The Security of Infants 9781487595401

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THE SECURITY OF INFANTS This book contains a great deal of information about the personality of young babies. But its greatest fascination lies not in the information it is able to supply, but in the many unanswered questions it raises. The author is convinced that each baby manifests his particular personality qualities very early in life, and the way that these are received by the environment into which he has been thrust will largely determine how he will stand up to the stresses of his future life. The development of a mental health assessment forms a yardstick by which a large variety of babies can be evaluated and should help us unfold some of the teasing obscurities of personality as they are revealed in infancy. If personality is a constant from early life to adulthood, such an instrument, revealing basic qualities in infancy, should lead therefore to greater understanding through school age and to adulthood, and help reveal the effect of environmental experiences on a growing child. The thesis of the book is that mental health in infancy is derived from a close dependent relationship with a mother-figure who gives a child an opportunity to form a dependent trust in her care and affection. From this relationship is derived the desire to become effortful, outgoing and independent in one's world, which leads eventually to trust in oneself as a person of uniqueness and worth. The book should have greatest appeal to child care workers, psychiatrists and pediatricians. Research centres for child development should be interested in the experimental aspect of the work. BETTY M. FLINT is Senior Research Associate in charge of Infant Research at the Institute of Child Study, Consultant to the Neil McNeil Infants Homes, Consultant to the Psychology Department of the Children's Aid of Metropolitan Toronto, and a Lecturer at the Ryerson Institute of Technology. In 1952 she became first president of the Nursery Education Association of Ontario.

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THE SECURITY

OF

INFANTS

Betty Margaret Flint

UNIVERSITY OF TORONTO PRESS

Copyright, Canada, 1959, by University of Toronto Press Printed in Canada London: Oxford University Press

Foreword MBS. FLINT HAS EVOLVED a test for infants which has proved to be of diagnostic value in placing a child for adoption. All child placement has been concerned with two matters: the adequacy of the home, and the health of a child's personality. Decisions regarding these matters have up until now been made for the most part on the basis of clinical experience of social workers, psychologists and psychiatrists. Mrs. Flint has attempted to devise a test which incorporates the fruits of sound clinical experience and also includes other significant aspects of a child's home life derived from the theory of security. She in no way claims that this is a final word in testing the personality of infants; rather, she views it as a beginning, not an end. To those of us who have had to assume the responsibility of appearing in court from time to time to pronounce that parents of a certain child are "unsuitable," the prospect of a forthcoming objective measure of the mental health of infants is very hopeful. The scale which Mrs. Flint provides is indeed a promising signpost towards this goal. It has been a privilege for my staff and myself to have been associated with the progress Mrs. Flint has made in her pioneering work in this worthy area. W. E. BLATZ

V

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Preface THIS BOOK describes a scale by which the mental health of infants may be assessed. This scale stems from two roots: the discussions of and reflections on the security theory of the Institute of Child Study at the University of Toronto; and the studies which my students and I have made of infants in clinics, institutions and homes. Although this book is culled from our thought and work of ten years, it is essentially an interim report. The scale has proved useful practically, but it is as yet far from established according to the formal criteria of reliability and validity. The purpose in publishing a report at this time is to speed up the development and use of the scale. Babies are remarkably hard creatures to adapt to the dictates of scientific methods. They have to be tested where and when they are available and the process is often long and tedious. Furthermore, the appraisals must be made by testers versed not only in science but in babies, and as babies can be detached from their mothers only artificially, the tester must be skilled in paying more than lip service to the mother-child relationship. Longitudinal studies require in addition the virtue of patience to await a baby's growth. Therefore it seems opportune to make public at this time the work we have done. In this way people far beyond our own Institute, who are interested in similar research, may abet the refinement of this instrument for measuring the security of infants and thus bring us nearer our goal—the promotion of good mental health. Many people have co-operated with and encouraged these studies. Dr. W. E. Blatz has encouraged the clarification of his Security Theory at the level of infants. Dr. Mary Northway provided the impetus and practical guidance towards publication. Professor Dorothy Millichamp has contributed much of her sound and perceptive knowledge of children. Other members of our Institute staff, Mrs. Noel Partridge, Miss Lindsay Weld, Miss Mary Kilgour and Mrs. Helen McNeil, have participated actively in the studies. Miss Marie Milton has been an extremely efficient secretary in preparing the manuscript; and we are indebted to Mrs. Marjorie Wilson for some of the graphics. Beyond our own Institute, I am grateful for the help of Dr. Bruce Quarrington, Research Fellow at the Centre for Advanced Study in vii

Vlll PREFAC

E

the Behavioural Sciences, and that of Dr. Eleanor Long, psychologist at the Children's Aid of Metropolitan Toronto. More particularly, I have been encouraged by the critical interest of my husband Lyman Flint; this has played a considerable part in the refinement of the theory. I should also like to acknowledge assistance from the Publications Fund of the University of Toronto Press. Institute of Chttd Study University of Toronto May 1958

B.M.F.

Contents FOREWORD

v

PREFACE 1. MENTA

vii L HEALTH IN INFANCY 3

Current Thoughts on the Mental Health of Infants The Security Theory of Mental Health The Security Theory of the Mental Health of Infants Good Mental Health Poor Mental Health

5 11 14 14 21

MEASURING THE SECURITY OF INFANTS 2. CONSTRUCTING A MENTAL HEALTH SCALE Selection of Items Considerations Regarding Endorsement Method of Endorsement Methods of Scoring Method A Method B Method C: Security Quadrates 3. A

STUD Y O F WELL-ADJUSTED AN D POORLY ADJUSTE D INFANT S 4

A Comparison of Security Scores Selection of Groups Administering the Scale Differences in Security Scores Reliability Variations in Breadth of Experience Regressions and Deputy Agents Use of the Scale for Guidance 4. A

STUDY OF TWO CHILDREN 4

27 27 33 33 34 35 36 0

40 40 42 43 44 45 46 47 9

Case I: An Analysis of Joe Case II: An Analysis of Bill What We Have Learned ix

50 56 59

X

CONTENTS SECUBTTY AND INSTITUTIONAL LIVING

5. THE SECURITY OF INFANTS IN AN INSTITUTION The Institution The Infants Method of Observation The Results Interpretation of the Results 6. SECURIT

Y AND THE PROBLEM OF INSTITUTIONALIZED INFANT S 7

Suggestions for Reducing the Adverse Effects Use of the Infant Security Scale for Prognosis A Study of Four Children Child E: Lorelie Child H: Michael Child K: Kathleen Child L: Ernest 7. SUMMARY

63 64 65 65 66 72 6

76 77 77 80 83 85 88

APPENDIXES I. EARLY STUDIES PRELIMINARY TO THE INFANT SECURITY HYPOTHESIS First Study, 1948 Second Study, 1949 Third Study, 1950 Discussion

95 96 98 101 104

u. SYMPTOMS OF SECURITY AND INSECURITY

105

HI. THE INFANT SECURITY SCALES

112

IV. ANALYSIS OF SCORES

123

REFERENCES

133

THE SECURITY OF INFANTS

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1. Mental Health in Infancy THE TWENTIETH CENTURY has been an era of challenge to man's previous way of life. A tremendously increased pace of living and facilities to communicate with people remote and unfamiliar have proved exciting and beneficial in some ways, and in other ways have threatened man's ability to cope effectively with all the experiences open to him. The first technical wonder to extend man's horizons was the automobile. Its use resulted in a change of living habits probably as extensive as those arising from the invention of the wheel by early man. The automobile was followed by the aeroplane, which made possible the intermingling of people vastly different from one another. The impact of seeing and experiencing different ways of Me challenged the comfortable Brightness" of each person's customary way and reduced the solid certainty that his own particular group had found a final answer to adequate and happy living. Now on the horizon looms the intriguing possibility of space travel, which in turn is accompanied by a shattering awareness of the finiteness of man, attempting to understand and to control a vast and complex universe whose laws remain in large part unknown and whose mysteries are unexplored. Mass communication through radio, moving pictures and television has made men vibrantly aware of the activity and attitudes of people all over the world. Although it has offered promise of increased understanding between nations, it has also brought attendant disadvantages. Through misuse and misrepresentation of news, the fears and apprehensions of men are magnified until it would appear that nations of comparable strength feel nothing but hostility and aggression towards one another. Thus communities of men live in a state of constant alertness to resist any infringements of their rights and borders. It appears that increased understanding in the physical sciences and greater technical skills have enhanced man's feeling of confidence in his capabilities. However, these have also threatened man's physical and mental well-being because his technical ability can create conditions which he is unable to control. Traffic accidents threaten every day, aeroplanes have presented insuperable hazards to Ufe and sanity during war, and now nuclear weapons may annihilate vast areas and thousands of people all at one time. The ineffectiveness of traffic laws to control a driver's speed and to aid his poor judgment is obvious. 3

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The thousands of tons of paper, recording speeches, suggestions, orders and proposed plans for control of nations, which lie in the files of the League of Nations and the United Nations attest the inability of man to come to grips with his most pressing problems. Yet, despite his failure and anxiety to control his communal living, he has had some success in finding laws to help him live effectively in his threatening world. In the early part of this century, preventive medicine was introduced to assist man to control some aspect of his physical well-being. Instead of waiting until they became ill, people were urged to take measures beforehand to ensure their health. Rules of diet, dental hygiene and physical fitness were made public. These rules were based on scientific discoveries relating specific causes to effects. If certain illnesses were caused by vitamin deficiencies, it seemed logical that good health could be maintained by the consumption of an adequate vitamin supply. Now, although there are still severe limitations in knowledge, a man can be not only treated for physical illness, but also assisted to maintain physical health. More recently, psychological science has shown signs of following a similar trend. The apparent increase in mental illness, at least in the Western world, has prompted psychiatrists and research psychologists not only to seek improved methods of treatment, but also to formulate laws of behaviour which can be oflFered as principles of mental health. Knowledge of the laws of human behaviour is beginning slowly to accumulate. Because of the limitations of research methods, only a single aspect of personality can be investigated at one time, and the tendency is therefore to attempt to relate specific causes of behaviour to later generalized effects. ( For example, a child who fails in school despite an adequate level of intelligence is sometimes presumed to do so because he is resentful of his teacher.) Nevertheless, some principles have emerged gradually from research which have been incorporated with confidence into rules of mental hygiene. On the other hand, psychiatrists and psychologists in the clinics, seeing people in their total ufe situation, have offered the world the most meaningful insights into personality. These insights or hunches are always open to scientific criticism, because they are necessarily lacking in clear-cut relationships and well-defined distinctions. A psychological observer in a clinic sees a person as he is at the moment, the end result of a multitude of experiences to which he has reacted in a characteristic way. These behavioural responses have shaped the

MENTAL HEALTH IN INFANCY 5

individual's personality from birth by a circular process in which he reacts to the environment, and in turn has an effect upon it. It is accepted that when a child is born he has certain strengths and weaknesses that are dominant in his physical and emotional make-up. As a result, from the beginning of his Ufe a relationship is established between him and his environment in which his strengths and weaknesses are given recognition. This recognition does not necessarily mean acceptance on the part of adults, but could in fact be in the nature of limitations which will discourage the child. As a result of this relationship, a unique pattern of behaviour is developed which takes cognizance of the child's original predispositions. In other words, his unique demands on the environment create unique responses. This process has a cumulative effect which shapes his attitudes and influences the development of his personality. The complexity of this process confronts a clinical observer with a variety of facts, too confused for him to trace them to their origin. He therefore comes to conclusions based upon what appear to be the most significant experiences and reactions appropriate to a person's present behaviour. In so doing, he necessarily ignores or glosses over much of the specific detail of the person's life, while grasping for more general principles and/or relationships which have emerged in the course of diagnosis. Despite the lack of scientific precision in this process, and the possibility of erring in the selection of significant aspects, some important observations regarding the etiology of personality adjustment have been made consistently enough to be incorporated into principles of mental health. It is from this process that some of the present thought has arisen regarding the importance of an infant's experience for his later adult life. CURRENT THOUGHTS ON THE MENTAL HEALTH OF INFANTS It was Freud who first convinced people that adverse experiences in infancy could lead to serious maladjustment in later life. In reference to these early experiences which he believed were forgotten because they were repressed, he stated (10), "... we must assume, or we may convince ourselves . . . that the very impressions we have forgotten have nevertheless left the deepest traces in our psychic life, and acted as determinants for our whole future development." The general implications of this theory, developed from the introspection of disturbed adults who recalled childhood experiences under hypnosis, are generally accepted as workable clinical hypotheses. However, much of the substance of the theory, such as the experience of sexuality

O TH

E SECURIT Y O F INFANT S

by infants, is still questioned, and the possibility of finding scientific proof of Freud's assumptions seems remote. Of course, the theory was formulated long before many scientific facts of human growth had been discovered. Despite this, it is acknowledged as providing a most useful frame of reference within which to describe and interpret abnormal behaviour of both children and adults. Its deficiency appears when it is applied to normal children, an occurrence which leads its adequacy as a comprehensive theory of personality to be questioned. Nevertheless, Freud's tremendous contribution to psychology has been his emphasis on the importance of early childhood experiences; and in the resurgence of interest which has recently taken place regarding the psychological state of infants in hospitals, institutions and similar environments, his frame of reference has been used to interpret that state. This renewed interest in infants has arisen from the actual observation of children who are developing or who have developed in an atypical way under conditions in which a relationship with a mother has been interrupted or has never existed. These conditions have called attention to the primary role of a mother in the very early psychological development of infants. Because the babies studied have all lacked the same factor, that is, a mothering adult, this lack has been accepted as the cause of their difficulties. It has been further inferred that the mother is the initiator of psychological development, and that without her a child therefore cannot develop normal psychological attributes. Although the current studies come closer to factual data than did Freud's method of recall, nevertheless the conclusions arising from them can be criticized on two counts: they are generalizations based on children whose development has been distorted; and certain assumptions regarding the importance of a mother to an infant are made without any scientific justification. Despite these criticisms, current work has considerable practical value, particularly if used as a basis for treatment of these unusual children. For example, it is known that children grown apathetic and unhappy through stay in hospital will once again become responsive, lively and interested if given the attention of one individual who will play with them and show a continuous interest in them. Although specialists recognize ways of treating, even they do not fully understand the process of recovery and therefore it is necessary to put forward a hypothesis which attempts to explain this process. Margaret Kibble (26,27) is one of the most enthusiastic proponents of the theory that the psychological tie between a mother and child

MENTAL HEALTH IN INFANCY 7

is the key to sound emotional development from birth. The continuous flow of mother-love to a child is thought to guarantee healthy development and to be the essential stabilizing force in his Ufe. Kibble (28) hypothesizes that a primary danger exists at birth and she states, "the appropriate expression of mother-love is a basic dynamic factor in overcoming the innate potentiality of the infant for anxiety and the tendency to regress to a simpler level of function." She assumes that a child has three physiological hungers—for oxygen, feeling and eating. His specific psychological needs are to feel secure, to get pleasure from bodily functions, and to feel he is a going concern in the world of human beings. The three hungers are satisfied by following the rhythm of a child's "inner needs" for actual food and also for stimulation. The hunger for stimulation is satiated by sucking activities, cuddling, adequate sleep, and adequate routine care in the form of bathing and elimination. This care is called "mothering." Regarding this, Kibble states (27, p. 104), "The art as well as the science of mothering is to initiate and give momentum to the first functions of the child as they develop in sequence, but two situations must never be allowed to come about— the overdevelopment of the child's emotional attachment for his mother, or a ruthless weaning from her." Kibble thinks three situations of a child's life—birth, weaning and toilet training—are potential areas of insecurity, and must therefore be handled skilfully by the mother. She incorporates some of the Gesell (13) philosophy of self-demand by stating (27, p. 72), "The human infant in the first year of life should not have to meet frustration or privation for these factors immediately cause exaggerated tension and stimulate latent defense activities. If the effects of such experiences are not skilfully counteracted, behaviour disorders may result. For the baby, the pleasure principle must predominate, and what we can safely do is bring balance into his functions and make them easy." "Only after a considerable degree of maturity has been reached can we train an infant to adopt what we know as adults as the reality principle." "The environment of the infant should be adapted to his needs, not the other way round." The mother is the basic factor in early emotional, social and mental development. Any distortion of the mother relationship makes a baby anxious (26, 27). "Infants who do not have a direct emotional attachment to the mother show various forms of distorted behaviour either in their eating and elimination or else in their speech or locomotion. . . . Later on in Me these children have great difficulty in building up their

8 TH

E SECURITY O F INFANT S

first relationships with other members of the family group and are thus unable to find the emotional outlet which they so urgently need." This thesis finds support in studies such as those of Spitz (31,32), Rheingold (25), Bakwin (2,3), Goldfarb (14,15), and Wolf (34), whose observations of children in hospitals and institutions have led them to conclude that the lack of a maternal figure in the life of such children has created conditions that lead to retardation in physical and mental processes and a dulling of emotional life. The latter operates against the establishment of satisfactory relationships with other human beings both at the time and in later life. As a result of his work with babies in hospital, Spitz ( 31 ) has pointed up the possibility that deprivation of maternal care, even in the early months of Me, may cause permanent impairment of mental health. Evidence from many studies confirms the belief of Spitz and Wolf (34) that children raised in institutions show an overwhelming decline in developmental quotient, even within the first twelve months of life. From various parts of the world comes evidence that many infants who are raised in institutions are untestable as a result of their apparent inability to relate either to adults or to play materials. Motor control and language development appear markedly retarded. The question of recovery from such apparent psychological damage is an open one, on which a variety of opinions appear. It is obvious to anyone who has observed a young child reacting to a hospital experience (30) that he seems to be in a state of emotional distress. Sometimes, when physical illness is severe, this distress seems to amount to both a physical and a psychological emergency. It is also apparent that dramatic physical and emotional recovery often takes place when such a child is returned to his home ( 1, 2, 3, 7, 29). No one knows how permanent is the psychological damage of prolonged hospital care. The study conducted by the Tavistock clinic team (30) on a twoyear-old child in hospital, although not proving irrefutably that every hospitalized child feels so threatened emotionally, provides evidence that some children certainly suffer severe emotional upset, which is even carried over into their homes on their return. Evidence from a variety of studies (1, 7, 30) indicates that the children show several common patterns of adjustment in their homes, one of the most evident being a refusal to recognize their mother at first, followed by weeks of apprehensive clinging to her wherever she goes. It is the contention of Spitz and Wolf (34) that even after a return to the mother and apparent recovery of emotional security, there is

MENTAL HEALT H IN INFANCY 9

always the possibility that psychic disturbance might be reactivated later, in time of stress. They further believe that after three months of deprivation a qualitative change takes place which rules against any complete recovery. Retrospective studies, based on more remote evidence but all pointing to the same phenomena, seem to support this contention. Bowlby (7), Goldfarb (14, 15), Bender (6) and many others have presented convincing evidence that many children whose relationships with their mothers were disrupted in early life, or who, living in an institution, had almost no mother relationships, became affectionless, psychopathic and frequently delinquent characters. Bowlby (p. 71) sums up evidence presented by the various studies by saying "that it leaves no room for doubt regarding the general proposition ... that prolonged deprivation of the young child of maternal care may have grave and far-reaching effects on his character, and so on the whole of his future life." The value of "mothering" and the adverse consequences of "maternal deprivation" are still queried by those who either have not seen infants so deprived, or, in their desire to be scientifically sound, wish clear-cut statistical proof of the postulates presented. Pinneau's virulent attacks (21, 22, 23) on Kibble's psychological and medical assumptions, and on Spitz's research design (32) and lack of statistical proof, may make a pure scientist glow, but serve only to alienate the clinical child psychologist who has been convinced by what he sees, that the general proposition regarding maternal deprivation and the psychological importance of mothering is true (33). The mothering thesis seems further supported by the observation that children separated from their true mothers can maintain their mental health if a substitute mother is provided within a short time after separation. This is particularly true of children placed in a foster home where they remain until return to their own parent or placement with an adopting parent. On the other hand, most of the writers indicate poor response to treatment of any kind once a child has suffered severe deprivation. Evidence to support this assumption is not yet conclusive. As Bowlby states (7, p. 46), "although the main proposition may be regarded as established, knowledge of the details remains deplorably small . . . that deprivation can have bad consequences is known, but how much deprivation children of different ages can withstand has yet to be determined." Ainsworth ( 1 ) and Bowlby have clarified the concept of deprivation by indicating that it is of three orders: a lack of any opportunity to form an attachment to a mother figure; deprivation for a limited period

10

THE SECUBITY OF INFANTS

—at least three months and probably more than six, during the first three or four years of life; a discontinuous relationship with one or more mother figures during the first three or four years. Evidence regarding the most vulnerable time within this period is discussed in Maternal Care and Mental Health (7, pp. 47-8). For a summary of the studies regarding maternal deprivation, Bowlby's book is unexcelled. An extensive discussion of the literature pertaining to motherchild relationships may be found also in Brody's Patterns of Mothering (9). Most of the studies about mothering and maternal deprivation, arising as they do from clinical studies, consider abnormal development and its etiology. Through a consideration of what is lacking in a child's life, direction is obtained regarding those qualities that should be present. As a result of these studies much emphasis is now placed on the very close relationship which should exist between mother and infant. Some authors even regard it as an extension of the biological closeness which exists before birth (20). Rooming-in practices being adopted by some hospitals in North America (30, pp. 141-68) are an expression of the belief that the security of a baby and mother will be enhanced by the fact that the tie between mother and child is not severed prematurely by placing a new-born child in the hospital nursery. This appears to be the North American adaptation of the successful European and English policy of having midwives come into the home for deliveries, thereby permitting the baby and mother a close relationship within the comfortable framework of the family. Natural childbirth ( 24 ) and the presence of the father during much of the delivery, although predominantly offering the mother more peace of mind, have implicit in them the thought that the more secure and happy a mother, the readier she is to welcome her child and to offer it necessary love and comfort (that is, adequate mothering). There is obviously no way of evaluating accurately the effect of these practices on the security of infants. It is necessary to rely on the comments of mothers and attendant physicians. Those comments (30) which are reported are generally favourable, although the chances of having a favourably biased sampling are great. A more positive and objective approach to the matter of the mental health of young children is found in the work of such people as Arnold Gesell and W. E. Blatz (4, 5). Gesell (10, 13) emphasizes the orderly sequence of development which takes place from the embryonic stage on through a child's life. He sees the growth of the mind as tied to the growth of the nervous system (12), and describes it as

