Attachment: The Balancing Act

The COVID-19 pandemic has prompted swift lifestyle changes for folks across the globe. Drastic social and quarantine measures have triggered fears and concerns about the foreseeable future. For caregivers, this has translated to increased time at home facing new challenges with their children. Mental health has become a secondary priority which can disrupt attachment patterns between parents and children of all age and developmental spectrums.

Caregiver characteristics that promote or hinder a safe and trusting relationship with their infants are the basis of attachment theory and have been correlated with later psychological functioning. Attachment can bear significant weight on self-perception and personal beliefs, and primary caregiver dynamics often mirror relationships with friends and romantic partners across the lifespan. Stemming from the womb, infants ingest, process, and interpret surrounding sensory inputs, including caregiver emotional states. Thus, greater exposure to parents experiencing anxious or traumatic distress during the quarantine period can trigger maladaptive mental health symptoms and family functioning.

Below are some pointers to foster a healthy home environment promoting secure attachment with your child while prioritizing self-care and emotional well-being.

  • Space

As the saying goes, everything in moderation, and this includes attending to your child. Engage in favorable outlets just for you to promote relaxation and mental healing. This will model and encourage your child to accomplish individual tasks and respect personal space. Benefits include enhanced autonomy, self-confidence, and agency to problem-solve. Take the breather!

  • Stability

It’s impossible to entirely mimic your child’s school structure, but it doesn’t mean that you can’t borrow some tactics and strategies. Healthy attachment is promoted by stable and safe parenting, and predictability throughout your child’s day can help reinforce that. Try to identify and jot down times for eating, sleeping, and playing. If developmentally appropriate, include your child in creating the daily plan to value their choices while establishing a consistent routine.

  • Praise

It’s important to remember that the pandemic has disrupted life as we knew it- provide patience and grace while your child projects their worries and fears. They too are navigating this new territory. Praise them for rolling with the punches, instill gratitude, and lend a shoulder for them to cry on when they miss their friends. This is the time to build them up while creating space for vulnerability. Critical parenting can contribute towards poorer psychological functioning. Highlight your child’s strengths while attempting to minimize negative language when they misbehave.

These deliberate practices will reap many rewards including enhanced ability to practice self-forgiveness, healthy emotional expressiveness, and self-soothing strategies with an intrinsic awareness that you are a reliable source of support. It’s okay for your child to not be okay, so long as they know that you will always be the lighthouse leading their way to safe terrain.

Dr. Bahar Rahnama obtained her Doctor of Clinical Psychology degree at the APA-accredited California School of Professional Psychology at Alliant International University, Los Angeles (CSPP-LA). Dr. Rahnama completed coursework and field-based training in congruence with her graduate specializations across family, child, and couple dynamics. Through both research and clinical practice, Dr. Rahnama’s interest encompasses the correlation between enactment of cultural norms and parent-child attachment styles. Her examination and focus on these factors have led to a multitude of clinical opportunities and advancements including her UC-Davis certification in Parent Child-Interaction Therapy (PCIT), an evidence-based model that meticulously targets disruptive behaviors in children between the ages of two and seven while enhancing a positive and healing bond between caregiver and child.

Pandemic Parenting Tips

Pandemic, coronavirus, COVID-19. Regardless of what you choose to call it, this globally-impacting disease translates to one universal fact—these are challenging and unprecedented times for all. In the midst of a new normal, mental health is sacrificed while many scramble to establish structure in their daily lives. In other words, life doesn’t simply stop, even when it may feel like we’re in a perpetual state of limbo. With survival mode as our shield of armor, we learn to shift and adapt.

Now picture this: school is closed for the remainder of the academic year, and parents suddenly have to tackle new roles including teacher, tutor, therapist, mediator, and friend—just more skills to add to your repertoire as a parent. Children are ripped from their routine, and in turn, may be manifesting these sudden changes in the form of anxiety, depression, and developmental regression. You may find that your fiercely independent six-year-old is now begging you to let her sleep in your bed. Your sweet and shy four-year-old is kicking and screaming with every ounce of his being. Your Tic-Toking teen has officially locked herself in her room and is refusing to engage with the rest of her family. Here’s where the good news kicks in—you are not alone, and this is not your fault—nor your children’s.

Below are some tips and tricks to tackle common behavioral and emotional concerns that parents are facing today, and more importantly to start welcoming mental health back to the forefront of your mind.

1.     Gut over guilt: Parental guilt is inherent, and especially now can be at an all-time high. It’s understandable to feel upset that your child was robbed of the joys and benefits of school, yet your desire to fill the void and promote happiness may be hindering them. By needing to fulfill their every demand, wish, and desire, you are strengthening your child’s capacity to eventually push back against structure and defy your requests. Follow your parental gut, the one suppressed underneath the guilt, and follow accordingly when something isn’t sitting right. It’s okay to delete that extra toy out of your Amazon cart, or to have difficult conversations with your child, even if it may upset them.

