baby whose cry is greeted with a slap is undergoing a very different experience emotionally and neurologically than the child whose cries result in immediate soothing. A caregiver’s predictable responses to the baby’s distress signals and her sensitive pacing of activities to engage her infant when the baby is alert are not only patterning the emotional behavior we can observe, but also actually building connections and modulating neurochemicals in the baby’s brain. This becomes the biological foundation for the child’s later efforts to maintain emotional balance.

Schore’s research on the neurobiology of emotional regulation focuses not only on the orbitofrontal system in the brain, which links the neocortex to the limbic system and modulates emotions, but also on the right hemisphere of the brain, where emotions of distress, sadness, and disgust originate. Dependent on the caregiver’s ability to accurately and sensitively respond, the baby communicates her internal state through a repertoire of emotional signals. Over time, the actual physical structure and neurochemical profile of the baby’s brain come to reflect the caregiver’s responses. According to Schore, the sensitivity and responsiveness of the mother are “literally shaping and fine-tuning the circuits in the infant’s limbic system, which will ultimately be responsible for the regulation of affect.”23 Through mutual interaction, the mother actually re-creates in the baby a psychological and physiological state similar to her own.

The baby left alone to cry or whose cries result in unpredictable or abusive responses may never learn what it feels like to maintain or regain balance through thoughtfully timed external soothing. This is our first model for a constructive, self-consoling pattern when faced with strong negative emotions. Fear or rage may frequently overwhelm a child who has not learned emotional regulation skills. Explosive aggression, freezing, or self-destructive behavior may result from a child’s disorganized efforts to handle strong feelings without a constructive experiential “map.”

As they mature, all children—like all adults—will be exposed to situations that will generate strong negative emotions of fear, anger, jealousy, or frustration. But here, in our first relationship, is the seat of our physiological and emotional patterning in regulating those emotions. A 1995 study by Dr. Angela Scarpa Scerbo, psychologist at Virginia Polytechnic Institute, and Dr. David Kolko, of the University of Pittsburgh, suggests that the ability to regulate emotion in childhood serves as a protective factor against one’s own aggressive behavior.24 While this ability can be taught in later childhood, the fundamental patterns for handling negative emotionality are formed in the first two years of life. By late preschool, failure to learn to modulate strong negative emotions may have taken its toll on the child’s social relationships and on self-image.

Emotional regulation begins with parental responses to a child’s behavior. There are four aspects to parental emotional regulation that are particularly important for young children: joyfulness, anger, fear, and empathic sensitivity. Joyfulness is crucial to self-esteem, relationships with others, and trust in a caregiver. Children of depressed mothers who receive relatively little stimulation of this emotion are at increased risk of depression and anxiety; later social and academic problems are also correlated with this experience.

Anger or rage, while experienced by all children, may be inherited behavioral tendencies. There is increasing evidence that irritability tends to run in families.25 If these emotions are not modulated in infancy or toddlerhood by caregiving adults, children may continue to act out high levels of aggression and overt conflict. The ability to control impulses may also be linked to this patterning and is definitely affected in a positive manner by constructive and consistent adult involvement.26 By school age, children who lack this skill are often already labeled bullies or troublemakers, and the pattern can be hard to reverse.27 If allowed to continue, the inability to regulate emotion may undermine the child’s ability to focus on learning tasks in school, as was the case with Jeffrey.

Chronic fearfulness may also be genetically based, but like rage it can be modulated by caregiving behavior.28 Easily frightened children, particularly little boys, may cause great concern for parents in our culture, which typically values outgoingness and boldness. The role for parents here is sensitive support and encouragement to expand the child’s experience, confidence, and competence.

Finally, empathy is a strong protective factor against antisocial behavior. By modeling sensitivity to the child’s needs and by encouraging the child to be aware of the impact of his behavior on others, parents help the child build a foundation for altruistic behavior.29 Dr. Patricia Brennan and her colleagues, who have looked extensively at protective factors against the development of criminal behavior, identify “orienting reactivity” (measured by skin conductance and heart rate) as a factor that distinguishes nonviolent from violent sons of criminal fathers. Orienting reactivity is a physiological measure of emotional sensitivity, the lack of which distinguishes many violent criminals. This quality may be heritable through an “inhibited,” shy, or fear-sensitive temperament. But researchers speculate that it is also shaped by early sensitive responses to the subtle emotional cues of the baby and young child.30

