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Relevance of Attachment Theory to Parenting Concerns Among Veterans With TBI

  • Post-Traumatic Stress Disorders (K Chard and T Geracioti, Section Editors)
  • Published:
Current Treatment Options in Psychiatry Aims and scope Submit manuscript

Opinion statement

Traumatic brain injury (TBI) is considered the signature injury of the Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (heretofore referred to as OEF/OIF/OND) US military conflicts. TBI can result in a myriad of cognitive, emotional, behavioral, and social-relational symptoms that can negatively influence one’s ability to parent. Additional factors can negatively impact the well-being of military families facing TBI, further increasing child-parent relationship strain: (1) high base rates of comorbid psychiatric conditions; (2) unique demographic characteristics of OEF/OIF/OND veterans; and (3) deployment stress that negatively impacts the emotional functioning of the veteran and their family. There remains a paucity of scientific literature supporting clinical interventions for improving parental functioning among veterans with TBI. With its focus on adaptive interactions and building a healthy child-parent bond, attachment theory offers a conceptual framework to consider when child-parent relationship ruptures occur after a parent has sustained a TBI.

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Notes

  1. Each scenario is a composite created from the authors’ clinical experiences with veteran parents with brain injury.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Okie S. Traumatic brain injury in the war zone. New Engl J Med. 2005;352(20):2043–7.

    Article  CAS  PubMed  Google Scholar 

  2. Defense and Veterans Brain Injury Center. DoD TBI worldwide numbers since 2000. http://dvbic.dcoe.mil/dod-worldwide-numbers-tbi. 2017. Accessed 5 Jul 2017.

  3. Edwards AR, Daisley A, Newby G. The experience of being a parent with an acquired brain injury (ABI) as an inpatient at a neuro-rehabilitation centre, 0-2 years post-injury. Brain Inj. 2014;28(13–14):1700–10.

    Article  PubMed  Google Scholar 

  4. Pessar LF, Coad ML, Linn RT, et al. The effects of parental traumatic brain injury on the behavior of parents and children. Brain Inj. 1993;7(3):231–40.

    Article  CAS  PubMed  Google Scholar 

  5. Uysal S, Hibbard MR, Robillard D, et al. The effect of parental traumatic brain injury on parenting and child behavior. J Head Trauma Rehabil. 1998;13(6):57–71.

    Article  CAS  PubMed  Google Scholar 

  6. Bornhofen C, McDonald S. Emotion perception deficits following traumatic brain injury: a review of the evidence and rationale for intervention. J Int Neuropsychol Soc. 2008;14:511–25.

    Article  PubMed  Google Scholar 

  7. Ducharme JM, Davidson A, Rushford N. Treatment of oppositional behavior in children of parents with brain injury and chronic pain. J Emot Behav Disord. 2002;10(4):241–8.

    Article  Google Scholar 

  8. Maestas K, Sander AM. Parenting in adults with traumatic brain injury. Arch Phys Med Rehabil. 2015;6(10):e44.

    Article  Google Scholar 

  9. Morriss E, Wright S, Smith S, Roser J, Kendall M. Parenting challenges and needs for fathers following acquired brain injury (ABI) in Queensland, Australia: a preliminary model. Aust J Rehabil Couns. 2013;19:119–34.

    Article  Google Scholar 

  10. Kieffer-Kristensen R, Siersma VD, Teasdale TW. Family matters: parental-acquired brain injury and child functioning. NeuroRehabilitation. 2013;32:59–68.

    PubMed  Google Scholar 

  11. Kieffer-Kristensen R, Teasdale TW, Bilenberg N. Post-traumatic stress symptoms and psychological functioning in children of parents with acquired brain injury. Brain Inj. 2011;25:752–60.

    Article  PubMed  Google Scholar 

  12. Taylor BC, Hagel EM, Cutting A, et al. Fiscal year 2011 VA utilization report for Iraq and Afghanistan war veterans diagnosed with TBI. Prepared for the VA Polytrauma and Blast-Related Injuries QUERI #PLY 05–2010–2. 2012. http://www.queri.research.va.gov/ptbri/docs/FY11-TBI-Diagnosis-HCU-Report.pdf.

