4/6 “Part 2 - ATTACHMENT THEORY. IMPROVING LIFE OUTCOMES.”

Jun 26

There are multiple causes for the decline in youth mental health described in Part 1. However, little consideration is given to the early years. Attachment theory may offer one clue as to the rise in mental health issues among America’s young people.

Part 2 of this report describes the basic tenets of attachment theory, highlighting domestic and international studies that establish a connection between attachment styles and positive life outcomes in education, addiction, and mental health. Two further studies show the negative effects of non-maternal care, in particular day care centers, affecting behavior long into childhood and young adulthood. This section reviews the general incompatibility of attachment theory with the U.S. economy and culture—explicitly the unique lack of federal support for primary care givers raising children in the early years. (For the remainder of this report, the primary care giver will be referred to as the mother.)

The federal government is not the first source of help. This section reviews wider sources of social capital that help support secure attachment in the early years. It takes a village to support a mother, and parents, in the raising of their child. The demise of “the village” in recent decades is part of what is driving up costs, family affordability concerns, and likely contributing to a decline in fertility rates.

WHAT IS ATTACHMENT THEORY?

Attachment theory, first developed by British psychiatrist John Bowlby then Mary Ainsworth, developed the hypothesis that a child has a primal need to bond to her mother. Attachment theory suggests that this emotional bond between mother and baby establishes recognizable patterns of relating to one another. This “blueprint” impacts the child’s relationship patterns with others thereafter. Attachment styles are designated as either secure, insecure (anxious-ambivalent or dismissive-avoidant), or disorganized. Ideally, a sensitive and responsive mother who is attuned to their child will form a secure attachment bond. Factors such as maternal stress, persistent maternal depression, poverty and other risk factors can hinder attachment.

Research since has borne out this thesis in a variety of cultural settings and is further supported by studies in neuroscience.

The human infant is one of the few mammals whose brain is not fully developed at birth. So large is the human brain that it would be impossible for a human child to leave the birth canal in childbirth if they were to develop fully in-utero. Instead, the new born baby’s brain is about a quarter of the size of that of an average adult. The brain, therefore, doubles in size in the first 12 months, reaching about 80 percent of its adult size by age 3. At this point, the synaptic connections—forming at a rate of one million every second since birth—begin to pare down to their most optimal, efficient, or used pathways.

This rate of growth phase and architectural wiring is therefore a unique window of opportunity, and is a process that requires the context of a relationship.

When an infant is first born she is not aware that she outside of the womb. For the first several months, the child doesn’t fully know she is a different individual to the mother. Such fusion for a baby demonstrates the deep bond between mother and child. It takes the long-term physical presence, care-giving, and nurturing presence of the mother for the child to begin to separate from the mother.

Critical to this neurological and social development is the process of a baby’s bonding with mother through touch, her voice, eye-to-eye contact, and over a continuity of predictable availability and care. The quality of attachment is affected by a number of factors, but primarily the attuned, caring responses of the mother over time.

Secure attachment allows for a child to handle stress, separation, and to self-soothe, through the balance of oxytocin, the bonding hormone, which counter-effects cortisol, the stress hormone. The co-regulation found in early childhood slowly becomes self- regulation – the ability for a child to withstand difficulty as an individual.

The foundational systems established by attachment determine a person’s abilities in self- regulation, empathy, susceptibility to vigilance, addiction, depression, and anger. Again, such system formation develops in the context of relationship.

DOMESTIC AND INTERNATIONAL STUDIES ON BENEFITS OF SECURE ATTACHMENT, LIFE OUTCOMES

The process of attachment deeply informs a child, as they go into later childhood, adolescence, and adulthood, on how they handle stress and their patterning of relationships. As the Centre for Social Justice in London, England note, “secure attachment in the first few years of life is strongly associated with the capacity to make satisfying relationships in later life,” versus more destructive ones.

According to a paper published by the Korean Pediatric Society, “Securely attached children also tend to become more resilient and competent adults. In contrast, those who do not experience a secure attachment with their caregivers may have difficulty getting along with others and be unable to develop a sense of confidence or trust in others.”

In the United Kingdom, the National Society for Prevention of Cruelty to Children recognizes that adults with insecure attachment are more likely to enter into “volatile relationships”, have poor parenting skills, behavioral difficulties, and problems with mental health.

Therefore, attachment isn’t just about the individual but has a multi-generational effect. The quality of attachment shapes an adult’s own emotional resources when it comes to parenting. According to the British Journal of General Practice, attachment “is a key factor in intergenerational parenting difficulties, and predisposes children to substance abuse, temper problems, homelessness, promiscuity, early pregnancy, and criminality.”

