Saturday, May 21, 2016

HBSE: Older-Child Adoptees

Children who are adopted after infancy (that is, after the ages of one or two) often experience a host of biological, psychological, and social problems not generally experienced by non-adopted children and children adopted in infancy. The following paper focuses on these former children, henceforth referred to as “older-child adoptees” or “older adoptees.”[1] The paper will look at this group’s history in the United States, some of the developmental problems they often encounter, interventions that might help them, and challenges that this writer believes he will encounter when working with these children and their adoptive parents. As will be argued, the problems these children experience can largely be attributed to the adverse beginnings that many of them had, most importantly their failure to form secure attachments with their first caregivers. It will then be argued that the best way to help these children is to help their adoptive parents form attachments with them.

Group Description

During much of American history, older children who could not be supported by their families were desired for their value as laborers. During Colonial times, many of these children were “farmed out,” that is, placed with “a middle or upper class family where they could work for their keep” (Davis, 2011 p. 29). Some families adopted these children, although most families treated them “more like unpaid laborers” than kin (Davis, 2011, p. 29). Farming out reached its zenith in the second half of the nineteenth century when Protestant minister Charles Loring Brace, convinced that hard work would benefit children’s souls, formed a program that ultimately placed around 200,000 children from the Eastern United States onto trains and sent them to farms out West (Davis, 2011, p. 30). About 90,000 of these children were adopted (Davis, p. 32).

During the Progressive Era, “[c]hildren began to be sought for adoption, not only for their economic value as workers, but also for their emotional and sentimental worth as family members” (Davis, 2011, p. 37). Consequently, the desire to adopt healthy infants increased, while the desire for older children decreased (Davis, 2011, p. 37). In the decades following World War II, the advent of the birth control pill, the legalization of abortion, and the growing acceptance of single motherhood worked together to decrease “the domestic availability of healthy infants,” which in turn lead to “a greater demand and social acceptability of children who were older” (Davis, 2011, p. 8). Subsequent legislation—most significantly, the Adoption and Safe Families Act of 1997, which made it easier for states to “move children out of foster care into safe, permanent homes more quickly” (U.S. Department of Health and Human Services, 2005, p. 14)—increased the number of older-child adoptees (Golden & Macomber, 2009, p. 26).

Although the demand for older-child adoptees has increased over the past several decades, they remain less sought after than younger children. One analysis found that adoption agencies tend to charge significantly less for older adoptees and that they direct lower-income families to these children (Davis, 2011, p. 8). It is not surprising then that a disproportionately large number of these children are adopted into lower-income families. One study found that “those who have incomes below $25,000 adopt all ages of children, including the hard to place older children,” while 84 percent of individuals with “the highest incomes, those over $195,960, adopt the younger, more desirable children” (Davis, 2011, p. 10).

Older-adoptees are also more likely than younger-adoptees, as well as non-adoptees, to be adopted into single-parent families; 38 percent of adoptees over the age of eight live in such families, while 62 percent live in two-parent families (Maza, 2002, p. 1; U.S. Department of Commerce, 2009, p. 1).[2] Fifty-eight percent of adoptees over the age of eight are adopted by their foster parents, 24 percent by relatives, and 18 percent by strangers, that is, individuals they did not know before the adoption process (Maza, 2002, p. 1). The median age of these children’s adoptive mothers and fathers are 42 and 43, respectively (Maza, 2002, p. 1).

Adoptees in general tend to be more ethnically diverse than the population at large. Twenty-three percent of public agency adoptees are black (compared to 13 percent in the population overall) and 21 percent are Hispanic (compared to 17 percent overall) (U.S. Department of Health and Human Services, 2013a; U.S. Department of Commerce, 2013). Fifty-one percent of these adoptees are male and 49 percent female (U.S. Department of Health and Human Services, 2013b).

Theoretical Application

Biological Development

Although this writer could not find any research focusing specifically on the biological development of older adoptees, there is substantial research regarding children in the child welfare system. Since a disproportionately large number of older adoptees come from the child welfare system, it makes sense to look at the biological development of these latter children and to infer that older adoptees have many similarities.