MENTAL HEALTH I N INFANC Y 1

1

essentially a patterning process. His experimental evidence is carefully presented and finds expression in the Gesell Infant Developmental Scale (11). He believes that there are three personality types, based on constitutional factors, and that within these types there are wide individual differences (13). It seems therefore logical that his theory of "self-demand" should develop from these differences. In order to ensure a child's physical and emotional well-being, one should first consider, when caring for him, his nature and needs. The culture (that is, parental care and routine procedures) should wait upon the child and adapt to his nature and needs during the first few months of Me. Gradually the child finds his own rhythm, which in turn is readily adapted to the family pattern as he matures. The principle of selfdemand is today generally accepted as sound, although there is some disagreement regarding the length of time that it should be perpetuated. According to reports, many children spontaneously adopt a routine congenial to a household rather rapidly. On the other hand, when a child does not do this and self-demand is extended beyond the first few months of his Me, self-demand becomes "permissive" care. It is now evident that most young children suffer a lack of security in permissive surroundings and show many symptoms of ill health which seem to indicate their desire to have limitations and boundaries imposed on their behaviour. THE SECUBTTY THEORY OF MENTAL HEALTH Blatz (5) offered a concept of the mental health of infants as part of his general theory of security. This theory has the advantage of providing an explanation with practical application to both good and poor mental health. The detail of its application (17, 18, 19, 29) has been most thoroughly investigated at the adult level, leaving the reference to infancy and pre-school years in general terms which lack clear definition. Briefly, the security theory is as follows. Mental health is defined (4, 5) as a "serene state of mind arising from the willingness to accept the consequences of one's own decisions and actions." As this is a dynamic state, man is always seeking serenity and finds it only temporarily as he faces new and changing situations in his daily living. Hence he never rests easy in a complete state of security, but rather faces a constant stream of problems that must be solved and that create in him temporary feelings of insecurity, the intensity of which will be based on his capacity to find a ready solution. The solution to his problems can be found in many ways, some of which are decidedly healthier than others. One way is reliance on a mature dependent

12 TH

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agent who shares the decisions which solve the problems, and who also shares the consequences of the decisions. This is a healthy method. Another way is total reliance on another person to make the decisions and to accept the consequences. This is called the "infantile dependent" solution because it resembles the state of helpless dependency of a very young child who permits others to care for his physical and emotional needs and to take complete responsibility for his well-being. Although an acceptable method by which a young child maintains mental health, this is an unhealthy way in adult life as it is a form of regression to a less mature stage of living. Another way of solving problems is the use of avoidance mechanisms ( deputy agents ). Deputy agents such as rationalization, compensation and sublimation permit the individual a temporary feeling of security. If the secure feeling is to be perpetuated, the deputy agents must be reinforced or increased in number. For this reason, deputy agents, although providing immediate relief from anxiety, are potentially undependable. Although some are always present in a healthy personality, there is danger that they might become predominant and permanent mechanisms of adjustment. If this happens the individual loses his capacity to criticize his own mental processes and thus becomes a poor mental health risk. The most healthy way for anyone to solve problems is to put forth effort to learn a skill, thereby relying on oneself for the solution. In addition, one must accept the consequences of whatever decision is made and of whatever action is necessary. This is called the "independently secure" way. It is apparent that independent security rests on a person's capacity to make, and act upon, his own decisions, that is to operate in an independent way. While doing this, he necessarily learns to accept insecurity, because through learning he discovers adequate ways of overcoming the anxiety of facing a problem and gradually develops a habit of thinking (feeling) that he is capable of solving his problems through his own efforts. Although the security concept of mental health had practical implications for clinical work with very young children, it still required clarification of its detail as it applied to the early years of life. If this could be done, it might be possible to develop an assessment of mental health which would permit an objective view of degrees of mental health of infants. Such an instrument would be of considerable value to social agencies caring for young babies where some estimate of a child's present adjustment and possible future security would assist in

MENTAL HEALT H IN INFANCY 1

3

planning both boarding home and adoptive care. It would also permit more accurate investigation of early childhood experiences than had been possible before and eventually perhaps indicate a way of validating the conclusions regarding maternal deprivation. If a mental health scale for infants could be developed on somewhat the same systematic basis as Gesell's Developmental Scale (11), it would be of value to parents, paediatricians and clinicians who needed an assessment of children's behaviour, particularly if it were deviating from the normal. Because of the inability of a baby to communicate his feelings, it was recognized that assessment would necessarily be dependent on behavioural manifestations which would lend themselves to a systematic evaluation of degrees of mental health. Through a clarification of the security concept, it should be possible to provide a systematic framework which might be used as a way of interpreting behaviour symptoms. The task was twofold, therefore: first, a clarification of the security theory at the level of infants; and second, the construction of a security test to measure mental health. In order to proceed, the theory of security of adults was used as the point of departure. In the past, those seeking indices of optimum mental health in adult life (18, 28) had looked for signs of independent action. Persons showing a high incidence of these were considered independently secure. When we started to seek indices of the mental health of infants, it was necessary to try to visualize how the adult state of independent security was reached over the period of the growing years. What kinds of infant and early childhood experiences were important to the emergence of a serene adult? What stages of psychological development preceded the final stage of a mentally healthy adult? In an attempt to find some of the answers to these questions, studies on data reported systematically by parents of infants were conducted for several years at the Institute (see Appendix I, page 96). These data were examined for evidence to support the adult security theory in its application to infants. The first effort involved a search for signs of independence, particularly in new situations, as criteria of security because it was assumed that these healthy modes of adjustment should appear very early. The results of this study created a dilemma in theory, because they indicated that the babies showing the greatest number of signs of independence (interpreted as refusal of care and direction) were less secure than those showing marked dependence (interpreted as acceptance of care and direction). From this study, we

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were thus forced to conclude that although all the babies showed signs of both dependence and independence, the truly secure baby was the one showing a preponderance of dependence. These data provided a second clue, evidently as important as the first. They indicated that one should seek out indications of the quality of the relationship between a child and the persons most directly caring for him, as well as signs of dependence and independence, as criteria of security. A third clue implicit in these data also seemed important: each baby evidenced some kind of personality "core" which reflected his general state of mental health. The adjustment of each child showed a quantitative difference which was consistent within each from the early months to five years of age. This difference could be assumed to be a core of security which grew in the early months of life. As these studies (Appendix I) gradually unfolded, our theory was modified to adapt to their implications. Finally, the following clarification of the security theory of the mental health of infants emerged. THE SECURITY THEORY OF THE MENTAL HEALTH OF INFANTS This concept is outlined in the diagram on pages 15-17 which may be used for reference when reading the following section. Good Mental Health Mental health in an infant is a serene state of mind arising from a feeling of self-worth and a conviction that his world is benign. It is developed in a child, from birth on, through a compatible relationship with his mother.* The relationship in the first few weeks of Me gradually reduces and finally overcomes the newborn infant's insecurity on being thrust into a world requiring considerably more adaptation than that experienced in utero. His totally helpless state requires constant care from his mother in order to reduce his recurrent discomfort arising from cold, wetness and hunger. During the neonatal period, this care is almost totally physical because the immaturity of the child arbitrates against his responding to care in any way other than by falling asleep after it is received. However, as he matures and becomes more wakeful and more aware of his environment, the child must recognize some relationship between the action which relieves his discomfort and the person who makes him comfortable. Gradually comes an awareness that he can expect care when he needs it and that there is a dependable "someone" on whom he can 'This term refers not only to his biological mother, but to anyone giving continuing immediate care.

MENTAL HEALTH IN INFANCY

15

16

THE SECURITY OF INFANTS

MENTAL HEALTH IN INFANCY

17

18

THE SECUHITY OF INFANTS

rely to replace his discomfort with comfort. He soon associates a "warm" feeling with the sight, sounds, smells and administration of this person because she consistently has relieved his anxiety and he can rest easy in the belief that she will always do so. He begins to recognize too not only that she cares for him when he cries, thus responding to his demand for care, but also that he can expect her to anticipate his needs. This anticipation in turn reduces his incidents of discomfort while prolonging his periods of comfort. As his awareness of this situation grows, an infant develops an expectation that the world will be benign in the future as it has been in the past. This aspect of an infant's mental health is considered the first essential quality and has been termed the "dependent trust" stage. It is reflected in his behaviour as he accepts happily the care his mother gives to his eating, bathing, dressing and sleeping activities as well as to his need for playthings and social contacts. His anticipation of her attention is obvious in such behaviour as quietening when he hears her approach, a reduction of activity when being changed, and a show of excitement on seeing his bottle. These early acts of caring for a child, although predominantly physical in nature and designed to relieve discomfort, have an important psychological aspect also. They usually are accompanied by affectionate interplay between a mother and child, and would seem to be an expression of the mother's feeling of love and tenderness towards her baby. While changing, dressing, feeding and bathing him, she will tickle, talk to, coo at, cuddle, pat, scold, and rock her child. This in turn elicits a response of chuckles, gurgles, kicking, hand-waving, and general delight from the baby as he slowly grasps the thought that he is a person of value to his mother. This gradually becomes established in his mind as a feeling of self-worth. It is this feeling of self-worth which lends the child sufficient confidence to put forth self-initiated effort towards limited goals in his world. He now wants to demand attention even when it is not really needed; he is energetic, socially outgoing, and interested in learning. He can also enjoy paying attention to play equipment because his feeling of self-worth naturally finds expression in a joyful release of energy. The rewarding consequences of such self-initiated effort further enhance the child's feeling of self-worth as he begins to be capable of satisfying some of his own needs (that is, for change of activity, or for food) and achieving some of his goals. As self-confidence becomes the predominant feeling, it becomes a core of self-trust, the second essential quality of mental health in a

MENTAL HEALTH IN INFANCY 1

9

young child. This self-trust is reflected in an infant's behaviour when he begins to show signs of what his mother will call "personality." Now he not only accepts her care but energetically demands it as well. He anticipates his mother's appearance when he hears her footsteps, and protests if they do not come towards him as he expected. He calls for attention if he feels ignored, indicates his desire for food, toys, change of activity, and more people, according to his own self-centred goals. He is no longer satisfied that his mother should anticipate all his needs. If his dependent trust and self-trust are becoming well established, he now believes that his self-initiated effort is rewarding not only because it is fun for himself alone, but also because it is acceptable to and appreciated by his mother. This acceptance becomes a secondary reinforcement to the child's self-confidence, expressed in his enjoyment of activity. Now he is quick to express his wishes and vehement in his protest when thwarted. He will want to play in the bedroom drawers, take the pots and pans out of the kitchen, feed himself before he is capable, and climb on the table to see what's there. His enjoyment of life reflects an underlying "good" feeling. If he is to continue to grow in mental health it is essential that the adults around him support his effort, although frequently it brings conflict between his mother and himself. This is a crucial time when he is ready to enjoy the satisfaction of completing a self-initiated project, but must necessarily be limited in his activity to ensure his own safety and the convenience of the total family. Should he be thwarted constantly in his efforts to project himself into his environment, he may lose some of his feeling of self-trust and eventually even lose his desire to be effortful. Such a condition will not arise, however, if opportunity is provided for him to direct his energy and outgoingness towards acceptable and safe goals. By providing substitute activities for those which are unacceptable, a parent continues to promote an increasingly deep sense of self-trust which can be seen in an infant's exuberant expressions of "good" feeling. Inevitably a parent will be unable to divert all a child's self-initiated activity into substitute channels, and the necessary thwarting of his goals will precipitate an angry protest and temporary emotional turmoil. This emotional outburst, in all its vehemence, sometimes shakes the faith of a parent in the wiseness of her decision. She should, rather, feel comforted by the fact that this is merely an expression of frustration from a self-directed, mentally healthy youngster who feels free to express himself, confident in the expectation that his rebellion will precipitate no denial of his mother's love although she may disapprove

20 TH

E SECURITY O F INFANTS

of his behaviour. It is only a less mentally healthy child who dares not chance such a strong display of feeling. He is full of doubts that it would be tolerated, hence he must inhibit much of his effort whether in emotional expression or effortful behaviour. Thus, to summarize, a child who has developed self-trust will demand care and attention, will anticipate rewarding consequences to his self-initiated effort in play, social contacts and routine aspects of his Me, and will enjoy the satisfaction of achieving his goals, with the expectation that most of them will be acceptable to his parent. Such a child is developing a core of security, and the stronger the core, the more sure and serene will the child feel in his world. As a baby develops a core of security most of his experiences will be well taken care of by himself and his mother. However, he will be faced inevitably with some situations of stress which will temporarily dispel his serenity and shake his conviction that the world is benign. At these times he will feel vulnerable and will resort to one of two modes of behaviour to relieve his feeling of uneasiness and momentarily resolve his difficulties. He may either regress to a less mature stage of development in which he depends on his mother to relieve his stress by making a decision and accepting the consequences of it, or employ a deputy agent which will permit him temporarily to delay making a decision, to delay putting forth effort, or to delay accepting the consequences of his action. Should he resort to a regressive formula, he will demand care, comfort and attention in situations where he is capable of resolving the problem through his own efforts. This regression will be seen in his relationships with other people, both adults and children, in his play with play equipment and toys, and in his attitude towards his routine care of eating, sleeping, bathing, toileting and dressing. For example, he may steadfastly refuse to accept some new food introduced to his diet, refuse to permit himself to be put to bed or bathed by anyone other than his mother, or be thoroughly uninterested in actively cooperating when being dressed—he may, for instance, refuse to hold his arm out for his coat sleeve. He may remain inattentive, or perseverate with toys, and cling desparately to his mother when he is expected to warm to a visitor. Should he resort to a deputy agent formula, he will use a variety of behaviour to avoid either putting forth effort to solve a problem or facing the consequences inherent in a threatening situation. These deputy agents generally take the form of crying about, withdrawing from, over-reacting to, and being compulsive about situations which a

MENTAL HEALT H IN INFANCY 2

1

child perceives as threatening. Each child will employ his own varietykind and frequency depending on his degree of mental health. Thus deputy agents may appear in a few or in all of the behavioural areas of an infant's life—eating, sleeping, bathing, toileting, play with play materials, social situations involving both adults and children, and physical experiences. They are likely to be evident particularly in new and strange situations which naturally hold more insecurity for an infant than those with which he is familiar. Some deputy agents which might appear in an infant's behaviour would be spitting out food, refusing to lie down in bed, screaming when toilet training is initiated, being tense and fearful when bathed, crying at loud or sudden noises, withdrawing from other children, resenting an adult's paying attention to another child, and being erratic and inattentive when playing with materials. Some deputy agents can be expected to appear in all children as temporary props which tide them over times of stress. Some may be used for a while but disappear when an infant grows more secure. Then again, they may be replaced by others more appropriate to the next stage of development or to a change in the demands of his culture. They can be reduced or increased in intensity according to the degree of stress in which a child finds himself. They operate to relieve temporarily the distress arising from a situation with which an infant feels unable to cope either by putting forth effort or through seeking assistance from a dependable agent, his mother. The above thesis regarding mental health in infancy can be depicted diagrammatically (see p. 22). Poor Mental Health In contrast to well children are babies who do not develop a core of security, and who, remaining in a constant state of uneasiness or anxiety, show symptoms which indicate mental ill health. Such infants employ regressive and deputy agent actions as permanent and predominating aspects of personality. Their state of ill health can be described as a disturbed state of mind arising from a lack of feeling of self-worth and a suspicion that their world is untrustworthy. Why do some babies get into this state? It would appear that they are questioning the dependent trust which should be firmly established with their mother. They seem to be doubting the reliability of the parental agent. In their minds is apprehension that care may not be forthcoming when needed and an uncertainty that the world is benign. Such apprehension and uncertainty can be the result of an unpredict-

22

THE SECUBIT Y O F INFANT S

able mother whose physical care is based on her own whims and goals rather than on her baby's needs. In this case, the child cannot predict that his mother will either accurately anticipate his needs or respond to the demands which he makes. In order to achieve even temporary serenity, the infant will over-demand care and attention at unpredictable times. His mother's assurance of comfort and serenity though minimal, has nevertheless been the only comfort that he has known. Therefore, he will cling to his mother in every way possible. He will whine in her absence, cling to her when she is near, and become frenzied if he expects a removal of her attention. Although he lacks dependent trust, he cannot risk ever refusing her ministrations because he fears refusal will bring a further withdrawal of the comfort he so badly wants. More seriously, should he consistently be denied necessary care when it is needed, he will gradually reduce his expectations to an apathetic acceptance of care and attention when they are offered and will make no demands on his mother at all. The mentally ill child, lacking dependent trust, will most likely be deficient in self-trust also. The inadequate attention of his mother,

MENTAL HEALTH I N INFANCY 2

3

which has probably provided little, or at best inconsistent, affectionate interplay, has mitigated against the development of any strong feeling of self-worth, and thus has robbed him of any motivation to be effortful and outgoing in his world. His underlying feeling seems to be one of chronic anxiety, apparent in his cautiousness, timidity and, in the most extreme cases, apathy. He seems either uncertain or unaware that self-initiated effort is rewarding. Hence he is uninterested in food or in feeding himself, accepts in an apathetic way the procedures necessary for bedtime, bath and dressing, lacks interest in play materials, and can muster little excitement in anticipation of response to a social contact. He may demonstrate many tics such as sucking his thumb, rocking, and shaking his bed. His apathetic state is further deepened should he fail to receive either encouragement for or approval of any self-initiated effort he may make. It is this state of serious disturbance which is observed in babies reared in those institutions* which give little attention to their emotional needs. In the absence of consistent warmth and loving attention from one adult, such institutional babies show a picture of apathy. Mealtime, bath and bedtime are drab routine chores, experienced without interest or enthusiasm. No sparkle of anticipation appears when an adult approaches; toys fall from cribs to be left unsought; language and motor skills are grossly retarded. Such babies appear to remain psychologically immature, while operating mainly at the physiological level of life. They accept food and rest at appropriate times, but beyond this seem to have withdrawn from life's experiences as if operating behind one enormous deputy agent. They appear to have no self-trust and very little dependent trust. Less seriously disturbed children who are carrying erratic feelings of self-trust, probably as a reflection of a questionable dependent trust, show behaviour which is frequently unpredictable. At one time they may appear effortful and bouncy, only to withdraw their energies at another time to be apprehensive and perhaps even sullen. They may demand affection, only to refuse it when it is given. They may want to play or to help themselves in routines, but be unable to take the initiative without first referring to an adult for approval or waiting to be urged. At one time they may enjoy being with people, both adults and children, while again they may scream to be taken away. Treatment of mentally ill babies necessarily consists of rearranging their environment and evaluating the efficacy of the new arrangement 'See pp. 63 ff.

24 TH

E SECURIT Y O F INFANTS

by observing behaviour. Usually, the solution seems to be to establish or re-establish a dependent trust in a young child. Where little trust in a dependable adult has been built, the procedure is uncomplicated. Providing a dependable adult to care for a child is sufficient opportunity for establishing this "first" relationship. Treatment of an older infant, who may have had a dependent trust and some self-trust feelings which have been shattered or at least threatened, is somewhat more complicated and requires more time. It will be necessary to break through the child's defences (obvious in his deputy agent behaviour) before an adult can gradually reassure him of her trustworthiness. Until this is accomplished, no trust relationship can exist between the two, and the child will continue to rely on his deputy agents, refusing either to put forth effort in an acceptable direction or to comply with the requests and administrations of the adult. Such is the security theory of infants, which evolved as work progressed on the Institute records (Appendix I, p. 000). Each aspect of this work helped to clarify the others. As our theoretical concept became clearer, various forms of a mental health scale were tried on young children. The weaknesses and strengths of these in turn contributed to greater clarification of thought.