  13. Sayer NA, Chiros CE, Sigford B, et al. Characteristics and rehabilitation outcomes among patients with blast and other injuries sustained during the global war on terror. Arch Phys Med Rehabil. 2008;89:163–70.

    Article  PubMed  Google Scholar 

  14. van Vliet-Ruissen C, McKinlay A, Taylor A. Adult functioning of mothers with traumatic brain injury at high risk of child abuse: a pilot study. NeuroRehabilitation. 2014;34:373–80.

    PubMed  Google Scholar 

  15. Gewirtz AH, Polusny MA, DeGarmo DS, et al. Posttraumatic stress symptoms among National Guard soldiers deployed to Iraq: associations with parenting behaviors and couple adjustment. J Consult Clin Psychol. 2010;78(5):599–610. doi:10.1037/a0020571.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ruscio AM, Weathers FW, King LA, et al. Male war-zone veterans’ perceived relationships with their children: the importance of emotional numbing. J Trauma Stress. 2002;15(5):351–7.

    Article  PubMed  Google Scholar 

  17. Samper RE, Taft CT, King DW, et al. Posttraumatic stress disorder symptoms and parenting satisfaction among a national sample of male Vietnam veterans. J Trauma Stress. 2004;17(4):311–5.

    Article  PubMed  Google Scholar 

  18. Allen ES, Rhoades GK, Stanley SM, et al. Hitting home: relationships between recent deployment, posttraumatic stress symptoms, and marital functioning for Army couples. J Fam Psychol. 2010;24(3):280–8.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Cohen E, Zerach G, Solomon Z. The implication of combat-induced stress reaction, PTSD, and attachment in parenting among war veterans. J Fam Psychol. 2011;25(5):688–98.

    Article  PubMed  Google Scholar 

  20. Davidson AC, Mellor DJ. The adjustment of children of Australian Vietnam veterans: is there evidence for the transgenerational transmission of the effects of war-related trauma? Aust N Z J Psychiatry. 2001;35(3):345–51.

    Article  CAS  PubMed  Google Scholar 

  21. Military One Source. 2015 demographics: profile of the military community. Department of Defense and Office of the Deputy Under Secretary of Defense (Military Community and Family Policy); 2016. http://download.militaryonesource.mil/12038/MOS/Reports/2015-Demographics-Report.pdf. Accessed 25 Apr 2017.

  22. Institute of Medicine. Returning home from Iraq and Afghanistan: assessment of readjustment needs of veterans, service members, and their families. The National Academy of Sciences; 2013. http://www.nationalacademies.org/hmd/Reports/2013/Returning-Home-from-Iraq-and-Afghanistan.aspx.

  23. Department of Veterans Affairs. White paper on the VISN 6 MIRECC post-deployment mental health registry study and data repository. Durham: Mid-Atlantic MIRECC; 2013.

    Google Scholar 

  24. Patrick V, Critchfield E, Vaccaro T, et al. The relationship of childhood abuse and early separation from the military among Army advanced individual trainees. Mil Med. 2011;176(2):182–5.

    Article  PubMed  Google Scholar 

  25. Seifert AE, Polusny MA, Murdoch M. The association between childhood physical and sexual abuse and functioning and psychiatric symptoms in a sample of U.S. Army soldiers. Mil Med. 2011;176(2):176–81.

    Article  PubMed  Google Scholar 

  26. Bonanno GA, Mancini AD, Horton JL, et al. Trajectories of trauma symptoms and resilience in deployed U.S. military service members: prospective cohort study. Br J Psychiatry. 2012;200:317–23.

    Article  PubMed  Google Scholar 

  27. Armed Forced Medical Surveillance Center. Associations between repeated deployments to Iraq (OIF/OND) and Afghanistan (OEF) and post-deployment illnesses and injuries, active component, U.S. Armed Forces, 2003-2010. Part II. Mental disorders, by gender, age group, military occupation, and “dwell times” prior to repeat (second through fifth) deployments. MSMR. 2011;18:2–11.