BEFORE DICK AND JANE: NURTURING THE
FOUNDATION FOR COGNITIVE LEARNING

The ability to learn broadly about the world “out there,” to focus on learning in school, and to master a range of interests in the world outside of self all hinge on a child’s freedom to direct attention away from internal needs—away from basic survival. When children have not been able to achieve some level of trust in at least one other person, when they are coming to school or to playgroups with strong feelings of fear, rage, or grief, when babyhood experiences push them into a state of constant vigilance or escape into a fantasy world, learning is compromised.31 The ability to focus on abstract concepts requires some degree of emotional security, which may not be available to children who have not found protection and trust in a caregiver during earliest childhood. Internal “noise” from unresolved emotional dramas can undermine learning, even for children of high intelligence.32 These are the children who, anticipating fearful experiences and with no secure base, will hang back. They will show little interest in exploration and will be reticent or frightened in new situations.33

A related ability children learn early from their caregivers is that of constructing an internal dialogue, to put feelings into words. The abilities to regulate strong negative emotions and to express feelings are essential to later problem solving, particularly in situations involving conflict or anger between peers. These skills are optimally taught in the first three years and are modulated in our first intimate relationship, generally long before we have expressive language.34

There is a strong correlation between school failure and aggressive or violent behavior.35 The single best investment parents can make in school success is a warm, attentive, and sensitive relationship with their baby. Here, in emotional nurturing and early stimulation, is the nucleus of “school readiness”: the building of self-esteem, and a sense of effectiveness, self-control, relatedness, and ability to communicate and cooperate with others.36 The child’s abilities to relate to other people and to know how to behave in social situations are key to successful transition to school. Restlessness, timidity, and proneness to fighting can undermine achievement.37 Self-expectations—formulated by children’s experiences with parental or caregiver expectations—play a crucial role in school adjustment. At least one study has shown that high gains in first grade were predicted by neither family social status nor children’s test scores at the beginning of the year; children’s high academic self-image and their social maturity were the key factors determining academic success.38

The devastating results to both emotional and cognitive development when a baby is deprived of early sensitive nurturing were clearly evident in the children arriving from the orphanages in Romania in the late 1990s. In a January 1997 episode of Turning Point, a weekly television newsmagazine, Tom Jarriel and Diane Sawyer focused on a group of Romanian children who had been adopted by Americans.39 While some children appeared to have done well since their adoption, many continued to show serious cognitive, social, and emotional problems. Due to the lack of adequate records documenting the children’s histories prior to their arrival at the orphanages, there were many questions left unanswered about these developmental disparities. All the children who spent their early months in the orphanages in Romania suffered severe emotional, cognitive, and social neglect. But there were wide differences in the ages at which the children came to their new families, the quality of care among the orphanages, and the length of time children languished without stimulation prior to adoption.

Left for months in rows of cribs in the orphanages, without a person to engage them in speech, holding, or play, the children featured on the program were all adopted at what we have traditionally believed to be highly malleable ages, before they were thirty-six months old. Often underweight and lagging in development, they came to loving homes in America that lavished on them the best nurturing, educational, and therapeutic interventions available. Several pairs of adoptive parents were interviewed on camera. Their stories, while different, were linked by a common heartbreak at their inability to restore to their children what they had lost in their first months—not just psychologically, but in terms of actual brain tissue.

Dr. Harry Chugani, then of Wayne University in Michigan, offered graphic testimony of the children’s losses. PET scans showed the areas of activity within the brain of a normal child in blues and reds. By contrast, the scans of the little Romanian girl whose story was used to illustrate the differences showed that the area of her brain that controls language was barely active. The area that interprets sound and emotion showed even less activity. “It’s a black hole,” said the voice-over on the film. Areas that should have been pulsating with color were black and still. Adopted at twenty-four months, this little girl could speak, but she couldn’t remember simple messages like the fact that her mother loved her. At age seven, she could not remember a simple three-number sequence.

Another child, a little boy, had no ability to create or maintain attachment to his adoptive parents of four years. He was equally happy to go home with total strangers. Born prematurely, this boy was thought to have been the product of a botched abortion. He had been kept in a cardboard box with a forty-watt bulb, which served as an incubator. At three, when adopted, he was covered with scars and could barely walk. As he matured, he improved physically, but his emotional damage was lasting. He was self-abusing, throwing himself against walls and making himself go into seizures by banging his head on the floor. A Frenchwoman, on assignment in Romania with Doctors Without Borders, was interviewed for the program. She explained that the orphanage staff was instructed to provide only basic physical care, especially focusing on sanitation. “No one is responsible for taking the baby in their arms . . . for feeding the baby . . . for playing with the baby . . . for speaking with the baby.”40

