依恋第四部分：照顾者和儿童对依恋的影响
第四部分描述了整个一生中的依恋。Goldberg 医生在这部分中，讨论了儿童和照顾者在依恋行为发展方面做出的贡献。
4.1 依恋：先天还是后天？
先天-后天的争论是20世纪最持久和最有争议的辩论之一。一个人的基本素质和行为是遗传决定？还是后天学会的？
现代的答案是，遗传决定了特定行为方式的能力，经验决定了这些能力是否，以什么方式，以及何时表现出来。依恋理论的情况也是如此。
依恋的关键问题是：
- 婴儿如何管理痛苦？
- 婴儿体验这些痛苦的频率？
- 遗传因素如何影响婴儿表达痛苦的方式？
- 婴儿如何通过经验和学习改变了自己回应压力的模式？
依恋理论家认为，本质上说，婴儿-照顾者依恋模式是后天习得的。
虽然婴儿的性格对婴儿-照顾者之间的关系有贡献，但是，照顾者提供的经验是婴儿依恋模式的主要决定因素。根据依恋理论，最重要依恋模式发展因素就是婴儿在其不安时从照顾者的反应中学到的经验。
相关研究对这种观点提供了一些支持，父母的养育方式对婴儿的依恋行为有重大的影响。
在婴儿出生之前，我们就能简单地从母亲对即将出生的婴儿的态度中预测出婴儿-照顾者之间的依恋类型。一些研究已经表明，与婴儿的行为相比，母亲在家庭中的行为能够更好地预测婴儿的依恋。
这些研究表明了照顾者在依恋模式发展过程中的重大的影响。
回应婴儿的小窍门
当婴儿受伤、生病或不安时，您可以对他作出多种响应。如果您现在的回应方式能够让婴儿感觉安全保险的，那么，他们就会相信有人在支持他。
4.2 照顾因素和依恋
4.2.1 养育风格
在第2部分中，我们描述了养育方式如何影响了孩子的依恋类型。
如果照顾者始终能够及时、敏锐的对婴儿的信号做出反应，并且能够接受婴儿的痛苦，那么，他们和孩子之间的联结往往都是安全型的依恋关系。
相反，非安全型依恋孩子的照顾者，在响应婴儿的不安迹象以及婴儿的舒适和保护需要时，往往做得不够。这些照顾者没有给予身体的、心理的、和情绪方面的响应，他们的养育风格往往不敏感或不可预知。
4.2.2 照顾者的敏感性和依恋风格
1972年，Sylvia Bell 和Mary Ainsworth 进行的一项调查了产妇对婴儿啼哭反应。那些对其婴儿的哭声反应更灵敏的母亲，其婴儿的啼哭较少，婴儿表达的声音和手势也更加多样化。研究人员曾经试图复制这些研究结果，但结果喜忧参半的。
大多数养育方式与依恋关系有关的研究都衡量了照顾者对其婴儿的不安信号的敏感性或反应。1987年对13项关于母亲敏感性和婴儿-照顾者之间的依恋情况，以及1997年进行的对66项研究进行评论表明，母亲的敏感性对依恋的影响程度是低中度的。
总的来说，结果喜忧参半，不如1972年Bell 和 Ainsworth 的研究令人信服。这可能是因为母亲敏感性和依恋方式已经被定义了。在许多情况下，依恋的定义比较宽泛，与1972年的研究中使用的依恋作为保护现象的原始构想相比，包括了婴儿-照顾者关系中的很多方面。
少数几项研究专门探索了在保护性环境中母亲的敏感性对依恋的影响。
其中一项研究发现，只有当社会支持程度很低时，母亲的低响应才会对依恋有重大的影响。其它的研究发现，安全型和抵抗型婴儿的母亲，他们在抚慰婴儿烦躁情绪的时候存在明显的差异。另一项研究发现，照顾者管理痛苦的能力，可以预测婴儿依恋的安全性。
紊乱型依恋的婴儿与他们的照顾者之间关系的研究，支持了照顾者行为/依恋之间存在联系的观点。那些促成了婴儿紊乱型依恋的照顾者，可能难以缓解其婴儿的不安，一些初步的证据也支持了这一理论。
陌生情境范例的研究项目发现，在有紊乱型依恋的婴儿中，那些令人感到害怕的，恐惧的，或极不敏感的照顾者的行为存在比例较高。我们将在第五部分：在逆境中依恋中详细讨论父母对紊乱型依恋的影响。
4.2.3 照顾者的依恋
正如我们已经看到的，父母依恋风格能够预测婴儿-照顾者的依恋模式。一项对9项研究的回顾发现，77％的自主型的成年人的婴儿是安全型，57％拒绝型成年人的婴儿是回避型，21％的先占型成年人的婴儿是反抗型，52％的未解决的成年人的婴儿存在紊乱型。
很少有证据表明照顾者特定性格特征与婴儿-照顾者之间的特定依恋模式有关。但是有证据表明，总体的养育方式和照料者的依恋历史，可能会极大地影响他们的婴儿，甚至是将来出生的后代的依恋结果。
4.3 婴儿的因素和依恋的关系