    Google Scholar 

  28. Pincus SH, House R, Christensen J, Adler LE. The emotional cycle of deployment: a military family perspective. 2011. Retrieved from: http://www.hooah4health.com/deployment/familymatters/emotionalcycle2.htm.

  29. Office of The Surgeon General United States Army Medical Command, Office of the Command Surgeon HQ USCENTCOM, Office of the Command Surgeon US Forces Afghanistan (USFOR-A). Joint Mental Health Advisory Team 7 (J-MHAT 7): Operation Enduring Freedom 2010, Afghanistan; 2011. http://armymedicine.mil/Documents/J_MHAT_7.pdf. Accessed 23 Nov 2015.

  30. Gewirtz AH, Erbes CR, Polusny MA, et al. Helping military families through the deployment process: strategies to support parenting. Prof Psychol Res Pr. 2011;42(1):56–62.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Mansfield AJ, Kaufman JS, Marshall SW, et al. Deployment and the use of mental health services among U. S. Army wives. New Engl J Med. 2010;362:101–9.

    Article  CAS  PubMed  Google Scholar 

  32. Flake EM, Davis BE, Johnson PL, et al. The psychosocial effects of deployment on military children. J Dev Behav Pediatr. 2009;30:271–8.

    Article  PubMed  Google Scholar 

  33. White CJ, De Burgh HT, Fear NT, et al. The impact of deployment to Iraq or Afghanistan on military children: a review of the literature. Int Rev Psychiatry. 2011;23:210–7.

    Article  PubMed  Google Scholar 

  34. Chartrand MM, Frank DA, White LF, et al. Effect of parents’ wartime deployment on the behavior of young children in military families. Arch Pediatr Adolesc Med. 2008;162:1009–14.

    Article  PubMed  Google Scholar 

  35. Lester P, Peterson K, Reeves J, et al. The long war and parental combat deployment: effects on military children and at-home spouses. J Am Acad Child Psychiatry. 2010;49:310–20.

    Google Scholar 

  36. Pemberton JR, Kramer TL, Borrego J, et al. Kids at the VA? A call for evidence-based parenting interventions for returning veterans. Psychol Serv. 2013;10(2):194–202.

    Article  PubMed  Google Scholar 

  37. Gibbs DA, Martin SL, Kupper LL, et al. Child maltreatment in enlisted soldiers’ families during combat-related deployments. JAMA. 2007;298(5):528–35.

    Article  CAS  PubMed  Google Scholar 

  38. Sogomonyan F, Cooper JL. Trauma faced by children in military families: what every policymaker should know. National Center for Children in Poverty. 2010. http://www.nccp.org/publications/pub_938.html.

  39. Rentz ED, Marshall SW, Loomis D, et al. Effect of deployment on the occurrence of child maltreatment in military and nonmilitary families. Am J Epidemiol. 2007;165(10):1199–206.

    Article  PubMed  Google Scholar 

  40. Paris R, DeVoe ER, Ross AM, et al. When a parent goes to war: effects of parental deployment on very young children and implications for intervention. Am J Orthop. 2010;80(4):610–8.

    Article  Google Scholar 

  41. Bowlby J. A secure base: parent-child attachment and healthy human development. New York: Basic Books; 1988.

    Google Scholar 

  42. Bowlby J. The nature of a child’s tie to his mother. Int J Psychoanal. 1958;39:350–73.

    CAS  PubMed  Google Scholar 

  43. Ainsworth MD, Blehar MC, Waters E, et al. Patterns of attachment: a psychological study of the strange situation. Lawrence Erlbaum Associates, Inc: Hillsdale; 1978.

    Google Scholar 

  44. Main M, Solomon J. Discovery of an insecure/disorganized/disoriented attachment pattern. In: Brazelton TB, Yogman MW, editors. Affective development in infancy. Nowrood: Ablex Publishing; 1986. p. 95–124.