Similar findings are reported by researchers from Princeton University, Columbia University, the London School of Economics, and the University of Bristol, who “found that infants under the age of three who do not form strong bonds with their mothers or fathers are more likely to be aggressive, defiant and hyperactive as adults.” In 2014, they reported that 40 percent of the 14,000 children surveyed in the U.S. lacked secure attachment. Children with secure attachment are, they argued, more likely to be “resilient to poverty, family instability, parental stress and depression.” Secure attachment has a determining, measurable effect too on boys growing up in poverty, who are two and a half times less likely to exhibit problem behavior at school. Among children growing up in poverty, poor parental care and insecure attachment before age four strongly predicted a failure to complete school. While “students who have a more secure attachment with their parents tend to get better grades than those who do not.”

Research shows that the quality of attachment can have an impact on mental and physical health outcomes across the life course, with insecure attachment related to more negative health outcomes.

Secure attachment is also strongly correlated with the development of empathy not just during childhood but lasting through adulthood too.

These academic and practitioner perspectives shine an important light on some of the possible factors in the increasing mental health crisis among young people. A lack of secure attachment, and with it the ability to handle stress, could be one of the reasons for the rise in anxiety and depression among young people in the United States. Insecure attachment and the difficulties in providing attuned, nurturing parenting, particularly among those with economic distress, may contribute to the inability to pass on strong stocks of social capital for those already struggling to accumulate it.

THE NEGATIVE EFFECTS OF NON-MATERNAL CARE

Jenet Erickson cites two studies that show the long-term negative impacts of non- maternal care, in an article for the Institute for Family Studies.

The National Institute of Child Health and Human Development Study of Early Child Care (NICHD-SECC) concluded that children who spent more than 30 hours per week in non-maternal care were, on average, three times more likely to exhibit poorer outcomes across all social-emotional development indicators—similar to the effect size of poverty on behavioral outcomes.

Of the 1,364 children followed for the longitudinal study from birth onwards, by age 4.5, children with 30 hours per week in non-maternal care were three times more likely to exhibit “weaker social competence, more behavior problems, and greater conflict with adults”. Those with less than 10 hours per week saw only 2 percent of children with such issues; 18 percent at 30 hours; and almost a quarter (24 percent) for those averaging 45 or more hours per week. Such behaviors were observed to persist through to age 15 regardless of socio-economic background: children who had experienced 30 hours plus in “any type of paid care before age four-and-a-half had higher average rates of risk- taking behaviors such as alcohol, tobacco, and drug use, stealing or harming property, and participating in unsafe activities.”

Figure 2. Percentage of four-year-olds exhibiting at-risk levels of behavioral problems, by time in non-maternal care

SOURCE: Data drawn from Table 8 of NICHD Early Child Care Research Network (2003). “Does Amount of Time Spent in Child Care Predict Socioemotional Adjustment During the Transition to Kindergarten?” Child Development 74(4): 976-1005. Per the study, “Proportions are adjusted for site, child gender, child ethnicity, maternal education, average income-to-needs ratio (6–54 months), 6-month temperament, maternal depression (intercept and slope), parenting (intercept and slope), child care quality (intercept), proportion of center care, proportion of peer group exposure, instability of care. Reproduced with permission from the Institute for Family Studies.

Similarly, studies of Quebec’s universal child care program, implemented in 1997 and which saw a rise in child care use, was shown to have dramatically increased rates of anxiety, aggression, and hyperactivity for children who attended. Follow-up studies 20 years later showed that these “negative social-emotional outcomes... persisted through adolescence and into young adulthood. Among young people from ages 12 to 20, self- reported health and life satisfaction decreased significantly.”

ATTACHMENT THEORY AND THE U.S. ECONOMY

Figures vary, but it is widely accepted that half of the American population have secure attachment.

However, this figure is perhaps on the decline, with a decrease in empathy and a rise in narcissism. While UCLA freshman were finding themselves increasingly less able to cope with the pressures of their first year at college, a 2014 review of 100 studies completed between 1988 to 2011 among college students, revealed a 15 percent drop in secure attachment over this period. The Atlantic explicitly asks if this rise in insecure attachment accounts for the wider decline in social trust and our institutions in America.

What America has achieved, beyond all other developed countries, is an industrial scale experiment in the raising of children as though attachment-theory was entirely inconsequential.

The most significant factor being that the United States is the only developed country in the world that doesn’t offer mandatory paid family or maternity leave at the federal level. By contrast, the OECD average of total paid leave available to mothers is 50.8 weeks,
up from an average of 17 weeks in the 1970s. The average of total paid leave available to mothers in the European Union is 64.6 weeks.

The United States, by contrast, offers 12 weeks of unpaid leave nationally. Even then, employers can force employees to use accrued paid vacation leave, paid sick leave, or paid family leave for this period. Any incapacitation during pregnancy is also covered by these 12 weeks of unpaid leave for companies with 50 employees or more within a 75-mile radius. Leave offerings thereafter vary by state. Federal provision means that for the lucky ones—in America you may have to go on vacation to have a baby. The unlucky ones either lose their job or have to return to work within two weeks of giving birth—as 1 in 4 mothers in America do.