Beginning shortly after birth, interactive “games” between baby and caregiver and the caregiver’s responses to the infant’s sounds have a direct impact on the development of speech and cognitive thought. The baby begins to learn very early that there is meaning and communicative intent in such exchanges. Early language disorders are highly predictive of later school problems. Studies show that greater than 40 percent of the children who have early language difficulties will have learning problems in school.41 One study found that maternal attentiveness and mood during feeding when infants were four months and twelve months of age significantly predicted children’s three-year-old language performance and four-year-old IQ.42 The research indicates that this interactive teaching is particularly effective when begun during early infancy. Babies whose mothers engaged them in a teaching process at four months, providing them with opportunities to observe, imitate, and learn, performed higher on IQ tests at age four than children who were exposed to the same teaching beginning at age one.43 In writing on the importance of early experience on cognitive development, Dr. Marc Bornstein says:

Infants are thought to be particularly plastic to such external experiences because of the still fluid state of the nervous system, because of primacy effects in learning, and because of the lack of established competing responses. This perspective helps to explain why many lifelong characteristics might assume their basic form in infancy and why infants’ caretaking experiences might be so influential in later life.44

Not surprisingly, children’s attachment classifications as measured at twelve to eighteen months tend to be predictive of school success. Children who are identified as anxiously or ambivalently attached are less likely than securely attached infants to make an easy transition into school.45 Teachers are more likely to view avoidant children as hostile, impulsive, withdrawn, and quick to give up. They are disobedient, overly dependent on their teachers, and poor at getting along with other children.46 Anxiously attached children, though less troubled by school than the avoidant group, also have limited social skills and lowered confidence levels.47 In preschool, 75 percent of the children in one study who were identified as having significant behavioral problems had been identified at twelve to eighteen months as anxiously attached.48 This relationship between attachment and social behavior continues into grade school.

By preschool, we can already see the child’s internal working model in action, replicating with teachers the interactions that the child learned at home. Preschool teachers respond differently to children in ways that reflect the children’s attachment histories.49 Anxious or avoidant children tend to provoke teachers’ anger, whereas teachers are generally tolerant of immature or dependent behavior in the ambivalent group. Anxiously attached children seem to receive messages of low expectation from teachers, while the attitude of teachers toward securely attached children remains warm, confident, and matter-of-fact and assumes compliance with their expectations. Research has shown that teachers’ expectations are associated with children’s IQ scores.50 It appears that the child’s internal working model continues to play out in grade school, where teachers’ responses influence their self-perception and subsequently their IQ scores as measured in first through sixth grade.51

WHEN THE BOUGH BREAKS:
THE IMPACT OF MATERNAL DEPRIVATION

The first clue is something that happened when Kaczynski was only six months old. According to federal investigators, little “Teddy John,” as his parents called him, was hospitalized for a severe allergic reaction to a medicine he was taking. He had to be isolated—his parents were unable to see him or hold him for several weeks. After this separation, family members have told the feds, the baby’s personality, once bubbly and vivacious, seemed to go “flat.”

—EVAN THOMAS REPORTING ON THE UNABOMBER,
TIME, APRIL 11, 1996

While attachment research has long focused on the baby’s behavioral attunement with the parent or caregiver, what we have discovered is that another, even more fundamental biological drama is simultaneously taking place within the infant’s brain. Based on discoveries by researchers such as Dr. Myron Hofer, a psychiatrist at the New York State Psychiatric Institute who initially studied the impact of separation on animals, we now know that long before working models are internalized by human infants, attachment behaviors serve the purpose of maintaining homeostatic balance in the baby’s physical and emotional systems.52

Nurturing behaviors like holding, touching, making eye contact, speaking, and rocking—even before they provide the baby with a template of learned expectations about relating to another—provide for the regulation of basic biological functions in the infant. These functions include the immune system, blood pressure, body temperature, appetite, sleep, and cardiovascular regulation. The infant is so fundamentally dependent for these functions on the mother’s continuous proximity that many researchers refer to the mother and baby as one biological system.53 The baby comes to associate physiological security or homeostasis, which he or she experiences as contentment, with proximity to the mother. The baby’s natural opiate network in the brain is stimulated by the normal nurturing and attending behaviors of the mother.54 This process links attachment to the central reward system—the same system that is stimulated by addictive drugs. These early physiological regulatory experiences—resulting in frequent states of contentment or of frustration or rage or confusion—are the building blocks of later mental representations of the parent and of the feelings associated by the child with similar experiences later in life.55

When the baby is screaming, the nurturing mother provides soothing to lower the baby’s state of alarm. When the baby appears droopy or depressed, an attuned mother will attempt to raise her baby’s state to a more elevated mood. These maternal behaviors, besides providing a moderation of the baby’s mood, are also maintaining an even balance of neurochemicals in the baby’s brain, resulting in the contentment we observe and the baby’s experience of emotional modulation, which over time becomes the child’s internalized model for self-regulation of strong emotions, as discussed previously.