显然，照顾者依恋模式和行为的形成过程中起着作用。但婴儿是不是也是如此呢？婴儿的性格特征对依恋的发展有影响吗？研究人员已经研究了婴儿的一些特征对依恋的影响，这其中就包括婴儿的气质，身体状况和医疗条件。
4.3.1 婴儿气质
气质是指由遗传因素决定的婴儿的行为和情绪。
因为经验总是在影响着行为，所以不可能对气质进行纯粹的衡量。但一般来说，婴儿往往会在出生后，在有重大遗传因素影响的行为方面立即显示出明显的差异。
婴儿表达痛苦的阈值是气质的一个因素。婴儿的痛苦和不适是依恋理论的核心组成部分。因此，婴儿的气质在依恋行为的发展过程中发挥着作用。
气质和依恋理论家一致认为，依恋受婴儿和照顾者因素的共同影响，但这两种因素的影响在每个变量上的重点有所不同。他们不同意陌生情境范例中的婴儿行为的定义。
对于依恋理论家，婴儿（基于他们在过去的有压力时的经验产生的）行为反映了婴儿对其照顾者的保护性的渴望。
4.3.3 婴儿的身体状况
气质理论家认为：是气质而不是与照顾者打交道的历史，决定了婴儿的依恋类型。根据气质理论，婴儿感受到的不同的痛苦强度以及他们调节痛苦的方式存在着先天差异。这些差异造成了陌生情境范例范围内的观察结果。
如果我们将回避型依恋关系中婴儿的情况考虑进来的话，气质理论家就会争辩说，这些婴儿比较温和的不安反应是生理程序编码决定的。所以，他们在陌生情境范例的研究中感到有点窘迫，也不需要寻求与他们的照顾者的接触和团聚。这非并像依恋理论家所说的那样，孩子在回避母亲。
有力的证据反驳了这一观点。压力的生理反应而不是行为反应的研究发现，回避型的儿童比其他的婴儿表现出了更多的生理唤起。这表明，陌生行为范例研究中的观察结果是一个孩子处理压力的方式，而不是实际水平的兴奋或不安。
4.3.3 婴儿的医疗状况
针对病患婴儿的依恋研究，可以深入了解婴儿因素在依恋发展中的作用。患有疾病的婴儿的生活通常与健康婴儿的生活非常不同。研究这些极端环境如何影响依恋有助于研究人员了解婴儿的因素如何影响了依恋模式的发展。
过去，人们普遍认为，婴儿的医疗状况会影响依恋安全。多年来，一些研究已经探索了各种婴儿医疗问题对婴儿-照顾者的关系的影响。一些研究已经表明，患有疾病的婴儿比其他婴儿更容易陷入不安全的依恋关系。然而一项包含了34例临床研究的分析表明，婴儿的医疗问题对依恋风格几乎没有什么影响。
4.4 婴儿-照顾者之间的互动
依恋研究者Alan Sroufe 阐述了婴儿的先天素质与其父母的照顾可能存在的相互作用，以及这些互动如何形成了依恋行为。
虽然父母教养方式决定了依恋类型，但婴儿气质可能决定依恋主要类别中婴儿的亚型。下文将对此作进一步讨论。
虽然照顾者的护理方式决定了孩子依恋的安全性，但婴儿的气质决定了不安全感的具体表现形式。
虽然婴儿的气质决定了行为的类型，但护理者对这些行为的反应决定了婴儿的先天倾向如何发展为特定的依恋方式。
有些婴儿隶属于在同一大类中的不同亚分。这为Sroufe对婴儿和照顾者因素相互作用的解释提供了支持。
研究中的一组婴儿倾向于高水平的痛苦，他们在分离时会在陌生情境范式中表达强烈的情绪，在重聚时会强烈地寻求联系。但是，由于这些婴儿在寻求接触时很矛盾，而且照顾者很容易安置他们，因此在依恋分类中，他们被认为是安全的，而不是抵抗的。
类似地，有一组处于安全依恋关系中的婴儿表现出最小的痛苦和寻求联系。他们被评为安全而不是逃避，因为他们对照顾者的返回，有着积极的反应。
4.5 情绪调节
情绪调节是指满足需求和对环境的期望的情绪反应的适应。情绪调节通过婴儿和照顾者的情绪调节的过程影响依恋关系。
最初，婴儿的气质决定了他或她的痛苦反应的强度。随着时间的推移，照顾者对这种反应的反应将决定婴儿如何学会调节他或她的先天性痛苦反应。
一些证据显示，3个依恋分组里面的照顾者对情绪的理解有所不同。例如，有回避型关系的婴儿的照顾者，和其他照顾者相比，在描述情绪图片时，会使用不那么激烈的标签。这可能是影响了依恋模式的发展的机制之一。
4.6 小结
依恋是婴儿-照顾者之间关系的一个方面。双方都对婴儿依恋模式的发展有贡献。这是一个相互作用的过程，婴儿的气质和照顾者对情绪的反应决定了婴儿（在有压力时候的）反应。
虽然婴儿和照顾者的因素的相互作用都会影响依恋，但主要照顾者在决定依恋关系中起着最大的作用。照顾者的思考和理解能力远远超过婴儿。
