e d i t o r’ s c u t
ADVERSITY APART FROM ATTACHMENT
“Everyone longs to be loved. And the greatest thing we can do is to let people know that they are loved and capable of loving.”
Fred Rogers
Lucas was three years old when his alcoholic mother committed suicide. His father was out of the picture, so it was he and his one-year-old brother who found her. They did everything they could to wake her up, not understanding she was gone. Eventually, their older brother came home from school and told a neighbor, who called the police. Lucas and his brothers went from foster home to foster home, experiencing five different placements within two years. He refused to eat and was severely malnourished. He wouldn’t talk in school or participate in class activities. He regularly flew into fits of rage and throw things. His social worker was at a loss for how to best care for Lucas.
Lucas and his brothers are not alone. Around the world, millions of children have been separated from their parents. The numbers are staggering:
● Unicef estimates that there are around 15 million double orphans, or children who have lost both parents.1
● A 2020 study estimated that there were between three and nine million children living in residential care.2 Of those, a majority have living parents but are separated from them.3, 4
● The International Foster Care Organization estimates more than 169,000 are in foster care around the world.5,6
● The UN Refugee Agency estimates there are more than 150,000 child refugees and asylum seekers who are separated from their parents.7
Children who have been separated from their parents have not only experienced the adversity of the separation, but also the adversities that led to the separation and that come as a result of the separation. Consider Abel. He was six years old when his mother died in childbirth. His father didn’t know how to help Abel grieve and became very distant. Eventually, the father decided that he couldn’t care for Abel and his baby sister, so he placed them in an orphanage. Abel and his sister were separated into different areas of the orphanage. Before, he had loved and adored her, spending hours caring for her while his father
grieved his mother. Now, he only saw her once per day. Abel experienced loss after loss after loss.
Attachment and Adversity
A healthy attachment can help a child to overcome adversity. Unfortunately, it also seems that children who have been separated from their parents (their attachment figures) are also more likely to experience adversity. In a study of 529 adults with care experience (e.g., residential care or foster care) during childhood, 100% of them reported at least one ACE, and 57% reported four or more ACEs.8 This number is much higher than what is seen in members of the broader public where rates of four or more ACEs vary from 1% to 38%.9 Clearly, ACEs are an important consideration as we care for vulnerable children. Further, these experiences are often layered and interwoven, adding great complexity to children’s developments into healthy, thriving adults. Experiencing multiple adversities, especially after being separated from parental care, can have lifelong impacts on the well-being of children and their physical, emotional, and brain development. 10
Resilience in Children Separated from Parents
Exposure to childhood interpersonal trauma, such as abuse, neglect, or loss of a caregiver, is associated with lower levels of resilience.3, 11 Further, children with these experiences often lack the support and protective factors needed to build healthy resilience However, research has found that many children with a history of adversity can show high levels of resilience, especially once they are removed from the circumstances of ongoing adversity and placed in supportive, stable, family-based care.12
In fact, supportive parenting13 and continuous, stable relationships with caregivers14 are among the most important factors associated with positive outcomes after separation from parental care. When healthy attachment is developed, research suggests it can contribute to vulnerable children demonstrating resilience.5 Caregivers can learn how to improve the quality of their child’s attachment and ways to support resilience through the small, consistent changes that can be made on a daily basis.
Family Offers Healing
What does this all mean for children who have been separated from their parents? What hope do they have? Interestingly, research shows that children can develop attachments with non-biological parents, such as adoptive, foster, or kinship parents, to great success. A review of
270 studies with over 230,000 children adopted from residential care and children who remained in residential care found that children moved to family care were more likely to show improvement in developmental milestones than children who remained in residential care.15 They saw gains in growth, height, attachment to their caregivers, and school achievement. Despite experiencing the negative effects of a break in their attachment, most children in the study were able to begin to rebuild their attachment and regain much of the development they had lost.
So, how do we do this? In order to facilitate better outcomes for children who have experienced early adversity, we must provide them with secure caregiving relationships in whatever way we can. Scripture and science both clearly suggest children develop best in families.4, 16, 17, 18 Ideally, children will be raised by healthy biological parents who care about and invest in their children’s wellbeing. However, we live in a broken world, and not all biological parents are willing or able to care for their children. In those instances, parents may need support to be successful, or it may be necessary to remove the child from parental care for his safety and well-being. In these cases, we want to find a placement for a child in accordance with his or her best interests. This can look like kinship care, adoption, or foster care. Whatever the setting, having a dedicated grownup who loves you matters for children. When children see a person’s eyes light up when they enter the room, they know they are
welcome and wanted. Often, that is the first step in building attachment.
It was for Lucas. He and his brothers found themselves in a new foster family. This family had a lot of experience with different children, and Lucas’s behaviors didn’t surprise them. They were happy he was with them and told him so regularly. For the first time, he heard “I love you.” He thrived on the routines of the home—meal times at the table, church on Sundays, and reading books on the couch at bedtime. His foster mother was a good cook; he ate well and quickly gained weight. He played outside and had daily chores. He went to therapy with his brother and his foster parents to help him learn how to regulate his emotions. His outbursts decreased drastically. Eventually, Lucas and his brothers were adopted by a family that loved them well. He grew up to be a successful adult with a job he loved and a great group of friends.
Lucas thrived in his secure attachment relationships with his foster family, a testament to the transformative power of such supportive relationships on building resilience and overall well-being a journey echoed by countless others in similar circumstances.