MEASURING THE SECURITY OF INFANTS

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2. Constructing a Mental Health Scale THE INFANT SECURITY SCALE* is a diagnostic check-list which attempts to assess the mental health (security) of babies from birth to two years of age (see Appendix III). It consists of a series of items descriptive of the behaviour of infants up to 24 months of age. The items describe behavioural symptoms indicative of a range of mental health states which a clinician might look for in the assessment of a baby's psychological well-being. The items are grouped according to four age levels -0 to 6 months, 6 to 12 months, 12 to 18 months, and 18 to 24 months— and, in effect, constitute four scales covering the total age range. SELECTION OF ITEMS The selection of items to assess the mental health of babies led to several considerations. The impossibility of exploring the mental life of an infant made it necessary to use behavioural symptoms as criteria of mental health. Hence, we first listed the kinds of behaviour that were observable in young children and decided which of these reflected a feeling of security and which reflected a feeling of insecurity. In making these decisions, it was desirable to keep in mind that our descriptive items of behaviour were to remain within the framework of the security theory, while at the same time being truly characteristic of babies. In itemizing behaviour during the first two years of Hie, it was necessary to take into consideration the rapidity of growth and the complexity of developmental change within this time. For example, some items of behaviour present at four or five months of age, will have vanished by eighteen or twenty months of age. Should the behaviour selected be relevant over the whole two years or should it be itemized according to different developmental stages? If developmental changes were to be incorporated into a series of items, such a statement as "takes to spoon feeding readily" would tell something positive about a four- or five-month-old baby, but would 'The term "scale" is used in recognition of the fact that it is not a test, but an explicit method of evaluating infant behaviour within a specific theoretical framework which defines various states and degrees of mental health. 27

28 TH

E SECURIT Y O F INFANT S

not describe a fifteen- or eighteen-month-old child. At the older age a comparable positive item involving feeding would have to be "accepts the opportunity to feed himself." A child's changing relationships with his mother and other children, the more complex environmental demands made upon him as a result of his increasing neuro-motor skills, and his willingness to make increased effort on his own behalf would need to be reflected in the items. Another consideration was that of cultural values. Should we list behaviour which we believed to be universal in application, or should we select behaviour which was to be found only in our Western culture? As the study progressed it seemed increasingly difficult to select "pure," culture-free items and the attempt was abandoned. Such a refinement may be the subject of future studies. In an attempt to find items truly descriptive of infants' behaviour, I turned first to records of 150 infants who had been or were under the care of a local agency.* These records were completed by psychologists during routine interviews with children and foster mothers. Interviews were part of the agency's procedure prior to adoption; the children concerned could be considered a typical sampling of the population. The fact that these records described the actual behaviour of infants as they were observed both at home and in clinic, indicated their potential worth to us. Descriptions of behaviour taken from these records were listed according to my decision that they reflected a state of either security or insecurity. This decision was based on my familiarity with the security concept and knowledge of infants, gleaned over a period of years in this same agency's clinic. When the categorization was complete, it was discussed with the senior psychologist in the clinic, who agreed substantially, although not completely, with it. The fact that the records included the age of each child made it possible to list the items according to age. Examples of the selection of these items follow: SECURE

Very responsive to social stimulation Bouncing and amiable "Talks" back Reaches eagerly for toys Notices changes in environment Spoon feeds easily "The Children's Aid of Metropolitan Toronto, whose staff have been most cooperative.

CONSTRUCTING A MENTAL HEALT H SCAL E 2

9

Full of initiative and interest Delights in pivoting, kicking, rolling Dislikes restrictions of the playpen Will amuse himself for long periods of time Loves to imitate Responsive to adult attention Tries to feed self Venturesome physically Persists in picking things up and reaching for toys Attempts words Laughs aloud at things which occur in the room Co-operates in a positive fashion INSECURE Thumb sucking, finger sucking (persistent) Temper tantrums Reluctant to start spoon feeding No interest in play materials Overly sensitive to tone of voice Impatient about waiting for dinner Indifferent to environment Rocking, hair pulling Dependent on adult attention and praise for adequate behaviour Must always be protected from excitement Needs to have foster mother near Jealous of attention given to other children Timid in play with others Shy Pouting, stubborn Light sleeper Never still a minute Cries out in sleep; whines in sleep Screams when placed on toilet Covets toys from other children Short span of attention Constant refusal of requests Shaking the bed; biting Lack of persistence Haphazard use of toys Suspicious of strangers Quick-tempered and impatient Over-active and restless Heedless of danger Cries in strange places Squeals and hits self when frustrated

(For the recording of items according to age levels, see Appendix II.) In order to broaden the sampling of items, symptoms of behaviour were selected from a second set of records which had been kept by

SO TH

E SECURIT Y O F INFANT S

parents connected with the Institute. On these records, the behaviour of infants was itemized in "areas" such as eating, sleeping, elimination, play, familial relationships, extra-familial relationships, tics, general (see Appendix II). Although many items were similar to those of the first selection, some new and different ones appeared. These are a sample: Spits out beets when first offered Cries when changed Squeals for toys Cries when carriage no longer pushed Cries and screams when being dressed Cries when visitor comes Angry when bathed by new nurse Screams on an elevator Cries at strange dog These also were recorded by age. Some of all these items were incorporated into a check-list which was formalized according to the security hypothesis, that is, under the headings Secure, Insecure, Deputy Agent, and Regression. A series of experimental try-outs, using the scale with a number of groups of children, was followed by critical analysis of the data collected and resulted in three revisions of the original scale over a period of two years (see Appendix III). The items of our final revision were selected on the following basis. ( 1 ) Items involving a child's initial adjustment to a new or changing situation were incorporated as particularly valuable indications of his way of maintaining security. When solving the problems of a new situation, a child could demonstrate by his behaviour whether he was developing security through expenditure of effort in play, social relationships, and routine aspects of his world or whether he was resorting to less adequate methods of a deputy agent nature. Such items as "Accepts new foods readily" and "Responsive to social stimulation from a stranger" not only demonstrate some aspect of the child's dependent trust but also evaluate his response to a new situation. Such items were placed on the scale in each of the Ufe areas ( sleeping, eating, play, social relationships, etc. ). (2) A feeling of security was believed to be indicated by two kinds of items: (a) those reflecting a state of dependence on adults and (6) those reflecting a desire for independence in some aspect of living

CONSTRUCTING A MENTAL HEALTH SCALE 3

1

wherein the child has sufficient skill to help himself. If a child has dependent trust in an adult he should be willing to accept direction and care when given. This willingness was demonstrated by such items as "Accepts new foods readily," "Will wait for meals patiently," "Accepts without protest, being put to bed," "Accepts being placed on toilet," and "Relaxed when bathed or washed by unfamiliar person." If an infant possesses self-trust he should desire to indulge in independent effort. This desire was demonstrated by the following items: "Accepts opportunity to try to feed himself," "Sleeps readily in new bed or new surroundings," "Indicates need for toilet," "Enjoys change of environment," "Amuses self happily in fairly restricted play area," "Enjoys the company of other children," and "Reaches for play material enthusiastically." ( 3 ) Feelings of insecurity were believed to be indicated by the use of deputy agents. These avoidance mechanisms indicated that a child was compensating for a lack of skill in solving problems, or for a lack of trust either in the adult or in himself, or for a lack of both. One way a child would demonstrate his lack of skill in problem solving would be through the use of a regressive formula, that is, he would resort to more infantile forms of behaviour. Such items as "Screams and yells when waiting for food" and "Sulks and cries long after hurt attended to" might indicate a child's lack of trust in an adult who should be able to set things right for him. On the other hand, such items as "Coaxing or forcing necessary to make child finish a meal," "Cries at the advances of strangers," and "Cries when other children take his toys" were thought to indicate primarily either a lack of skill in the child or an unwillingness to put forth sufficient effort to solve his own problems. A regressive item, reflecting an immature type of behaviour, was of the following order: "Accepts food from mother only," "Cries when put on toilet or pot," and "Screams, cries, turns to mother in a crowd." In all, deputy agent and regressive items demonstrated (a) anxiety, (fo) compulsive dependence, (c) clinging to the familiar, or (d) insistence on exact routine or on everything being "right." It was felt that every child would show some signs of each of these kinds of behaviour in the normal course of growing up. Signs of dependent and independent behaviour are present in both healthy and unhealthy youngsters; signs of a deputy agent and regressive nature appear in both too. It was expected that healthy children, although showing a preponderance of dependent and effortful behaviour, would

32 TH

E SECURIT Y O F INFANTS

use deputy agent and regressive forms on occasion; for example, as safety valves to tide them over times of stress. Only when these forms became habitual ways of solving problems or were being used extensively would they indicate a marked degree of ill health. Some descriptions of behaviour were included in a separate section of the scale apart from the above classifications. These particular items were felt to indicate an insecurity more fundamental than that reflected by the deputy agent or regressive items. It was hoped that some of them would reflect the kind of emotion underlying the child's overt behaviour. "Resents having to feed self," "Resists toilet routine," and "Seems timid physically" are examples. Others might reflect some physiological reason for a child's insecurity. Such would be "Poor eater," "Poor sleeper," and "Physically apathetic and listless." Still others might indicate a disrupted relationship between child and adult, a relationship in which no dependent trust existed and from which, of course, no self-trust could develop. Such items as "Prolonged upset when hurt," "Fearful of changes in environment," and "Uneasy with other children" are examples. An item involving behaviour in a new situation, when placed in the Secure column on the scales, was differentiated from the others by an asterisk (*). The Deputy Agent and Regressive items were grouped together in one column on the right-hand side of the scales; a Regressive item was denoted by a number sign (#). As a result of taking into consideration the increased complexity of behaviour with age, there was a different number of items on each test: 82 at age 0 to 6 months, 100 at age 6 to 12 months, 127 at age 12 to 18 months, and 132 at age 18 to 24 months. The distribution of the number of items according to the various types (Secure, Insecure, Deputy Agent, and Regressive) is shown in Table I. TABLE I DISTRIBUTIONS OF TYPES OF ITEMS ON THE MENTAL HEALTH SCALES

Age in months

Secure

Insecure

Deputy Agent

Regressive

Total: Deputy Agent & Regressive

0-6 6-12 12-18 18-24

31 40 47 46

19 24 35 36

27 25 31 37

5 11 14 13

32 36 45 50

CONSTRUCTING A MENTAL HEALTH SCAI£

33

CONSIDERATIONS REGARDING ENDORSEMENT (1) The items on the tests described embraced a very wide range of life experiences, and for this reason the tests were not equally applicable to all children. Children exposed to a wide range of life experiences could be endorsed on all items, whereas those whose lives had been restricted could be endorsed on a smaller number of items only. Therefore, if a scale were scored on the basis of every item listed, a comparison between such children would yield a false picture of their mental health, as a child with limited experience would be penalized. Because it is quite possible for a child who has been exposed to limited experience to feel as easy and to be as healthy as one who is handling much broader experience, some recognition of this fact had to be made when endorsing items. Instructions were therefore included to the effect that those items which were not part of a child's experience at the time of testing were to be stroked off. Such items would be determined by questioning the parent. With this adjustment, comparisons could be made, since each child would then be judged according to the way he was handling his own particular number and kinds of experiences. (2) Because the number of items on each of the four scales differed, consideration simply of the number of endorsements under each category (Secure, Insecure, Deputy Agent) would not permit any meaningful comparisons between children tested at different age levels. Developmental studies would be impossible, too, unless some method were found of arriving at comparable scores. (3) In understanding a child's adjustment, there seemed to be value in considering Deputy Agent and Regressive scores separately. Since the items making up these scores differed in number, some way of regarding them as a proportion or ratio would need to be used if they were to be compared. For these reasons, scores were to be expressed as percentages, derived from raw scores which had taken into consideration the variety of each child's experiences. METHOD OF ENDORSEMENT The following instructions are given for endorsing the scales: (1) Place a check (v/) beside each item which applies to the child. (2) Leave unchecked those items which are a part of the child's experience but which do not apply to him.

34

THE SECURITY OF INFANTS

(3) Stroke out those items which do not apply to the child because they are not yet a part of his experience. (4) If debating whether to check under the Secure or the Deputy Agent column, check both. Children are frequently inconsistent and contradictory in their behaviour. (5) The endorsed items should reflect the child's "usual" behaviour rather than merely his present or occasional behaviour. Consider what he has been Lice over the past few weeks.

METHODS OF SCORING Method A The first method assessed the balance among the Secure, Insecure, Deputy Agent, and Regressive items endorsed. In order to arrive at scores, three facts were to be considered: (1) the total number of items on the scale; (2) the total number of items applicable to the child's experience; (3) the total number of endorsements for the child. The percentage score became: Total number of endorsed items Total number of applicable items X 100. Table II gives an example of the score of a child (Child A) 23.9 months old with an I.Q. of 110. TABLE II

Secure Total number of items (18-24 months) Total number of items applicable Total number of endorsements % score

Insecure

De puty Agent

Regressive

Total: De,iuty Agent & Regressive

46

36

37

13

50

40

34

28

13

41

31

4

5

3

8

4 5 3 8 31 -X100 = 77% -X 100 = 12% -X 100 -18% -X 100 = 23% — X 100 = 20% lo 40 34 41

This method of scoring permitted an estimate of the child's security and insecurity and gave some indication of the usual way in which he solved his problems (in terms of Deputy Agent or Regressive actions). The number of applicable items told something about the extent or limitation of his world. No attempt was made to interpret the score of the Insecure column with the other scores. It was felt that such an attempt would be postponed until we had a greater understanding of the scale and had

CONSTRUCTING A MENTAL HEALTH SCALE

35

decided on the appropriate weighting of the items. Only the items under the Secure and the combined Deputy Agent and Regressive columns were considered. The scores in the example could be interpreted in the following way. The world of Child A is more restricted than that of some children in his age group: 40 of 46 Secure items and 41 of 50 Deputy Agent and Regressive items apply to him. Child A's feeling of security is predominant: 77 per cent of the applicable Secure items and 20 per cent of the applicable Deputy Agent and Regressive items are endorsed. Child A uses regressive mechanisms more frequently than deputy agent mechanisms when overcoming insecurity: 23 per cent of the applicable Regressive items and 18 per cent of the applicable Deputy Agent items. It was obvious that a single score was needed to order each child on a continuum of mental health. Therefore method R was devised. Method B In this method, the scores on the Secure column were considered positive, and those on the Deputy Agent and Regressive columns were considered negative. The scores on the centre Insecure column were not considered. The total number of Deputy Agent and Regressive items endorsed was subtracted from the total number of Secure items endorsed, and this difference was considered as a proportion of the total number of items applicable to the child in the Secure and Deputy Agent and Regressive columns. The single security score for Child A, in the example given, would be: 31 endorsed Secure items — 8 endorsed Deputy Agent & Regressive items 40 applicable Secure items + 41 applicable Deputy Agent & Regressive items

(Security Score) To assign an equal value to each item is, in itself, an arbitrary decision. Some items may have more importance in the total security picture than others, but as yet there are no data to indicate what, if any, the correct weightings should be. It is also to be noted that in these scales as they stand at present some items are independent of another, while others appear on both the Secure and the Deputy Agent-Regressive sides of the tests. This inconsistency gives a spurious boost to the scores according to the

36

THE SECURITY OF INFANTS

direction of the heavier endorsements. Thus a healthy child may obtain a higher security score and an unhealthy child a lower one than they probably should. However, this method does provide a means of ordering scores into a continuum even though it exaggerates the extremes. Method C: Security Quadrates Valuable information about the balance of factors making up an individual child's security is obtained by considering the endorsement of items indicative of the dependence and effort being shown by the child. Every item of the scale has two characteristics: it reflects a predominance of either dependent or effortful behaviour and it reflects either acceptance of a situation or person (Secure items) or refusal of a situation or person (Deputy Agent and Regressive items). Hence every item may be categorized in one of four ways: acceptancedependence; refusal-dependence; acceptance-effort; refusal-effort. This categorization is found recorded on the left side of each item of the scales (see Appendix III). On the Secure items, the symbol "D" indicates accepts dependence, while "E" indicates accepts effort. On the Deputy Agent and Regressive items, the symbol "D" indicates refuses dependence, and the symbol "E" indicates refuses effort. Endorsed items may be tallied under these categories and represented in a graph demonstrating the proportion of a child's acceptance of the opportunity to be dependent or to put forth effort to his refusal of the opportunity to be dependent or to put forth effort. The endorsements in each category are expressed as a percentage: Total number of endorsed items in each category Ë L v 100 Total number of applicable items in each category By using a quadrate and representing ( 1 ) the percentage acceptance of dependence as a square, (2) the percentage acceptance of effort as a square, (3) the percentage refusal of dependence as a square, and (4) the percentage refusal of effort as a square, it is possible to portray the degree to which a child accepts the dependence or opportunity for effort offered to him ( see Graph I ). These lines are interpreted as follows. (1) The upper left square indicates that the child concerned is accepting 80 per cent of the total amount of dependence offered him. (2) The upper right square indicates that the child is accepting 70 per cent of the opportunities to put forth effort which come his way. (3) The lower left square indicates that he is refusing 18 per cent of the total amount of dependence offered him. (4) The lower right square indicates that he is refusing 22 per cent of the opportunities to put forth effort which come his way.

CONSTRUCTING A MENTA L HEALTH SCAL E

37

GBAPH I. Security quadrate. The infant represented shows a high degree of acceptance of both dependence and effort and a low degree of refusal. According to our hypothesis, this is the kind of balance of factors we should anticipate finding in a highly secure child. Conversely, we should expect an insecure child to show small upper squares and proportionately larger lower squares; that is, a low degree of acceptance of both dependence and effort and a high degree of refusal (see Graph II).

GRAPH II. Security quadrate for an insecure child.

38

THE SECURITY OF INFANTS SOME CONSIDERATIONS AND PROBLEMS

By the time the third revision of the Infant Security Scale was ready for use, several problems had emerged. The fourfold arrangement of scales to cover twenty-four months of growth was one of these. Although the fourfold division was felt to be the best plan for evaluating the rapid changes in children, it presented a difficulty in terms of relating one scale to another. Would each scale measure the same phenomena? The possibility of incorporating all the items into one scale eventually might have to be considered. Further, the method of obtaining data could lead to a biased account of a child. Because the scale attempts to measure the "usual" state of a child, rather than how he is "at the moment," reliance on parental evaluation is necessarily heavy. This leaves opportunity for parental bias to appear. This defect is at least partially counteracted, however, by the consideration that much of an infant's mental health depends upon the attitudes of his mother towards him, whether these be biased or not. If the scale measures the child as the parent perceives him, then it might well be a fairly accurate assessment of his own good feeling. Such a consideration may not be true of older children as they do not live in such a close association with their mothers. We have stated that we believe a child develops a core of security which gains in strength as he experiences more and more of his world. Just when this core starts and how soon it becomes crystallized are still open questions. It seems obvious that it begins to develop much earlier in some children than in others. During the period of infancy, it is apparently a fragile thing. However, should our postulate be right, then the scales should have some predictive value regarding it, and our items should measure some general quality rather than mere day-to-day fluctuations. Until experimental data are obtained either to prove or disprove the existence of such a core, this theory too will remain tentative. The accumulation of data will also assist in the refinement of items for measuring this "general quality." The present scale is directed to the normal child whose outgoing energy is observed readily in his behaviour, whether it be of a secure or a deputy agent and regressive flavour. It is possible that items applicable to an insecure, apathetic child have been overlooked. There are items in the Secure column, however, such as "Waits patiently for meals," which could apply to an apathetic child as well as to a secure child. An apathetic child, despite his basic insecurity, might be endorsed on such an item because he is dependently secure regarding the

CONSTRUCTING A MENTAL HEALT H SCAL E 3

9

satisfaction of his basic appetites. His lack of outgoing energy would be noted in unendorsed independently secure items involving social relationships, play with materials or philosophy (reaction to physical sensations and strange experiences), but would not necessarily be indicated by Deputy Agent or Regressive endorsements. Further refinement of the items should help to differentiate between these two types of children. The addition of "Can be reassured when impatient for meals," for example, might indicate a secure child in contrast to an apathetic one. Despite these present inadequacies, it is felt that the scale can be used to advantage in its present stage. It provides a systematic way of collecting psychological data on babies; the data collected can help clarify our theoretical framework; and the scale construction can be tested.