Generally speaking, children from the child welfare system experience more biological problems than children outside the system. These former children, for instance, are more likely to be exposed to drugs, alcohol, and tobacco in utero; consequently, a greater number of them are born with “birth defects, central nervous system impairment, and HIV infection” (Kools & Kennedy, 2003, p. 40). These children also tend to be shorter in stature than their peers (Pears & Fisher, 2005, p. 118), and they have more problems with “vision, hearing, and dentition” (Kools & Kennedy, 2003, p. 40). Moreover, children from the child welfare system take longer to develop gross motor skills than children outside the system (Hansen, Jawad, Ryan, & Silver, 2011, p. 342).

Psychological Development

Research has confirmed that older adoptees have more psychological problems than both younger adoptees and non-adoptees. Sharma, McGue, and Benson (1996b) found that those adopted when two years of age or older are more likely to suffer from frequent feelings of sadness and anxiety than those adopted before two and non-adoptees (p. 107; 1996a, p. 89). They also found that those adopted when two or older have a more negative outlook on life and feel less confident that they will find happiness (1996b, p. 107; 1996a, p. 89). Howe (1997) found that children adopted after the age of one are significantly more likely than those adopted within their first six months to have an “[u]pet/anxious reaction to major life change(s) before the age of 9” and to display a “[h]igh level of anger/hostility during adolescence” (p. 406). Older adoptees are also more likely to develop eating problems (Howe, 1997, p. 405).

There is no conclusive evidence that older adoptees have a slower rate of cognitive development (Odenstad et al., 2008), although this seems likely given that children from the child welfare system have a slower rate of cognitive development (Pears & Fisher, 2005, p. 112). Older adoptees struggle more academically than other children. Sharma et al. (1996b) found that older adoptees generally perform worse academically than younger adoptees and non-adoptees (p. 104). Howe (1997) found that older adoptees are significantly more likely than younger adoptees to have “learning problems at school” and that they are more likely to fail basic standardized tests (p. 406).

Social Development

Sharma et al. (1996b) found a strong correlation between the age at adoption and antisocial behavior. Specifically, they found that those adopted between the ages of two and ten are significantly more likely than those adopted before the age of one and non-adoptees to have “hit or beat someone up more than 3-4 times,” “damaged property just for fun,” or “used a knife or a gun to get something from a person” (Sharma et al., 1996a, p. 89; Sharma et al., 1996b, p. 107). They further found that those adopted after the age of ten were significantly more likely to perform these actions than those adopted between two and ten (Sharma et al., 1996a, p. 107).

Older adoptees also have more difficulty assimilating into their adoptive families. Howe, Shemmings, and Feast (2001) found that older adoptees are less likely to feel that they belong to their adoptive families: only 52 percent of those adopted after the age of two feel that they belong, compared with 64 percent of those adopted between one and two and 74 percent of those adopted before one (p. 340). Older adoptees are also less likely to feel loved by their adoptive parents: 59 and 69 percent of those adopted after the age of two felt loved by their mothers and fathers respectively, compared with 69 and 81 percent of those adopted between one and two and 87 and 87 percent of those adopted before one (p. 340). It is not surprising, then, that older adoptees are less likely than younger adoptees to get along well with their adoptive parents (Sharma et al., 1996a, p. 89; Sharma et al., 1996b, p. 107). It is also not surprising that they have higher disruption rates than younger ones (Haugaard, Wojslawowicz, & Palmer, 2008, pp. 66-67; Sharma, 1996b, 103).

Towards an Explanation

A strong case can be made that older adoptees struggle so much because they often have especially adverse beginnings. Haugaard, Wojslawowicz, and Palmer (2008) point out that “[t]hese children often have a history of severe abuse or neglect in their birth homes and possibly in subsequent placements” and that “they may have been uprooted from several foster or institutional placements in addition to a possibly traumatic removal from their birth home” (p. 62). Although children tend to be remarkably resilient, some adversities, especially when encountered early in life, are simply too much for many of them to overcome.

Donald Winnicott’s concept of good-enough parenting can shed some light on the matter. Winnicott defined good-enough parenting as parenting that, “although not always immaculately attuned to the needs” of one’s baby, nonetheless protects the baby from “impingement” (“Mother, Good-Enough,” 2006), that is, factors causing “great anxiety” (“Impingement,” 2006). If good-enough parenting during one’s first months and years is a necessary precondition for healthy development, then it can be seen why so many older adoptees, who face especially adverse beginnings, struggle. For instance, adverse in utero conditions, which a disproportionately large number of older adoptees experience, “can affect the development of the fetus and the subsequent health and birth weight of the infant” (Zastrow & Kirst-Ashman, 2010, pp. 54-55). Pears and Fisher (2005) note that the “early neglect” and “emotional abuse” experienced by children from the child welfare has been “significantly and negatively associated with a number of different developmental domains including height for age, visuospatial processing, memory, executive function, and language” (pp. 118-119).

