What are “Means?”

“Means” are simply the tools and ways available to realize an intention. “Attachment means” are the strategies the IP uses to enlist caregiving and emotion sharing, as well as the attachment figure’s ability to respond in an attuned manner. They have to do with how the IP integrates and brings his or her emotional, cognitive, linguistic, and motor skills to bear when he has a need to reconnect with attachment figures, and they have to do with the flexibility and mind set of the attachment figure’s response.  So to be clear, these sections describe the skills and deficits that the IP currently has, and how that predisposes referral behaviors.

There is a lot to read and a lot for you to learn in this section, but we are looking only for remarkable information.  Here again, we are not looking for answers to all of the questions we ask here – just those most relevant to the referral concerns.

Areas to assess:

Emotional Attachment Means

This section has to do with the skills the IP has to maintain a sense of emotional well-being and availability for learning and emotion-sharing experiences. The IP that gets upset easily, has difficulty calming himself or herself or is not easily calmed by others, then they are more subject to negative reinforcement in the environment. Further, they have the effect of delaying their development because they tend to remain in static systems and withdraw from normal levels of uncertainty and novelty. The IP with an optimistic, “approach stance” towards novelty and uncertainty is more available and likely to be more flexible.

But we have already assessed neuroregulation in the above sections – so this section is not merely about the IP’s internal mechanisms. Attachment is about how people regulate their emotions in the context of interdependent relationships. It is about signaling and responsiveness to others in the IP’s efforts to maintain well-being. This section looks at how the IP conveys emotionality to others and uses and responds to relationships to maintain emotional availability and to embrace uncertainty. It looks at how available the IP is for interdependent, co-regulation of emotions.

But importantly, it looks at the environment as well. It looks at how well others are able to read the IP’s emotional needs and respond effectively.  Are they attuned? Do they make efforts to attune or do they simply view expressions of emotions as inappropriate behaviors?

To complete this section, it is useful to look at both ends of the attachment relationship: the IP and attachment figures in the IP’s life.

Development of Self-Regulation and Autonomy

As children mature emotionally, they move from highly dependent and proximal forms of self-regulation, to more symbolic and interdependent forms of self-regulation:

Dependent/Non-symbolic Means

The Student depends greatly on others to self-regulate and shows little ability to self-regulate in productive ways.

  • The IP requires the physical presence of caregivers in order to restore regulation/proximal, dependent style
  • The IP  often resorts to repetitive, infantile, or self-stimulatory behavior in order to restore regulation/ withdrawn, sensorimotor, or non-symbolic      style

Interdependent/Symbolic Means

The IP relies on others to self-regulate in a mutually interdependent way.

  • The IP seeks help and comfort from others using words, gestures, or symbols.
  • The IP is able to remain calm and focused enough for problem solving or solution      finding.

Relationship to Coping Skills and Play

An IP’s ability to cope with negative feelings or adverse circumstances is related to how his self-regulatory system works.

Hypersensitive or high-strung children tend to become easily dysregulated (act out, melt down, explode) when faced with negative feelings or adverse circumstances (i.e. having to wait or defer gratification; coping with frustration or disappointment; coping with demands).  These children can be bossy, bullying, aggressive, rigid, defensive, or controlling around peers.

Hyposensitive children have more of a tendency to withdraw or act helpless when faced with negative feelings or adverse circumstances.  These children can be unmotivated, helpless, or avoidant around peers.

  • When the IP dislikes or otherwise has a negative reaction to something, how does she go about solving her problem?
  • Can the IP step back from a problem that is causing too much frustration – or is he or she seemingly stuck repeating frustrated efforts until he or she melts down?

Another main consideration is whether the IP works with others and can remain open to receive help – or does she resort to coercive tactics?