3. A Study of Well-Adjusted and Poorly Adjusted Infants A COMPARISON OF SECURITY SCORES PRELIMINARY TRIALS with the Infant Security Scale had shown that the scale differentiated among babies. The crucial points, however, were whether or not it differentiated on the basis of mental health and then, if it did so, whether or not the security criteria were applicable. It has been postulated that a core of security develops in a mentally healthy child; it remains with him and grows in depth as he develops. Should our test measure this core, it would be expected that the scores of the well-adjusted children, when tested several times, would remain relatively constant. Conversely, it has been postulated that a child in poor mental health holds erratic feelings of security and has probably developed little or no core of security. It would be expected, therefore, that he would be vulnerable to minor variations in his world which would be reflected, first, in low scores on the scale and, secondly, in fluctuating scores on test-retest trials. Selection of Groups To assess the validity of the scale, two experimental groups of babies were sought: one well adjusted and one poorly adjusted. It was assumed that a well-adjusted baby would be in good mental health and his report would show a preponderant endorsement of positive mental health items on the scale, while the report of a poorly adjusted baby would show a reduced endorsement of positive items, and a pronounced endorsement of negative mental health items on the scale. It was understood that this assumption would require further investigation later, since recent studies had made us well aware that "good overt adjustment" is not necessarily synonymous with sound mental health. For the present, however, it was assumed that significantly different scores between the two groups of babies would indicate that the scale was measuring at least some aspect of mental health. The criteria for the selection of the two groups were: (1) living arrangements; and (2) overt behavioural adjustment. 40

WELL-ADJUSTED AN D POORL Y ADJUSTE D INFANTS 4

1

The children in the well-adjusted group who would be most likely to approximate good mental health were selected on the basis of having two advantages: they were living in their own homes, which they had known from birth; there was the assurance of co-operation from their parents, who were known to the staff of the Institute and judged as likely to give their babies experiences conducive to good mental health. Most of the babies in the group had been registered at the Institute for admission to its Nursery School at three years of age. The children in the poorly adjusted group were selected from a larger group of children who were separated, of necessity, from their mothers and were living in foster homes. Some of them had been placed in more than one foster home. Only those children were selected who were reported by the supervising agency to be making a poor adjustment to their foster homes. The adjustment reports were made by the foster mothers and substantiated by the supervising nurse, the paediatrician and the psychologist connected with the agency caring for these children. When first selected, the total experimental group consisted of 13 poorly adjusted and 13 well-adjusted children. As the study progressed, however, 7 more well-adjusted children were added in order to increase the amount of data available. Ideally, all the children should have been the same age when first tested, but this was impossible because of the limitation of time, particularly with the poorly adjusted children. It was surprisingly difficult to find a group of poorly adjusted children who could be recruited for immediate study. Many months would have elapsed had we insisted on children who fulfilled the experimental conditions and who were also alike in age. As a result, the age spread was as follows: of the poorly adjusted group on first testing, two children were below 6 months of age, five children were between 6 and 12 months of age, five children were between 12 and 18 months, and one child was over 18 months of age. There was more homogeneity in ages among the well-adjusted children on first testing, eight being under 6 months of age, seven being between 6 and 12 months of age, three being between 12 and 18 months of age, and two being over 18 months of age. Our particular group of poorly adjusted children was much less homogeneous than our well-adjusted group. The children in it varied widely in age at first testing; there was considerable variation in their past experiences, in the atmosphere and socio-economic status of their present foster homes, and in the degree of uncertainty of plan for their future. They ranged in developmental level from within the 70"s

42 TH

E SECURIT Y O F INFANT S

to within the 120's. Only two children had developmental quotients over 110. Many of them would not be available to the study right up to two years of age. A further complication arose from the fact that it was the duty of the agency to make changes in the children's environment in an effort to improve their adjustment. It was anticipated, therefore, that the babies in this group would show fluctuations in scores over time and that some of them probably would show marked increases to the good; the core of security in children such as these might have been started but inadequately rooted, and therefore these children would be expected to respond readily to benign experiences. On the other hand, the children of the well-adjusted group were generally living in comfortable homes. Their parents were usually professional people, some of whom were in the upper socio-economic level. The range in developmental level was from the 70's to 131, with the greater proportion showing above average development. All the children would be available for study up to two years of age. Administering the Scale A different procedure governed the collection of data for the two groups of infants. As the poorly adjusted children were under constant assessment by the staff of the agency, the experimenter went to the foster homes and administered the Gesell and Cartel developmental tests. During these visits, she collected the information to complete the Infant Security Scale. The children were seen regularly whenever possible, at approximately eight- to twelve-week intervals. Each time a record was taken, a developmental test was administered by the same experimenter. Although relying heavily on the foster mother's report, the examiner was able to evaluate some of the infant's responses herself and she weighed these against the foster mother's judgment. The number of tests on these children varied. Ideally, all these children should have been seen at three-month intervals until they were twenty-four months of age. Some of the children, however, were seen only twice or three times before a change in plan took them away from the care of the supervising agency. Some children showed marked improvement in mental health and were placed for adoption, while others were returned to their true parents. In dealing with the well-adjusted children, the experimenter went to each home and administered a developmental test at the time the initial record for the Infant Security Scale was taken. During this visit, the record was explained to the mother and she was instructed how to endorse it. After this time, a record was sent to the parent at three-

WELL-ADJUSTED AND POORLY ADJUSTED INFANTS

43

month intervals to be endorsed by her and returned. It was recognized that such a method left room for error of interpretation, but because an attempt had been made to orientate the parent to the philosophy of the scale and to explain the terminology, it was felt that these records would be endorsed accurately. Because the experimenter could not see all the children at the appropriate intervals, this group of parents, comprised of professional people—mainly psychologists, social workers and nursery school teachers, who had the advantage of a knowledge of research method—was selected in the hope that they could maintain a greater degree of objectivity than could an unselected group. The period of record taking lasted twenty-four months. The number of tests obtained over this period was different for the well-adjusted and the poorly adjusted children. It is readily seen (Appendix IV, Table III) that most of the children in the poorly adjusted group received two or three tests, while most of the children in the well-adjusted group received from five to eight tests. Differences in Security Scores Security scores were calculated on all records of the well-adjusted and poorly adjusted infants (Appendix IV, Tables I and II). Casual inspection of the scores of the children making a poor adjustment in foster homes (Appendix IV, Table II) indicated that wide differences existed among the children. The range in scores on first testing was —.01 to -J-.39. Changes in scores occurred in re-testing and these also showed a diversity of pattern. There were increases in eight scores, six of which appeared to be large. There were decreases in five scores, two of which were very slight and three fairly large. The general trend on later tests was upward; the average increase from first to last test for the total group was seven points. There were more fluctuations from test to test within the scores of this group than within the scores of the well-adjusted group. Casual inspection of the scores of the children in the well-adjusted group (Appendix IV, Table I) indicated a highly stable group in which, on the whole, similar status was maintained from test to test. The occasional low score appeared. One child showed a dramatic increase in score on second testing; another child showed a sharp decline in score after twelve months of age. Mean and median scores were calculated for both groups of children on each of the four scales. These were based on the first scores recorded within each scale because the children were sometimes tested twice on the same scale (Appendix IV, Tables I and II).

44

THE SECURITY OF INFANTS

The trend of the median scores for each group is shown in Graph III. It demonstrates that the well-adjusted babies achieved higher scores than the poorly adjusted babies.

GRAPH III. Trend of median scores of well-adjusted and poorly adjusted children. Reliability Any attempt to assess the reliability of a measure inevitably involves a consideration of the stability of the phenomenon being measured, as there is always an interaction between these two. Therefore the reliability of the Infant Security Scale on test-retest might possibly be reduced as a reflection of the fact that the quality we measure in the children (security) might be expected to change somewhat from test to test. An indication of the reliability of the scale was obtained by the testretest method using product moment Pearson r correlation. These correlations were based on the scores from the total number of children who were appraised at any pair of consecutive levels, regardless of the clinical group to which they belonged. For example, the scores of all the infants who had received two tests between 6 and 12 months, whether they came from well-adjusted, institutional,* or poorly adjusted groups, were included in the reliability check at this level. 'See chap. 5.

WELL-ADJUSTED AN D POORL Y ADJUSTE D INFANT S 4

5

The correlations, of course, are not based on the same cases throughout. Some subjects were appraised only twice, others as many as five times. The number of cases considered at each age level and the resulting correlations are shown in Table III. TABLE III Level Tests 1 Two tests within 6- to 12-month level 2 Between 6- to 12-month level and 12- to 18-month level 3 Two tests within the 12- to 18-month level 4 Between 12- to 18-month level and 18- to 24-month level 5 Two tests within the 18- to 24-month level

Number of cases

r

Level of significance

22 21

.72 .78

.001 .001

25 25

.89 .46

.001 .05

26

.91

.001

From these results, it appears that the test-retest reliability of the Infant Security Scale is satisfactory and, with the exception of level 4, tends to increase with age. The deviation of results at level 4 from the over-all trend led us to inspect the scores more carefully. It was found that four children showed radical changes in scores between the two tests. When their scores were eliminated, the remaining 21 scores gave a test-retest correlation of .92. In examining records of the four children whose scores had varied grossly, we discovered that they had undergone radical psychological change in response to changing environment, and this was reflected appropriately in their changed scores. It appears therefore that the Infant Security Scale has sufficient promise of reliability to be worth further expansion and refinement. VARIATIONS IN BREADTH OF EXPERIENCE Examination of the raw scores has revealed a considerable amount of secondary data providing insight into the variety of experiences to which young babies are exposed. It has demonstrated also a wide variation in the modes of adjustment employed by the children. It will be remembered that each child is scored only on those items which apply to his own experiences. Thus the number of items checked for a child indicates the breadth of his experience and the number of opportunities offered him to operate in his environment. Scores for both groups showed a considerable variation in the number of applicable items (Appendix IV, Table IV). The number of items applying to the children at the various age levels is shown in Table IV.

46 TH

E SECURIT Y O F INFANT S

TABLE IV RANGE IN NUMBER OF ITEMS APPLYING TO CHILDREN TESTED

Age in months

Number of items

Range

0-6 6-12 12-18 18-24

47-63 56-76 57-92 83-96

16 20 35 13

The widest variation in the number of experiences applying to the children appears in the "toddler" age level (12-18 months); here the range is 35 items. The smallest variation appears from 18 to 24 months of age; here the range is 13 items. The diversity in the number of experiences permitted children has considerable bearing on mental health. Does a child who is protected from experiences that are open to other children of comparable age feel more or less secure than others? If he feels secure at the moment, will he be open to future insecurity by a sudden widening of his Ufe experiences? Theoretically, such a child will become insecure unless his new experiences are carefully presented as he builds self-confidence in his own skill to handle them. His mother must be careful to judge the child's capacity to handle experience lest his feeling of easiness be shattered. It is assumed at present that a limited child may feel as easy and as self-confident as a child open to very broad experiences. This assumption is taken into consideration by the scoring of the scales. For this reason, two children of widely different experiences may have similar security scores. REGRESSIONS AND DEPUTY AGENTS The security concept implies that there is a difference between the mental health of a child who tries to cope with difficulties through the use of a regressive agent and that of a child who tries to cope by using deputy agents. Generally speaking, a child who uses a regressive formula looks to a dependent agent to solve his problem for him while a child using deputy agents attempts to solve the problem by his own efforts, fails, and then employs an escape mechanism. It has been expected that all children use both methods in combination, but the question of the proportions of each remains. It is probable that some children use one method more consistently than the other. If this is so, what does the difference reveal about their mode of adjustment?

WELL-ADJUSTED AN D POOHL Y ADJUSTE D INFANT S 4

7

An examination of Table V (Appendix IV) reveals a difference in endorsements between well-adjusted and poorly adjusted children. When each group was considered separately, it was found that Deputy Agent and Regressive items were endorsed more highly for the poorly adjusted children; in every case but one, endorsement was from two to four times greater for the poorly adjusted group. Many of the children with outstandingly low scores showed a higher number of Regressive endorsements than Deputy Agent endorsements. Considering both well-adjusted and poorly adjusted children as a total group (see Appendix IV, Table V), it is apparent that the proportion of Deputy Agent endorsements is higher at every age level than the proportion of Regressive endorsements. Considering the differences by tests, the following is evident: 0-6 months: 80 per cent of the children on every test are more Deputy Agent than Regressive items. 6-12 months: 59 per cent of the children on every test are more Deputy Agent than Regressive items. 12-18 months: 66 per cent of the children on every test are more Deputy Agent than Regressive items. 18-24 months: 92 per cent of the children on every test are more Deputy Agent than Regressive items.

endorsed on endorsed on endorsed on endorsed on

It is obvious that the proportion of deputy agents gradually increases from 6 to 24 months of age. USE OF THE SCALE FOB GUIDANCE Security scores are based on two things: the number of items applicable and the proportion of Secure endorsements to Deputy AgentRegressive endorsements within the range of applicability. If we think of the applicable items as indicating the child's range of experience or wealth of contact with his world, and the security score as his adequacy within this range, it is possible to consider four types of infant adjustment. (1) Low applicability and high score. This child is secure within a narrow range. Probably he needs help in slowly expanding his experience beyond such confined limits. (2) High applicability and high score. This would seem to represent the ideal: the infant who is adequately dealing with a wide range of experiences. (3) High applicability and low score. This child is having plenty of experience in his world, but is handh'ng it inadequately. Probably his

48 TH

E SECUMT Y O F INFANT S

world should be limited deliberately so that he may become adequate within a narrower range. (4) Low applicability and low score. This child is probably in the least satisfactory state. He needs his experiences limited still further, and careful treatment to help him attain adequacy within these, possibly going back to experiences of simple dependency. While number 2 (high applicability and high endorsement) and number 4 (low applicability and low endorsement) appear as the extremes of best and worst mental health, to attempt to place the other two combinations on a continuum is difficult and leads to some theoretical speculation. In brief, this gives rise to the question: which has better mental health—a person who functions securely within a relatively narrow range of living, or a person who functions less adequately, but within a wider range? Does the mental health of an individual depend, in large part, on his ability to find a comfortable range of experience for himself and to live within it?

4. A Study of Two Children WE HAVE SEEN that the Infant Security Scale shows differences among children when they are tested individually. It has also pointed up marked differences between groups of well-adjusted and poorly adjusted children in the directions expected. The next concern was to discover if the scale would contribute to our knowledge of individual cases, that is, whether it would add depth to our understanding of a baby's psychological adjustment. Two children were selected for detailed study, one from the poorly adjusted group and one from the well-adjusted group. Their records were analysed, first, by describing the behaviour of each child as depicted by the endorsed items of the scale and, secondly, by considering the extent to which each child accepted or refused the opportunity either to be dependent or to put forth effort (scoring method C). The second approach grew out of the theory of infant security. It will be remembered that the items on the Infant Security Scale were selected to indicate the degree to which a child accepts dependence and the degree to which he puts forth effort. Conversely, comparable items were listed to evaluate the degree to which he was refusing dependence and the degree to which he was refusing to put forth effort. According to the theory of infant security, effortful behaviour on the part of a child is preceded by a dependent relationship with an adult and, in fact, stems from it. Without dependence, a child will not develop sufficient confidence to enable him to put forth consistent effort. The scoring method C discussed in chapter 2 was the outcome of this theory. Thus, a well-adjusted child should reveal a high endorsement of acceptance of dependent items accompanied by a high endorsement of effortful items. A poorly adjusted child would be expected to provide a low endorsement of acceptance of dependent items accompanied by low endorsement of effortful items. Unlike the well-adjusted child, the poorly adjusted child would be expected to show either a high endorsement of items involving refusal of both dependence and effort or, at the other extreme, a very low endorsement of both dependent and effortful items. Joe, the child selected from the poorly adjusted group, was seen clinically by me each time the scale was administered. On every occa49

50

THE SECÜBITY OF INFANTS

sion but one, I had the advantage of seeing him in his foster home where his behaviour presumably would be more usual than if he had been brought to clinic. My own evaluation, therefore, as well as that of the foster mother, was available for the report. Bill, the child from the well-adjusted group, was seen only once by me, during which time the research project was discussed with his mother. After this time, Bill's mother completed the reports herself. She was particularly interested in the project because she had been a research psychologist herself. Her reports were thoughtful and completed with care. Many helpful suggestions came from her criticisms of the scale. CASE I: AN ANALYSIS OF JOE This little boy, of normal intelligence, was referred for study as a child who was making an inadequate adjustment in his foster home. He was considered to be poorly adjusted, therefore, and the course of his development was followed carefully up to the time when he was seen for his final adoption test. Observation When first seen, this little boy was ten months of age. He was in his second foster home, which had been supplied by the child care agency; his first placement had been an unsuccessful private one. He was most attractive, bright-eyed, and markedly sociable while in the familiar framework of his foster home. He played eagerly with toys, whacking and banging them, and his gross motor development seemed to be progressing at a normal rate. The Scale The patterning of his endorsements on the scale indicated that despite his ability to establish a pleasant relationship with the examiner, his over-all mental health was poor. His general behaviour demonstrated many fearful symptoms. Particularly did he show marked distress when placed in an unusual or strange situation or if he was taken out of the familiarity of his own house. Sudden noises or movements bothered him. He was so sensitive to noise that he could not tolerate a squeaky rubber toy. He resented being put to bed and was restless and cried a great deal through the night. He was always hungry and never seemed satisfied with his mildly coeliac diet. He suffered real distress when having bowel movements and the skin around his buttocks was chapped a great deal of the time.

A STUD Y O F TW O CHILDRE N 5

1

On the whole, Joe seemed to be a timid child physically, disliking boisterous play and showing signs of distress on physical contact. He seemed to crave attention and affection constantly, giving the impression that he never felt that he received sufficient. He created the general impression of a highly strung, irritable baby with a very bad temper. Despite the difficulties that the foster mother was having with Joe, she was fond of him and seemed patient and understanding. Observation This child was seen twice again in the same foster home: once at 12 months and once at 16 months of age. On both these occasions, he appeared an attractive youngster and came readily to the examiner while the foster mother was present. He laughed and giggled while playing and was outgoing generally. He enjoyed toys in an exuberant way, exhausting their possibilities quickly and many times throwing them to the floor.

The Scale At both 12 and 16 months of age, the security scale still indicated extreme signs of insecurity at home, although Joe's behaviour to the tester was very pleasant. He still seemed dissatisfied with his feedings, waking at night for a bottle and requiring one to be comforted. He still had loose stools as a result of his mild coeliac condition and seemed terrified of being placed on the toilet seat. He was so terrified of bathing that it was necessary to bath him in the restricted space of the kitchen sink. He could not tolerate being cared for by a stranger, such as a baby sitter or neighbour. Anxieties were still marked in his social behaviour: he wanted the foster mother and the other children to be with him all the time; he disliked being left alone with the foster family's children for playtime. He resented the foster mother's giving attention to the other children or to the dog and would slap out at them when she showed them any favour. He showed aggressiveness in his play with the other children. By 16 months of age, he had started to walk and, while attempting to pull himself to his feet by means of chairs, had terrified himself by pulling some over. On the other hand, by 16 months of age there were some signs of improvement. Although still dissatisfied, his demands for food did not seem so strong as formerly and he was beginning to take an interest in feeding himself. During the interval from 12 to 16 months, although still showing fear of bath and toileting, he seemed a little more relaxed than he had been. Now, rather than being uncomfortable when cuddled, he could relax into a person's arms and enjoy the contact. He

52 TH

E SECURIT Y O F INFANTS

could tolerate boisterous play with adults and children and his enthusiasm for toys was marked. He still had a strong temper and was described as "very stubborn when tired." At the end of the interview at 16 months of age, the question of adoption was considered by the agency. He was well within the average range developmentally and, on this basis, was ready for placement. It was decided, however, that he was not ready emotionally for a change of home and adoption was deferred therefore in favour of a further period of observation. Unexpectedly shortly after this, Joe had to be transferred to a new foster home. This was a home in the country in which there were four other children, including one foster child of approximately the same age. Here Joe was observed once more at 20 months of age. Observation His relationship with the experimenter was delightful; he was friendly, effervescent, keen to get to the toys and playing up to the attention he was getting in a most delightful way. He was obviously fond of the foster mother and had made a place for himself in the home almost immediately after placement.

The Scale The scale indicated a seemingly transformed child. Gone was his anxiety and dissatisfaction about food. He accepted all visitors and strangers with enthusiasm, and did not show any sign of uneasiness if left alone with them when the foster mother was out of sight. He went to bed without protest and slept well. His fear and anxiety over toileting had dissipated. He was beginning to delight in his successes regarding toilet training. Very occasionally he would soil himself deliberately as if he were resentful about something. The foster mother reported that he got into a "bad mood" about once a week, during which time he was rather cranky, but she felt that these moods were diminishing in frequency. Joe particularly delighted in being played with, especially when such boisterous activity as being tossed up in the air was involved. He enjoyed play with the other children. He was delighted with all kinds of changes in his environment, liked going out in crowds, and was content having people come in. He no longer rocked or sucked his thumb and had had no temper tantrums since his arrival in the home. He could play happily by himself but still preferred to have people around. He got along quite well with the contemporary foster chud.

Joe was seen twice more in this foster home and on both occasions

A STUD Y O F TW O CHILDRE N 5

3

gave the impression of a mentally healthy child. His outgoingness and bounciness, along with his bright-eyed expression, made him a most attractive youngster. His mental health score remained high. He gave the impression of a solidly established, highly secure youngster and was finally recommended for adoption at 21 months of age. The experimenter had the pleasure of testing Joe and seeing his adoptive mother a year after his adoption. Continued happy adjustment to his world was in evidence. In his adoptive home, he had formed close relationships with his adoptive parents and was making a satisfactory and happy life for himself with them. Summary of security records on Joe. His scores were as follows : 10.1 months —.01 12.2 months +.03 16.3 months +.21 20.5 months +.42 22.5 months +.45. Joe's scores changed from exceedingly low ones on his first two records to high ones comparable to any achieved by the children in the well-adjusted group. The clinical survey, based on an item analysis of the scale as well as the experimenter's judgment of the child, showed an increase in mental health until, by 22.5 months of age, it was deemed that Joe was physically, mentally and emotionally ready for an adoption placement. An examination of areas of difficulty and easiness shows that the bulk of his difficulties on the first three observations lay in sleeping, bathing and toileting situations; in his relationships with people; and in the area of "philosophy." Freest of difficulty was his behaviour involving play with play equipment. The most difficult experiences for him to handle were those of physical sensations and strange situations. Security quadrate. It was desirable to examine Joe's security picture by method C. The balance of his dependent and effortful behaviour could be considered in order to add depth to our understanding of the strengths and weaknesses of his adjustment. Graph II depicts Joe's changing mental health status from first to fifth examination. It will be remembered that the proportion of dependent items appears on the left of the chart, with acceptance above the centre horizontal line and refusal below. The proportion of effortful items is recorded on the right of the chart with acceptance above the centre line and refusal below. The proportion of endorsations of each of the four kinds of items is represented by the four sections of the quadrates. A comparison of one graph with the next demonstrates the changes

54

THE SECURIT Y O F INFANT S

GRAPH IV. Security quadrates of a poorly adjusted and a well-adjusted child. These diagrams show that the well-adjusted child maintains a high degree of dependence and effort throughout infancy. The poorly adjusted child becomes well adjusted, as is indicated by a decrease in his refusals and an increase in his acceptance of dependence and effort. which took place in the endorsement of items from the earliest tests with their very low security scores to the latest with their high security scores.