    Google Scholar 

  45. Weinfield NS, Sroufe LA, Egeland B, et al. Individual differences in infant-caregiver attachment: conceptual and empirical aspects of security. In: Cassidy J, Shaver PR, editors. Handbook of attachment: theory, research, and clinical applications. New York: The Guilford Press; 2008. p. 78–101.

    Google Scholar 

  46. Marvin R, Cooper G, Hoffman K, et al. The circle of security project: attachment-based intervention with caregiver-pre-school child dyads. Attach Hum Dev. 2002;4(1):107–24.

    Article  PubMed  Google Scholar 

  47. Cummings EM, Davies PT, Campbell SB. Developmental psychopathology and family process. New York: the Guilford Press; 2000.

    Google Scholar 

  48. Collins NL, Read SJ. Cognitive representations of attachment: the structure and function of working models. In: Bartholomew K, Perlman D, editors. Attachment processes in adulthood. Philadelphia: Jessica Kingsley Publishers, Ltd; 1994. p. 53–90.

    Google Scholar 

  49. Main M, Kaplan K, Cassidy J. Security in infancy, childhood and adulthood: a move to the level of representation. Monographs of the Society for Research in Child Development. 1985; 50(1–2): 66–104.

  50. Bretherton I. Attachment theory, retrospect, and prospect. Monographs of the Society for Research in Child Development. 1985; 50(1–2): 3–35.

  51. Riggs SA, Riggs DS. Risk and resilience in military families experiencing deployment: the role of the family attachment network. J Fam Psychol. 2011;25(5):675–87.

    Article  PubMed  Google Scholar 

  52. Kobak R, Cassidy J, Lyons-Ruth K, et al. Attachment, stress, and psychopathology: a developmental pathways model. In: Cicchetti D, Cohen DJ, editors. Developmental psychopathology, Vol 1: Theory and method. 2nd ed. Hoboken: John Wiley & Sons Inc; 2006. p. 333–69.

    Google Scholar 

  53. De Wolff M, van IJzendoorn MH. Sensitivity and attachment: a meta-analysis on parental antecedents of infant attachment. Child Dev. 1997;68(4):571–91.

    Article  PubMed  Google Scholar 

  54. Cafferty TP, Davis KE, Medway FJ, et al. Reunion dynamics among couples separated during Operation Desert Storm: an attachment theory analysis. In: Bartholomew K, Perlman D, editors. Attachment processes in adulthood. Advances in personal relationships, Vol. 5. London: Jessica Kingsley Publishers; 1994. p. 309–30.

    Google Scholar 

  55. Medway FJ, Davis KE, Cafferty TP, et al. Family disruption and adult attachment correlates of spouse and child reactions to separation and reunion due to Operation Desert Storm. J Soc Clin Psychol. 1995;14(2):97–118.

    Article  Google Scholar 

  56. Fonagy P, Target M. Attachment and reflective function: their role in self-organization. Dev Psychopathol. 1997;9:679–700.

    Article  CAS  PubMed  Google Scholar 

  57. Bick J, Dozier M. The effectiveness of an attachment-based intervention in promoting foster mother’s sensitivity toward foster infants. Infant Mental Health. 2013;34(2):95–103.

    Article  Google Scholar 

  58. Sela-Kaufman M, Rassovsky Y, Agranov E, Levi Y, Vakil E. Premorbid personality characteristics and attachment style moderate the effect of injury severity on occupational outcome in traumatic brain injury: another aspect of reserve. J Clin Exp Neuropsychol. 2013;35(6):584–95. doi:10.1080/13803395.2013.799123.

    Article  PubMed  Google Scholar 

  59. Substance Abuse and Mental Health Service Administration. National Registry of evidence-based programs and practices: Attachment and Biobehavioral Catch-up (ABC). http://nrepp.samhsa.gov/ProgramProfile.aspx?id=68. 2016.

  60. Dozier M, Zeanah CH, Bernard K. Infants and toddlers in foster care. Child Dev Perspect. 2013;7:166–71. doi:10.1111/cdep.12033.