Howe (1997) showed that early neglect accounts for many of the above-mentioned psychological and social problems encountered by older adoptees. Howe divided older adoptees into two groups, one that received “non-adverse care for their first year of life or up until the time of placement” (p. 403) and one that received “adverse care for their first year of life or up until the time of placement” (p. 404). The former group could be said to have received good-enough parenting. Many of these children lived alone with their mothers for their first year or so without giving social services any “cause for concern.” Their mothers eventually entered into new sexual relationships and had more children, after which time the first child suffered “neglect, abuse, or rejection by both the mother and/or the stepfather” before being removed by social services (p. 403). Howe found these children tended to engage in “problem and antisocial behavior” (described above) at significantly lower rates than older adoptees who began life under adverse care (p. 409) and that they engaged in this behavior at similar rates to those who were adopted as infants (in other words, those who generally received non-adverse care from the very or nearly very beginning) (pp. 405-406).

To understand in more depth why older adoptees struggle, it will be helpful at this point to introduce attachment theory, originally formulated by John Bowlby. Hughes (1999) describes attachment as the process in which the child and caregiver develop a close emotional connection that makes the child feel valuable (p. 545-546). As the child ages, the caregiver increasingly begins to socialize her; that is to say, the caregiver begins to deny some of the child’s demands (p. 546). The socialization process often fills the child with a sense of shame and emotional distress (p. 546). In a healthy child-caregiver relationship, the caregiver responds to these feelings by reassuring the child that she is valuable but teaching her that others are also valuable and that they have their own rights and feelings (p. 546). Through this process, Hughes writes, the child “develops the ability to consistently feel empathy, tolerate frustrations, regulate [her] emotions, control [her] behaviors, and recognize the difference between right and wrong” (pp. 546-547). Research since Bowlby has shown that failing to form secure attachments early in life can lead to a host of problems, including unhealthy relationships later on and numerous psychological and social problems (Hardy, 2007, pp. 28-29).[3]

Bowlby argued that infants who fail to form attachments with their caregivers during their first thirty months of life are unable to do so later on (“Bowlby’s Evolutionary Theory,” n.d.). Although it is now known the children can in fact develop attachments past this stage, it is considerably more difficult to do so (Hughes, 1999, p. 551). Van den Dries, Juffer, van IJzendoorn, and Bakermans-Kranenburg (2009) point out that numerous studies have shown that children adopted in early infancy “usually develop normative attachment relationships,” while those placed later on are “at greater risk for developing unfavorable attachment relationships” (p. 412).

In light of all this, it seems clear that the failure to form early attachments accounts for many of the problems experienced by older adoptees. Sharma et al. (1996b) provide evidence for this. They divided their subjects into five groups: (a) those raised by their biological parents, (b) those adopted before the age of one, (c) those adopted between two and five, (d) those adopted between six and 10, and (e) those adopted after ten (p. 105). Instead of finding a continuum in which problems increased the later one was adopted, they found a “remarkable lack of differences” between individuals adopted between the ages of two and five and those adopted between six and ten (p. 110). These two groups were nearly indistinguishable in several important areas; significantly, both groups were equally likely to have frequent feelings of sadness and anxiety, to feel pessimistic about their futures, and to engage in the above-mentioned antisocial behaviors (p. 107). It can be reasonably inferred that children adopted when two or older experience so many problems because they are less likely than non-adoptees to develop secure attachments to their biological parents and less likely than younger-adoptees to develop secure attachments with their adoptive parents.

Needs and Interventions

For the success of their placements and for their own psychological and social development, it is important for adopted children to form attachments to their adoptive parents. Forming attachments can be incredibly difficult, especially with children who have attachment problems, but it can be done (Hughes, 1999, p. 551), and efforts should be made on the micro, mezzo, and macro levels to facilitate this endeavor.