  • What does he do when he’s relatively calm?
    • Does he attempt to express himself, or does he act out his frustration or anger?
  • When getting upset, does she remain stationary and cry helplessly – expecting others to move in, or does she remain organized enough to approach caregivers?
    • Can she engage in two-way communication when a problem occurs?
  • At what point, or concerning what issues does he lose his ability to engage in mutual problem solving?
The IP’s Attachment Means

Assuming that the IP is the recipient of caregiving rather than a Caregiver, we assess the following variables:

  • Does the IP send clear, readable affective signals?This is not about verbal communication, which is assessed in a subsection below. This is about sending readable signals to others that help them attune to the IP (sounds and actions expressing emotions that are clear to      Caregivers).  Some infants take a long time or never really develop different cries for different things.  Some individuals, especially those that started life with Sensory Integration Dysfunction, can show confusing affects (e.g., they may be smiling but angry and aggressive at the same time), or they may be relatively affectively flat – showing little expression at all.  Some, especially those that experienced abuse or trauma at the hands of Caregivers send confusing or incoherent signals that reflect very high levels of anxiety.
    • Does the IP show unreasonable or exaggerated signals that seem out of proportion to the distress involved?
    • Does the IP get over-excited or overstimulated to the point of becoming disorganized in their behavior?
    • Does the IP respond easily or with difficulty to Caregiver efforts to stimulate and/or soothe (engage in co-regulation)
  • Does the individual have a static, withdrawal stance towards novelty and uncertainty, or does the IP embrace novelty and at least mild uncertainty?
    • Is the IP generally rigid and inflexible or open and adaptable?
    • Does the IP generally respond by studying reality for a moment and responding or does the IP react reflexively
    • Does the IP impose templates of past relationships on current ones or does he or she treat different people differently?
      • Are the patterns of relating seen similar across all people?  If not, describe how the IP relates differently to some people or people in roles (Caregivers, Teachers, peers).
Caregiving Patterns in the Environment
  • How well do Caregivers attune to the IP’s needs?
    • Is the problem more of difficult to read signals from the IP, or the Caregiver’s misattunement?
    • How does misattunement predispose the referral behaviors?
    • Are Caregiver patterns individualized to the IP, or are they inflexible?

Social Attachment Means

This section deals with how the IP uses or benefits from social relationships to handle emotions related to the referral behaviors.

Caregivers and Intimate Relationships

We tend to rely interdependently on our loved ones to help us through difficult times.  We also want to share our positive experiences with them as well.  So here we look at experience-sharing in general, both positive and negative, and how these patterns of relating predispose referral behaviors.  We also look at axes that involve overly independent (avoidant) versus interdependent forms of attachment bonds(healthy, as well as possible clingy and overly dependent).

Self v. Other

This is an axis that goes from overly independent (possibly avoidant) to the health of the IP’s interdependent relationships.

  • How does the IP use or benefit from interdependency, experience-sharing and co-regulation of emotions?
    • Does the IP approach others to share experiences, positive or negative, or does the IP tend to avoid others or not realize that others can be helpful?
      • How does the IP approach others and for what reasons?
      • Does the IP approach others to share affective/subjective experiences at all, or does he or she only relate to others when they want or need something (instrumental reasons)?
      • Does the IP expect others to be helpful, or do they tend to handle things themselves?  In general, if the IP tends to handle things alone, it is at a cost or he or she does it in maladaptive ways (e.g., keeping everything bottled up; engaging in destructive or self-injurious ways; exploding till spent)
      • If the IP has difficulty or does not do this, is it because he or she cannot due to difficulties knowing how they feel?
      • If the IP has difficulty or does not do this, is it because he or she has generalized difficulties with communication, or just difficulty communicating or trusting others to communicate how they feel?
Attachment v. Exploration
  • Is the IP generally secure and able to engage in a healthy balance between attachment and exploration behavior?  A secure person wants regular contact with loved ones, but is not clingy, dependent or controlling of others.  A secure person enjoys learning and exploring the world.  They are not worried so much about the security of their relationships that they spend undue energy on controlling Caregivers or other intimate relationships (friendship; lovers).
    • Is the IP preoccupied with controlling the whereabouts and availability of Caregivers?
    • Does the IP avoid relationships, relating only when necessary and for instrumental purposes mainly?
    • Are the IP’s relationships exclusively with Caregivers for purposes of receiving caregiving?
    • How much is the IP able to get his or her emotional needs from Surrogate attachment figures such as Teachers, friends, peers?
    • Does pride in accomplishment motivate the IP (attachment to self)?
  • Subjectivity and Intersubjectivity
    • If the IP has difficulty  or does not do this, is it because he or she lacks capacity for  understanding his or her own perspective (little or no knowledge of self – as in developmentally young children that are expected to be the subject of their feelings rather than to be able to look at them in terms of cause and effect – see Cognitive means below)?
    • Does the IP tend to be self-reflective and to see his or her role in problematic relating?
    • Can the IP take the perspective of others, or do they rely mainly or only on self-reference points?