A STUD Y O F TW O CHILDRE N 5

5

The earliest test indicated Joe's refusing a high degree of dependence as well as considerable effort. There was a small degree of dependence evident and approximately the same degree of acceptance of effort as there was refusal of it. The second test, which showed a slight increase in security, demonstrated an increase in the acceptance of dependence and a decrease in its refusal. Behaviourally, however, there seemed to be approximately the same degree of acceptance and refusal of effort as in the first test. In the third test, which showed a sizable increase in security, a considerable increase in the degree of effort and a slight decrease in the refusal of effort were demonstrated, although approximately the same degree of acceptance and refusal of dependence was showing. In the last two tests, which showed high security scores, refusal of both dependence and effort had diminished to almost nothing, while acceptance of both dependence and effort had increased to almost 100 per cent of the items. On the last test, there was 100 per cent acceptance of the dependent items. It appears that the example of Joe, demonstrates that effortful behaviour complements dependent relationships in the mental health of children. Joe's case substantiates our hypothesis. Implications The first impression created by Joe's security score was that he was in a very poor psychological state; his score was the lowest obtained on any child to that date. His succeeding scores, although showing improvement, gave no hope that he could eventually show a high degree of mental health. When his final tests indicated that he was up to the level of the well-adjusted children, therefore, further item analysis and consideration of the implication of the patterning of his endorsements brought out some tentative hypotheses. It became apparent that despite his difficult behaviour, Joe was building a relationship, though a negative and unsatisfactory one, with his foster mother. His first few records indicated persistent refusal not only of the things he was expected to do, but also of some of the dependence being offered by the foster family. His refusal, however, was an energetic one. The foster mother could never ignore his unrest as he persisted in expressing it vehemently. It seemed that a psychological struggle to find his place in the world was going on both within him and outwardly. This behaviour could be contrasted with that of other children with problems who were probably easier to live with but who were failing

56 TH

E SECURIT Y O F INFANT S

to establish a relationship of either a positive or a negative nature. Perhaps by the very nature of Joe's struggle, despite his poor score, one could anticipate his regaining mental health. When seeking signs of mental health in children, therefore, perhaps we should regard turmoil and struggle, as well as ease and comfortableness, as assets, and passivity as a deficit. CASE II: AN ANALYSIS OF BILL Observation Bill was seen once by the examiner when he was 2 months of age. At this time he was a healthy, well-settled and particularly alert baby. He was visited in his home, where the atmosphere was relaxed and his mother slow moving and easy with him. His parents were professional people, much interested in their children and very willing to contribute information which might be helpful to the research study. Bill's older brother was attending kindergarten. During the course of the study (18 months), the family moved to a new home without apparent upset to Bill. The Scale Table V gives the security scores for each of Bill's tests and the proportion of endorsements for the various types of items. It can be noted that Bill's security scores remained high throughout the total period of his infancy. Examination of the scores under the Deputy Agent and Regressive columns indicates that he has followed the pattern common to most of the children in the well-adjusted group in so far as he shows deputy agent symptoms throughout the total period, but to a small degree only. On four occasions, regressive behaviour was resorted to, but apparently as a temporary mechanism of adjustment only, since these were the only occasions on which it appeared. TABLE V SECURITY SCORES ON "BILL"

Age in months 2 4 7.6 11 15 18 21.9 23.3

Percentage of items endorsed Deputy Agent Regressive Security 4 9 87 0 93 7 10 92 9 8 0 95 0 93 3 0 89 7 8 97 6 8 6 95

Security score + .34 + .43 + .43 + .46 + .44 + .43 + .44 + .43

A STUD Y O F TW O CHILDRE N 5

7

Bill's first report indicated that he was settled in every aspect of his Ufe with the exception of feeding and sleeping. He was accepting diaper change without protest and enjoying his bathing activity. He was responsive to physical handling, such as cuddling, and, if disturbed, could be comforted easily. He was enjoying vocalization and, despite his age, seemed to enjoy himself or be content when put outside in the carriage or taken shopping. He was aware of groups of people and seemed to enjoy them even at this early age. He responded to social stimulation, but also was content if left alone. He enjoyed kicking and bouncing. His difficulty with regard to eating seemed to be a temporary one; he refused a substitute bottle, prefering the breast. The interpretation of this difficulty as temporary was borne out by the fact that by 4 months of age he was quite happy to accept the bottle. In the sleeping area of his life, he seemed unusually aware of the familiar element; he was wakeful if put to bed in a strange place, and could be contented only if in one position for sleep. At 2 months of age, he was crying in his sleep occasionally. By 4 months of age, he was no longer wakeful when put to bed in a strange place, but his restlessness and the desire to be in one position for sleep persisted. By 4 months of age, the scale indicated that Bill was becoming increasingly aware of his environment, and was taking it in his stride with enthusiasm. He enjoyed loud noises and bright lights and was particularly sensitive to people; he preferred company most of the time, although he would not cry when alone. He was always ready to respond happily to strange people and would turn from such things as feeding if he heard a footstep or voices. The next two records, taken at 7 and 11 months of age, give the impression that Bill continued to progress in a happy, enthusiastic way through all his life experiences. By 7 months of age, his eating difficulties had completely disappeared, but he was still having some trouble in sleep. He persisted in his need to sleep in one position, and frequently cried out and was restless while sleeping. He was particularly prone to cry on waking from naps. He remained enthusiastic for his bath and co-operative when being diapered. He continued to enjoy physical contact, such as rough play and cuddling; he enjoyed change in the environment and delighted in his own physical games and vocal play. His marked sensitivity to people seemed to be increasing; he enjoyed a crowd, and obviously preferred to be in the company of many people. Now he whined or cried if left alone in his playpen for any length of time; indeed, marked sociability seemed now to be one of Bill's characteristics.

58 TH

E SECUBIT Y O F INFANTS

By 11 months of age, Bill was ready to take on the new task of feeding himself. He would accept any kind of care from a stranger; in fact, he would play up to it as an older child might, actually being amused by it and "trying out" the stranger as if to see what kind of reaction he might get. Co-operative behaviour and enjoyment of life's activities remained marked. He was particularly keen about visiting new people and new places. He had progressed somewhat in his inner contentment in that he was now able to play alone for longer periods of time and was showing marked enthusiasm and interest in play materials. The next two records, taken at 15 and 18 months of age, again show consistent readiness to accept new developmental experiences and an apparent trust in his parents and other people. He remained enthusiastic about food and wanted very much to feed himself, although he could permit his parents to do this if it were necessary. Although he was eager for food, he could wait patiently until it appeared. He still enjoyed being fed by visitors. He would go to bed without protest and usually slept soundly. His habit of crying on waking continued, and occasionally he would wake to noises which were merely common house noises. He could accept being put to bed in a strange place, but tended at these times to be more wakeful and demanding of attention. He continued to enjoy bathing and physical experiences. His attitude towards changing experiences was one of keen enjoyment. He continued to respond socially and to enjoy other people's company, although the inner content noticed at 11 months remained; he was able to play happily alone. His enthusiasm for toys continued throughout this whole period. When reported at 21 and 23 months of age, Bill was still showing excellent adjustment in every area, with the exception of sleeping. He still cried out while sleeping and sometimes on waking from naps. He was a light sleeper and wakened readily to noises, although some improvement here was obvious. At 21 months of age, he seemed to be going through a period of shyness with strangers; he would cling momentarily to his mother until he became accustomed to them. He was showing strong sensitivity to the voices of strangers and, if approached in a boisterous fashion, would become upset temporarily. He continued to take all other new experiences in his stride, maintaining keen interest in toys and in the routine procedures of life. Bill's adjustment is one which indicates good mental health through the period of infancy. It seems characterized by trust in his parents and other people, and enthusiasm for new experiences. He seems to show rather unusual sensitivity to people, and marked enjoyment of contacts

A STUD Y O F TW O CHILDRE N 5

9

with company and with strangers. In only one "life area," that of sleep, is there a consistent difficulty. His record from 2 to 24 months of age indicates that crying during sleep or at the end of his nap persisted. At times, he was a light sleeper. Looking through Bill's records, one gets the impression of a positive, outgoing, buoyant child, with no difficulties of note. Security quadrate. Consideration of the patterning of endorsements according to acceptance and refusal of dependence and acceptance and refusal of effort (see Graph IV) brings to light the following facts. According to the security hypothesis, it was anticipated that the dependent child would feel secure and, hence, confident to expend effort to solve his own problems and to enjoy people and things. The dependent child would also, therefore, show independence through his desire to put forth effort on his own behalf. Bill's case illustrates this principle. From early infancy, his acceptance of both dependence and effort are very high. By 15 months of age, there is 100 per cent acceptance of both, and this continues through 24 months of age. Only three of his eight records indicate any refusal of dependence and at no time is there any marked refusal of either dependence or effort. WHAT WE HAVE LEARNED The analysis of the developmental security records of these children has substantiated our hypothesis that a strong dependent relationship with a mothering person is crucial to an infant's mental health. It seems further to bear out the expectation that effortful behaviour can be manifested only after a trusting dependency is established. Use of the Infant Security Scale in this fashion has provided a means of comparing the minute detail of each child's adjustment within a consistent frame of reference. In this way it has been possible to deepen our understanding of the strengths and weaknesses of each child and to see the psychological mechanisms used by each to establish and maintain his unique degree of mental health. The analysis of Joe's records has been particularly useful because it has permitted a look at the dynamics of a child in conflict, struggling to establish a feeling of well-being through a proper balance of dependent and effortful behaviour. Out of his conflicting fears and aggressiveness, Joe comes to terms with himself and his environment and grows easy in his world. Through his records, one is made aware that the Infant Security Scale can be used as a rather sensitive instru-

60

THE SECURITY OF INFANTS

ment whereby to analyse mental health. Casual observation and clinical interview did not reveal clearly the positive changes in Joe's adjustment which pointed towards the final happy ending of his story. Only the detailed analysis of the scale made us aware of these. Finally, Joe's records may have given us some general psychological insight regarding the mental health of infants. Whereas we had expected that signs of easiness and smooth adjustment were forerunners of good mental health, we now felt that perhaps strongly expressed conflict and difficulty in adjustment might also be an indication of psychological strength which could presage good mental health.

SECURITY AND INSTITUTIONAL

LIVING

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5. The Security of Infants in an Institution FOR MANY YEARS those in contact with infants living in institutions have recognized that the development of such children is inhibited. These infants are generally characterized by poor physical growth and a lack of interest in their world. They seem to lack purpose and constructive effort in their play; their relationships with adults and other children appear superficial; they frequently exhibit tics such as head banging, bed rocking and persistent thumb sucking. Attempts to administer developmental tests are disappointing because it is difficult to elicit responses from the babies. In cases where tests are completed, the results generally indicate retardation in the rate of development. Phenomena such as these have aroused research workers in all parts of the world to study the implications of these symptoms for the developing personality of children ( see chapter 1 ). The appraisal on the Infant Security Scale of a group of children living in an institution should demonstrate how an atypical group would be differentiated through use of the scale. An institution which cared for babies from birth to three years of age was available in this city, and arrangements were made for a study to be done. In undertaking this research project on babies living in an institution, it was not our concern to relate the children's behaviour to maternal deprivation or to any other environmental cause. It was assumed that some common human element was lacking in institutional environments generally and that this lack created an abnormal psychological state in young babies. Our concern was with this state and what it meant psychologically. Could it be measured by the Infant Security Scale? It seemed probable that the phenomena observed in the behaviour of these babies were indications of poor mental health. Assuming that our scale measured mental health, we were interested in learning the degree to which the mental health of these babies was impaired, the extent to which they would lack dependent trust, self-trust and willingness to put forth effort. Would our scale show increasing decline in security scores, as suggested by other studies which showed a decline in a child's developmental level with prolonged institutional experience? 63

64

THE SECUBITY OF INFANTS

Observation of the degree of apathy noted in the older children, compared with that noted in the younger, led us to expect that an increasing decline in mental health would in fact accompany prolonged stay in the institution. It was hoped that the detailed symptoms indicating change from month to month could be recorded and, later, analysed to give some insight into the psychological states of the children. Finally, we wanted to learn the degree to which the Infant Security Scale would differentiate between the group of well-adjusted children and the group being reared in an institution. THE INSTITUTION* At one time a beautiful residence, the institution building had been altered to provide accommodation for infants from birth to 18 months of age. Because homes for the children were lacking, many of the children had to be kept on until they were three years of age; overcrowding was the result. The children were housed in beautiful nurseries, seven or eight in each. The nurseries were spotless, well cared for, and well equipped with facilities for working with and washing the babies. Each cot was separated from the next by a dividing wall in which a glass pane was inserted about a foot higher than the railing of the cots; hence the babies were somewhat isolated from one another. At intervals marked by an increase in chronological age, the babies were moved from one nursery to the next where the routine was modified slightly to meet their more advanced needs. Meals for the children were prepared in a special infant-diet kitchen and brought to the nurseries on one large tray; they arrived already apportioned out for each child. In any one nursery, therefore, meals varied little from those in any other in amount, form or manner of presentation. Opportunity to feed themselves began for these children after 18 to 20 months of age. The children were spotlessly clothed at all times; each was given a complete change of clothing once or twice daily, according to necessity. The clothes were shared by all; no child had clothes of his own. Because time and personnel to dress the children were lacking, they seldom went outdoors during the fall and winter months. A plastic toy was hung on each infant's crib and a variety of soft animals and a few plastic playthings were made available as each child grew older. Children under 10 months of age were restricted in their activity "This study was conducted by Mary Kilgour, R.N., Diploma in Child Study, under my supervision.

INFANTS IN AN INSTITUTION

65

in so far as they were seldom out of their cribs other than to have a bath and to eat. Children over 10 months of age were placed on the floor of their own nursery for one hour in the morning, and children of walking age might have up to three hours daily out of their cribs. The activity of the children never took them outside the confines of their own nurseries. Because of limited staff and the consequent necessity for the person in charge of each nursery to work very quickly, little conversation was carried on with the children. Physical care was given quickly and efficiently; time for cuddling, chatting or playing with the children was cut to a minimum. Twice weekly the children were checked by a paediatrician. The person in charge of the routine of the institution was a graduate nurse. THE INFANTS Sixteen infants were selected for observation, thirteen of whom had entered the institution from the hospital of their birth. Two were admitted at 6 months of age ( Children L and N ) and one was admitted at 4 months ( Child K ). There were four children in each of the age groups: 0-6 months, 6-12 months, 12-18 months, and 18-24 months. Such a selection would provide a sampling in each of the levels of the scale. METHOD OF OBSERVATION Four children were observed each week, about four to five hours being spent on each observation. On the basis of these, items on the scale were endorsed. A total of five observations was obtained for each child at intervals of approximately one month. In all, eighty observations were made over a period of four and a half months, providing five security records on sixteen different children. The observer was a registered nurse with special qualifications in obstetrics from the Presbyterian Hospital in New York City, experienced in the care of infants, and completing her second year of study at the Institute of Child Study, University of Toronto. When making an observation, the observer remained at the institution for a period of four to five hours in order to record bathing, feeding, play, and afternoon bedtime behaviour. As well as receiving reports from the attendants in charge, the observer handled and played with the infants herself, making her own evaluation of their behaviour.

66

THE SECURITY OF INFANTS THE RESULTS

The security scores for the sixteen children on five tests are shown in Table VI. This lists the children chronologically from the youngest to the oldest. Each score is entered according to the child's age at the time the test was given. The total of the five scores and the change from the score on the first and the last tests for each child are shown in the right-hand columns. The median scores of all the test results within each age level are shown at the bottom of the chart. In order to show some of the results more clearly, trend lines of scores for each child from the first to the fifth test were shown in Graph V; similarly, the trend of median scores for each age level of the test are shown in Graph VI. Security scores decrease as age increases and institutional care is prolonged. This is demonstrated by the following facts. ( 1 ) There is a general decrease in scores as the children grow older. This is shown by the decrease in mean scores from youngest to oldest children. The youngest child's average score is -J-.23 and the oldest child's average is +.06. (2) Further, both the median and mean scores for all the children within each age group show decrease from the youngest to oldest level (Graph VI and Table VII). (3) For every child but one, the first score is greater than the final score and the scores of the older children both start at a lower level and decrease to a lower level than do those of the youngest children (Graph V and Table VII). When these differences between first and final scores are tested by the T formula, the significance is beyond the .01 level of confidence. (4) The amount of decrease from first to last test is generally greatest in the scores of the youngest children, and smallest in the scores of the oldest children (Tables VI and VII). (This may be accounted for in part by the method of scoring which does not take into consideration endorsements of the Insecure column. These endorsements were heaviest for the oldest children.) It appears therefore that the mental health of these babies has been adversely affected by their institutional experiences and the more prolonged the experience, the more serious is the effect. It also appears that the most rapid decline probably takes place in the youngest babies, which would tend to indicate that they are much more responsive to the environmental climate than is generally believed.

TABLE VI

SECURITY SCORES ON SIXTEEN INSTITUTIONALIZED INFANTS* Age in months

Total of Decrease from scores of first test to Children 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 each child fifth test A B C D E

32 33 21 15 31 30 27 45 34 31 26

F

12 21 29 22

19 22 20 25 28 49 18

G H I

40 44 21 29 25 23 16 20 -03 08 01 39 11

J K L M N O

-04 -03 18 10 03 24 20 13 01 11 14 03 06 04 01 28 30 19 19 13 10 04

P TOTAL AVERAGE

MEDIAN

06 01 05 22 21 21 21 13 15 08 -01 05 0 1 - 2 1 -09 09

+29

+21.6

+10.5

09 -01

07 -01 -06 08

+07

*Score« listed according to age of children with total scores for each child demonstrating a general decline with progressive age.

113 128 150 130 183

20 12 25 05 28

112

02

-01 81 69

0 36 13

28 102 33 98 34 -36

13 22 08 09 08 07

32

01 209 13

68

THE SECUBITY OF INFANTS

GKAPH V. Trend lines of Security Scores from first to fifth tests for each infant in an institution.

GRAPH VI. Trend of median scores for the total group. TABLE VII

FIRST AND FINAL SCORES OF CHILDREN LISTED ACCORDING TO AGE Age in months 1 2 3 4 5 6

7 8 9 10 11 12 13 14 15 16 17 18

19 20 21 22 23 24

Average: first scores

First

Scores

Final

Average: final scores

Difference between averages

+.19

-.16

+.09

-.17

Í+.32 1 +.31 ) +.45 1 +.31

+.12 +.19 + .20f +.26

Í+.49 +.18 -.03

+.21 +.16 -.03

+.39

+.03

+.20

f+.24 I +.14 1 +.28 1 +.13

+.11 +.011 +.06Í +.05

+.06

-.14

+.12

Í+.22 1 +.15 1 +.01 I +.09

+.13 +.07 -.061 +.07

+.05

-.07

+.35

+.2B

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THE SECURITY OF INFANTS

Each child shows a unique pattern of decrease. This can be seen in the following way. ( 1 ) There is a wide variation of decrease from first to last test. The greatest decrease is 36 points (Child H); the smallest decrease is 2 points (Child F). One child (Child G) showed no change from first to last test. (2) The trend of scores shown in Graph V demonstrates each child's unique pattern. Five children show a consistent trend downwards with variation in the degree of decrease. Others show both large and small fluctuations from test to test. Thus, despite common experiences which produce the same general effect on all the babies, each child maintains his unique pattern in response to the institutional experience. There are wide individual differences in the scores of institutionalized infants. That individual differences in scores are considerable is apparent from the fact that the range in scores covers 70 points, from +.49 to —.21; also, the scores of different children differ widely at similar age levels, despite the fact that the children have somewhat comparable experiences for a similar length of time. For example, Child E's score at 9 months is +.40, while that of Child G, who has been in the institution for approximately the same length of time, is —.03. Moreover, similar scores appear at different age levels. Child G's score at 9 to 14 months, for example, is as poor as that of Child P at 21 to 24 months (Table VI). Therefore, whatever is the general effect of institutional life upon infants, it is not an identical effect upon all of them. This fact may be important in a consideration of what should be done with institutionalized babies. The security scores of most infants decline when the children are transferred to a new nursery. This was apparent in the scores of eleven of the babies transferred from one nursery to another (adapted very slightly to an older age level) during the study. Nine of the eleven babies showed a decrease in score after transfer; two showed an increase. For seven children, the decrease appearing after transfer was greater than any other decrease noted for these children. Individual differences in the degree of decrease were marked. From this, it would appear that these children were markedly sensitive to even minor changes in environment, although individual differences were apparent here also. This fact could be useful in planning a move for such children, particularly a move out of the institution to a home.