If a baby is separated from the mother, he or she experiences the loss not only of the emotional but also of the physiological balance of basic systems that are maintained by the mother’s proximity. This is similar if not identical to the kind of loss adults experience at the death of a life companion or a great love. One’s entire physiological system may go into shock. We find ourselves unable to eat or eating too much, unable to sleep or sleeping too much, lacking energy or highly agitated, and experiencing heart palpitations, high blood pressure, and memory lapses. As Dr. Hofer says:

Insofar as mutual homeostatic regulation characterizes our first relationship and insofar as mental representations are built on this experience, some of the characteristics or later mental derivatives from this preverbal stage may be more readily understood. For example, affect states associated with the experience of separation later in life involve sensations of fragmentation and loss of control that may derive from the early experience of regulation of so many infant systems by the first relationship. The biological, symbiotic aspects of the early mother-infant interaction may also help us understand the power of some of the many bodily sensations—the sensations in heart and stomach so familiar in everyday speech—that are experienced in connection with memories associated with important people in our lives.56

The implications of this information for the expression of violence are attracting growing concern. Dr. Gary Kraemer, of the Harlow Primate Laboratory at the University of Wisconsin at Madison, defines violence as “unregulated aggression,”57 pointing out that society accepts and even encourages some forms of regulated aggression, such as in sports, movies, and video games. But when violence occurs outside socially approved channels, it is culturally categorized as antisocial behavior.

Attachment behavior is the developmental process whereby social regulation of emotion and behavior is first embedded in the human species. Early caregivers are the linchpin in this process. Kraemer, like Hofer, focuses on the neurobiology of these processes. His research on rhesus monkeys, described in chapter 4, demonstrates that deprivation of adequate nurturing in early life leads to the dysregulation of neurobiological processes, one result of which can be violence. When little monkeys are separated from their mothers, there is alteration of the neurobiological mechanisms that the baby uses to deal with stress. The result is exaggerated or blunted emotional responses and enduring changes in the infant monkeys’ performance of cognitive tasks. Specifically, when baby monkeys were separated from their mothers and raised in cages with other little monkeys but no mother, they showed several social deficits that placed them at risk for aggressive behavior. When exposed to a social group, they were not as playful, and they clumped or clung more to each other than mother-reared monkeys. They showed less grooming and approaching with other monkeys and were generally less outgoing. When stressed as adults, these monkeys became hypo- or hyperresponsive—their responses were unpredictable. They were both retiring and antagonistic without provocation. They were often self-injuring. The aggression they showed in reaction to the triggering event was out of proportion in both severity and duration and was directed toward improbable objects. From a temperament perspective, the monkeys were either shy or reckless (extremely “inhibited” or “uninhibited”).58

Kraemer attributes these extreme behaviors to the dysregulation of the system of neurotransmitters in the brain. The usual biological coping responses were not adequately stimulated by early learning from the caregiver and will remain impaired in future social encounters. In addition, the cognitive performances of mother-deprived monkeys differed substantially from that of the mother-reared monkeys. Mother-deprived monkeys were actually better and quicker than mother-reared monkeys at finding raisins hidden under novel objects. But when the task changed to finding a raisin under a familiar object, mother-deprived monkeys had great difficulty shifting to the new task. They were, in short, able to learn one problem-solving approach “too well.” As a result, they appeared to be more rigid and less flexible in learning new tasks.

Dr. Kraemer is concerned that children who are deprived of adequate early caregiving due to abuse or neglect are flooding school systems across the country.59 He sees clear parallels between some children requiring special education in public schools and the behavior of mother-deprived monkeys he observes in the laboratory. He believes that many mother-deprived or neglected children are entering classrooms designed for mother-nurtured children, where the coping skills these children have learned are likely to fail. In addition, their neurobiologically based differences are reinforced by peer rejection. Kraemer’s research points toward the fact that the traditional approach to educating children who have been deprived of early nurturing by placing them in environments designed for nondeprived youngsters ignores their totally different neurobiological wiring—an oversight that contributes to their growing alienation and aggression.