John Bowlby described the idea of an “internal working modelthat individuals use to develop expectations for new relationships.  This is a very important part of the antecedent setting conditions for any social function of behavior.

  • Does the IP have fixed and rigid expectations of others?
    • Does he or she expect them to adapt to him or her all the time?  Do other in the home or school environment negatively reinforce demanding behavior?
    • Does the individual trust  others?  Do they expect misattunement?  Do they expect abusiveness or abandonment and begin relationships by testing Caregiver  commitment to them?
    • Does the individual engage in frequent testing of what works to get attention, without referencing the appropriate ways use to get it and the amounts of attention others expect to get?

Cognitive Attachment Means

Cognitive attachment means have mainly to do with concepts of time, sequence, and waiting. Concepts of place and distance are related to the time it takes for caregivers to respond.  Concepts of time and duration and sequence rely on the ability to recognize patterns in the environment that help the IP understand how long he or she will have to wait for things like attention, reunion with loved ones, etc.

Initial concepts of sequence and duration are formed very early on, as the infant watches the patterns of Caregivers and develops ideas of how long things take, the steps involved, business v. availability of attention (see “The Goal/Corrected Partnership below).

The Two Infants and the Bottle

In this example we look at how two 5 month old infants handle the potential distress of waiting to be fed.  One of them is developing typically, and the other – possibly heading towards autism and who does not pay attention to patterns of other’s behaviors (tracking, monitoring), is developing atypically.  Both infants get hungry at the same time and start to cry or signal hunger?

The attuned mother hears the cries and responds, “OK, honey, I’m getting you the baba.” But she does not approach the baby.  She goes to the refrigerator, retrieves the bottle, washes off the nipple, and pops it in the microwave for a few seconds.  She announces, “OK, it’s ready,” and then she approaches the baby, seats her in her lap, and then begins giving her the bottle. The baby is now satisfied.

Now, if we look at the above sequence of actions that starts with the infant signaling hunger and finally getting fed, we can see it as analogous to a “behavioral melody,” just as individual notes are connected into a single idea or “behavioral gestalt” where each individual action is meaningful only in terms of its part in the sequence.  The question is, “how many notes does it take for the infant to ‘name that tune?’”

The typically developing infant can recognize that tune in just a few notes.  She would only complain if the sequence were unusual (e.g., Mother answers the phone in the midst of the sequence and she does not continue to follow through typically, or, the steps are taking longer than the infant has come to expect).  She might stop crying as soon as Mother says, “OK, honey, I’m getting you the baba.”  Maybe not.  She might not stop signaling until she sees Mother actually taking care of business – going to the refrigerator, etc.  Generally, as soon as Mother initiates the sequence, the baby’s anxiety lowers and so does the intensity or urgency of the signaling.

Patterns like this can be ambiguous.  We are always looking for reference points that let us know the availability of social attention (attachment-related behavior) or other things we might want.  For instance, it can be very difficult for children (and others) to be able to tell how long someone will be occupied by the telephone, work, shopping, etc.

The Two-year-old and Mommy on the Phone

Typical two-year-olds are both very concerned about Mom’s [Caregiver’s] availability and unable to judge how long certain things take.  They can be very familiar and comfortable with behavioral melodies/gestalts that consist of tangible actions and procedures.  But they’ll have difficulty being able to judge how long more complex things such as talking on the phone, seeing Mommy on the computer or talking to another adult, etc. will take.  Their primary concern is Mother’s availability.  They’ve only recently emerged from attention on demand sequences that were typical of the first half of the first year, and are struggling with deferring their needs or appraising the real availability of the Caregiver.