2.     Establish structure: This is both to your benefit and theirs. Create a makeshift school or daycare, one where rules are written and verbalized. Sit down with your child and identify at least three rules or tasks to be followed daily. Including your children in this activity places the accountability in their court. Children thrive off structure, even when they crave chaos and spontaneity. Find a happy medium and attempt to create a weekly schedule to check off homework, meals, and playtime.

3.     Negative attention = attention: Highlight positive behaviors you are desiring more of, and practice selective ignoring when the negative behaviors are not posing a safety threat. This applies to children across all ages. Ignoring your child does not make you neglectful, so long as you are boosting their confidence and recognizing them for their polite manners, problem-solving skills, and following the rules. Replace words that are trigger points for children including “don’t” or “stop” with positive statements that promote the behaviors you are wanting to see in them (e.g. please use your inside voice; please keep your hands to yourself).

4.     Set consequences: This one is tough. Every family has a different tactic and strategy when it comes to discipline. However, removing desirable objects and activities from your child of any age when they are breaking important rules or acting defiantly is an effective measure to establish greater harmony at home. Sit down with your child and identify three consequences that can be enforced in a single day if a house rule is broken. These may include losing electronic privileges such as the television or cellphone for four hours after refusing to complete homework, or losing coloring time for 20 minutes after screaming at a sibling. Setting concrete consequences removes the power struggle and heated arguments by simply identifying and sticking to the structure. Selective ignoring will be a key player if your child attempts to refute.

5.     Spend quality time with your family:  You’re probably wondering why that would be a suggestion when you are with your loved ones more than ever, but there is a difference between physical presence and emotional connection. Go for walks as a unit, play board games, spend a few minutes each day letting your child pick the activity to build their confidence and assurance that their opinions matter, and remind every family member that you love and appreciate them. These are trying times, but your family will get through this as a team, one day at a time. Remember to prioritize your mental health—your silent, but efficient, captain chartering new territory in the right direction.

Dr. Bahar Rahnama obtained her Doctor of Clinical Psychology degree at the APA-accredited California School of Professional Psychology at Alliant International University, Los Angeles (CSPP-LA). Dr. Rahnama completed coursework and field-based training in congruence with her graduate specializations across family, child, and couple dynamics. Through both research and clinical practice, Dr. Rahnama’s interest encompasses the correlation between enactment of cultural norms and parent-child attachment styles. Her examination and focus on these factors have led to a multitude of clinical opportunities and advancements including her UC-Davis certification in Parent Child-Interaction Therapy (PCIT), an evidence-based model that meticulously targets disruptive behaviors in children between the ages of two and seven while enhancing a positive and healing bond between caregiver and child.

How to help children cope with stress or trauma after an injury

While working in the Pediatric ICU/Burn unit at the University of Washington Harborview Medical Center, I found that many parents whose children had experienced traumatic injury such as a burn, accident, assaults from other people or animal attacks found it helpful to have specific symptoms to watch for and suggestions to help them manage their children’s reactions to the stressful event.

In the first several days after a stressful incident, your child may feel jumpy, confused, irritable and worried. This is an absolutely normal response for children and it may take some time for them to feel better. Typically, these types of acute stress symptoms last from a few days to one month. If these symptoms persist for more than a month they could be potential signs of Post-Traumatic Stress Disorder (PTSD). If your child needs extra help and continues to be upset, worried, or shows a loss of interest in usual activities for a few weeks after the injury it is recommended that you consult with your pediatrician or a psychologist.   

Studies have shown that roughly 14-34% of children exposed to a trauma meet full criteria for PTSD (1-4). However, children with less severe symptoms of PTSD also experience significant distress (5). Factors associated with increased risk of developing PTSD are prior trauma, female gender, parental coping, and history of parents with mental health difficulties. Cognitive-Behavioral Therapy (CBT) remains the best and most validated treatment for children with PTSD. This treatment includes managing the physical pain (if an injury has occurred), brief consultation, crisis intervention, and family support. 

How do I recognize symptoms of stress/trauma in my child?

Behavioral changes may include:

  1. Withdrawal – may keep to him or herself more than usual, be quieter, etc.

  2. Anhedonia- Loss of interest in activities that (s)he typically enjoyed before the stressful incident occurred

  3. Fear of the dark

  4. Fear of being alone

  5. Nightmares that are not generally related to the incident

  6. Intrusive memories (recurrent, unwanted distressing memories and/or reliving the traumatic event as if it were happening again)

  7. Sleep problems

  8. Changes in appetite

  9. Irritability

  10. Hypervigilance- high degree of arousal or sensory sensitivity and constant scanning of the environment for threats

How do I help my child cope with a stressful event?

