EFFECTS OF A SECURE ATTACHMENT …

1 IMHJ (Wiley)RIGHT INTERACTIVE shortstandardtop of AH7base of dropINFANT MENTAL HEALTH JOURNAL,Vol. 22(1 2), 7 66 (2001) 2001 Michigan Association for Infant Mental HealthARTICLEEFFECTS OF A SECURE ATTACHMENTRELATIONSHIP ON RIGHT BRAIN DEVELOPMENT,AFFECT REGULATION, ANDINFANT MENTAL HEALTHALLAN N. SCHORED epartment of Psychiatry and Biobehavioral SciencesUniversity of California at Los Angeles School of MedicineABSTRACT:Over the last ten years the basic knowledge of brain structure and function has vastly ex-panded, and its incorporation into the developmental sciences is now allowing for more complex andheuristic models of human infancy. In a continuation of this effort, in this two-part work I integratecurrent interdisciplinary data from ATTACHMENT studies on dyadic affective communications, neuroscienceon the early developing right brain, psychophysiology on stress systems, and psychiatry on psychopath-ogenesis to provide a deeper understanding of the psychoneurobiological mechanisms that underlie infantmental health.

2 In this article I detail the neurobiology of a SECURE ATTACHMENT , an exemplar of adaptiveinfant mental health, and focus upon the primary caregiver s psychobiological regulation of the infant smaturing limbic system, the brain areas specialized for adapting to a rapidly changing environment. Theinfant s early developing right hemisphere has deep connections into the limbic and autonomic nervoussystems and is dominant for the human stress response, and in this manner the ATTACHMENT relationshipfacilitates the expansion of the child s coping capcities. This model suggests that adaptive infant mentalhealth can be fundamentally defined as the earliest expression of flexible strategies for coping with thenovelty and stress that is inherent in human interactions. This efficient right brain function is a resiliencefactor for optimal development over the later stages of the life :En los u ltimos diez an os el conocimiento ba sico de la estructura y funcio n del cerebro se haexpandido considerablemente, y su incorporacio n como parte de las ciencias del desarrollo permite ahoratener modelos de infancia humana ma s complejos y heur sticos.

3 Como una continuacio n a este esfuerzo,en este ensayo que contiene dos partes, se integra la actual informacio n interdisciplinaria que provienede los estudios de la unio n afectiva en relacio n con comunicaciones afectivas en forma de d adas, laneurociencia en el desarrollo inicial del lado derecho del cerebro, la sicofisiolog a de los sistemas detensio n emocional, as como la siquiatr a en cuanto a la sicopatoge nesis, con el fin de presentar unconocimiento ma s profundo de los mecanismos siconeurobiolo gicos que sirven de base para la saludmental infantil. En este ensayo se explica con detalle la neurobiolog a de una relacio n afectiva segura,un modelo de salud mental infantil que se puede adaptar, y el enfoque del mismo se centra en la regla-mentacio n sicobiolo gica que quien primariamente cuida del nin o tiene del maduramiento del sistemal mbico del infante, o sea, las a reas del cerebro especialmente dedicadas a la adaptacio n a un medioDirect correspondence to: Allan N.

4 Schore, Department of Psychiatry and Biobehavioral Sciences, UCLA School ofMedicine, 9817 Sylvia Avenue, Northridge, CA 91324; fax: (818) 349-4404; e-mail: SchoreIMHJ (Wiley)LEFT INTERACTIVE shortstandardtop of rhbase of rhcap heightbase of textambiente que cambia ra pidamente. El temprano desarrollo del hemisferio cerebral derecho del infantepresenta profundas conexiones en cuanto a los sistemas nerviosos l mbico y auto nomo, y es responsablepor la respuesta humana a la tensio n. De esta manera la relacio n afectiva facilita la expansio n de lashabilidades del nin o de enfrentar diferentes situaciones. Este modelo sugiere que la salud mental infantilcapaz de ser adaptada puede ser fundamentalmente definida como la expresio n ma s temprana de estra-tegias flexibles para enfrentarse con lo novedoso y con la tensio n inherente en las interacciones efectiva funcio n del lado derecho del cerebro es un factor de resistencia para el desarrollo o ptimoen los niveles posteriores del ciclo SUME :Pendant ces dix dernie`res anne es la connaissance de base de la structure et de la fonction ducerveau s est conside rablement accrue, et son incorporation dans les sciences du de veloppement autorisemaintenant des mode`les plus complexes et heuristiques de la petite enfance humaine.

5 Dans un effort depoursuite de cet effort, j inte`gre dans ce travail divise en deux parties des donne es interdisciplinairesactuelles issues d e tudes sur l attachement des communications affectives dyadiques, la neuroscience surle de veloppement pre coce de l he misphe`re droit du cerveau, la psychophysiologie sur les syste`mes destress, et la psychiatrie sur la psychopathoge ne`sedefac on a` offrir une compre hension plus approfondiedes me canismes psychoneurobiologiques qui sous-tendent la sante mentale infantile. Dans cet article jede taille la neurobiologie d un attachement solide, un mode`le de sante mentale adaptative, et je metsl accent sur la re gulation psychobiologique que fait le mode de soin principal du syste`me limbique arrivanta` maturite du petit enfant, les re gions du cerveau spe cialise es dans l adaptation a` un milieu changeantrapidement. Le de veloppement pre coce de l he misphe`re droit du petit enfant a de profondes connexionsdans les syste`mes nerveux limbiques et autonomiques et l emporte pour la re ponse humaine au stress, etde cette manie`re la relation d attachement facilite l expansion des capacite s a` faire face de l enfant.