On the micro level, social workers and counselors can teach adoptive parents how to better bond with their children. Ward (1981) argues that the attachment process between adoptive parents and older adoptees is essentially the same as that between biological parents and infants, the main differences being in the details. For instance, “positive interaction” is necessary for all types of caregiver-child attachment, but, whereas biological parents often establish this by making eye contact with their infants (p. 31), adoptive parents might establish it by “reading to the child, going on outings, even sitting close together in front of the television set” (p. 32). Teaching parents how to make some of these connections could potentially make a big difference.

Hughes (1999) emphasizes that learning to properly discipline one’s adopted child is necessary for attachment. Parents, he writes, must learn “to regulate their own emotions” and “express anger in response to specific behaviors in a quick, direct manner, and then follow that expression with reassurances and comfort” (p. 553). Early in the child’s placement it might be necessary for the parents to keep “the child in close physical proximity” so that they can “make many of [her] choices for [her] and provide [her] with a sense of safety.” In time, the child will, it can be hoped, “begin to internalize the choices, wishes, and values of [her] parents” (p. 553). Again, teaching these methods to parents could help many of them form attachments with their adopted children.

Another essential micro-level intervention is providing therapy to adopted children who have attachment problems. Hughes (1999) writes that traditional therapy does not usually work for such children because it “presupposes that the child has the readiness and ability to form [an intimate] therapeutic relationship” (p. 554). Since this is not possible for those with attachment problems, such individuals should receive therapy that is “structured to replicate the attachment sequences that characterize normal developmental attachment” (p. 555). The therapist should “work to elicit and share positive affect with the child and provide the child with an opportunity to experience surprise and delight in response to the adults’ active engagement with [her]” (p. 555). In time the therapist should “should actively engage the child and help [her] explore the sense of shame [she] has associated with both earlier experiences of neglect and abuse and current experiences of discipline and frustration in [her] adoptive family” (p. 555).

On the mezzo level, connecting adoptive parents with support groups could prove to be an invaluable help. Hughes (1999) points tout that “other parents have the greatest understanding of the difficulties and stresses associated with raising children with attachment problems, and are best able to offer support and guidance on parenting interventions that proved to be effective with their own children” (p. 557). Kramer and Houston (1999) discuss the Hope for the Children (HFTC) program, a support network for foster parents in the process of adopting special-needs children (p. 614-615). These foster parents live in the same community and receive support from “senior citizen volunteers, tutors, therapists, mentors, and family advocates” (p. 611). Most of those involved in the program find resources these beneficial (p. 629). Although HFTC is not a viable option for most adoptive parents, it nonetheless illustrates the many benefits of being connected with both formal and informal supports.

On the macro level, more should be done to ensure that adoptive parents are better educated. Egbert and LaMont (2004) surveyed individuals who adopted special-needs children and found that a large number of them were “uninformed about the realities of their child’s background” (607) and that they consequently felt less able than more informed parents to handle the children’s “behavioral and emotional issues” (p. 608). Reilly and Platz (2004) conducted a similar survey and found that parents listed counseling, which included different educational services (p. 55), as their largest unmet need (p. 64). Consequently, it would be beneficial to require child welfare agencies and adoption agencies to disclose to adoptive parents more of their potential adopted child’s background. It would also help to have funding for additional counseling and educational services.

Self-Assessment

I believe that I would be able to effectively educate and counsel adoptive and would-be adoptive parents. I have found that I have been able to relate well with most of the adoptive parents I have met over the years, partly because I have a similar socioeconomic background and worldview as many of them. I fear that I might have trouble counseling older-adoptees, however. I always enjoy spending time with children, but I think I need to learn new skills in order to better lead and counsel them.

In the past I have been so concerned about children liking me, thinking me fun, that I have often failed to earn their respect. Gurland and Grolnick (2008) found that children feel more comfortable with adults who “behave in predictable, category-consistent ways” (p. 245). For example, the children in their research “reported greater rapport with an adult who engaged in a typical adult behavior (i.e., read a newspaper) than with an adult whose behavior was counter-typical (i.e., played with a toy)” (p. 245). If I can learn to take my love for children but act less “child-like” when around them, I think they might be more comfortable around me and that I in turn might be able to more effectively help them.