Because the two-year-old has this difficulty appraising Caregiver availability, he predictably begins to act up as soon as he sees Mom get on the phone.  He may not be able to tell if she’ll be a long time (as when she’s talking to relatives or friends), or a short time (ordering a pizza).  But what he has perfected is his strategies for getting her off of the phone!

Even as adults, we can have difficulty if we do not really understand the sequence of things, such as how long it might take to get the results of a test.   Stanley Greenspan maintains that things like duration are too long when they take longer than expected and they are too short when they are shorter than expected.  He points up the relationship between our behaviors and our expectations.  We get impatient and maybe irritable, because we don’t know how long a response will take.

I’m saying here, that we tend to use conceptual guideposts such as sequences, timepieces, calendars, etc. to make these judgments.  These are essentially cognitive tools.  In this section, we examine the IP’s mastery of the tools and reference points that help them know when attachment (attention) and caregiving will take place, and, whether or not or how they develop strategies for expecting or waiting.

The Clingy, but otherwise Emotionally Secure 2 ½ -year-old

Sebastian was referred for clingy behaviors with his mother. He cried whenever she was out of sight – even if she went upstairs just for a minute. He melted down whenever she left the house to go to work. When she was home, he wouldn’t play independently and she couldn’t get anything done when he was there.

He never did this with his father, and neither parent could figure out why. Their parenting styles weren’t all that different.

As it turned out, Sebastian’s father was an engineer and his mother was a nurse. Sebastian’s father had fairly regular hours. He sometimes returned home late, but he was there every night and every morning. Sebastian’s mother on the other hand had her schedule handed to her every week, and every week it was different. She always worked either the morning shift or the graveyard shift, meaning she was there to put Sebastian to bed every night.

The problem was that Mom was not there every morning. [15]  Mom would return from work sometimes after Sebastian’s father had brought him to school.

Also, as you will learn in the section on sleep (see Writing Treatment Plans); it is typical for most people to wake up for very brief moments periodically through the night. They’re called “microwakings.” Usually, we satisfy ourselves that everything is as it was when we went to bed and we go back to sleep with no memory of these events. However, when a IP notices that something is different, he can become very aroused very quickly and become wide awake with anxiety. This happened to Sebastian whenever his mother put him to bed. He would wake up in a normal microwaking and become very alarmed when she wasn’t there.

What the referral behaviors represented was Sebastian’s desperate attempts to control the availability of his mother. Since he did not understand her schedule (he was 2 ½ years old and he did not yet understand concepts of today or tomorrow, nor did he truly understand what the days of the week meant), he could ever rest in the comfort of knowing that he will see his mother for sure at a later time. The only strategy he could understand was to do whatever he could to not let her go. Even though the strategy never worked, his behavior devolved out of desperation and being emotionally overwhelmed, into clinginess.

Sophia and Frank

Sophia and Frank have been married for 17 years. Frank, a salesman, travels on a regular basis for his job. His out of town trips usually last about 2 or 3 days, and he always calls when he arrives at his hotel, and then just as he leaves his hotel for the trip home. Frank also always leaves the name and number of his hotel and flights with Sophia before he leaves for each trip.

Frank kisses Sophia goodbye. They both know that he’ll be in L.A. for 3 days. He’ll return home on Thursday, and his flight arrives at 6 pm.

Sophia did not get a call Tuesday night. This didn’t alarm her too much, but it wasn’t typical of Frank. Frank mentioned that he had scheduled a lot of meetings in a short period of time, so she figured that he was just too busy to call. She called his voicemail to tell him she loved him.

Sophia didn’t get a call Wednesday night either. This gave her a pit in the bottom of her stomach, but this has happened before she told herself, and Frank is a very reliable guy. She called his voicemail again, but this time she mentioned that she was getting worried and wanted a call as soon as possible.