Other countries also offer better healthcare provision. American women of reproductive age have the highest rate of avoidable deaths, are the most likely to have trouble paying medical bills, the most likely to skip or delay needed care because of costs, and are among the least likely to have a regular doctor among developed countries. Despite having the second most expensive cost of childbirth in the world, after Japan, the United States reports higher maternal mortality than other developed nations, particularly for women of color. If the country wants to prioritize strong attachment, it should prioritize bringing that number down. Especially when the CDC have determined that 2 out of 3 of pregnancy-related deaths are preventable.

Further, American culture is perhaps distinct in its neglect of early years in the private sector and employment culture. Female participation in the labor force in other countries comes with a much greater acceptance of the biological realities women face: namely childbirth. As such, maternity leave, maternity pay, health care, and job protections are standard issue in other developed countries but presented as perks in the United States. Such provisions help families of all backgrounds to have the necessary space and financial security to be able to bond and care for newborn infants, in a way that doesn’t force parents, in particular women, to return to the labor market prematurely.

But before rushing to the federal government for assistance, a look at the wider social capital context is necessary. Social capital decline has caused the demise of “the village” that supports the family in the raising of their child. This may help to explain a declining fertility rate, the rise of parents who say they are finding parenting harder than expected, and increasing pressures on affordability of raising a family.

THE DEMISE OF “THE VILLAGE”

Hillary Clinton popularized the adage that “It takes a village to raise a child” in her 1994 book of that title. Whatever the author intended, the idea has taken on a life of its own. There is widespread acceptance that a child can be raised by a village of care-givers, none of them primary.

Ignoring attachment theory as a guiding principle, it is seen as beneficial for infants and toddlers to be provided with multiple sources of attachment in early childhood, particularly at day care centers. Parents often believe that infants and toddlers in a facility are increasing their socialization skills, and improving the chances for their child’s emotional and social success later in life. Some day care centers sell their services offering socialization as a benefit.

Yet it is likely that the opposite is true. As Jenet Erickson, and Katharine B. Stevens note, according to a longitudinal investigation in the U.S., “children who had experienced at least 30 hours per week of non-parental care were rated by teachers as having worse social skills and poorer work habits” at both third and sixth grades. A village of child care assistants can deliver food and diaper changes but are a poor substitute for the emotionally attuned, predictably available, sustained interaction provided by a mother. To this end, child care does not facilitate secure attachment, rather it provides fractured sources of irregular potential attachment figures. This instability likely helps to explain the higher levels of cortisol in children in day care centers, especially those attending for longer periods.

A child is not raised by a village. Rather parents are supported by a village in their raising of a child. Being a stay-at-home mother is said to be one of the most stressful and demanding roles, and if compared to employment the equivalent of 2.5 jobs, that if remunerated would have a salary value in excess of $160,000 per year. Emotionally available, attuned mothering requires significant inputs and support from others, including financial stability. Stable family life based in marriage offers the first layer of “village”. Especially in infancy, the mother is supported by the father. As the child emerges through the early years, the father plays an increasingly important role in helping the child to explore and influencing cognitive processing networks. The next ring of support is, ideally, grandparents and wider extended family. This family is perhaps supported by friends in a faith community or a neighborhood, informally through friendship, or through moms’ groups, mother’s helpers, young babysitters from across the street. Further, there is professional support in local libraries, doulas, healthcare providers, parent coaches, and for those who can afford them nannies, au pairs, and some pre-schooling.

What has been notable, is the alarming decline of “the village” for young parents and mothers. The reasons for this, and the extent of decline, will vary by state, zip code, the educational and income bracket of the parents, and the age at which women have children.

But the factors that can combine to have a consequential impact on the availability of the village include any of the following:

Almost a quarter of America’s children live in single parent homes, more than in any other country, and more than three times the global average. Any attempt to secure the village must start with securing the stability of families built around marriage, as described in our report “Family Stability: Bridging America’s Social Capital Divide.”
In 2022, 67.9 percent of mothers with children under age 6 participated in the labor force (compared with 76.7 percent of mothers whose youngest child was age 6 to 17). This is a significant rise since 1975, when 39 percent of mothers with children under age 6 participated in the labor force, (54.9 percent of mothers whose youngest child was age 6 to 17). Therefore, the number of stay at home mothers able to provide community for each other has declined considerably in the last 48 years, dependent upon education and income background.