I also fear that I might have trouble reaching out to more troubled adoptees, that is, adoptees who had especially adverse beginnings. I say this because I had a fairly sheltered childhood and have not known many people from broken homes. I therefore worry that I might have difficulty understanding these children and that ipso facto I might have trouble helping them. I am confident that I can come to better understand these children much like I would come to better understand anyone from a culture or subculture different than mine. I might, for instance, apply the model of cultural competence designed by Campinha-Bacote (2002). This model, originally designed for nurses in the mental health field, claims that cultural competence can be attained by respecting the client’s culture (p. 183), learning to “collect relevant cultural information” about the client’s history (p. 184), learning about the client’s ethnic group (p. 185), and personally meeting people from different cultures (p. 186). In other words, I believe that simply learning more about older adoptees and spending more time with me will help me to know them better.

Conclusion

Most researchers agree that older-child adoptees experience so many developmental problems because they had adverse infancies. Many have persuasively argued that many of these problems result from these children’s failure to form secure attachments with their first caregivers. To better help these children and their adoptive families, more attention should be given to micro-level interventions that have effectively helped older children bond with their adoptive parents. Hughes (1999) describes techniques that he presumably uses in his own practice, but research should be devoted to discovering which techniques work best. Social workers should then familiarize themselves with these techniques and be prepared to teach them to others.


References

Bowlby’s evolutionary theory of attachment. (n.d.). Retrieved November 22, 2013, from
http://www.psychteacher.co.uk/attachment/evolutionary-theory-of-attachment.html

Campinha-Bacote, J. (2002). Cultural competence in psychiatric nursing: Have you “ASKED” the right questions? Journal of American Psychiatric Nurses Association, 8(6), 183-187.

Davis, M.A. (2011). Children for families or families for children: The demography of adoption behavior in the U.S. London: Springer.

Egbert, S.C & LaMont, E.C. (2004). Factors contributing to parents’ preparation for special-needs adoption. Child and Adolescent Social Work Journal, 21(6), 593-609.

Golden, O. & Macomber, J. (2009). Framework paper: The Adoption and Safe Families Act (ASFA). In Urban Institute, Intentions and results: A look back at the Adoption and Safe Families Act (7-35). Retrieved from http://www.urban.org/UploadedPDF/1001351_safe_families_act.pdf

Gurland, S.T., & Grolnick, W.S. (2008). Building rapport with children: Effects of adults’ expected, actual, and perceived behavior. Journal of Social and Clinical Psychology, 27(3), 226-253.

Hansen, H., Jawad, A.F., Ryan, T., & Silver, J. (2011). Factors influencing gross motor development in young children in an urban child welfare system. Pediatric Physical Therapy, 23(4), 335-46.

Haugaard, J.J., Wojslawowicz, J.C., & Palmer, M. (2008). Outcomes in adolescent and older-child adoptions. Adoption Quarterly, 3(1), 61-69.

Howe, D. (1997). Parent-reported problems in 211 adopted children: Some risk and protective factors. Journal of Child Psychology and Psychiatry, 38(4), 401-411.

Howe, D., Shemmings, D., & Feast, J. (2001). Age at placement and adult adopted people’s experience of being adopted. Child and Family Social Work, 6, 337-349.

Hardy, L.T. (2007). Attachment theory and reactive attachment disorder: Theoretical perspectives and treatment implications. Journal of Child and Adolescent Psychiatric Nursing, 20(1), 27-39.

Hughes, D.A. (1999). Adopting children with attachment problems. Child Welfare, 78(5), 541-560.

Impingement. (2006). In Edinburgh International Encyclopedia of Psychoanalysis. Retrieved from http://0-literati.credoreference.com.skyline.ucdenver.edu/content/entry/edinburghpsychoa/impingement/0

Kools, S., & Kennedy, C. (2003). Foster care health and development: Implications for primary care. Pediatric Nursing, 29(1), 39-46.

Kramer, L. & Houston, D. (1999). Hope for the children: A community-based approach to supporting families who adopt children with special needs. Child Welfare, 78(5), 611-635.

Maza, P.L. (2002). Who is adopting older children. The Roundtable: Journal of the National Resource Center for Special Needs Adoption, 16(2), 1, 6.

Mother, Good-Enough (Winnicott). (2006). In The Edinburgh international encyclopedia of psychoanalysis. Retrieved from http://0-literati.credoreference.com.skyline.ucdenver.edu/content/entry/edinburghpsychoa/mother_good_enough_winnicott/0

Odenstad, A., Hjern, A., Linblad, F., Rasmussen, F., Vinnerljung, B., & Dalen, M. (2008). Does age at adoption and geographic region matter? A national cohort study of cognitive test performances in adultery inter-country adoptees. Psychological Medicine, 38, 1803-1814.

