Toward prevention of developmental disorders. (1987)

In examining attachment behavior, it is evident that certain mental disorders have in common the early interruption of the necessary bond between mother and child. Treatment predicated on consideration of disrupted attachment has led me to successful intervention in many childhood disturbances, most notably early childhood autism. The fact that autistic children who were treated with mother-child holding therapy have fully recovered and have achieved normal development suggests that autism, the most extreme developmental disturbance, provides an important window into the working of normal development. If normal development can be achieved in cases of autism through this therapy, then we must consider the possibility of establishing normal development in other types of problem children and optimum development in normal children. REVIEW OF THE LITERATURE Early childhood autism has sparked controversy both in diagnosis and treatment since it was first defined in 1943 by Kanner. Until now there has been no systematic approach that either explained the disorders or led to an effective treatment. Kanner fixed on isolation as the primary disturbance in autistic children; hence the name autism. He suggested that all other behaviors of these children were derived from isolation.1 The intense interest in autism shown by researchers and therapists over the past four decades may stem from the fascination at finding a child who seems totally uninterested in human contact or who actively denies such contact. The literature reveals that there is a major disagreement among researchers concerning whether autism is organically determined, environmentally caused, or results from both environmental and organic causes. In addition to different views concerning the cause of autism, there are a number of different methods of treatment, including shock,2 the use of various drugs,39 behavior modification,1012 psychotherapy,1318 the use of parents in treatment,1924 or institutionalization.25 None of these various treatments has been proven effective in helping the children overcome their disabilities. HYPOTHESIS Starting with the hypothesis that autism represented disturbed attachment to the mother with unresponsiveness or withdrawal as the major mode of defending against the ruptured bond, I theorized that intense physical contact by the mother would break through the child's withdrawal and make possible the formation of a strong tie with the mother. The autistic child would then be free to develop normally once he was safe in the context of a strong bond with the mother. The development of my thesis and the results are gleaned from cases treated over a ten-year period beginning in the course of a training fellowship and subsequently as part of a general practice of child psychiatry. The theory of maternal-infant attachment is related to other work.2634 However, applying holding between mother and autistic child to establish an effective bond is original. The importance of bonding at birth has received a great deal of attention in recent years. Klaus and Kennell have shown that children who are not bonded at birth show difficulties later in life. My results suggest that the bonding can be repaired at a later stage of development. This therapy forges new bonds, repairs disrupted bonds, and reinforces bonds once established and consequently fortifies the relationship against disruption during the stress of various life circumstances related to separation. Holding therapy suggests that the mother-child bond is primary and essential for healthy child development. The finding that mothers are helped by holding therapy underscores the importance of the mother's need to be healthy in order for the child to be healthy. The treatment of unresponsiveness and disturbed attachment has its roots in the scattered research on gentling animals27 and the voluminous literature on attachment.29 Infants are born with different characteristics and vulnerabilities. …