INFANTS IN AN INSTITUTION

71

The security scores of the institutionalized infants are consistently lower than those of the well-adjusted infants and generally lower than those of the poorly adjusted infants. Comparison of scores of the institutionalized babies with the well-adjusted ones raised in a normal home environment reveals a consistent superiority among the welladjusted babies. This is true also of the poorly adjusted infants with the exception of the scores of two poorly adjusted babies which appear in the age level 0-6 months. ( See Graph VII. )

GRAPH VII. Median scores of three different groups of children represented at six-month intervals. Although some institutionalized babies under 6 months of age have scores higher than +.40 (the median score of the well-adjusted group over 6 months of age), no institutionalized baby of 10 months or more achieves a score as high as -f-.40. Only three of the well-adjusted babies older than 6 months of age fall below a score of .25. It is therefore apparent that institutional care can seldom, if ever, nurture mental health to the same extent as can home life. This is particularly true if institutional care is prolonged. It would appear that institutional care is least damaging to mental health up to and

72

THE SECURITY OF INFANTS

about 10 months of age. After this age, it seemingly fails to meet those psychological needs of infants which are essential for the maintenance of an adequate degree of mental health. INTERPRETATION OF THE RESULTS This group of institutionalized babies reacted for the most part in the way we had anticipated. All but one child showed a decline in his security score over the five-month period. Further, a marked decline in status is indicated from youngest to oldest in the group. How can these findings be interpreted in "security" terms? It would appear that these institutionalized babies, whose scores in the early months approximate the scores of some well-adjusted children, may have developed some feeling of dependence as a result of the physical acts of comfort offered them in the daily routines of bathing, changing and feeding. Despite the lack of some one mothering figure, they have been able to absorb something salutary from their institutional experiences. The decline in scores for the group which becomes marked around ten months of age suggests, however, that this dependence was of a fragile nature. Either the acts of depending were insufficient in number or they occurred with such a wide variety of people that an infant could not gain a feeling of being an unique individual. Thus, no genuine first relationship of trust with an adult could be established. Lacking a trust in others, the child is necessarily deprived of the opportunity to build a trust in himself, and as he grows older any outgoing effort on his part is either limited or blocked off completely. Under his present circumstances, a decline in mental health status seems inevitable. He remains at the level of a very young child, despite his progress in physical growth and increase in motor capacity. These he cannot use to advantage in his environment because he lacks the inner urge to do so. He lacks the inner urge which a normal baby expresses in his enthusiasm to take the world in his stride, accepting and anticipating new developmental experiences. He lacks the inner urge which is based on self-trust. This interpretation is substantiated by the fact that the scores of the youngest babies decline rapidly. So dependent is a young child on a mothering person for his feeling of well-being that, without her, he cannot grow any psychological strength within himself. The rapid decline in scores and the fluctuations from test to test point up the fact, not popularly acknowledged, that very young babies are highly sensitive to their surroundings and to their everyday experiences.

INFANTS I N A N INSTITUTION 7

3

Evidently infancy is not a period of blissful unawareness but a most crucial time in the development of a child's attitudes and inner easiness. The tremendous range and variation in scores of different children of comparable age and institutional experience lead us to speculate that some children develop dependent trust much more readily than do others. Apparently some children can squeeze more positive experiences from a discouraging environment than can others. Why this is so is a question. Do some children select experiences for their attention which are more salutary than those selected by other children, or do all children attend to die same experiences but some interpret them differently? Whichever the case, is the difference based on a child's constitutional predisposition? Does one child's sensory equipment differ sufficiently from that of another as to create such wide divergence in perceptions of experience? Casual observation would incline us to believe that some children are markedly sociable from the first few weeks of Me. If this is so, does such a child, because he enlists the passing interest of a variety of busy adults, build a dependent relationship more readily than another? Will such a child suffer less in an institutional environment than other children? The variation among the older babies particularly gives reason to suspect that once a minimal dependence is formed in a very young child, it is relinquished at a rate different from that of the next child in response to apparently similar circumstances. The marked decline in security scores of most of the babies after transfer from one nursery to another seems to indicate an unduly fearful reaction to change. Despite the fact that the change in routine and location appeared minor to adults, the evidence suggests that it was major for the babies. This conclusion is reinforced by the observations of the experimenter. As part of the examination procedure, the children were carried out of their own nurseries and into a new room; in many cases, fear was expressed through terror-stricken screaming or complete immobility as if the child were rooted to one spot in the new room. Such behaviour could be interpreted as indicating that these children, having failed to develop a good relationship with people, and having no self-trust on which to rely, have put their trust in the objects and surroundings of their familiar room and cot. Removal from these surroundings is equivalent to removal from everything on which they rely for their feeling of easiness. They are bereft of the props by which they maintain even minimal security. In this situation, individual differences in response are marked; apparently some children have developed stronger inner states than have others. It is apparent that we

74 TH

E SECUBIT Y O F INFANT S

cannot interpret within our adult framework the full meaning of change for these babies, but it seems probable that it is important to them. The fact that the difference in scores between the well-adjusted and the institutional groups of children in the first six months is relatively small indicates that at least some of the children in both groups are of comparable status. As the children grow older, however, the difference increases; the status of the institutional group falls farther and farther below that of the well-adjusted group. We would assume then that the mental health of the institutional group has become poorer. The opportunity to form a healthy dependent relationship has been denied the institutionalized children and they give the appearance of having lost any urge to seek it. The possibility of arousing their interest in and developing their capacity for a dependent relationship is crucial to their future mental health; according to our postulate, they can never become truly secure without it. Studies such as those of Bowlby (8) and Bender (6) indicate that this capacity has already been permanently damaged; however, the highly unique way in which the children in the institution described here make use of the experiences offered them leads us to expect that the capacity for dependent relationships (leading to trust in others and then in self) may be permanently damaged in some and not in others. Detailed studies of individual children (some of which follow) suggest that the possibility of recovery is much greater for some than for others. Careful study of each child's reactions gives more direct indication of how one might go about re-establishing a trusting state. It is obvious that a warm, continuous relationship with one or two persons would be essential for all the children, but apparently children differ in the way they permit a channel of communication to develop between themselves and their outside environment. The data so far seem to indicate three different ways. One is that of direct physical contact to which some children seem most responsive. Picking up, cuddling, stroking, bouncing, and talking to this kind of child seem to open the door to his small world. A second method of establishing contact is through the material, inanimate objects in their environment and the opportunity to manipulate them. This kind of infant might remain apathetic towards a purely social game with an adult, but would respond to a game with play materials and, through this, gradually permit a channel of communication to grow. A third way seems to be through an interest in contemporaries. Some infants who

INFANTS IN AN INSTITUTION

75

apparently have lost interest in either direct social contact or play with play objects will enjoy watching the activity of other children close by. Although there is no interaction between them and the play activity of the other children, this active watching process seems to retain for them a thread of interest outside their "inner" selves.

6. Security and the Problem of Institutionalized Infants SUGGESTIONS FOR REDUCING THE ADVERSE EFFECTS IT is APPARENT from our study, as well as from other studies, that life in an institution has an adverse effect upon the mental health of babies. A short period spent in an institution, coming at a particular time and in particular circumstances, creates disturbances. Prolonged care seems to create severe mental health disability. We in Western communities are faced with the practical fact that some babies, for a variety of reasons, must be placed in institutions for a period of time. Does this present study point out a way in which this kind of experience can be made less damaging, and even positive, for some children? One fact seems obvious, from both our research and our work with infants: that up to about ten months of age, some adequate degree of mental health can be retained even under adverse institutional circumstances. The provision of a nursing staff which remains constant for each group of children would greatly enhance the possibility of the children's developing a dependent-trust relationship. If the staff were trained to recognize the significance of mental and emotional stimulation through social play, vocal play, and the use of play materials, a child could enjoy the expenditure of effort in his environment and the opportunity to experience self-trust. The provision of at least a few articles of clothing and a few toys which would belong to one child alone and not to the whole community of children would greatly reinforce a child's feeling of selfworth. If such measures could be taken in an institution, the children, although not assured of mental health equal to that of children in their own homes, still might not suffer irreversible damage in the early months of life. The degree to which damage might occur beyond this period of time or at an older age is still open to question. We do know that we cannot expect all children to take the same thing from experiences; some maintain mental health longer than others. It is apparent that some children have or develop greater psychological strength than others and that each child has a unique way of expressing it. With training, nursing staffs can be made more sensitive to these characteristics. They can become aware of the most appro76

THE PROBLEM O F INSTITUTIONALIZED INFANT S

77

priate way of building a relationship with each child; they can be made to see the vital necessity as well as the pleasure of establishing a relationship, not only with the outgoing, bubbling, sociable baby, but also with the quieter, more withdrawn child. The abnormal degree of fear shown by these babies would probably not be manifest in babies well founded in a dependent relationship. There is a possibility that some fearful symptoms would be present, however, in view of the limited number of experiences to which these children have had to adjust. A volunteer programme, whereby the children were taken from their nurseries and gradually offered ever broadening experiences from early infancy on, might well ease their distress in the face of new situations. This would not operate, of course, with children lacking a basic dependent trust in others. The rapidity of the decline in mental health during the early months of life indicates that children are more sensitive then to the presence of stimulation and more vulnerable without it than at any later time. Either placement in a foster home or added stimulation and human contact within the institution is indicated for the early, rather than the later, months because of the greater ease with which a child responds then. USE OF THE INFANT SECURITY SCALE FOR PROGNOSIS The present Infant Security Scale, although imperfect in many ways, would have practical value in terms of selecting those infants most likely to respond to placement in a home or to added stimulation within an institution. Detailed individual analysis offers clues about a child's easiest avenue of response to adults. The scale appears to measure at least some aspect of mental health and certainly discriminates among children. With children who show serious mental health disability, some adjustment in scoring is necessary to take into account the high endorsement of Insecure items which appears with this institutional group and not with a well-adjusted group. A STUDY OF FOUR CHILDREN The following is an example of the method of analysis using the records of four children. Child E: Lorelie Monthly security scores: +.49, +.40, +.44, +.29, +.21. Examiners comments. Lorelie shows a steady decline in mental health. From the first observation at 7 months of age when she was an eager,

78 TH

E SECURIT Y O F INFANTS

interested, lovable baby, to the last observation when she was solemn, sad and inert, she presents a frightening picture. The fact that her security status declined as she received less and less attention in the institution would lead us to believe that these phenomena were related. In her first nursery her bed was at the door and she received considerable attention from those people passing up and down the hall. She was a favourite, spoken to by everyone, petted, carried about and talked to. Later, after a change of ward she was given less attention and was merely one of many children. It appears that directly after the change she struggled to maintain some attention from adults by screaming for what she had known previously. When no response was forthcoming, she appeared to give up and withdraw into apathy so that by the time of the last observation she responded in a very meagre way to deliberate adult stimulation. She spent periods of time rocking, or standing with her eyes closed and her head resting dejectedly on the rails of her crib. The security scale. Consideration of the routine areas of Lorelie's life indicates a normal adjustment from 7 to 10 months of age. After this, symptoms of disturbance appeared in the areas of eating, sleeping and elimination routines. She lost enthusiasm for food; her sleeping habits became restless and generally poor; her acceptance of diaper change and bathing activity showed increasing signs of passivity. At times she showed some resistance to a strange adult handling her. Normal baby activity of kicking, moving about and vocalizing, which had been obvious during the first two observations, decreased until by 9 months of age she showed little interest in vocalization, and by 12 months of age no interest at all. The eager responsiveness to both adults and children which had been noted on her first three records was replaced by an increasing lack of outgoingness, which was demonstrated by a passive acceptance of the presence of others. Her enthusiasm for toys was replaced by indifference. Some emotional resilience was apparent in that she would still respond to cuddling and could be comforted when hurt. While trusting an adult in this direct and warm kind of contact, she showed apprehension and tension when played with in a boisterous fashion. Degree of acceptance and refusal of dependence and of the opportunity to put forth effort (Graph VIII). Graphs depicting the proportion of endorsements of this child's acceptance or refusal of dependent items and acceptance or refusal of effort items (method C) demonstrate the change occurring from the first to the last test. The small squares of the quadrate represent the proportion of items endorsed out of the total number within the child's experience. The upper left square shows a high degree of acceptance of dependence, decreas-

THE PROBLEM OF INSTITUTIONALIZED INFANTS

79

GRAPH VIII. Security quadrate for Child E. ing slightly in the last two tests. The upper right square indicates a high degree of acceptance of effort items in the first test, with a decrease to the last test. After the first test, a small amount of refusal of both dependent and effort items appears. In every test, there is less acceptance of effort than acceptance of dependence. This can be interpreted to mean that usually when this child is given an opportunity to accept dependence, she is ready for it and similarly she generally accepts the opportunity to put forth effort. The last two tests, however, indicate an increasing amount of refusal of both effort and dependence items. A significant aspect of this analysis lies in something which has not been graphically depicted, that is, the number of items which do not apply to her experience. The serious limitations of the institutional

80

THE SECURITY OF INFANTS

environment are indicated by the fact that only 80 per cent, approximately, of the items which apply to most of the well-adjusted children, apply to this child. She is deprived of many of the normal experiences of both a dependent and an effortful nature to which she could respond. A further consideration which applies to the mental health assessments of the total group of institutional babies is the intensity of their disturbance as indicated through a high endorsement of items of the Insecure column. This has not been taken into consideration in the total score, or in the graphing of dependence and effort items. Prognosis. This child responds most directly to physical and social contact with an adult. This seems to be the one thing in her environment to which she holds. Her interest in other things, such as toys and routine procedures, has faded but she still seems to wait for immediate tactual satisfaction to satisfy her need for people. In view of the very rapid decline in her score in the two months' time when her environment deprived her of this kind of contact, it is felt that she may be more dependent upon this kind of stimulation for the maintenance of good feeling than are other babies in this study. It is suggested that her mental health could be restored by building up a relationship with people through physical contact. If this were started early, her recovery should be fast; if she did not receive it, her mental health would probably decline to a severe degree. Child H: Michael Monthly security scores: +.39, +.11, +.18, +.10, +.03. Examiner's comments. When first observed at 10 months of age, this little boy gave the impression of an outgoing child who despite his sad eyes was enthusiastically interested in the activity of the nursery. He was responsive immediately to adult attention and affection and enjoyed the physical contacts made during routine care. He kicked, crawled and investigated in a normal baby way. He showed signs of some emotional stress in his tenseness, his frequent temper tantrums and his habit of rocking. A month later a radical change in behaviour was observed and this was accompanied by a drop in security score from +.39 to +.11. The change in behaviour accompanied a transfer to a new ward; it seemed apparent that he was highly sensitive to the difference. He also lost five ounces in weight and gained only seven ounces over the period of the next two months. From the time of transfer, this child's score reflected a steady decrease in security. His behaviour seemed to indicate that he was in a state of conflict between anger and fear, as he vacillated from tenseness and screaming on the one hand to eager initial approach followed by apathy and listlessness on the other. On the final testing his initial approach to a situation seemed to indicate that he would have liked to accept and enjoy experiences, but could not

THE PROBLEM O F INSTITUTIONALIZED INFANT S 8

1

trust himself to believe that the outcome would be satisfying. He seemed to lack trust in himself and appeared to be losing trust in his world. The security scale. Michael's positive approach to the routine situations of his Me at 10 months of age showed a change for the worse by 15 months. Instead of accepting food in a relatively easy way, he became anxious and tense when it was presented. He screamed the moment food was in sight and tensely gobbled it down as if it might disappear. His satisfactory sleeping habits of 10 months of age had disappeared, to be replaced by jumpiness and wakefulness at slight noises. When put to bed he vacillated between passively accepting his situation and fussing and screaming. From active co-operation when being diapered at 10 months of age he went through a period of active resistance and finally at 15 months of age he was accepting diapering passively. Bathtime changed, too, from a pleasant experience at 10 months to an unsatisfactory and unhappy one by 15 months of age. In spite of the fact that he babbled very little in response to adults and children at 11 months of age, he was interested and co-operative with them. After 12 months his co-operative relationship deteriorated so that he seemed to be anxious with adults; and by the end of the observations he showed signs of being jealous of the other children. The eagerness and enthusiasm in approaching new situations, which he had shown at 10 months, changed after transfer to apprehension and withdrawal in the face of new things. His temper tantrums became more prolonged and were accompanied by head-banging, while his rocking intensified over the four-month period and was accompanied by occasional thumb sucking. One of the positive qualities in this child's adjustment had been his sustained interest in toys. Through this interest the examiner on the final observation was able to overcome his initial desire to withdraw from a new situation and to have him approach with enthusiasm the new things which she presented. She was able to help him have confidence in himself and, as a result of her encouragement and assurance, he played with a toy for 16 minutes after an initial period of withdrawal from it. One might conclude, then, that in spite of a rapid decline in his emotional well-being, he was still responsive to at least one aspect of his environment. Degree of acceptance and refusal of dependence and of the opportunity to put forth effort (Graph IX). Analysis of Michael's acceptance or rejection of dependence and the opportunity to put forth effort indicates high acceptance of dependence on the first test and a some-

82

THE SECURIT Y O F INFANT S

GRAPH IX. Security quadrate for Child H.

what lesser degree of acceptance of effort. Some refusal of both effort and dependence is present. The second test demonstrates his reaction to a change of nursery; acceptance of both dependence and effort falls off markedly and there is a comparable increase in refusal of dependence and effort. The next three tests indicate a re-establishing of a greater degree of dependence and effort, but there is also more refusal of both and this continues to increase. The limited environmental opportunities are demonstrated in Michael's case by the fact that only 75 to 80 per cent of the items which would apply to a child in a normal environment apply to him. Prognosis. It appears that two positive aspects remain in this child's response to his world: an enthusiasm for food and a response to material things such as toys. Through these channels it should be possible for an adult to re-establish a personal relationship with the

THE PROBLEM O F INSTITUTIONALIZED INFANT S 8

3

child. This would have to be a consistent, continuing relationship with some one person in whom he could put his trust because his needs were being met. Only through the re-establishment of a trust in people could he finally develop a mentally healthy attitude of trust in himself as a person of worth. It is suggested that this kind of treatment would need to be started immediately before further deterioration of the child's relationships took place. Child K: Kathleen Monthly security scores: +.28, +.30, +.19, +.19, +.06. Examiner's comments. This little girl was 15 months of age when first observed, and had been in the institution for approximately a year. Her security score was lower already than that of most of the well-adjusted babies of her age who had been observed. She was showing many favourable mental health symptoms such as an outgoingness to people, and an interest in playthings and routine care such as eating, sleeping and bathing. Her enjoyment of such toddler activity as standing in her crib and crawling or running about on the floor was a good sign. The negative aspects of her adjustment, however, were marked sensitivity to voices or boisterous play, and apprehension and timidity as if she felt threatened when her activity was interfered with when toys were taken away, or when she was exposed to change of scene. Rocking seemed to be a further symptom of disturbance. Four months later (when her score was +.06) she appeared to be still an eager child, but her responsiveness seemed to have a decidedly anxious flavour. Although desirous of personal contact, she seemed to feel apprehensive and uncertain as to its outcome; for example, she accepted cuddling but without any sense of easiness. Her interest in routine care had vanished and she was now accepting care passively. Even her enthusiasm for food was gone. She gave the impression that she felt threatened by change of any kind, even a change of activity. She expressed fear strongly by crying and whining or by withdrawing from experiences. The security scale. The routine aspects of Kathleen's adjustment reflect decline. At first she was eager for food, but immediately after transfer to her present ward, she refused to eat for three days. Her enthusiasm was restored, however, until the third observation, when she was enjoying only familiar foods; by the final observation she was described as "a difficult child to feed." Her sleeping habits remained unaffected, but she showed symptoms of disturbance developing in the areas of bath and toileting. Her enthusiastic acceptance of bath at 15 months changed by 19 months to an anxious acceptance which seemed to be related to her strong anxiety for adult attention. Experiences which strongly involved physical contact, such as boisterous play, became signals for withdrawal and/or screaming. Some rocking was

84 TH

E SECURIT Y O F INFANT S

noted in the early observations; and by 19 months marked thumb sucking and head banging were recorded. This child throughout the observations had been sensitive to people (perhaps through fleeting contacts with them as they walked past the door of the nursery). She showed undue sensitivity to tone of voice; by 19 months she appeared to be slightly jealous of the other children. From a mildly healthy interest in toys and material things at 19 months of age, she became anxious and passive towards them. Degree of acceptance and refusal of dependence and of the opportunity to put forth effort (Graph X). Despite her stay of a year in the institution, Kathleen showed a relatively good mental health picture when first seen. Although it was far poorer than that of the welladjusted children, nevertheless she was making a good dependent adjustment to her limited world and was putting forth effort to a fair degree. There was some refusal of both effort and dependence. It was

GHAFH X. Security quadrate for Child K.

THE PROBLEM O F INSTITUTIONALIZED INFANT S 8

5

only when she was nearly 17 months of age that there was a marked decline; a serious dropping off of her effortful responses to her small environment was accompanied by an increase in her refusals to put forth effort and to depend on people. About 75 to 80 per cent of the items which apply to well-adjusted children were applicable to Kathleen. Prognosis. This child seemed to be in a state of conflict, wanting to trust people and herself and to enjoy her experiences but lacking the inner certainty which would allow her to do so. At times she gave the impression, through her eagerness, that she was hopeful that experiences might be satisfying, but this eagerness was constantly being dispelled by a feeling of anxiety that nothing was worthwhile. On the one hand, she seemed to be on the defensive, actively resisting things which might threaten to change her world and hence upset her equilibrium; and on the other hand, she seemed to feel that many things were not worth resisting, as evidenced by her increasingly passive acceptance of adult care, fleeting interest in toys and loss of interest in food. She still seemed to have an open door to the world through her desire to cling to the few things which gave her pleasure. Hence, given a consistent environment of affection and stimulation, she should be able to improve her mental health through the development of trust in people. In this way, she might build up her enjoyment of an interest in her world. Child L: Ernest Monthly security scores: +.13, +.10, +.04, +.01, +.05. Examiner's comments. Ernest is an example of a child who had a low score when first tested and whose score continued to drop slightly. When he was tested from 16 to 20 months of age, his behaviour was characterized by symptoms similar to those which had developed gradually in the younger children. He was listless and apathetic when first seen; his expression was dull and all his activity had a passive flavour. He seemed to lack enthusiasm for anything, including crawling, sitting, rocking, and manipulation of toys. The security scale. The picture of the routine aspects of Ernest's Me remains substantially the same from the first to last test. He maintained some enthusiasm for food and his sleeping habits remained satisfactory. There was an increase in passivity in situations involving a response to adults, such as being put to bed and being diapered. He showed increased negativism to bathing activity; he began to show apprehension towards strangers. He seemed uncertain of physical contact; he could not enjoy boisterous play or cuddling; if he were hurt, he could not accept comfort

86

THE SECURITY OF INFANTS

from an adult. He gave the impression of being physically timid. The first four records indicated displeasure when his physical activity was interfered with, but the last record indicated a passive acceptance in this respect. Rocking his crib and sucking his thumb seemed to remain emotional outlets; frequent temper tantrums were indicated throughout. Change in environment seemed to threaten him as he consistently reacted by signs of tension or by crying. When first seen this child was content generally to play passively alone, but the last three records seemed to indicate more desire for attention, in that he whined when alone. Further, he seemed to enjoy the presence of the other children for he watched their activity intently; however, he did not make any advances to them. Parallel activity with them, and his new-found skill of toddling about, were positive signs of good feeling. Passive enjoyment of toys combined with a minimal amount of manipulation and a contentment to be confined in a restricted space seemed to give evidence of a low level of interest. This impression was reinforced by the fact that he never babbled and seldom smiled throughout the experimental period. He consistently showed tension and passivity when he was with an unfamiliar adult or when he was in a strange situation. Degree of acceptance and refusal of dependence and of the opportunity to put forth effort (Graph XI). This child showed greater lack of dependent relationships and less willingness to put forth effort than any of the other children in this group. From the beginning his acceptance was grossly limited and his refusal of effort and dependence was marked. He seemed to lack trust in others and trust in self. His mental health state was poor. Of the items which would apply to a child in a normal environment, approximately 75 to 80 per cent apply to him. Prognosis. Reports indicate that this child had been operating at a low level of activity for many months before being observed; he gave the impression that his ability to respond with enthusiasm to anything in his world was sadly limited. This child seemed to be of two minds regarding the people caring for him. On the one hand, he seemed not to have developed a need for adults, for there was no warmth towards them or trust in them; on the other hand, he had a fearful perception of them in new situations or if they were strangers, or if their voices were sharp; and in some cases he resisted their presence and care. These were the most obvious demonstrations of his awareness of them.