    Article  PubMed  PubMed Central  Google Scholar 

  61. • Bernard K, Simons R, Dozier M. Effects of an attachment-based intervention on high-risk mothers’ event-related potentials to children’s emotions. Child Dev. 2015;86:1673–84. Study examines maternal sensitivity through a neurobiological lens and demonstrates deficits in parents are impacted by the ABC intervention.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Bernard K, Dozier M, Bick J, et al. Enhancing attachment organization among maltreated children: results of a randomized clinical trial. Child Dev. 2012;83:623–36.

    PubMed  PubMed Central  Google Scholar 

  63. Jernberg A. Theraplay: child therapy for attachment fostering. Psychotherapy. 1984;21(1):39–47.

    Article  Google Scholar 

  64. The Theraplay Institute. What is theraplay. 2013. http://www.theraplay.org/index.php/what-is-theraplay-3.

  65. Makela J, Vierikko I. From heart to heart: Theraplay research at SOS children’s villages Finland. Espoo: SOS Children’s Village Association; 2004.

    Google Scholar 

  66. Bratton S, Landreth G, Kellam T, et al. Child Parent Relationship Therapy (CPRT) treatment manual. New York: Taylor and Francis; 2006.

    Google Scholar 

  67. • Bratton SC, Opiola K, Dafoe E. Play therapy: a comprehensive guide to theory and practice. In: Crenshaw DA, Stewart AL, editors. Child-parent relationship therapy: a 10-session filial therapy model. New York: Guilford Press; 2015. p. 129–40. Description of evidence-based therapy model grounded in attachment theory, that emphasizes the importance of the parent-child relationship as the mechanism for change.

    Google Scholar 

  68. Karlin BE, Cross G. From the laboratory to the therapy room: national dissemination and implementation of evidence-based psychotherapies in the U.S. Department of Veterans Affairs health care system. Am Psychol. 2014;69(1):19–33.

    Article  PubMed  Google Scholar 

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Acknowledgements

The writing of this manuscript was supported in part by the Office of Academic Affiliations Advanced Fellowship Program in Mental Illness Research and Treatment; the Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center; and the Hunter Holmes McGuire VA Medical Center.

The views expressed in this manuscript are those of the authors and do not represent the view of the federal government.

The authors wish to acknowledge Robert S. Marvin, Ph.D., and Craig Shealy, Ph.D. for their insightful feedback and guidance, which helped shape this manuscript.

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Authors and Affiliations

  1. Mental Health Service, Hunter Holmes McGuire Veterans Affairs Medical Center, 1201 Broad Rock Boulevard (116B), Richmond, VA, USA

    Lillian Flores Stevens Ph.D. & Treven C. Pickett Psy.D., ABPP-Rp

  2. Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA

    Lillian Flores Stevens Ph.D. & Treven C. Pickett Psy.D., ABPP-Rp

  3. Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA

    Lillian Flores Stevens Ph.D. & Treven C. Pickett Psy.D., ABPP-Rp

  4. Defense and Veterans Brain Injury Center (DVBIC), Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA

    Lillian Flores Stevens Ph.D. & Treven C. Pickett Psy.D., ABPP-Rp

  5. Virginia Treatment Center for Children, Richmond, VA, USA

    Jennifer L. Hinesley Psy.D.

  6. Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA

    Jennifer L. Hinesley Psy.D. & Treven C. Pickett Psy.D., ABPP-Rp

  7. Department of Psychology, James Madison University, Harrisonburg, VA, USA

    Anne Stewart Ph.D. & Kelly Atwood Psy.D.

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  1. Lillian Flores Stevens Ph.D.
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Correspondence to Lillian Flores Stevens Ph.D..

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Lillian Flores Stevens declares that she has no conflict of interest. Jennifer L. Hinesley declares that she has no conflict of interest. Anne Stewart declares that she has no conflict of interest. Kelly Atwood declares that she has no conflict of interest. Treven C. Pickett declares that he has no conflict of interest.

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Flores Stevens, L., Hinesley, J.L., Stewart, A. et al. Relevance of Attachment Theory to Parenting Concerns Among Veterans With TBI. Curr Treat Options Psych 4, 241–253 (2017). https://doi.org/10.1007/s40501-017-0117-x

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