THE LOOK OF LOVE:
THE EFFECTS OF MATERNAL DEPRESSION

Emotional as well as physical unavailability of caretakers takes a huge toll on babies. Dr. T. Berry Brazelton, demonstrating the impact of even short-term loss by the infant of his mother’s accustomed attending behaviors, videotaped an unforgettable series of encounters between a handsome four-month-old infant and his mother. The film features a split screen. On the left side we see a beautiful baby boy in an infant seat, propped on a table. On the right side we see his mother’s head and shoulders as she faces her baby. For the first minutes, we watch this mother engage her baby in their normal way. The baby widens his eyes, raises his eyebrows, and smiles as she sits down in front of him. His arms and legs move fluidly in a regular rhythm toward her as she talks to him. He coos back at her greeting. He is animated, happy, eager to continue their “conversation.” When his mother talks to him, he “talks” back. Her words are timed so that she waits for his response, and then she delightedly continues. The pair take turns with sounds and smiles and touches. Then the scene changes. On the tape, Dr. Brazelton explains that the mother has been instructed to get up and leave, and that when she returns, she is to keep her face stilled, without expression. She is asked not to engage her little boy at all and not to respond to his attempts to engage her. Brazelton explains that she is asked to violate the baby’s expectancy, to prove that the expectancy was set.

The baby greets his mother’s return with the same smiles and coos and enthusiastic kicks we saw in the first sequence. He clearly expects her involvement. As his mother’s face remains unmoved, he stops briefly to look at her and furrows his brow. Then he begins again to engage her as he had before, with even more energy and excitement. When she does nothing, the baby grows louder and kicks harder, causing his little seat to wobble precariously. We see the mother’s restrained face, still sober and without expression. As the baby heightens his efforts, he cries, looks frightened, and kicks harder, gradually almost throwing himself out of the seat. The mother stays with her task, though her face looks pained. Finally, in the last frames, the baby almost falls forward as he tries to sit up, folding his trunk over his legs, as if to throw himself out of the seat to engage his mother’s action. He will even risk hurting himself to “get her back.” Brazelton notes, “Little girls will withdraw; boys will become violent in their efforts to reengage their mothers.” This amazing sequence, lasting only a few minutes, is a condensed version of the progression researchers are studying in the infants of depressed mothers.

Children like Jeffrey whose mothers are seriously depressed during their first two years of life show dramatic differences in their emotional behavior and in their neural physiology by comparison with children of nondepressed parents. When depression prevails in the first years, by school age the children typically show problems in self-control, peer relationships, attention, and focus.60 There is also a high correlation between maternal depression and both abuse and neglect.61 Children of depressed parents are at increased risk of developing depression and anxiety disorders of their own.62 Preschool-age boys whose mothers are depressed tend to act out, showing more aggression, refusing to mind, and often having problems with toilet training. Girls at the same age tend to internalize their anxiety and often withdraw, though either gender may reverse this pattern.63

Dr. Geraldine Dawson, at the University of Washington, studied the links between maternal depression and disruptions in children’s early social and emotional development. Depressed mothers find it hard to show immediate positive responses to their babies’ efforts, and to engage in interesting and stimulating interactions with them. Because of their depression, they show generally more negative moods. They smile infrequently, their faces are often still, flat, or frowning. These mothers rarely laugh or use animated voices or variety in their vocal tones.64 Here we see the influence of the hand that rocks reluctantly.

As early as three months of age, when babies are observed in interaction with their depressed mothers, the babies begin to mimic their mothers’ depressed mood. They show lower levels of motoric activity, vocalize less, look away from eye contact more frequently, and protest more often.65 Dr. Ed Tronick, of Boston Children’s Hospital, who has been studying these depressed pairs since the late 1980s, says that the mothers’ moods appear contagious. The same contagion appears to also influence the interactions between nondepressed mother-child pairs who spend more time in playful states. When normal infants were tested to compare the negative impact of still-face situations (as in Dr. Brazelton’s tape) to the effects of brief physical separations from their mothers, they exhibited more protest and despair and were actually more difficult to console following the still-face than the separation situation.66 The implication is that the impact of emotional unavailability may be even more stressful on the infant than physical separation.67 When infants of depressed mothers are paired with nondepressed adults, their depressed style of interacting persists, suggesting that they generalize their expectations with even nondepressed adults. Dr. Tiffany Field, of the University of Miami Medical School, has found that babies whose mothers’ depression subsides by the baby’s sixth month showed normal motoric and mental development by their first birthday. But children of mothers who continue to be depressed for the child’s first three years show the strong patterns of emotional dysregulation discussed earlier. Some researchers speculate that these symptoms may be inherited. Others believe that the patterns are learned and can be offset by the early involvement of a nondepressed parent or consistent supplementary caregiver.68

