Attachment and Chronic Pain in Children and Adolescents

Abstract

Although attachment theory is not new, its theoretical implications for the pediatric chronic pain context have not been thoroughly considered, and the empirical implications and potential clinical applications are worth exploring. The attachment framework broadly focuses on interactions between a child’s developing self-regulatory systems and their caregiver’s responses. These interactions are believed to create a template for how individuals will relate to others in the future, and may help account for normative and pathological patterns of emotions and behavior throughout life. This review outlines relevant aspects of the attachment framework to the pediatric chronic pain context. The theoretical and empirical literature is reviewed regarding the potential role of attachment-based constructs such as vulnerability and maintaining factors of pediatric chronic pain. The nature and targets of attachment-based pediatric interventions are considered, with particular focus on relevance for the pediatric chronic pain context. The potential role of attachment style in the transition from acute to chronic pain is considered, with further research directions outlined.

Child catastrophizing about parent chronic pain: A potential child vulnerability factor

“…Improved understanding of how children’s trait catastrophizing develops in the context of parental chronic pain is needed. Child catastrophizing about parent pain is likely impacted by child development, dispositional empathy (Goubert et al , 2005), and parent–child attachment (Donnelly & Jaaniste, 2016). Incorporation of these variables in future work will assist in clarifying their impacts on child pain catastrophizing.…”

Dejavniki tveganja in psihološka obravnava kronične bolečine pri otrocih in mladostnikih

“…Na ravni odnosa s starši se oblikuje tudi otrokova navezanost, ki vsebuje tri pomembne dejavnike, ki lahko doprinašajo k razvoju kronične bolečine: (a) vzorec izražanja čustev (ponotranjanje, pozunanjenje); (b) vzorec vedenjskega odziva na zaznano grožnjo in (c) kognitivna ocena ogrožajoče situacije. Otroci, ki razvijejo kronično bolečino, so na vseh treh omenjenih področjih manj učinkoviti, saj pri njih prevladuje nevaren stil navezanosti (Donnelly in Jaaniste, 2016). Za razvoj bolečinske simptomatike pa niso zadostni Kronična bolečina pri otrocih in mladostnikih pogoj le neugodni dejavniki na ravni družine in staršev, ampak mora biti otrok kot oseba s svojimi psihičnimi procesi (mišljenje, čustvovanje, vedenje) in biološkimi značilnostmi dovzeten za razvoj tovrstne simpotmatike (slika 2).…”

Adaptive functioning of children and adolescents with persistent pain: associations with sensory modulation and attachment ​​​​​​​

“…Atypical sensory modulation patterns predispose the child to be more susceptible to various parental responses, and have been found to be associated with insecure attachment (Whitcomb, Carrasco, Neuman, & Kloos, 2015). Theoretically, insecure attachment patterns that develop within threatening environments (Crittenden, 2008) influence the perception of threat and regulation of arousal (Schore, 2003), and evoke behaviours that prioritise care elicitation, such as pain signalling (Donnelly & Jaaniste, 2016;Kozlowska, 2009). These behaviours can interrupt engagement in regular activity and reduce functional capacity.…”

“…Post-traumatic stress disorder is more common in children and adolescents with persistent pain than healthy children (Noel, Wilson, Holley, et al, 2016), and those with persistent pain attending care are more likely to have experienced negative antecedent life events, such as physical illness, parental conflict, bullying, social loss, and have unresolved symptoms of loss and trauma (Ratnamohan & Kozlowska, 2017). Theoretically, Donnelly and Jaaniste (2016) proposed that the activating or immobilising patterns associated with insecure attachment may link with: (1) autonomic responses to threat that increase hypervigilance and neural sensitivity, (2) pain signalling behaviours to elicit responses from care-givers, and (3) cognitive appraisals of threat. These processes may predispose children and adolescents with insecure attachment to persistent pain and impaired function.…”

“…Children with persistent pain attending tertiary care have been found to have insecure attachment styles (Kozlowska, 2009;Ratnamohan & Kozlowska, 2017). Although theoretically it has been proposed that the child with persistent pain's attachment pattern may also impact his or her perception of sensory events (Crittenden, 2008;Donnelly & Jaaniste, 2016), the relationships between sensory modulation and attachment patterns have not been investigated in clinical populations.…”