鉴于婴儿对照顾者的依赖，这种能力把照顾者们推向了一个负责任的位置，并控制婴儿依恋行为的发展。（待续）
Diane Benoit, MD, FRCPC
Sheri Madigan, PhD, C.Psych (监督实践)
5/12/2010
Susman-Stillman A, Kalkoske M, Egeland B, Waldman I. Infant temperament and maternal sensitivity as predictors of attachment security. Infant Behaviour and Development. 1996;19:33-47.
Van Ijzendoorn MH. Adult attachment representations, parental responsiveness and infant attachment: a meta-analysis of the predictive validity of the Adult Attachment Interview. Psychological Bulletin. 1995;117:343-387.
The Infant Mental Health Promotion Project and the Department of Psychiatry, The Hospital for Sick Children. A Simple Gift: Comforting Your Baby [video]. Toronto: The Hospital for Sick Children; 1998. Used by permission.
Attachment: Nature or nurture?
The nature-nurture debate is one of the most enduring and controversial of the twentieth century. Are a person’s essential qualities and behaviours genetically determined or learned? The modern answer is that the capacity to behave in a particular way is genetically determined but experience determines whether, how and when capacities are engaged. This is the case with attachment theory. A key theme of attachment is how infants manage distress. How often infants experience distress and how it is expressed are influenced by genetic factors, but responses to stress are modified by experience and learning.
Attachment theorists believe that infant-caregiver attachment patterns are essentially learned. Although infant characteristics contribute to the infant-caregiver relationship, experiences provided by the caregiver are the primary determinant of infant attachment patterns. According to attachment theory, the most important factor in the development of attachment pattern is an infant’s experience of caregiver response in times of distress.
