Neurocognitive considerations in the treatment of attachment and complex trauma in children

Abstract

Accumulating evidence suggests that children suffering deprivation and maltreatment at critical times in their development often pay a cognitive toll. While children vary to the extent that neurocognitive domains are affected, those factors influence how children process, manage and understand traumatic and attachment experiences as well as how they respond to treatment. Current research on trauma and attachment favor some aspects of cognition over others. The literature discusses attention, memory, cognitive biases, internal working models, beliefs and attributions as ways that impact an individual's understanding of experience. Other categories such as working memory, processing speed, verbal, auditory or perceptual processing, metacognitive skills, and cognitive rigidity or flexibility rarely surface. This paper examines what is and is not known about the interface of cognition with attachment and complex trauma and how that knowledge can inform treatment. It explores existing research and offers a case vignette as an example of how that knowledge can be integrated into treatment strategies.

Preventing intergenerational trauma transmission: A critical interpretive synthesis

“…Most adult trauma intervention approaches reviewed in this synthesis were underpinned by an understanding of the need to establish a therapeutic relationship within which traumatic effects can be explored, trauma‐induced reactions identified and modified, and self‐efficacy increased. The quality of the therapeutic relationship itself is known to be one of the most important factors to effect improvement regardless of therapeutic model used (Zilberstein, ). A trauma and attachment lens needs to be implicit within such therapeutic relationships, as trauma that occurs within attachment relationships affects the ability to feel safe and to experience empathy and understanding in other attachment relationships, including therapeutic ones (Allen, ).…”

Unresolved Attachment Mediates the Relationship Between Childhood Trauma and Impaired Personality Functioning in Adolescence

“…The central aspect of trauma in unresolved individuals is their attachment disorganization and fear in situations that represent a severe threat to the self (i.e., danger, separation, solitude, loss). In these situations, they are in need of protection and comfort; however, their caregivers cannot help them soothe their hyperarousal, restore safety, and integrate traumatic experiences (Obsuth, Hennighausen, Brumariu, & Lyons-Ruth, 2014;Zilberstein, 2014). From this perspective, the traumatic element is not the frightened or frightening caregivers per se, but the personal experience of their failure to respond appropriately during moments of severe attachment distress.…”

Recalling a Devastating Tornado: Qualities of Child Recollections and Associations with Mental Health Symptoms

“…It is difficult to know if the findings are a result of exposure to the Joplin tornado alone or due to exposure to a different trauma, or even chronic trauma exposure. Research suggests that trauma exposure, particularly when it is chronic and occurs early in life, can disrupt cognitive development (Zilberstein 2014), including executive functioning and IQ (Enlow et al 2012) and emotional development, including self-soothing (Courtois 2004). In turn, these deficits could affect a child's ability to create a coherent account of their traumatic experiences or to identify or express emotions or ways the trauma has been resolved.…”