THE PROBLE M O F INSTITUTIONALIZED INFANTS

87

GRAPH XI. Security quadrate for Child L.

It appears that only through prolonged treatment could Ernest finally establish any trust in adults; in fact, any positive emotion he demonstrated seemed to go out to other children rather than to adults. The most direct approach by which to start building some responsiveness, therefore, might be through children. A play situation including two or three other children and one adult might begin pleasurable contact. The degree to which his mental health could be restored cannot be predicted. The examination of these children by the Infant Security Scale has revealed clearly some of the strengths and weaknesses of their psychological Ufe and has indicated a way of entry into it. Used in this fashion, the scale can be of real value in the treatment of children who have developed in atypical ways as a result of some deficiency or abnormality in their environments.

7. Summary AS A RESULT of our research, the Blatz security theory has been refined at the level of infancy. In addition, a mental health assessment form has been developed whereby various degrees of an infant's mental health can be demonstrated. The use of this scale, even in its experimental phase, has brought to light two main considerations: first, the strengths and weaknesses of the instrument; and second, some interesting hunches about the mental health of infants. With regard to the scale, it became apparent that despite its usefulness as an instrument for clinical evaluations, it contained many defects, some of which have been discussed in chapter 2 (method B). After it was used for some time, it became evident that the wording of some of the items could be greatly clarified by the substitution of more specific questions or by an elaboration of some items to make the meaning more exact. Also, the use of four scales to cover the total age range of infancy proved to be relatively clumsy. Sometimes, when a child was evaluated around the age break in the scales, it was felt that he might have been more fairly recorded on either the scale above or the scale below that indicated by his chronological age. In addition, our attempt to keep continuity from one scale to the next necessarily created much duplication of items on each of the scales. On the present scale, the number of items on the Secure side is not the same as those on the Deputy Agent and Regressive side (see p. 32). It has become evident that the scoring would be facilitated and the evaluation would be made easier if an equal number of positive and negative symptoms were available for endorsement. These items should be the positive and negative aspects of the same phenomena. A further insight came to us as a result of the study of babies in an institution. This study made us aware of the importance of the centre Insecure column in a true evaluation of a child showing serious mental health disability. For this reason, an expansion of the number of Insecure items so as to correspond with Deputy Agent and Regressive items should improve the scale. With these thoughts in mind, a revision of the four scales has been made, condensing the four scales into one common to all age levels. Items were reworded, a comparable number of Secure and Deputy Agent items was included, and the Insecure column was greatly ex88

SUMMARY 8

9

panded.* This new single scale seems to be a more sophisticated one, and is now ready for studies of reliability. Because the form and the wording are so similar to that reported in this book, the validity will probably be satisfactory, although this too will have to be tested eventually. The matter of agreement between two independent raters will also have to be tested. The future work at the Institute of Child Study will be towards the establishment of a truly reliable measure and ultimately a more refined scale. The present scale favours the outgoing, energetic children who generally respond positively to their environment and experience. Threfore, any scores on a cross-section of the population will inevitably show a distribution skewed in favour of high scores. This is a natural phenomenon to occur at present, as most young children are probably in a state of rather good mental health. The development of mental health scales at the Institute is not limited merely to children in infancy. Work has been progressing for several years on a form to measure mental health in the pre-school years. This work, being carried out by Millichamp,** Laidlaw and Flint, has extended the infant scale and the concept of mental health upwards through the years two to five. Data have been collected on our Nursery School and Kindergarten population since 1954. This information is being analysed with a view to eventual refinement of the scale. Grapko has devised a test to assess security of elementary school children, called "The Institute of Child Study Security Test, Elementary Series: The Story of Jimmy."t This is now being used by some teachers as a means of assessing the mental health of school children. The recent publication of Measuring Security in Personal Adjustment, by Mary and Leonard Ainsworth,t is a refinement at the adult level of the security concept of personality and is accompanied by four tests designed to measure the extent of an individual's security and insecurity in four areas of life adjustment: familial intimacies, extra-familial intimacies, avocation, and philosophy. The way the present work is progressing lends hope that eventually both our theoretical framework and our means of measurement will form a continuum from infancy through adult life. "The Revised Infant Scale available at present in mimeographed form at the Institute of Child Study, University of Toronto, 45 Walmer Road, Toronto. e *D. A. Millichamp, "Upstairs and Down," Bulletin of the Institute of Child Study, XVIII (Sept. 1956); and "The Child and His Adults," Bulletin of the Institute of Child Study, IX (Dec. 1957). tAvailable at the Guidance Centre, Ontario College of Education, Toronto, Ont. ¿Toronto: University of Toronto Press, 1958.

90

THE SECURITY OF INFANTS

Has the Infant Security Scale contributed anything to our knowledge about mental health? It would appear that it has. Despite the relative crudeness of its structure, it does differentiate between groups of children. It gives further insight into the aspects of a child's life which either detract from or add to his mental health. It provides a method of comparing one child with another, not only in relation to his degree of mental health, but also in relation to the psychological mechanisms whereby he maintains his mental health. It has contributed to a greater clarification of thought regarding the mental health of infants and has pointed the way for many new studies. At the present time, a study is in progress to attempt to measure a baby's reactions to a situation of prolonged stress, stress which occurs when a baby must be removed permanently from his familiar foster parent to a new adoptive parent. Also, the present scale has an immediate practical use in such settings as adoption agencies or children's institutions. It provides an objective and systematic method of assessing the personality qualities of a young baby and points up the strengths and weaknesses of each child. With such a tool, psychologists recommending placement or social workers placing children in either foster homes or adoptive homes can assess the possibility of an easy or difficult adjustment and indicate wherein a child is most likely to demonstrate his uneasiness. We have discovered that any attempt to assess the psychological well-being of an infant leads inevitably to some measure of his mother too, because it is she who inevitably gives order and meaning to a child's first experiences. The total of all these experiences becomes the atmosphere in which his mental health is nurtured and it is this which in part we are attempting to assess. Although it would be more precise to measure some quality of the infant alone, our present stage of sophistication precludes this possibility. Our very early studies (Appendix I), which were closely tied to adult security, started us on a search for independent qualities, at that time regarded as probable symptoms of mental health. It took several years of speculation before we were able to recognize that this quality had a rightful place in a concept of the mental health of infants, but only when regarded as an accompanying symptom of a trusting dependence. It was not a healthy symptom if it became all-pervasive and if not founded in dependence. Thus our first confusion of theory gradually became clarified over the years. We now believe that independence is developed in the way depicted by the diagram below. Explained in its simplest form, two qualities combine in a mentally healthy infant: dependent trust and self-trust. Dependent trust is the first quality a healthy infant develops from the care and guidance

SUMMARY

91

given by his parent. From this he develops a feeling of self-worth which, in turn, gives him self-confidence to put forth effort and act independently in some aspects of his life. This independent action, because it brings satisfaction from self-initiated effort, develops a feeling of self-trust in the infant. At the infant level, we choose to describe this phenomenon of independent action by the term effort, a term which seems more appropriate for the highly dependent infant. It is hoped that these studies will contribute something to the renewed interest in the psychological Hie of infants. The relating of infant experiences to later adjustment has been explored in a relatively superficial way, as only gross relationships have yet been perceived (7, p. 63), that is, we know that adverse effects follow on maternal deprivation. Perhaps this work will deepen our understanding of the implication of such experiences as maternal deprivation. Having the scale makes possible a study of infants while they are actually undergoing experiences and should lead to more explicit results than studies that have had to depend on relationships between phenomena observed in later life and reported early experiences. If it is the atmosphere rather than specific incidents (trauma) which creates good or poor mental health, then we must study what comprises a good and poor atmosphere. This should be facilitated by a method which permits us to study infants in their usual setting. Gradually, as knowledge accumulates, our original purpose of understanding the contributing factors to mental health will be fulfilled. We at this Institute have been most fortunate in having the active co-operation of parents, child care agencies, and institutions which see value in research as pointing the way to the greater understanding of

92 TH

E SECUBIT Y O F INFANTS

how to develop mentally healthy children and adults. Two current studies make use of community facilities; one on the reaction of infants to change of home; and a second more practical one on the changing of a residential nursery programme (reported in chapter v) in order to implement infants' mental health by providing a benign physical and emotional environment. The opportunity to attempt the establishment of a benign environment for children being raised apart from their families offers scope to evaluate the effects of the changed programme on the children and to assess how much it might contribute to their future mental health. Such evaluation should be helpful to those operating institutions in various parts of the world, as the effects of institutional care seem to follow a common pattern wherever the institutions are located. These studies will be reported in our next publication. A few years ago, research into the security of infants would have seemed remote from the problems of adults who must maintain mental health in a world of speed and sputniks. We now know that this is not so. It seems apparent that adverse experiences in early infancy can affect the mental health of an individual in such a way that, faced with stress in later life, earlier conflicts and feelings of inadequacy can be reactivated and mental health seriously affected. It has been demonstrated already that many persons experiencing maternal deprivation show later signs of mental ill health. We cannot state with assurance that every person experiencing maternal deprivation will make an inadequate later adjustment because, so far as we know, no attempt has ever been made to seek out and study mentally healthy adults who suffered deprivation in their early years. Such a problem would be complex and long-term and to wait for conclusive evidence would be foolish. Enough is known that we can emphasize with confidence the importance of a consistent, continuous mother relationship for an infant. Many other relationships remain to be explored, one of the most obvious being the general atmosphere in which an infant is nurtured. Greater understanding of the factors contributing to mental health in infancy should help in preventing well infants from becoming ill, and in diagnosing and treating those who deviate from health. Such treatment and preventive care should, in turn, help to develop healthier children and adults who are capable of coping with their problems.

APPENDIXES

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Appendix I EARLY STUDIES PRELIMINARY TO THE INFANT SECURITY HYPOTHESIS RABELY does a scientist approaching a new field of investigation have the good fortune to start out with a clear-cut hypothesis, collect his data, and substantiate his theory. Most published studies have been preceded by preliminary investigations which, as the studies gained momentum, were recognized as mere academic skirmishes which cleared the way for the main part of the work. The early studies were then discarded and forgotten. In this publication we are giving a resume of our early investigations into infancy, not to show the inadequacies of method and content but rather to demonstrate how the effort and results of each study helped us to swing the direction of our hypothesis and gradually change our ideas about the mental health of infants. Through this process the theory basic to the main body of the book was developed. Preliminary studies began in 1948. These were based on records of infant and pre-school children which had been made by parents and nursery school teachers for many years as part of keeping regular and comprehensive records about the children attending the Institute of Child Study Nursery School. Infant records on 110 children were available. There were also records at the pre-school level on 175 children who had been observed regularly in various aspects of their development, some through school age and up to adolescence. The Institute studies are longitudinal and hence the children were of various ages when our studies began. These first studies unfold the course of thought prior to the formulation of the security hypothesis. We began, in the first instance, by seeking signs of independence as signposts of mental health. It became apparent that such signs were only one small indicator of what we sought. More significant apparently was the human relationship which a child had with those who cared for him. This human relationship could be characterized by an acceptance or rejection of the care being offered to him. Broadly interpreted, this could be thought of as an acceptance or refusal of dependence. Attempts to find group patterns of dependence or independence failed as it became apparent that each child maintained a characteristic quantitative difference throughout 95

96

APPENDIX I

his early years in the amount he demonstrated. Hence, it seemed apparent that what we sought was related to a personality state rather than to a common phenomenon of learning. Finally we realized that acceptance or refusal of dependence was merely the expression of a child's response to a relationship and that acceptance characterized the more stable infant and refusal characterized the less stable. Hence, some fundamental measure of a secure state would be related to a measure of dependence because a mentally healthy infant can take a dependent state for granted. Following are the actual studies. FIRST STUDY, 1948 Hypothesis The young infant should be extremely dependent. His growth towards independent behaviour begins early and in very small stages and progresses slowly. Problem What kind of behaviour at the infant level indicates this growing independence? Method Diary records ( see Table I in this Appendix ) which had been kept for three complete days each month on infants from birth to two years of age were investigated. Eating situations were selected for analysis with respect to: (a) A child's acceptance or rejection of new foods on first presentation; ( b ) the amount of initiative a child showed in helping himself in eating, e.g., use of spoon, use of cup; (c) parental attitudes towards growing independent effort on the part of a child. TABLE I SAMPLE OF EATING RECORD FOR ONE CHILD How Offered Age in months

Food

Time

Accompanying foods

4

Orange juice Pablum

9:00 A.M. 9:55 A.M.

Water (bottle) Breast & bottle

5

Clo

9:30 A.M.

Orange juice (spoon)

6

Prune juice Tomato juice

3:50 P.M. 9:17 A.M.

Clo

Presentation by adult

Child's reaction

Grandmother, Always takes aunt everything of& parent fered; very interested in food

Adult treatment

APPENDIX I

97

TABLE I, cant. How Offered Age in months 8

10

Food

Time

Accompanying foods

Carrot

1:51 P.M.

Pablum, bottle

Given first

Spinach, potato Beef juice Tomato

1:55 P.M.

Bottle after

1 tbsp. beef juice over potato

Asparagus

12:05 P.M.

Apple juice Rusk Prunes

5:50 P.M. 3:08 P.M. 5:55 P.M.

1 tsp. each Potato, beef juice, formula Formula 1 tsp. Milk 1 tsbp. Pablum, milk

11

Beets

12:22 P.M.

Potato, beef juice, milk

12

Tapioca

11:50A.M.

Potato, carrot, beef juice

13

Bacon, bread & butter

8:15 A.M.

Pablum, milk

14

Egg, coddled 12:10 P.M. Rice 12:10 P.M. Sunwheat 12:10 P.M. Blanc mange 11:55 A.M. Cream of Wheat Lamb chop, 12:04 P.M. Peas Banana 5:40 P.M. Custard 12:02 P.M.

Potato, carrot

15

17

Potato, tapioca. sunwheat Lamb chop, potato, carrots

Baked trout

12:10 P.M.

Potato, carrot. tomato

Rice pudding

12:10 P.M.

Potato, carrot, tomato Bread & butter

Soup, veg. 16

Presentation by adult

5:35 P.M.

Liver, Cauliflower Scraped apple Macaroni

11:40 A.M.

Roast lamb Mead's cereal

11:40 A.M. 7:18 A.M.

Milk, sunwheat Apple sauce and butter Potato and peas Bacon, milk

Sweetbread

11:45 A.M.

Potato, carrots

Chicken

11:58 A.M.

Potato

2:50 P.M. 5:35 P.M.

Potato

Child's reaction

Adult treatment

Made faces, but took all Took readily

Takes everything offered

1 tb»p. Always hungry for meal 2 tbsp. bacon i slice bread & butter li tbsp. 1} tbsp. 4 tbsp.

Guided mother's hand to egg, which likes particularly

Mashed

Ate eagerly Objected when gone Hungry Takes food readily

Refused towards No more offered end (first time offered) Cried twice Mother explained pointing to dinner first dessert before first course over Hungry

98

APPENDIX I

Results The records taken off the original reports in this fashion were inconclusive regarding the growth of independence in young children. It did appear, however, that the last three columns (presentation by adult, child's reaction, adult treatment) were to be the most significant in revealing something about mental health. These seemed to indicate that the relationship between a parent and her child was the most significant aspect to study, rather than seeking further along the lines of growing independence. SECOND STUDY, 1949 A new study was than begun, using different records. These were "Non-compliance records" which had been kept on children by their parents one day every two weeks from birth to two years of age. These data were rich in information about young children, but analysis was limited to certain aspects.

Hypothesis

An infant is almost totally dependent after birth, but slowly grows in independence. This growth towards independent status might best be shown by a study of non-compliance (interpreted as an act of refusal to be dependent). Problem To analyse the pattern of compliance and non-compliance of different infants to discover whether a developmental picture emerged as a result of their attempts to achieve independence.

Method (1) Results were analysed regarding the number of times a child accepted each routine ( eating, sleeping, bathing, dressing, elimination, i.e., change and toilet), and the number of times he refused by crying or by some other form of behaviour. The parents' treatment of noncompliance was also noted. Records of 144 days (24 hours a day) were analysed in this way, noting behaviour in seven different routines. (2) Data were analysed according to the following headings: age, situation, behaviour, treatment, result. Frequency of acceptance or rejection was noted in the left-hand column by a check (\/). (See Table II in this Appendix. ) Analysis of this kind was made on records of several children ranging in age from 1 month to 24 months.

TABLE II SAMPLE OF PRELIMINARY ANALYSIS OF NON-COMPLIANCE RECORDS: CHILD 336a Age in months

Situation

4

Elimination Play Dreasing Bath vVvVEllminatioii Dressing Visiting vVElimination Dressing Play Play or sleep Play or fleep Out

Eating Play Play Play Elimination It

Sleep Elimination Eating

Play Elimination Bath Dressing Play

Requirement

Behaviour

Fusses Cries 10 minutes Sleepy acceptance Enjoys it Acceptance To be changed Dress for outside Cries and smiles alternately Stares at her, cries Visit Aunt To be changed Cries & struggles Dressed for outside Cries & struggles Diapers changed Rattle in crib Undressed

With rattles on bed Lie on mother's bed Lie on mother's bed For ride in carriage Orange juice and oil Lie on mother's bed Play in crib in living room Play on chair Change diapers

Fusses, vomits. cries Cries 20 minutes Cries Cries when carriage stops Spits most of it out Cries

Treatment

Ignored Sleeps Routine completed Is undressed Routine completed Sleeps Fed Ignored Routine carried out Picked up and cleaned Ignored

Stopped crying Changed Wets diapers

Ignored for 5 minutes Completed walk

Changes diaper

Proceeds with routine Moved to living room Ignored and then Cries moved Cries 20 minutes Fed Smiles & stretches Changed

Lying quitely after Finally fusses and Got her up waking. 6.45 A.M. cries Scampers of? To have diapers changed Wants milk in Eat pablum and Given biscuit bottle; cries when milk from glass has to have it from glass Put in family circle Playpen in living Cries circle room Cross Diapers changed Have bath Enjoys hugely To be dressed Accepts In playpen Diverted with toy Cries

Eating

Eat dinner and drink milk

Hungry first Cries at milk

Eating

Drink milk

Cries

Play Play

Playpen Playpen

Cries Loses interest

Diapers changed

Indifferent: watches others Indifferent: watches others Pushes it away Fed by spoon Restless Stands up in bed Put down until sister in

vVElimination Dressing

To be dressed

Eating Dressing Sleep

Take milk Dress for bed To sleep

Result

Stops for a minute Sleeps

Undressed Drank small amount Content Cries Content Sleep Stops crying

Eats it & crlei again Happy until left again

Plays and cries intermittently Drinks 1} cups milk

Put some milk in mouth with spoon Diverted with toy Takes some milk & fed with spoon Diverted Plays Moved to another Happy room

Ate 4 ounces Sleeps

100

APPENDIX I

(3) Data were portrayed graphically showing the number of times a child refused dependence in each routine by crying, or by other milder forms of rejection, as a percentage of the total number of times the routine was presented. This was expressed in ratio form. Incidents of resistance expressed by crying were indicated by the solid block, while milder indications of resistance were denoted by diagonal lines. The blank space indicated the amount of acceptance. ( See example below. ) I/ 3 of situations rejected by crying 1/3 of situations accepted 1/3 of situations rejected by fussing, turning head,etc.

