As part of our agenda of looking at how we can improve outcomes for our most vulnerable children, Children’s Services staff in East Lothian council asked Dr Burns to speak to us about the role of Attachment in Early years and the impact it has on health and outcomes in later life.
It was very inspiring talk. Many of us in Children’s Services are very aware of how important attachment is. The key messages and learning for us were:
· The physiological consequences of poor attachment in relation to brain development and good physical health in adulthood.
· As service providers we need to be aware of the danger of making people passive recipients of services rather than being actively engaged.
This increases their sense of hopelessness and being out of control
A summary of the talk follows below helpfully provided by Vivien McVie (Policy and Planning Officer) Children’s Services. Dr Burns presentation is linked at the bottom of the post
Hopelessness and Life expectancy:
Studies have compared life expectancy in Liverpool, Manchester and Glasgow: there is 60 % excess morbidity in Glasgow – predominantly in four areas: drug-related, alcohol-related, suicide, violence
Susan Everson did a study of men in 1997 which found a connection between increased risks of dying from heart disease (x4) and hopelessness. The reason for this was that the group of men who felt hopeless had laid down more fat in the carotid artery than the others. Thickening of the carotid artery causes blockages in the artery and leads to stroke and death. For a brief summary of the study see: http://atvb.ahajournals.org/cgi/content/short/17/8/1490
What causes the fat to be deposited in the artery?
Hopelessness is stressful. Stress produces cortisol – used for fight or flight reactions. Cortisol causes abdominal fat to be mobilised for use as energy (for use in fight or flight) so when it breaks away, it can end up lining your arteries if it does not get used up (e.g.by running).
Hopelessness may not be acutely stressful but causes ongoing stress – people have been observed to have consistently higher levels of cortisol over the long-term. Only a slight rise can produce damage over the long-term.
A study on re resilience
A study of Jews surviving concentration camps (Aaron Antonovsky) found that while 70 % had the expected poor consequences for health and mental wellbeing, there were 30% who had survived the experience very well. Before their experience in the camps started, these resilient 30% had already developed a sense of coherence in their view of the world, which they had experienced as structured, predictable and explicable, and also had the inner resources to deal with what came next. They felt they could meet things head on and try to purposefully deal with what happened each day – i.e. a sense of self-efficacy, even in such circumstances:
“a feeling that … these demands are seen as challenges, worthy of investment and engagement.”
Causes / Consequences of stress:
People need to experience the world as understandable, manageable and meaningful, or they will experience chronic stress. Tests in Canada showed that the longer a child remained in residential care (“orphanages”) the higher their levels of cortisol were at the end of each day. Tests of adults have shown a link between lack of control in their working lives and higher cortisol levels.
Dr Burns observed in his own working life as a surgeon that people who are manual workers do not heal as fast from wounds, i.e. not the usual 10 days but 12 days to recover from abdominal surgery. This is because these people are not as much in control of their working environment as their bosses and so experience more stress. Another consequence of the resultant higher levels of cortisol is an inflammatory response, slowing down healing and this inflammatory response also leads to heart attack and stroke.
The inflammatory response from stress is compounded if you smoke, and are overweight – if you have all three it is x8 worse.
Inflammation in the arteries causes clots to happen, arteries get ruptured – heart attack follows.
Attachment : Causes/ consequences of stress in children:
Inconsistency in parenting is the most stressful for children (more than consistently abusive/neglectful parenting).
Brains of children who have disordered attachment are affected in three parts with a fourth under discovery:
1) The part of the brain that deals with judgment and decision-making is affected
2) Short-term/working memory is affected
3) Aggression, fear and anxiety are all heightened
When fight or flight dominates, there is no room left for learning or any other type of executive functioning.
Domestic abuse can be experienced in utero and it blocks development of certain parts of the baby’s brain because the baby is stressed and is producing higher levels of cortisol – this affects the genes and so they can pass these defective genes on to their own child.
Further consequences – self-control is inhibited so this affects likelihood of committing crime, getting involved in drug-abuse, earning a steady income. Reaction times are slightly dulled so road traffic accidents are more likely.
Supplied byVivien McVie April 2011
Dr Burns presentation