With the dawning of the psychobiological research that illuminates the neurological counterparts of observable behavior, researchers like Dr. Dawson are looking increasingly to brain physiology to comprehend the path of depressed moods in infancy. Several studies using EEG measures have provided evidence that the expression of different emotions is associated with activation of the right or left frontal lobes in the brain. The left frontal region is believed to be relatively more activated during the experience of joy, interest, and anger—emotions associated with “approach” toward the external environment69—while the right frontal lobe is activated when experiencing the emotions associated with withdrawal from the environment, including distress, sadness, and disgust. Depression is associated with relatively more EEG measured activity in the right frontal region. In even very young infants, researchers have found right frontal activation during crying and left frontal activation during expressions of happiness.70

When infants had much greater right than left frontal activation during normal conditions, they were more likely to cry upon separation from their mothers. These individual differences in frontal EEG activities under normal conditions are predictive of differences in children’s tendencies to express primarily positive or depressed feelings.71 When there is generalized increased frontal lobe activity, researchers believe that it indicates a tendency toward the intense expression of emotions of all kinds.72 Over time, it may be that the preponderant activation of the right frontal lobe is reinforced by the depressed mother. When the infant’s display of positive emotions goes unnoticed or unrewarded, patterns of neuronal activity associated with pleasure may rarely or never be stimulated, while negative, angry, or sad patterns may be built. Some researchers speculate that a critical period may exist for this aspect of cortical mapping and its consequent connections with the limbic system. This process and pattern of right or left brain activation is the biological underpinning of future expectations of reward and punishment within relationships.73

An additional underlying concern for children of depressed mothers is that they are generally experiencing greater stress than children of nondepressed mothers—stress that leads to increased cognitive and social problems in school. Rather than being available to their infants for reciprocal eye contact, touch, and verbal exchanges and being attuned to the subtle cues initiated by the baby to maintain emotional and physical modulation, depressed mothers respond to their babies from behind the wall of their own unmet needs. As Geraldine Dawson, reporting on Tiffany Field’s work, wrote:

Depressed mothers and their infants spend more time engaged in mutual negative states, such as mother “anger-poke” and infant “protest,” or mother “disengage” and infant “look away.” These infants joined their mothers in inattentive or negative states, resonating with their mothers’ depressed behavior. With repeated dyadic exchanges of negative mood, inattention, and inadequate responsivity, these infants may develop abnormal, stressful responses to social interactions.74

The stressful responses measured by Dawson and Field register as early as three months, when babies of depressed mothers showed elevated heart rates.75 Interestingly enough, these infants did not visibly behave as though distressed, according to the trained observers. Several subsequent studies found higher salivary cortisol levels in the children of depressed mothers, an indication of the activation of the adrenocortical system, which is activated in emotionally stressful situations.

The psychological unavailability of a depressed mother renders her infant emotionally, socially, and cognitively vulnerable. These babies have a limited range of secure experiences in stressful situations and have little practice in drawing upon others to receive emotional support. With poor models for self-soothing, feeling helpless and emotionally disorganized places these infants at high risk of later aggressive or self-destructive behavior. Without confidence in their ability to elicit soothing from a trusted adult, such children may attempt to soothe themselves by rocking or head banging.76

By preschool, unless the child’s caretaking is balanced by a competent nondepressed caregiver, children of depressed mothers may develop a tendency to focus on negative emotions and thoughts, show little ability to initiate or even engage in play, and develop rigid or inflexible emotional and cognitive patterns in an effort to maintain control.77 The hypothesis being examined by researchers studying children of depressed mothers is that there is a sensitive if not critical period in earliest development, particularly from the child’s eighth through eighteenth month, when children are vulnerable to establishing enduring behavioral and neurological patterns from exposure to maternal depression.78