Around 3:30 on Thursday, the time Frank was supposed to board the plane home; Sophia’s anxiety has jumped to a new level. She pages Frank, and he doesn’t answer the page. Her anxiety escalates further, and she resolves to let him have it when he arrives.

At 6:30 on Thursday night Sophia is now quite worried.  She calls the hotel room, the desk; she looks up his flight on the internet, and calls Frank’s secretary at her home. He hasn’t notified anyone of anything.

At 8 pm on Thursday. Sophia is freaking out. She pages him repeatedly, and emails everyone in his department. She calls the police department in L.A. and the local hospitals.

At 8:30, Frank finally calls. He forgot his cell phone charger, and due to complications with a product he had sold – he had to fix it alone, was frazzled himself, and was in a place where he couldn’t really call. Since he screwed up the sale – he didn’t want to call the office either. He arrived at his hotel so late every night that he hesitated to call home due to the time difference. He thought he was being considerate. The problems with the product would require his presence for another two days – but he forgot to notify the hotel desk.

When she heard Frank’s voice, she experienced feelings of hurt and anger, along with great relief. She let him have it, but she tempered her anger because once he explained she understood, and she was grateful that he was alright. Sophia warned him never to it again, and after hearing about how his failure to connect with her affected her – he never made the same mistake again.

The above example describes attachment in terms of plans and expectations for reunion. The plans involved sophisticated temporal (3 days; 6 pm on Thursday; flight leaves at 3:30 pm on the 18th…), and spatial concepts (L.A. – 600 miles away and in a different time zone). Note that physical reunion was not necessary to bring about a significant reduction of attachment stress in Sophia – although she won’t be completely happy and relieved until she can see and touch him.

The example also demonstrates attachment behavior and the sophisticated range of Sophia’s attachment means. She used her cognitive concepts to form her expectations of when Frank was to call and arrive. Her episodic memory also played a great part in her expectations. She knew to call the hotel, look up his flight, and call his secretary – all concepts of their lives. She used language to acquire information and communicate – both written and verbal. All of her responses were comprised of motor actions – from speaking, to dialing the phone, operating the computer, and thinking about the past and future (see Motor Planning, below). Sophia brought all of these to bear in order to bring about reunification.

Now, an example more common to our professional experience:

Lori and Separation Anxiety

3-year-old Lori is entering preschool. Before that, she was cared for by her grandparents while Mom and Dad worked. They always picked her up in the afternoon. Lori’s Grandmother has been a regular part of her life since she was born.

Lori was born with a difficult to soothe temperament and has a mild form of autism. She does not yet understand the concepts of before and after, “this afternoon” or later. She has not yet had the experience of being in the care of other surrogate figures who would meet her needs until she reunited with her Teacher. She lacked many of the linguistic skills to express herself in a way that was readily understandable to strangers.

Lori’s first few months of preschool were fraught with problems. She cried constantly for weeks. She demanded much more attention and soothing from adults at school, and engaged in deliberate misbehavior in order to ensure immediate proximity of school caregivers.  Even when she appeared calm – she did not engage in exploring the classroom environment – something she did when she was at home – albeit in an impaired way. While she never said anything like, “I want my Mommy” or “Where’s Mommy,” the staff knew what the problem was.

Adults at school would try to reassure her that Mommy was coming “later,” “after snack” and “after the Goodbye Song.” This only made her more upset, because she only understood the “Mommy’s coming…” part and immediately looked to the door. Even when given immediately responsive attention – she couldn’t really be satisfied, and she engaged in escalated self-soothing/[primitive] self-regulatory behaviors such as rocking, hand-flapping, and even banging her head on the floor – which she did rarely at home.

Finally, Lori discovered, by repeated and rote experience, that Mommy always came after she finished her lunch. She went through a period of trying to get to her lunchbox as soon as she arrived, presumably as a sign of her magical thinking that eating her lunch would produce her Mommy. But this was thwarted by staff, and she soon understood, perhaps not on a very deep level, that no harm would come to her, and that Mommy did indeed arrive after the Goodbye Song.