REFERENCES
1. UNICEF (2016). For every child, end AIDS: Seventh stocktaking report, 2016. UNICEF. https://www.unicef.org/reports/every-child-end-aids-seventh-stocktaking-report-2016
2. Desmond, C., Watt, K., Saha, A., Huang, J., & Lu, C. (2020). Prevalence and number of children living in institutional care: global, regional, and country estimates. The Lancet Child & Adolescent Health, 4(5), 370-377. https://doi.org/10.1016/S2352-4642(20)30022-5
3. Wilke, N. G., Howard, A. H., Todorov, S., Bautista, J., & Medefind, J. (2022). Antecedents to child placement in residential care: A systematic review. Institutionalised Children Explorations and Beyond, 9(2), 188-201. https://doi.org/10.1177/23493003221082333
4. van IJzendoorn, M. H., Bakermans-Kranenburg, M. J., Duschinsky, R., Fox, N. A., Goldman, P. S., Gunnar, M. R., Johnson, D. E., Nelson, C. A., Reijman, S., Skinner, G. C. M., Zeanah, C. H., & Sonuga-Barke, E. J. (2020). Institutionalisation and deinstitutionalisation of children 1: A systematic and integrative review of evidence regarding effects on development. The Lancet Psychiatry, 7(8), 703-720. https://doi.org/10.1016/S22150366(19)30399-2
5. IFCO (n.d.). Foster care around the world. IFCO. https://www.ifco.info/about-foster-and-kinship-care/foster-carearound-the-world/
6. Petrowski, N., Cappa, C., & Gross, P. (2017). Estimating the number of children in formal alternative care: Challenges and results. Child Abuse & Neglect, 70, 388-398. https://doi.org/10.1016/j.chiabu.2016.11.026
7. UNHCR Hong Kong (n.d.). Fleeing Unaccompanied: Healing the suffering of children who’ve lost everything. UNHCR Hong Kong. https://www.unhcr.org/hk/en/unaccompanied-children
8. Howard, A. H., Gwenzi, G. D., Taylor, T., & Wilke, N. G. (2023). The relationship between adverse childhood experiences, health and life satisfaction in adults with care experience: The mediating role of attachment. Child & Family Social Work, 28(3), 809-821. https://doi.org/10.1111/cfs.13006
9. Hughes, K., Bellis, M. A., Hardcastle, K. A., Sethi, D., Butchart, A., Mikton, C., Jones, L., & Dunne, M. P. (2017). The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. The Lancet Public Health, 2(8), e356-e366. https://doi.org/10.1016/S2468-2667(17)30118-4
10. Herzog, J. I., & Schmahl, C. (2018). Adverse childhood experiences and the consequences on neurobiological, psychosocial, and somatic conditions across the lifespan. Frontiers in Psychiatry, 9 https://doi.org/10.3389/fpsyt.2018.00420
11. Simeon, D., Yehuda, R., Cunill, R., Knutelska, M., Putnam, F. W., & Smith, L. M. (2007). Factors associated with resilience in healthy adults. Psychoneuroendocrinology, 32 (8-10), 1149–1152. https://doi.org/10.1016/j.psyneuen.2007.08.005
12. Fisher, P. A. (2015). Adoption, fostering, and the needs of looked-after and adopted children. Child and Adolescent Mental Health, 20(1), 5-12. https://doi.org/10.1111/camh.12084
13. DeGarmo, D. S., & Forgatch, M. S. (1999). Contexts as predictors of changing maternal parenting practices in diverse family structures: A social interactional perspective of risk and resilience. In E. M. Hetherington (Ed.), Coping with divorce, single parenting, and remarriage: A risk and resiliency perspective (pp. 227–252). Lawrence Erlbaum.
14. Flores, E., Cicchetti, D., & Rogosch, F. A. (2005). Predictors of resilience in maltreated and nonmaltreated Latino children. Developmental Psychology, 41(2), 338–351. https://doi.org/10.1037/0012-1649.41.2.338
15. Van IJzendoorn, M. H., & Juffer, F. (2006). The Emanuel Miller Memorial Lecture 2006: Adoption as intervention. Meta-analytic evidence for massive catch-up and plasticity in physical, socio-emotional, and cognitive development. Journal of Child Psychology and Psychiatry, 47(12), 1228-1245. https://doi.org/10.1111/j.1469-7610.2006.01675.x
16. Ijzendoorn, M. H., Bakermans-Kranenburg, M. J., Coughlan, B., & Reijman, S. (2019). Annual research review: Umbrella synthesis of meta-analyses on child maltreatment antecedents and interventions: Differential susceptibility perspective on risk and resilience. Journal of Child Psychology and Psychiatry, 61(3), 272-290. https://doi.org/10.1111/jcpp.13147
17. Ferrara, P., Cutrona, C., Guadagno, C., Amodeo, M. E., Del-Vescovo, E., Ianniello, F., & Petitti, T. (2018). Changes in trajectories of physical growth in a domestic adoptees sample: A preliminary study. The Turkish Journal of Pediatrics, 60(4), 464-466. https://doi.org/10.24953/turkjped.2018.04.021
18. Wade, M., Fox, N. A., Zeanah, C. H., & Nelson, C. A. (2019). Long-term effects of institutional rearing, foster care, and brain activity on memory and executive functioning. Proceedings of the National Academy of Sciences, 116(5), 1808–1813. https://doi.org/10.1073/pnas.1809145116