Sociologist Karl A. Pillemer concludes that 27 percent of the U.S. adult population is estranged from a family member for reasons such as historic abuse, breakdown of family ties through divorce of cohabitation, and other conflicts with adult- children cutting off parents perceived as being on the rise in the US, the UK, Australia and Canada.
The decline in attendance at houses of worship has further shrunk the village. In 1999, 70 percent of Americans said they attended a house of worship. In 2020, that figure was for the first time below half at 47 percent.
As Daniel Cox has noted, Americans have fewer close friends than they once did. 33 percent of Americans had more than 10 close friends in 1990. In 2021, only 13 percent of Americans did.
As both Daniel Cox and Richard Reeves have noted this “friendship recession” applies in particular to men.
Research shows a decline in neighborliness, and neighbors who socialize with one another. In 1974, 61 percent of Americans would spend a social evening with someone in their neighborhood at least once a month. In 2014, 46 percent did.
Trends also suggest a lack of children playing outdoors together amongst neighbors in free, unstructured, spontaneous play; replaced instead by organized “play dates”. The lack of spontaneity may be based in safety concerns, but is likely to be a symptom of the lack of neighborliness and the decline of the village that supports parents in the raising of their children.
In 2021, President Biden’s “Build Back Better” plan for child care and universal preschool would have made it “difficult for religious providers to remain in operation.” Suspicion toward the role of faith-based groups in the provision of pre-school, education, child care, or support services to families would further diminish the village.

A lack of a village may also explain a University of California, Irvine study, which showed that mothers today spend more time on “child care activities” a day than they did in 1965: 54 minutes compared with 104 minutes in 2012. This “intensive parenting” trend is also seen outside of the U.S. It is possible this additional time is compensation for both parents being in work, but just as likely reflects the demise of the village and support available, even for mothers who are in employment. But “intense parenting” does not necessarily mean the predictable, abundant availability required for secure attachment.

Lack of a village diminishes the resources, emotional and otherwise, required to support parents as they invest emotional energy and time in raising their children. This may explain why 62 percent of parents say being a parent has been at least somewhat harder than they expected, and 26 percent saying it’s been a lot harder. In the JAMA report previously cited, the period of 2016 to 2020 saw a rapid decrease in caregiver mental health (-5 percent) and emotional well-being and coping with parenting demands (-11 percent). This, COVID-related drop, suggests that policies that curtailed the availability of the village available to support parents had a negative impact on parent mental health. It underlines the need for policy to enable, not interfere with, the building of the village that supports parents in the raising of their children.

Among other factors, the village shrinking, and the increased stress measured above, may also be one of the causes for the rise in one-child families. The $300,000 cost of raising a child is, perhaps for most, an alarming amount especially when combined with the demise of the village that makes the demands of parenting more enjoyable. A greater supply of social and emotional resources, as well as voluntary practical help associated with “the village,” could perhaps play a role in helping support a higher fertility rate. And yet, for now, much of the focus from policy makers is on trying to expand child care provision.

Sixty percent of families had dual earners in 2012 versus just 25 percent in 1960. Upward social mobility, as measured by household income, is achieved by having smaller families and pooling two incomes, rather than one. For many, a period on just one income, is not feasible from a monthly budgeting perspective. For others, career breaks associated with caring for children can be ruinous.

This creates tension around how parents want to raise their children, because many Americans aspire to raise children with one parent at home for the early years.

CHILD CARE

A recent YouGov survey found that only 11 percent of full-time working mothers said using full time center-based child care was the best arrangement for families with children under age 5: 37 percent wanted flexible work with both parents sharing care, and 28 percent wanted one full time stay-at-home parent.

According to American Compass, 53 percent of married mothers “prefer to have a one full-time earner and one stay-at-home parent while raising children under the age of five.” In 2022, 7 percent of dads and 28 percent of moms were full-time stay at home parents.

Respondents to a Pew survey believed that in general, parents with young children in 2019 were best off with the father in full time employment (76 percent) while working part time was best for mothers (42 percent), and mothers not working at all (21 percent).

The picture here illuminates the conflict. In general, it appears that mothers and parents want to have more involvement in the raising of their children by the mother and/or father staying at home than are able to achieve it. The choice to use child care seems wildly unpopular as a first preference. Yet its use is in heavy demand: “Two thirds of young children receive some nonparental care (day care), compared with one fifth of children in the mid seventies.”

As Erica Komisar writes, for those mothers who are unable to care for their child, the second-best option is individual care, such as given by a father, relative, or nanny. This substitution isn’t without grief or complication for the child. It does, however, provide a consistent alternative surrogate attachment. Komisar notes with sobriety that, “the least good option for surrogate care is day care or institutional care.”

Part 3 considers policy proposals that would allow us all to create better conditions for achieving secure attachment. Secure attachment, established in the early years, is a unique opportunity to establish a solid foundation for the creation of social capital throughout childhood, adolescence and into adulthood.