As the research has uncovered the implications of maternal depression, new directions in treatment for depressed mothers and their babies are being explored. Particularly effective for both mothers and babies is massage therapy—massage given to mothers and taught to them as a way of positively engaging their babies. Various nurturing efforts to alter the mother’s mood to more positive thoughts and emotions are also employed, including music, aerobics, yoga, and visual imagery. In a study by Dr. Field, mothers’ anxiety levels and salivary cortisol levels decreased after a thirty-minute massage. After a month of two massages a week, mothers’ depression levels were significantly decreased, as were urinary cortisol levels.79 To increase the mothers’ sensitivity to their babies’ cues and to positively affect the babies’ mood, mothers were also trained to massage their infants. Two groups of mothers were compared, one group giving their babies fifteen-minute massages, and a second group rocking their babies for fifteen minutes. Each group performed these tasks twice a week for six weeks. Babies who received massages spent more time than the rocked infants in active, alert states; they cried less and had lower levels of salivary cortisol following massage. The massaged babies also fell asleep more easily after massage than the rocked babies did after rocking. They gained more weight, were more easily soothed, and showed more positive mood in face-to-face interactions with their mothers.80 Another line of early intervention for depressed mothers is simply the availability of a nondepressed partner: a father, a friend or relative, even a familiar and consistent professional mentor. Field’s data suggest that nondepressed fathers and even nursery teachers can compensate for the potential negative impact of maternal depression.81

THE HAND THAT GUIDES

We are living in a time when parenting skills and discipline techniques are sold in kits, books, DVDs, and television shows. “Canned” approaches to getting children to mind are proliferating and have been for several decades. The implication of these approaches is that once you learn the system, it’s all downhill. Neighbors, friends, and family members may also offer well-meaning advice, generally based on a set of skills that worked with their child or children. When all else fails, most of us resort to what we know best—how it was done when we were little—the ways of our own parents.

For the majority of parents, skills learned from families of origin and from packaged approaches usually work just fine. But for parents who have themselves been abused or neglected, or whose families of origin have been encumbered with emotionally destructive patterns, a deeper level of education together with outside support or therapy may be essential for constructive parenting. In addition, children with unique emotional or physical needs challenge these “one-size-fits-all” systems as well as everything that seemed to work before in the family experience. As we learn more about the individual differences that characterize children at greater risk of impulsive-aggressive behavior, such as ADHD children, and those with bold, uninhibited temperaments who are insensitive to punishment, we are also becoming more knowledgeable about the importance of matching parenting skills—particularly discipline skills—to the individual needs of parents and children. This matching becomes important shortly after birth as the reality of the individual child is recognized by parents. No one set of techniques for motivating and disciplining children works across the board for all toddlers and preschoolers. As temperament research has examined the effectiveness of parenting skills with varying temperaments to ensure “goodness of fit,” we have learned some surprising things about the importance of knowing and accepting children’s different needs prior to learning a system that will enable a child to mind.

ADHD children, for example, inevitably provide even seasoned parents with serious challenges. With these children, parents who attempt to use a communication-based system for discipline will be seriously frustrated as will the child. Such systems as Dr. Thomas Gordon’s Parent Effectiveness Training (P.E.T.) work well with many children but rely on focused listening. ADHD children lack the ability to screen multiple sources of stimulation and discern a command, let alone follow through on it. With ADHD children, the need is for clear structure of the child’s environment and a regimented, well-explained, and well-rehearsed reward system. Children who are bold or relatively undeterred by parental disapproval also need a clear, reward-based system; punishment-based systems don’t work well with children who are unfazed by social disapproval.82 On the other hand, children who are very sensitive, inhibited, or shy will respond easily to gentle, communication-based discipline systems. Even as babies, such children may immediately be deterred by a loud voice; serious consequences such as a loss of privileges or time-out may be overkill, necessary only in rare circumstances.

The basis for any system of discipline begins with first relationships, in which primary caregivers pay attention to and articulate the child’s positive behaviors. Conscious awareness by both parents and child of the child’s capabilities, strengths, and assets is the first step in a discipline system. For the child’s security and self-esteem and for the parents, belief in the core goodness of the child needs to come first. Only when this shared perception is in place is the next step—a disciplinary system—going to be optimally effective. The hand that rocks the cradle first needs to embrace the child.

HOW DOES OUR GARDEN GROW

The interactive “dance”—the timing and degree of reciprocity and sensitivity between an infant and first caregiver—lays the foundation for the exchanges that the baby, then child, then adult will echo throughout life. How we relate to others is birthed in this subtle flow of tiny behaviors exchanged between parents and infants and becoming over time the subterranean sea of learned expectations of self and other. Adult relationships—be they between politicians or businesspeople or a shopper and the grocery clerk in the checkout line—are all influenced by this, our first and most profound relationship. The interchanges between caregivers and infants ripple out to all levels of society, affecting relationships from the playground to the Supreme Court.