Two years later, Lori entered public Kindergarten. She had still not yet developed concepts of sequencing and she still had major deficits in episodic memory. It was her peers’ individual episodic memories of previous separations and reunifications that helped them adjust to the new longer day and different routine. Lori was hardly more prepared for her entry to Kindergarten than she was for preschool. Everyone prepared for the worse – including Karen, the school’s Autism specialist.

Karen advised Lori’s grandparents to take her to the school campus during the summer session to let her meet her teachers, see her classroom, and play on the playground. Karen also had long ago made a videotape, shot from a Student’s-eye level of the Teacher doing things like Morning Circle, Story-time, Music, etc. Lori watched a copy of the tape for several weeks before school, along with her grandmother – who sang the songs and sat next to her like a peer. Karen also took pictures representing the various routines in her schedule, and made up a picture schedule for her that was placed on her desk. The day before school started, Karen conducted an abbreviated run-through of the routines with Lori and her grandmother – taking her through each transition and to each location of the various routines, in the order in which they were to take place. Lori’s entry into Kindergarten went much smoother than anyone anticipated.

Karen took great pains to enhance Lori’s ability to develop expectations of Caregiving and attachment reunion. This was wise given that Lori still had not developed sufficient temporal and spatial concepts to go through an unfamiliar form of separation without major problems. And knowing that Lori’s attachment means still consisted of primitive self-soothing behaviors, this minimized the likelihood of a constellation of defensive, attachment behaviors and trauma.

  • How does the IP make use of ordinal, sequential concepts and memory to regulate attachment distress?As the IP develops memory and the ability to develop narrative sequences, he or she can tolerate more space not only in terms of time and duration between emotional refueling (short moments when attachment partners reconnect that serve as  reconfirmation of the Caregiver’s presence, emotional availability and protection and attachment security; Mahler, S. and Pine, M.M. and F., Bergman, A.; 1973; The Psychological Birth of the Human Infant, New York: Basic Books), but also in terms of physical separation.  This depends in large part on first, the development of joint attention behaviors (being able to direct other’s attention to a referent from a distance with pointing and/or words).  Being able to point at things allows the attachment pair to remain connected within each other’s eye- or earshot.  Memory allows the infant to tolerate short separations because she can remember that Mother’s disappearance is merely part of a familiar behavioral melody/gestalt, and that her reappearance is a pretty sure thing (not always a given – ask Sophia in the example above!).The development of narrative sharing, or the IP’s ability to describe events that occur in the absence of the Caregiver or that occurred in the past or that may occur in the future, allows for even greater displacements of time and place.  Finally, mastery of technology such as telephone use, writing,  email, Skype, Facebook, etc. can allow for longer and more distal separations – even from across the world.

Gregg is anxious about when he gets to go home

Gregg, an 11-year old with high-functioning autism lives in a group home. His parents pick him up on Friday every week. He begins asking his Teachers and Caregivers at the home, “When is Mommy coming?” around mid-morning on Monday, and asks the same question frequently throughout the week – at least 5 to 10 times per hour.  He did this every single day and every single week for years. He could be engaged in instrumental communicative exchanges (requesting goods and services, answering questions, and protesting) most of the time, but whenever he expressed a thought – it was the simple imperative, “When is Mommy coming?”

The supposedly experienced staff described this as a “preservative behavior” and resolved to ignore it. They pointed to the fact that Gregg could recite the days of the week, could answer questions such as “What comes after Thursday?” and even answered his own question half of the time (he would ask “When is Mommy coming?” and then if ignored or asked by adults, “When do you think?” he would readily answer, “On Friday”).

It occurred to no one that Gregg really didn’t understand what Friday meant. His ability to rotely recite the days of the week and [rotely] answer questions did not help him anticipate the moment of his parent’s arrival at all, and the answers he intermittently received from adults did little to assuage his anxiety. Instead, they were all locked into a cycle where Gregg’s anxiety lead to his questions, followed by the ineffective answers staff gave, and then his repeating the questioning as a desperate and uncreative means to manage his anxiety.