6 Cemode`le sugge`re que la sante mentale adaptive infantile peut e tre fondamentalement de finie commel expression la plus pre coce de strate gies flexibles pour faire face a` la nouveaute et au stress qui sontinhe rents aux interactions humaines. Cette fonction efficace de l he misphe`re droit du cerveau est unfacteur de ressort pour le de veloppement optimal lors des stades ulte rieurs du cycle de :In den letzten zehn Jahren hat sich die grundlegende Kenntnis der Gehirnstrukturund funktion eindrucksvoll erweitert. Ihre Einbindung in die Entwicklungswissenschaften erlaubt esnun komplexere und erprobbare Modelle der menschlichen Kleinkindzeit zu entwickeln. In Fortsetzungdieser Anstrengungen integriere ich in dieser zweiteiligen Arbeit gegenwa rtige interdisziplina re Er-gebnisse aus Bindungsstudien u ber dyadische, gefu hlsgesteuerte Kommunikation, aus der Neurologieu ber die sich fru h entwickelnde rechte Gehirnha lfte, aus der Psychophysiologie u ber Stresssysteme undaus der Psychiatrie zur Psychopathogenese, um ein tieferes Versta ndnis der psychoneurobiologischenMechanismen, die der seelischen Gesundheit des Kleinkinds zugrunde liegen, zu ermo dieser Arbeit zeige ich die Neurobiologie der sicheren Bindung auf, ein Beispiel der Anpassungin der seelischen Gesundheit des Kleinkinds und ich beziehe mich auf die psychobiologische Regulationdes kindlichen limbischen Systems durch die prima re Bezugsperson.

7 Das limbische System ist jeneGehirnregion, die speziell fu r die Anpassung an eine sich schnell a ndernde Umgebung zusta ndig ist. Diesich schnell entwickelnde rechte Hirnha lfte des Kleinkinds hat bedeutende Verbindungen zu dem lim-bischen und dem autonomen Nervensystem und ist bestimmend fu r die menschliche Stressreaktion, wo-durch die Bindung die kindlichen Anpassungsleistungen erleichtert. Dieses Modell unterstell, dass dieangepasste seelische Gesundheit des Kleinkinds im Grunde so definiert werden kann: Es ist das ersteAuftauchen der flexiblen Strategien, um mit Neuem auszukommen und zeigt, dass Stress zur men-schlichen Interaktion dazugeho rt. Diese effiziente Funktion der rechten Gehirnha lfte ist eine Bedingungfu r die optimale Entwicklung im weiteren Relationship on Right Brain Development 9 IMHJ (Wiley)RIGHT INTERACTIVE shortstandardtop of rhbase of rhcap heightbase of text**The fundamental importance of the psychological as well as the biological health of theinfant has long been held as a cardinal principle by every clinical discipline that deals withyoung children infant psychiatry, behavioral pediatrics, child psychology, developmentalpsychoanalysis, and more recently, the emerging fields of developmental psychopathology andinfant mental health.

8 And yet a more precise characterization of the concept of infant mentalhealth, like the definition of mental health itself, has been elusive. Theoretically, it is clearthat there must be links between infant and adult mental health, yet these too have been ill-defined. Although there is a large body of clinical knowledge in psychiatry, abnormal psy-chology, and psychoanalysis affirming the centrality of early relational experiences on enduringadaptive and maladaptive aspects of personality, there has been some question as to the struc-tural mechanisms by which such events positively or negatively influence the process of de-velopment as it continues over the lifespan. In other words, how do the earliest interactionsbetween a maturing biological organism and the social environment influence infant mentalhealth, what are the central functions that define infant mental health, and how does it influencemental health at later stages of development?

9 The defined mission of theInfant Mental Health Journalis to focus upon infant social-emotional development, caregiver infant interactions, contextual and cultural influences oninfant and family development, and all conditions that place infants and/or their families at riskfor less than optimal development. In this work I want to suggest that although the uniqueimportance of optimal development has long been addressed by the psychological sciences,due to the advances of the decade of the brain, developmental neuroscience is now in aposition to offer more detailed and integrated psychoneurobiological models of normal andabnormal development. The incorporation of this information into developmentalpsychologicalmodels could forge closer links between optimal brain development and adaptive infant mentalhealth, as well as altered brain development and maladaptive mental theoretical concept that is shared by an array of basic and clinical sciences is the conceptof regulation (Schore, 1994, 1996, 1998d, 1999c, 2000b), and because it integrates both thebiological and psychological realms, it can also be used to further models of normal andabnormal structure function development, and therefore, adaptive and maladaptive infantmental health.

10 Interdisciplinary research and clinical data are affirming the concept that ininfancy and beyond, the regulation of affect is a central organizing principle of human devel-10 SchoreIMHJ (Wiley)LEFT INTERACTIVE shortstandardtop of rhbase of rhcap heightbase of textopment and motivation. In the neuroscience literature Damasio asserts that emotions are thehighest order direct expression of bioregulation in complex organisms (1998), and that pri-mordial representations of body states are the building blocks and scaffolding of development(1994). Brothers argues that emotion occurs in the context of evolved systems for the mutualregulation of behavior, often involving bodily changes that act as signals (1997, p. 123).Emotions and their regulation are thus essential to the adaptive function of the brain, which isdescribed by Damasio:The overall function of the brain is to be well informed about what goes on in the rest ofthe body, the body proper; about what goes on in itself; and about the environment sur-rounding the organism, so that suitable survivable accommodations can be achieved betweenthe organism and the environment.