The research provides some support for this view. Parenting style has a significant impact on an infant's attachment behaviour. Infant-caregiver attachment classifications have been predicted prior to birth simply from mothers’ attitudes about the upcoming birth of their infant. Numerous studies have shown that maternal behaviours in the home predict attachment at one year better than infant behaviours. These findings point to significant caregiving influence in the development of attachment patterns.
Caregiving factors and attachment
Parenting style
Part two of the series described how parenting styles affect a child’s attachment classification. Caregivers who are consistently available, sensitive to their infant's signals, and receptive and accepting of their distress tend to have babies who are securely attached with them. In contrast, caregivers of infants with insecurely attachment tend to be less responsive to their baby's signs of distress and needs for comfort and protection. These caregivers are unavailable either physically, psychologically or emotionally and tend to be insensitive or unpredictable in their parenting style.
Caregiver sensitivity and attachment style
In 1972, Sylvia Bell and Mary Ainsworth carried out a study of maternal responsiveness to infant crying. Mothers who were more responsive to their infant's cries had babies who cried less and expressed more varied vocalizations and gestures. Researchers have since tried to replicate these findings with mixed results.
Most studies on parenting style and attachment include some measure of caregiver sensitivity or responsiveness to infants’ signals of distress. A 1987 review of 13 studies on maternal sensitivity and infant-caregiver attachment and a more recent 1997 review of 66 studies found a low to moderate effect of maternal sensitivity on attachment.
In general, the results are mixed and less compelling than the 1972 Bell and Ainsworth findings. This may be because of the way maternal sensitivity and attachment have been defined. In many cases, the definition of attachment is broader and includes more aspects of the infant-caregiver relationship than the original conception of attachment as a protective phenomenon used in the 1972 study.
A few studies have examined maternal sensitivity specifically in protective situations. One found that low maternal responsiveness had a significant effect on attachment but only when social support was low. Others found significant differences in maternal soothing of infant fussing between mothers of babies classified as secure and resistant. Another study found caregiver distress management predicted attachment security.
The most support for a caregiver behaviour/attachment link comes from research with infants with disorganized attachment relationships with their caregivers. Caregivers who promote disorganized attachment in their infants might have difficulty relieving infant distress because they are a source of fear to the baby. There is some preliminary evidence to support this theory. Frightening, frightened or extremely insensitive caregiver behaviours have been found to be elevated in caregivers of infants classified as having disorganized attachment in the Strange Situation Paradigm. A more detailed discussion of parental influences on disorganized attachment will be included in Attachment part five: Attachment under adversity.
Caregiver attachment
As we have seen, parental attachment style predicts infant-caregiver attachment. One review of nine studies found 77% of adults classified as autonomous had infants classified as secure, 57% of dismissing adults had avoidant infants, 21% of preoccupied adults had resistant infants and 52% of unresolved adults had disorganized infants.
There is little evidence that specific personality traits in the caregiver are associated with a particular pattern of infant-caregiver attachment. But there is evidence that general parenting style and caregivers' attachment histories may significantly influence their infant's and even future generations’ attachment outcomes.
Infant factors and attachment
Caregivers clearly have a role in the shaping of attachment patterns and behaviours. But can the same be said of infants? Do infant characteristics influence developing attachments? Some infant characteristics that have been studied by attachment researchers are infant temperament and the presence of a medical condition.
Infant temperament
Temperament refers to those aspects of an infant's behaviour and emotional responsiveness which are genetically determined. It is impossible to get a pure measure of temperament since experience always has an influence on behaviour. But in general, infants tend to display noticeable differences in behaviour that are present immediately after birth that likely have a significant genetic influence. An infant’s threshold for expressing distress is a temperament factor. Infant distress is a central component of attachment theory. It follows that infant temperament has a role in the development of attachment behaviours.