Pears, K., & Fisher, P.A. (2005). Developmental, cognitive, and neuropsychological functioning in preschool-aged foster children: Associations with prior maltreatment and placement history. Developmental and Behavioral Pediatrics, 26(2), 112-122.

Reilly, T. & Platz, L. (2004). Post-adoption service needs of families with special needs children: Use, helpfulness, and unmet needs. Journal of Social Service Research, 30(4), 51-67.

Sharma, A.R., McGue, M.K., & Benson, P.L. (1996a). The emotional and behavioral adjustment of United States adopted adolescents: Part I. An overview. Children and Youth Services Review, 18(1/2), 83-100.

Sharma, A.R., McGue, M.K., & Benson, P.L. (1996b). The emotional and behavioral adjustment of United States adopted adolescents: Part II. Age at adoption. Children and Youth Services Review, 18(1/2), 101-114.

U.S. Department of Commerce, Census Bureau. (2013). State & county quickfacts, USA. Retrieved from http://quickfacts.census.gov/qfd/states/00000.html

U.S. Department of Commerce, Census Bureau. (2009). Custodial mothers and fathers and their support: 2007. Retrieved from http://www.census.gov/prod/2009pubs/p60-237.pdf

U.S. Department of Health and Human Services, Children’s Bureau. (2005). A report to Congress on adoption and other permanency outcomes for children in foster care: Focus on older children. Retrieved from http://www.acf.hhs.gov/programs/cb/resource/report-to-congress-on-adoption-and-other-permanency

U.S. Department of Health and Human Services, Children’s Bureau. (2013a). Race/ethnicity of public agency children adopted: October 1, 2011 to September 30, 2012 (FY 2012). Retrieved from http://www.acf.hhs.gov/sites/default/files/cb/race2012.pdf

U.S. Department of Health and Human Services, Children’s Bureau. (2013b). Sex of public agency children adopted: October 1, 2011 to September 30, 2012 (FY 2012). Retrieved from http://www.acf.hhs.gov/sites/default/files/cb/gender2012.pdf

Van den Dries, L., Juffer, F., van IJzendoorn, M.H., & Bakermans-Kranenburg, M.J. (2009). Fostering security? A meta-analysis of attachment in adopted children. Children and Youth Services Review, 31, 410-421.

Ward, M. (1981). Parental bonding in older-child adoptions. Child Welfare, 60(1), 24-34.

Zastrow, C.H., & Kirst-Ashman, K.K. (2010). Understanding human behavior and the social environment (8th ed.). Belmont, CA: Thomson Books/Cole.


[1] It would be ideal to have a more concrete definition for older adoptees, instead of simply defining them as children adopted “after infancy,” that is, “after the ages of one or two.” The reason for this somewhat nebulous definition is simply that the major studies examined in this paper define older adoptees differently. Sharma, McGue, and Benson (1996b) and Howe, Shemmings, and Feast (2001) define older adoptees as children adopted after the age of two, while Howe (1997) defines them as children adopted after the age of one. As will be argued, there are good reasons for believing that children adopted before the age of two are not very developmentally different than children adopted before the age of one. The real differences, it will be further argued, seem to occur after the age of two. All of this, of course, means that Howe (1997), by including children adopted between the ages of one and two in his group of “older adoptees,” could have theoretically failed to capture the differences between younger and older adoptees. It does not appear that Howe (1997) has done this, however, presumably because his sample included few children between the ages of one and two.

[2] Due to a lack of available statistics, this demographic information could not be found for children adopted “after infancy,” that is “after the ages of one or two.” It is therefore assumed that the demographic information for children adopted between the ages of two and eight is not significantly different than that for children adopted after the age of eight.

[3] A “secure attachment” is essentially the relationship of child-caregiver love and trust described by Hughes (1999). Van den Dries, Juffer, van IJzendoorn, and Bakermans-Kranenburg (2009) write that children evidence that they have secure attachments when they “seek contact with their attachment figure when they are upset” and when they are subsequently “easily comforted” (p. 410). Children who do not have secure attachments, by contrast, “show signs of avoidance and resistance” (p. 410).

No comments:

Post a Comment