Here are some tips on how to manage acute stress symptoms:

1. If your child is experiencing nightmares: Wake your child up and reorient him/her (e.g., explain that (s)he is at home with you). Comfort him/her and provide reassurance that (s)he is in a safe place and encourage your child to go right back to sleep.

2. If your child is experiencing Intrusive memoriesflashbacks: use a STOP sign or distraction technique. This was often successful with pediatric ICU patients who had recently experienced a traumatic injury.

The STOP sign steps are as follows:

  • STEP 1- Ask them if they continue to have thoughts or images of the incident

  • STEP 2- If the response is “yes,” then ask your child if (s)he wants to learn a way to stop having the thoughts. Because re-experiencing a trauma is upsetting, your child will most likely say “yes”. However, by simply asking, you are giving your child a sense of control and engaging him/her in the decision making process. 

  • STEP 3-Ask your child if (s)he knows what a stop sign looks like? Show a photo or present the big red sign. Ask your child to describe that sign to you so you know they have a good understanding of what you are talking about. You can also draw a picture to show him/her.

  • STEP 4-You probably have pretty good understanding of your child’s favorite cartoon character or superhero. So next, you will ask your child when (s)he is experiencing a flashback to imagine a stop sign. This technique will stop the flashback because you are now overwhelming their senses with a red colored sign that says STOP. Then tell him/her to imagine a favorite cartoon character or superhero. Though this seems to be extremely simple, it can be very helpful for your child to feel that they have a way to control these uncomfortable and stressful flashbacks.

Simple distractions include playing a game, reading a book, singing a song, etc. is also helpful.

3. If your child is experiencing hypervigilance: Use relaxation techniques (i.e., focused breathing, visual guided imagery, music).

4. No matter what, normalize your child’s reaction. Tell him/her this is a normal response to something scary. 

5. Most importantly, give your child the expectation that the symptoms will resolve. Tell your child that (s)he is going to be ok. Tell your child that this will go away. 

6. Do not force your child to talk about the stressful situation if (s)he is not ready to do so. Always follow your child’s lead in these types of situations. 

 7. A reminder, in case these symptoms do not resolve a few weeks after the incident it is recommended to consult with your pediatrician or a psychologist.   

Resources

Here are some links to a handout from the National Child Traumatic Stress Network for you and your child that I often give to parents at the hospital:

http://www.aftertheinjury.org/sites/ati/files/aftertheinjuryhelpingmychildcope.pdf

http://www.aftertheinjury.org/sites/ati/files/aftertheinjuryhelpingmyselfcope.pdf

For your child:

http://www.aftertheinjury.org/sites/ati/files/aftertheinjurytipsforkids.pdf

Link to the National Child Traumatic Stress Network:

http://www.nctsn.org/trauma-types

Link for rating your child’s reaction: 

http://www.aftertheinjury.org/how-your-child-doing

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Dr. Narineh Hartoonian is a Clinical Health and Rehabilitation psychologist at the Rowan Center for Behavioral Medicine. She has several years of interdisciplinary clinical and research experience in health and rehabilitation psychology and has served the needs of many individuals with chronic medical conditions and disability. Dr. Hartoonian received her Bachelor and Master of Science in Physiology from the University of California, Los Angeles (UCLA) and her Doctorate in Clinical Psychology from Loma Linda University (LLU). She has taught various graduate and undergraduate courses in the physiological sciences, health and psychobiology.


REFERENCES

1. Kassam-Adams, N., Winston, K. F. Predicting Child PTSD: The Relationship Between Acute Stress Disorder and PTSD in Injured Children. (2004). Journal of the American Academy of Child & Adolescent Psychiatry. 43 (4); 403-411 

2. Keppel-Benson, J. M., Ollendick, T. H., Benson, J. B., Post-traumatic stress in children following motor vehicle accidents. (2002). Journal of Child Psychology and Psychiatry. 43 (2); 203-212. DOI: 10.1111/1469-7610.00013

3. Aaron, J., Zaglul, H., & Emery, R. E. (1999). Posttraumatic stress in children following acute physical injury. Journal of Pediatric Psychology, 24(4), 335– 343.

4. Stallard, P., Velleman, R., & Baldwin, S. (1999). Psychological screening of children for post-traumatic stress disorder. Journal of Child Psychology and Psychiatry, 40(7), 1075–1082.

5. Carrion, V. G., Weems, C. F., Ray, R., & Reiss, A. L. (2002). Toward an empirical definition of pediatric PTSD: The phenomenology of PTSD symptoms in youth. Journal of the American Academy of Child and Adolescent Psychiatry, 41(2), 166–173.

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