Attachment Style in Children With Chronic Diseases: A Comprehensive Review

Abstract

Objective: To investigate how attachment style has been studied in children with chronic disease in the scientific literature, and what repercussions this attachment has on this population. Data sources: An integrative review of the literature was carried out from a survey in the LILACS, MEDLINE and SciELO databases, including original national and international publications in Portuguese, Spanish and English from 2007 to 2018, using the descriptors “apego” and “criança” in the Health Sciences Descriptors (DeCS), and “attachment” and “children” for the Medical Subject Headings (MeSH). Sixteen (16 articles) were obtained for the sample analysis. Data synthesis: The chronic diseases found in the research were neurobehavioral disorders such as attention deficit hyperactivity disorder (ADHD) and autism, childhood obesity, and chronic migraine. The predominant attachment style was insecurity, which could compromise the biopsychosocial development of the child. Conclusions: The type of attachment between child and primary caregiver may be considered a protective or risk factor for child development. Considering this premise, it is important to equip/inform families based on dialogic educational practices, in which professionals create opportunities and means for families to develop their skills and competencies, and acquire resources which meet the child’s needs. It is important that this professional helps the family to build secure bases for their child with chronic disease, understanding that the main focus for promoting child development is in the family unit.

Fatores associados à violência física grave contra crianças e adolescentes com transtornos mentais

“…Não é fato novo que as condições crônicas produzem mudanças na vida da família, exigindo ajustes na organização do dia a dia para o atendimento às necessidades da pessoa sob cuidados 23 . O desequilíbrio e a deterioração da dinâmica familiar são eventos comuns e intimamente associados à ocorrência de conflitos em decorrência da elevada carga de demandas 24 . O estresse associado a eventos adaptativos pode causar sofrimento ao cuidador, aumentando as chances de ocorrência de conflitos e, como consequência, de violências a quem está sendo cuidado 10 , especialmente frente a ausência de dinâmicas que produzam o necessário suporte familiar 25,26 Crianças com transtornos mentais apresentam alto risco de violência física desde as menores idades, aumentando as chances de consequências graves no desenvolvimento físico e emocional ao longo da vida, pois o abuso tende a se repetir com o tempo 20 produzindo marcas de difícil mensuração.…”

Family implications during deprivation of liberty and Attachment Theory: a qualitative metasynthesis

“…Attachment is a feeling biologically stimulated by the search for comfort and security, structured through internal operating models and mental representations of oneself and attachment figures. The way families strengthen their ties, the way a child is linked to parents and/or caregivers, seeking to feel valued and safe, can be explained through this theory (21) .…”

“…Secure attachment can be defined as one in which caregivers (attachment figures) provide children with a positive worldview, enabling family members a feeling of freedom so that they can express their feelings, in addition to allowing autonomy for them to explore the environment and develop their confidence. Insecure attachment, on the other hand, is a demonstration of difficulties and insecurity by family members, evidenced by feelings of anxiety, depression and low self-esteem, the result of living with an attachment figure that presented itself as unstable and vulnerable (21) .…”

“…The attachment system, on the other hand, is configured by the identification of risk situations, attachment figure availability, with expression of emotional behaviors, such as crying, smiling, screaming, destined to generate affective responses that strengthen supports, ties and affections. The system has the function of making people feel safe, classifying personal relationships and the environment as non-hazardous and susceptible to exploitation; however, if any threat is identified, it returns to seek security in the attachment figure, used as an affective support to face moments of difficulty (21) .…”

“…Researchers (37) state that affective deprivation and exposure to unstable and impersonal care, added to tie breakdown, can be detrimental to a child's development, resulting in the formation of unsafe attachment. A knowledge synthesis (21) , published in the Brazilian and international scientific literature of research on how attachment style has been studied among children with chronic diseases in the period from 2007 to 2018, highlighted that early attachment relationships are related to long-term consequences in a child's life, influencing cognitive and language development, self-esteem, independence and school performance.…”