On April 22, 1997, an advertisement in the New York Times featured a full-page photograph of a baby’s face. Scrolling down the left side of the bottom half of the advertisement were the phrases: “Every hug. Every lullaby. Every kiss. Every peek-a-boo. Every word. Every touch. Every warm blanket. Every giggle. Every smile. Everything you do in these first three years becomes a part of them.”83

Our children are the barometers of our nation’s strength, their caregivers charged with a role of fundamental significance. Here in the arms of those first rocking our future lies the potential to protect against the rending of society by unsocialized aggression. In order that our babies grow into voting adults who care about such issues and who have the capacities for complex problem solving, the basic ability to connect with other people, to empathize, to regulate strong emotions, and to perform higher cognitive functions must be the intended lessons of the hands that rock the cradles.

POSTSCRIPT

Perhaps the most surprising piece of research discovered while writing Scared Sick concerns the impact of maternal depression on the infant. Maternal depression can have an impact on an infant brain that is no less devastating than child abuse and neglect! The reason? Maternal attunement—physical and emotional availability to “read” a baby’s cues and respond to them constructively, and the capacity to soothe and comfort or to arouse and stimulate—is required in the beginning of life when the baby’s nervous system has not yet matured, and it is critical to health. At this time of life, babies are totally dependent on an adult for these functions. Interactions with the caregiver form the basic architecture of the infant’s developing nervous system and provide the foundation for the child’s emotional self-regulation, including the gradually developing ability of the child to modulate strong negative emotions.

In the absence of a mother’s (or another committed caregiver’s) availability to attune, the infant brain is left to its own raw responses, which leave the child subject to overwhelming emotional responses—particularly fear—on a chronic basis. This overwhelming of the brain’s fight-or-flight system to respond effectively to fear is the definition of emotional trauma and often lies at the root of physical, emotional, and behavioral ill-health.

The devastating stories of adopted children neglected early in their lives are not limited to the Romanian children of past decades. An August 2013 New York Times story of a Russian child adopted by a Texas family illustrates the continuing ignorance of the importance of this time of development and its impact on all that follows.84 After just three months with his adoptive parents, the Shattos, three-year-old Max was left briefly by his new mother, Laura, in the family backyard to play alone with his brother, also adopted from Russia. Accompanied by the two family dogs, the boys had access to a swing set, a trampoline, and slide. Laura returned after a few minutes to find Max lying on the ground, not breathing. When the autopsy found a “multicolored collage of bruises on Max’s body,” Laura, a teacher, was accused of killing the child.

Max’s death followed another horrific story of a Russian child placed with American parents who, three years ago and without appropriate arrangements, returned the seven-year-old child to Russia on an airplane alone, saying only that they couldn’t handle the child’s emotional problems. Max’s death was viewed by Russian authorities as the final straw in what they viewed as American disregard for Russian adoptees and triggered an international furor between Russian and American legislators and media, each country blaming the other for the child’s death. Max was declared by Russian officials to be the twenty-first Russian child to die from abuse or neglect while living with American adoptive families.

Max’s adoptive parents cited countless problems that Max had manifested in his short stay, including head banging, clawing his skin, and hurling his body on the floor. New York Times investigative journalists reviewed countless documents and extensively interviewed the Shattos. Records indicated that they had sought help from a pediatrician in Fort Worth who specialized in foreign adoptions and who subsequently told investigators he had seen the child with numerous self-inflicted injuries, finally prescribing risperidone, an antipsychotic medicine sometimes used for children and teenagers who are autistic and engage in self-injurious behavior. The family was clearly unprepared for handling the little boy, whose biological mother had neglected him since before birth and finally consigned him to an institution, from which the American family adopted him. Upon hearing of Max’s death, his biological mother, whose troubled background was well documented, said she wanted to kill the Shattos and demanded the return of her younger son, also placed with the Shattos. But her history with the two little boys is marked by chronic alcoholism and neglect. Max had been removed from her care at eight months when he was found “dirty and hungry and untended.” He was sent to a hospital and subsequently to the orphanage. A year later Max’s little brother was born and was removed for the same reasons at seven months.

Though the criminal investigation concluded that Max’s injuries were self-inflicted, clearing Laura Shatto of charges of negligence, the real responsibility for this kind of situation—which is echoed in the lives of thousands of abused and neglected American children as well as eastern European children and children across the world—is ignorance and indifference. The effects on the brain of the first thousand days of experience lasts a lifetime. We can all take a role in shifting this conversation from allocating blame to creating a safety net for all children from the beginning.