Temperament and attachment theorists agree that attachment is influenced by both infant and caregiver factors but they differ with respect to the emphasis they place on each of these variables. They also disagree on the meaning of infants’ behaviour in the Strange Situation Paradigm. For attachment theorists, infant behaviour reflects the baby's expectations of the caregiver as a protector based on past experiences in times of stress.
In contrast, temperament theorists believe that it is temperament and not history with caregivers which determines an infant's attachment classification. According to temperament theory, there are innate differences in infants’ intensity and modulation of distress. These differences result in the range of behaviours observed in the Strange Situation Paradigm. If we consider the case of infants in avoidant attachment relationships, temperament theorists argue that these infants are physiologically programmed to have relatively mild distress responses. Therefore, in the Strange Situation Paradigm, they feel little distress and have no need to solicit contact with their caregiver on reunion. It is not that they are avoiding her, as attachment theorists would claim.
There is strong evidence against this view. Studies that which look at the physiological rather than behavioural responses to stress have found that avoidant children show as much or more physiological arousal than other infants. This suggests that the behaviour observed in the Strange Situation Paradigm is a child’s way of dealing with stress rather than the actual level of arousal or distress.
Infant medical conditions
Attachment research on infants with medical conditions provides insight into the role of infant factors in the development of attachment. The lives of infants with medical conditions are often very different from those of healthy infants. Studying how these extreme circumstances influence attachment helps researchers understand how factors in the infant affect the development of attachment patterns.
In the past, it was generally believed that infants’ medical conditions affected attachment security. Over the years, a number of studies have explored the impact of various infant medical problems on the infant-caregiver relationship. Some studies have shown that infants with medical conditions are more often involved in insecure attachment relationships than other infants. However, a study that analyzed 34 clinical studies on attachment showed that infants’ medical problems had little impact on attachment style.
The infant-caregiver interaction
Attachment researcher Alan Sroufe illustrates how innate qualities in the infant and parental caregiving might interact to shape attachment behaviours. While parenting style determines attachment classification, infant temperament may determine the baby's subgroup within a major category of attachment. This is discussed further, below. While caregiver care determines a child’s security of attachment, the infant's temperament determines the particular form in which insecurity is expressed. While an infant's temperament determines the type of behaviour, the caregiver's response to these behaviours determines how the baby's innate tendencies develop into a particular attachment style.
There are some infants who fall into subgroups of the main attachment classifications. This provides support for Sroufe’s explanation of the interaction of infant and caregiver factors. A subgroup of infants who are predisposed to high levels of distress expresses strong emotions in the Strange Situation Paradigm upon separation as well as vigorous contact seeking upon reunion. But because these infants are unambivalent in their contact seeking and easily settled by caregivers, they are considered secure rather than resistant in their attachment classification. Similarly, there is a subgroup of infants in secure attached relationships who show minimal distress and contact seeking. They are rated as secure rather than avoidant because they are positive in response to their caregivers’ return.
Emotion regulation
Emotion regulation refers to the adapting of emotional reactions to satisfy the demands and expectations of the environment. It is through the process of emotion regulation that both infant and caregiver factors influence attachment relationships. Initially, it is an infant’s temperament that determines the intensity of his or her distress response. Over time, the caregiver's reaction to this response will determine how the infant learns to regulate his or her innate distress response.
There is some evidence to suggest that caregivers in the three attachment groups read emotions differently. For example, caregivers of infants in avoidant relationships describe emotional pictures with less intense labels than other caregivers. This could be one mechanism that influences the development of attachment patterns.
Attachment is one aspect of the infant-caregiver relationship. Both partners contribute to the development of infant attachment patterns. It is the interplay between an infant's temperament and a caregiver's response to emotions that determine the baby's style of responding during times of stress. Although infant and caregiver factors interact to influence attachment, it is the primary caregiver who plays the greatest role in determining the attachment relationship. A caregiver's ability to think and understand far exceeds that of the infant. Given the infant’s dependency on the caregiver, this capacity places caregivers in the position of responsibility and control in the development of infant attachment behaviours.
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