Finally, someone came up with the idea that Gregg needed a picture schedule in order to truly understand his attachment schedule (that he was prematurely forced to be in due to his life’s circumstances). This helped quite a bit, and repeated questioning about Friday was reduced by about 50%. The problem was that after years of anxiety related questioning, Gregg never really explored ways to engage caregivers by talking about other things. The simplistic approach of ignoring his questions or trying to redirect him to other topics – because his anxiety was never acknowledged – never allowed him to feel comfortable exploring other topics. At least now, the teaching of other means of engaging others can begin in earnest.

The concept of the “Goal Corrected Partnership

This is a term coined by John Bowlby to describe a later stage of attachment where an attachment pair engages in coordinating and planning reunification (if not final – his theory has been revised in subsequent years to take into account that in some cultures, family members rarely separate for any appreciable amount of time) This is based on prerequisite temporal and spatial concepts as seen in the examples above.  Ultimately, these concepts allow for one or both partners to adjust their plans for reunion and to engage in “waiting strategies” (behaviors that help pass the time so that waiting is more tolerable).

Changes in Goal Corrected Partnerships through Development

Patterns of attachment and exploration behavior are expected to change with age and development.  They move from attachment and caregiving behavior on demand earlier in life, to co-regulated schedules based on cognitive concepts and emotional ability.  We look at differences the IP has with others his or her age, or how difficulties understanding component elements and concepts of separation predispose the IP for referral behavior.

Keep in mind that the environment expects the IP to be able to handle separation and to expect proportionate amounts of attention.  “Attention” is generally a good thing.  Attention-seeking tends to become defined as a behavior problem when (1) the way that the IP goes about it is inappropriate or coercive; (2) the IP insists on attention when it is not available, is unreasonable about waiting for it or expects immediate gratification, or; (3) the amount of attention expected by the IP is unreasonable or a mismatch for the environment.

In preschool, communication allows for planning separation based on a shared or negotiated plan that encompasses usually concepts of sequence (“Mommy will come to get you after the Goodbye Song.” Before that, infants and toddlers are widening their attachment circles to include more secondary or surrogate attachment figures (Father; Grandparents and relatives; Babysitters, etc.).  Beginning as early as 3 ½ or so, children can explore, relatively free of distress if they are engaged in interesting activities alone or with peers.  The amount of time the IP spends getting his or her needs from wider circles of attachment surrogates increases in inverse relationship to needs for refueling from primary attachment figures.  That is, the person can get their needs met increasingly from friends and becomes less reliant upon primary caregivers as sole providers of attachment gratification.   Finally, adults develop intimate attachment relationships where “significant others” serve as primary attachment figures, as well as their attachments to their own children.

Given the above, these questions are appropriate for this section:

  • Appropriateness/Inappropriateness involving the way the IP goes about seeking attention
    • Is the problem the way the IP goes about seeking attention?  Describe these ways.
    • Do the ways of going about seeking attention resemble those of younger children, or are they coercive in a unique, pathological or bizarre way?
  • Appropriateness/Inappropriateness of age-appropriate Goal Correction
    • Can the IP wait for a moment before the caregiver can get around to meeting his emotional needs, or does he demand immediate responding most of the time?
    • Has the IP learned simple patterns of the environment and attachment figure behavior that enable her to understand that they cannot always come immediately?
    • Does the IP understand schedules, sequences, and calendars?  Can they make use of them to understand when their attachment figures come and go?
  • Proportionate/Disproportionate amounts of attention
    • Does the IP have unusual needs for attention?  Are they typical of the IP’s chronological age?  Developmental age?
    • Are their chronic and unrelieved sources of anxiety driving the needs for constant attention?
      • Are these rooted in a history of abandonment or deprivation of empathic care early that lead to chronic attachment insecurity?
      • In a related way – are  the IP’s primary attachment figures emotionally or physically available?  Has the IP had a chance to establish a secure and trusting relationship(s) with primary or surrogate attachment figures?
      • Are the anxieties related to fears of failure in academics or in peer relationships?

Communicative Attachment Means

This section refers to the IP’s abilities to use communication for the purpose of sharing emotions, getting soothing or interest from being with others, getting needs met, etc.  In this section, you also might mention whether or not the IP uses communication for relating beyond getting his or her needs met (instrumental v. experience-sharing functions of communication).  Describe the ways in which the IP communicates non-verbally and non-verbally his needs for separation and reuniting with caregivers.  Describe how the IP makes use of joint attention, prosodic, non-symbolic and symbolic, non-verbal and verbal means to regulate the availability and behaviors of caregivers?

Communicative attachment means must match the environment’s demands for separations of time and place.  A lack of ability can result in over-dependence on 1:1 attention or reliance on only a small circle of Caregivers that understand the IP’s unique ways of communicating.

We can see in typical development how the relationship between communication and narrative allow children to rely less on primary attachment figures and sustain their own emotional needs through relationships with surrogate attachment figures through the use of communication.  We have seen above that mastering distal forms of communication such as with narrative description of events, writing, and telephonic/electronic, can keep anxiety low.

Language Intentionality
  • Does the individual give clear signals of their needs or intentions, or these signals so unique or self-referenced (private, idiosyncratic language; metaphoric speech; neologisms)?
  • Do they take into account the understanding of others (e.g. autistic “metaphoric or private language” references such as “Barney, Barney” to indicate the desire for the goodbye ritual to begin [based upon a years-old reference to the Barney Goodbye Song in which no one in the present environment understands] vs. language based on linguistic community understanding such as “Is Mommy coming soon?”)?
  • Does the IP direct his or her communication at others or is it broadcast to the world as if the IP doesn’t really understand the purpose of communication?  This is a concept called “agency,” or that people are “agents” that have intentions and that can understand other’s intentions.  The IP may be so primitive in his or her understanding of communication that they make only associations between sounds or actions they make and certain consequences happening.  They do not really understand that their actions are the reasons for responses from the environment.
  • Are the signals she gives differentiated?
    • Lower ability individuals have a small repertoire of communication means.  They tend to use the same means or tools and forms of communication for a wide variety of functions or circumstances (e.g. cries when hungry; tired; needs attention).  If this is the case, assess whether or not there are differences in the forms (e.g., cries) that others can tie to specific communications (e.g., cries in a different way when hungry; tired; in pain, etc.).
    • Higher ability individuals can be the opposite.  They have a larger repertoire of communication means, so they may use many forms to communicate the same intention (e.g., indicates want or need to avoid something by behaving in different ways: outright refusals of different sorts; lying; making excuses; pretending not understand or hear; blaming, etc.)
  • Are the IP’s directed at specific individuals?
    • Does the IP use different forms of communication for different people or different situations?
  • Is there evidence that the Student can profit from language or symbols (such as picture or object schedules) to engage in goal-corrected partnerships?  Does he ask questions regarding the whereabouts of attachment figures and the times they’ll return (as in the example of Gregg, above)?

Motor/Spatial Axis

This has to do with the IP’s use of his or her motor skills and space to get attachment emotional needs met.  It really a question of who comes to whom?  Some individuals become so crippled by their emotional meltdowns that they cannot get up and seek help.  Others come rushing to them.  Others do this in all circumstances because that is the way they’ve become conditioned by others in the environment.  Others have real mobility and sensory/spatial orientation issues (as in blind children) that predispose them to highly dependent means of emotional coping.

  • Does the IP approach others when they have difficulty coping with certain emotions?
  • Do they approach others to share positive emotions?
  • How many steps of looking will the IP engage in in order to get others to help them cope with strong emotions?
  • How many places will the IP search for reference points on how to feel or what to do?
  • What reference points do they use?
    • Are they social (i.e. the individual bases his or her feelings and anticipations; regulates anxiety by referencing how other are feeling or handling the situation)?
    • Or, like younger children, does the IP reference only Caregivers and rely on the idiosyncratic means developed between the IP and individual Caregivers.
    • Or, are they entirely self-referenced (how others feel doesn’t seem to matter or affect the individual)