Results When the patterns of non-compliance and compliance of the different infants were compared, they varied greatly. Each child presented a quantitative difference in acceptance and rejection which was typical of his behaviour in all routines. The following examples illustrate this point. Child 287a showed a characteristically greater proportion of acceptance than of rejection and most of his rejection appeared in the early months of his adjustment to life. In eating, mild forms of rejection appeared throughout which probably indicated his attitude to the increasing developmental demands of that situation. Child 336a showed a characteristic pattern throughout all routines of a great amount of rejection in both mild and strong forms. Her rejection of care was more marked than her acceptance of it. Rejection appeared in all routines and continued throughout the total age range of her infancy. Toilet training was attempted unsuccessfully at 9 months, once more tried at 12 months, carried on with a struggle until 20 months of age, and once more given up until 23 months of age. At no time in her infancy did she seem relaxed in the acceptance of adult care. Child 320 also indicated a characteristic attitude. He showed little resistance to routine care throughout his infancy and seemed to go through Me in an accepting, easy way. In bathing a very small degree of mild resistance appeared on four occasions. Dressing presented almost no problems. He showed a little less resistance than Child 287a and a great deal less than Child 336a. In contrast with Child 336a, his resistance was not generalized but rather was specific to situations, sleeping being his most resistant area.

APPENDIX I 10

1

Further Analysis To collect further data, sleep routines for six more children were graphed (240 days in all). The same individual differences were apparent. There was no specific age at which non-compliance appeared for each child, and there was a definite quantitative difference in each child's ratio throughout the two years. This further substantiated our conclusion that no common pattern of acceptance and refusal of care was to be found in the behaviour of infants; and because acceptance and refusal of care were merely manifestations of a child's relationship with his parent, it was safe to assume that wide variations existed in relationships between parents and children. The unique quality of each parent-child relationship was strikingly apparent in the graphs of non-compliance. The part played by a parent in either contributing to or detracting from her child's mental health was clearly demonstrated as each interacted with the other. For example, Child 336a was far less mentally healthy than Child 287a, a phenomenon which seemed to reflect in large part an apprehension and uncertainty in the mother of the former and an ease and assurance in the mother of the latter. A further assumption based on these data was made. It appeared that a child who was regularly rejecting care was less secure than a child who usually accepted care, and therefore it seemed likely that rejection of care should be a sign of insecurity. Taking the data a step further in interpretation, a dependent child was secure, while a child striving for independence was insecure. THIBD STUDY, 1950 (Pre-school Studies) To evaluate further the conclusions emerging from the above data, studies were undertaken of the non-compliant behaviour of 115 preschool children who had attended the Nursery School of the Institute. Every occurrence of non-compliant behaviour had been recorded on a special form for each child from the time of his entry at two years of age to his graduation at five years. This recording was done routinely by the staff as a part of the regular research programme. Analysis These records were analysed by tallying the number of non-compliant acts each month for each child, correcting for attendance during the month, and graphing quantitatively for each child. In this way it

GRAPH I. Frequency of incidents of non-compliant behaviour for Child A and Child B in Nursery School—

demonstrating the highly individual characteristics of each child's non-compliance.

APPENDIX I 10

3

was possible to compare one child with another. To discover a possible group trend for non-compliant behaviour over the three-year period, figures were totalled and graphed to represent the average number of incidents of non-compliant behaviour each month for the 115 children. Further, graphs were drawn showing the number of non-compliances for each situation in the nursery school, for both the individual children and the group. Results The results of this analysis indicated that each child had such a highly individual pattern over his three years that it was impossible to classify the graphs even into types (see Graph I in this Appendix). Each graph had its individual peculiarities and the graph representing the average number of non-compliant acts for the total group each month from two to five years of age closely resembled a straight line (see Graph II in this Appendix).

GRAPH II. An average number of non-compliant incidents for 115 children based on a twenty-day month for three years—showing the average trend line approximating a straight line. Conclusions It was thus concluded that there is no developmental age norm for the appearance of non-compliant behaviour of children in nursery school from the ages of two to five years. Each child varies in his own unique way, not only in the frequency of non-compliant acts, but also in the time when peaks of non-compliant behaviour appear, and according to specific situations where non-compliance appears.

104

APPENDIX I DISCUSSION

Translating the results of these data into the security hypothesis led to the following deductions. At the infant and pre-school levels, individual differences rather than chronological age determine the degree of conformity or non-conformity. Patterns apparent at the infant level persist up to at least five years of age. Routines in a "good" home and the nursery school are structured to develop acceptance of direction or "conformity," and these are based on a sound dependent-trust relationship with an adult rather than reflecting any real effort on the part of the adult to make the child responsible for his own activity. Since the procedures in both a good home and a good nursery school are geared to developing mentally healthy attitudes, it seems reasonable to conclude that dependence builds security to the age of five years. A child who trusts an adult in a dependently secure way, therefore, can accept direction with self-confidence. Further, he can accept small steps in taking responsibility because he believes that he can handle them, partly because the adult believes he can, and partly because he is building a self-trust through his early satisfactory relationships relating to adult care. Thus, we came to believe that security status could conceivably be measured in early infancy by an almost completely dependent state; as a child grows older, by a balancing of dependence with a small degree of independent effort which would grow greater as the child's experience broadened. Hence, a mentally healthy child would show signs of both dependence upon adults and independent effort. This became the thesis of the studies which we have described in this book.

Appendix II SYMPTOMS OF SECURITY AND INSECURITY

TABLE I SIGNS OF SECURITY (Agency records) 0-6 months

6-12 months

12-18 months

Accepts vegetables readily Holds bottle Very responsive to social stimulation Bouncing and amiable Sleeps through night without eleven o'clock bottle Talks back Reaches for toys, inspects them and retains them for a long time Active and alert

Friendly Notices changes in environment Reaches out towards people Spoon feeds easily Coos, chuckles, laughs aloud and squeals Co-ordination good Combines two objects Tries to take milk from a glass Alert, bouncy Full of initiative and interest Delights in pivoting, rolling, and kicking Holds bottle Dislikes restrictions of play pen Attempts many words Amuses self for long periods on floor or sitting in high chair "Lots of spunk"; will stand up for himself Wonderful disposition

18-24 months

AT HOME

Loves to imitate Long span of attention Responsive to adult attention Holds a cup Alert to environment Bounces to music Full of initiative and bounce

Tries to feed self Attempts to say any word he hears Venturesome physically Uses a spoon Plays with toys long time

IN TEST SITUATION

Reaches towards tester and material with enthusiasm Very responsive to social stimulation Reaches for toys, inspecie them and retains them for a long time

Friendly Notices changes in environment Reaches out towards people Eager for toys Coos, chuckles, laughs aloud and squeals Co-ordination good

Loves to imitate Long span of attention Responsive to adult attention Bangs toys noisily Alert to environment Shows initiative and bounce

105

Alert and observant to noises Interested Co-operates in a positive fashion Going to testing room without security of foster mother being near

106

APPENDIX H TABLE I, con». 0-6 months

Clutches and retains rattle and will carry it to her mouth Bouncing and amiable Talks back Active and alert

6-12 months

12-18 months

Combines two objects Attempts to talk Alert, bouncing, full of initiative and interest Amuses self for long time with material Persists in picking things up and reaching for toys "Eager little thing" Attempts words Laughs aloud at things which occur in the room No crying

18-24 months Attempts to talk in sentences

TABLE II SIGNS OF INSECURITY (Agency records) 0-6 months

6-12 months

12-18 months

18-24 months

Need to have foster mother near No response to toileting Jealous of attention given to other children Timid in play with others Shy Pouting Light sleeper Sucks fingers and thumb Never still a minute Crying out in sleep Screams when placed on toilet

Whines in sleep Covets toys from other children Short span of attention Rocking Shaking bed Lack of interest in toys and household equipment Hair pulling Thumb-sucking Biting Constant refusal of requests Shy Temper Bangs head in sleep Lack of persistence Haphazard use of toy» (undirected play) Suspicious of strangers Quick temper and impatience Extreme temper tantrum Over-active and restless Heedless of danger Falls constantly Jealous of foster mother Resents attention to others Cries in strange places Squeals and hits self when frustrated Very stubborn

AT HOME

Tongue-sucking Thumb-sucking

Temper Reluctant to start spoon feeding Persistent thumbsucking No interest in materials Overly sensitive to tone of voice Impatient about waiting for dinner Indifferent to environment Dependent on adult attention and praise for adequate behaviour Rocking Excitable child who must always be protected, from excitement

Tongue-Bucking Thumb-sucking

Temper Thumb-sucking No interest in material Crying when toys presented Making strange Indifferent to environment Fear of crackly paper Rocking

IN TEST SITUATION

Need to sit on foster mother's lap Hesitant about picking up material when urged Shy Crying Pouting Sucks nngers and thumb Hyper-active Reluctant to give up toy when another presented

Shy Clings to foster mother Sits on lap Short span of attention Rocking Thumb-sucking Refusal of requests Temper Undirected use of toys Apprehensive and suspicious of strange adult Hyper-active Need to cling to doll sM the time Heedless of danger Whining Crying Rocking Squeals and hits self Slaps at toys pushea them off table Stubborn

APPENDIX H

108

TABLE II I SIGNS OF INSECURITY (Continuous Records for Child I) Age in months

Eating

0-6

Sleeping

Elimination

Play

Cries out in sleep

6-12 Fretful while wait- Doesn't sleep well Cries when placed Cries when carriage ing for bottle when environon "pottie" for no longer pushed ment changed elimination Cries out in sleep Cries to be changed when hears noises near by 12-18 Spits out beets when first presented Cries when being fed; "wants everything in sight" Refuses to be fed and insists on doing it himself

Wakens in sleep Cries when wet and cries at various intervals

18-24 Refuses supper Yelled with rage Refuses to eat unwhen put to bed til maid sat be- Refuses to be still side him and ate for sleep some bread and Cries when made butter to lie down on bed

Squeals for toys

Tantrum when Refuses to give up taken off "pottie" tooth-brush Refuses to urinate Cries when taken in "vessel" out of sand-pile Cries when placed and brought inon "vessel" doors Cries when placed Cries for toys on commode

APPENDIX n

109

TABLE III, cont. Extra-familial Familial

Older

Contemporary

Cries to be lifted Cries to be picked up Cries when father and mother leave the room Cries when hears mother's voice

Cries (wet and cold) Fretful, whining Cries when fed by strange nurse

Cries to be held by Cries when handled mother by strange nurse Screams when mother returns home after a visit Screams when clothes put on; "wants everything". Yells when mother goes out Doesn't want clothes put on, fights everything Cries when undressed

General

Cries when light turned off Fretful

Cries when brother leaves to play elsewhere Pushes brother away from mother

Cries when visitor Cries when alone comes out doors Acts self-conscious before aunt; hides behind mother Cross when handled by grandmother Refuses supper from new nurse Very shy Angry when bathed by new nurse Temper when mother leaves room

Screamed in an elevator Cries when ready for bath Frightened by squirreís on the fence Cries when dressed and undressed Temper tantrums Cries for boots to be put on Cries at strange dog Screamed when hammock fell down

APPENDIX n

110

TABLE IV SIGNS OF SECURITY (Continuous Records for Child II) Age in months

Eating

Sleeping

0-6 Holds bottle; puts Smiles on waking lt in and out of his mouth

6-12 Feeds self a biscuit

Elimination

Dressing

Washing

Stops crying on being lifted (wet)

Can be left alone Urination in toilet when wakens

Kicks and smiles in bath

12-18 Partly feeds self Settles readily to Indicates when wet Yells to have spoon sleep in own hand Calls to be taken Indicates a desire up in morning for more food by No longer cries pointing and when light is grunting turned out

18-24 Eats everything in front of him Ate dinner alone Eats meal without assistance

Urinates when Tries to put on placed on shoes "vessel" Indicates when Accepts dressing bowel movement is completed Indicates need

Happy in bath

111

APPENDIX H

TABLE IV, cont. Extra-familial Play

Familial

Older

Contemporary

Vocalizes "A-woo" Smiles in response Imitates sounds to being changed Plays with beads Talks back Excited when presented with toys Plays alone Calls for attention Plays happily with Calls for mother in toys the next room "Talks" to toys Imitates mother playing with toys Enjoys noisy play

Vocalizes "A-woo" Enjoys kicking actlvity

Friendly with strangers

Plays happily by self Responds to Smiles at everyone on the floor mother's requests in sight Explores cupboards with enjoyment Good interest in materials (1 hour or more) Playfully crawls away when called Asks for toys Delights in building on blocks Happy with toys Happy alone all morning

General

Vocalizes "Da-da" Cheerful Kicks, smiles, laughs Tries to stand alone Tries to pull to feet

Calls out to children playing

Happy and talkative Pulls on light when directed

Runs to meet father Walks about with Plays happily with maid while she boys does housekeeping duties Interested In people in next garden

Good-natured No tears when needle put in arm for toxoid Imitates words

Appendix HI THE INFAN T SECURIT Y SCALES INFANT SECURITY SCALE I Age 0-6 months

Name

Date. Secure

1

Birthdate....

Insecure

Deputy Agents 3

D

*Accepts new foods readily

Unhappy at mealtime

D

EJ D

Enthusiastic about food "Takes to spoon feeding readily

Poor eater

E4 D D

E

*Sleeps readily in new bed or surroundings Accepts bed without protest *Adjusts easily to new position for sleep Sound sleeper Relaxed in sleep

Negative attitude towards sleep

E

D E E E D D E

Accepts change of diaper Content when wet Enjoys bath

E

Enjoys having face, ears or nose cleaned

D

Enjoys rough handling

E E D

*Relaxed when on scale Recovers readily from hurts Responsive to cuddling

D E Poor sleeper

E E E

Miserable when changed Angry when changed Fearful of bathing and cleaning Loose stools or constipation

D D E E

Seems physically timid

D

Upset by loss of support "Sickly child"

E E D

fRefuses new foods —spits out turns away pushes hand cries Cries and frets at feeding time Refuses spoon feeding Regularly throws up fCries when placed in unfamiliar bed or surroundings Cries when put to bed Contented only in familiar position for sleep Fitful sleeper Restless sleeper Cries out in sleep Cries when diaper changed Cries when wet or soiled Cries or tensed up when bathed Resists having face, ears and nose cleaned—pushes hand Cries or becomes tense unless handled gently Tense and cries when on scale Hard to comfort when hurt Squirms, restless, pushes away when cuddled

INFANT SECURITY SCALE I, cent. Secure E E

D E E E E E D E D

E E E D

*Not upset although seemingly aware of change of environment Not upset by change in familiar environment

Insecure Fearful of change in environment

* Not upset by unusual appearance of familiar figure

Enjoys vocalization Enjoys—loud noises bright lights *Enjoys car rides, shopping expeditions, outings in the carriage Enjoys or is unaware of an unusually large group Content when left alone At ease in the company of people Responsive to social stimulation from strangers Can accept shared attention

Clutches toys Reaches for material enthusiastically Enjoys own physical activity Accepts interference to own activity 'Accepts dependence. 'Refuses effort.

Deputy Agents E

fCries, tenses or withdraws at change of environment

E E D

Cries when familiar environment changed Screams, cries or withdraws at strange appearance of

familiar figure

Undue sensitivity to extreme physical sensations

E E

Cries or withdraws from — loud noises very bright lights Screams or becomes ill in car or during outing

Unusual sensitivity to the présence of others

E D

(Feelings easily hurt) Overly sensitive to tone of voice voice Unhappy when attention given to others

E D

Uninterested in stimulation

E E

Cries when toys presented Ignores toys within vision

Physically apathetic and listless Resentful of restrictions

E

Lacks interest in toys

'Accepts effort. 'Behaviour in a new situation.

D

D

Cries when left alone Frets or turns to mother in the presence of others fCries at advances of a stranger Screams at sharp or harsh tone of voice Cries when mother gives attention to others

Cries when physical activity interfered with 'Refuses dependence. fRegressive behaviour (see p. 33).

INFANT SECURITY SCALE II Age: 6-12 months

Date.

Secure D E

*Accepts new foods readily Enthusiastic about food

Birthdate...

Name.. Insecure Unhappy at mealtime Poor eater

Deputy Agents D E

D

Accepts food from anyone in charge

Needs a familiar person around at mealtime

D

E

*Sleeps readily in new bed or new surroundings

Resistant attitude towards sleep

E

D E

Accepts bed without protest *Adjusts easily to new position for sleep Sound sleeper Relaxed in sleep *Accepts being put to bed by anyone

E E D D D E D E

Co-operates when diaper changed 'Co-operates when placed on "pottie" or "toidy" Indicates when movement completed Content when wet or soiled Enjoys bath

D E

Usually protests when new food offered; spits out, turns away, pushes hand, cries, fusses Coaxing or forcing necessary for child to complete meal fAccepts food from mother only Cries when placed in unfamiliar bed or unfamiliar surroundings Cries when put to bed fContented only when in a familiar position for sleep Cries out in sleep

Poor sleeper

E

Needs familiar person around at bedtime

D

Cries when put to bed by ununfamiliar person

Miserable when toilet needs being attended

D

Refuses to co-operate when being changed ; cries, kicks, rolls over, hits, pinches Screams when placed on "pottie" or "toidy" Cries when wet or soiled Screams when having bowel movement Cries or becomes tense when bathed

D Loose stools, or constipation

D E E

INFANT SECURITY SCALE II, cont. Secure

Insecure

Deputy Agents

E

Enjoys having face, ears and nose cleaned

Fearful of bathing and cleaning activities

E

D

'Relaxed when bathed and cleaned by an unfamiliar adult

Needs familiar figure to administer toilet and cleaning needs

D

Seems timid physically

D

D

Enjoys rough play

E

Relaxed when being weighed

E

Recovers readily from hurts

Prolonged upset when hurt

E

D

Responsive to cuddling

Resents physical affection

D

Fearful of change in environment

E

E

*Enjoys changes in environment

D

*Enjoys unusual appearance of familiar figure

E E D

*Amuses self with vocal play Enjoys physical activity Accepts interference with physical activity Enjoys car rides, shopping expeditions, outings in carriage Enjoys a crowd

E E

E Does not suck thumb or fingers, no rocking, ear pulling, hair pulling E No temper tantrums

E

D

Resists having face, ears and nose cleaned; pushes hand, turns away, cries, kicks Tense and unhappy when bathed or cleaned by an unfamiliar adult fCries or becomes tense if played with roughly Cries and becomes tense when weighed Sulks or cries long after hurt attended to Squirms, restless, pushes away from cuddling fWithdraws, cries or becomes tense when environment changed fScreams, cries, withdraws at

unusual appearance of fami-

liar figure

Physically apathetic and listless Unhappy in car or on outings Frightened in a crowd

D

Screams and cries when physical activity interfered with E Screams or becomes ill in car or during outings E fScreams, withdraws, or turns to mother in crowd E Sucks thumb or fingers, rocks, pulls own hair, pulls ear E

Frequent temper tantrums

INFANT SECURITY SCALE II, cont. Secure E D

Content to play alone Enjoys the company of people

E

*Responsive to social stimulation from strangers

D E D E E E E D

Insecure

Deputy Agents

Miserable when left alone Uneasy in the company of strangers

E D

Normally sensitive to tone of voice Enjoys the company of other children Can accept shared attention

Undue sensitivity to tone of voice Uneasy with other children

D

Enthusiastic about toys Concentrates intently when playing with toys Maintains interest for a long time in toys Eager for new toys Will relinquish a toy

_ _ Physically apathetic and listless

E E

Uninterested in toys Fleeting attention to toys

Fearful of a new toy Feelings hurt when toy taken away

E D

Withdraws or ignores new toys Clings to own toys

E D D

|Cries or whines when left alone fFrets or turns to mother in the presence of others fCries at advance of strangers Screams at unusual tone of voice fCries or whines when left to play with other children fCries, pushes other children when they are getting attention

INFANT SECURITY SCALE III Name

Age: 12-18 months Date.. Secure D

*Accepts new foods readily

E

Enthusiastic about food

E D D

D

E

*Holds spoon when expected to do so Will wait for meal patiently Permits self to be fed when necessary *Will accept food from anyone in charge Unconcerned if tray mussy

Birthdate..

Insecure

Deputy Agents

Unhappy at mealtime

D

Poor eater

E

Resents having to feed self

E

Resents waiting for meals

D

Resents being fed

D

Needs familiar figure around at feeding time Upset by mussy tray

D E

E

Sleeps readily in new bed or new surroundings

Resistant sleep

D

Poor sleeper

D

E

Accepts without protest being put to bed Sleeps undisturbed by noise

Restless sleeper

E

E

Relaxed in sleep

D

*Accepts being put to bed by anyone in charge

attitude

towards

E

Needs familiar person around at bedtime

E

D

fUsually protests when new foods offered; spits out, turns away, pushes hand, cries Coaxing or forcing necessary to make child finish meal Refuses to hold proffered spoon Screams and yells when waiting for food Gets angry if not allowed to feed himself f Accepts food from mother only Refuses to eat if tray mussy fCries when placed in unfamiliar bed or unfamiliar surroundings Cries when put to bed Must have quiet place for sleep Jumps, twitches, turns a lot in sleep fCries when put to bed by unfamiliar figure

INFANT SECURITY SCALE III, cent. Secure

Insecure

D

Accepts toilet routine

Resists toilet routine

D

D

Accepts change to dry clothing

Resists change of wet clothing

D

E

Indicates need for toilet

E

Indicates need for dry clothes

Discontented if clothing wet

D

E

Indicates when movement completed Enjoys bath and washing

Dislikes being bathed washed

and

E

Needs a familiar person to minister bathing needs

D

Seems timid physically

D

E D D E D E D Ë E D E E E

*Relaxed when bathed or washed by unfamiliar person Enjoys rough play

E

Deputy Agents

Cries when put on toilet or "pottie" Cries and is restless when clothing changed Does not indicate need for toilet Cries if clothes not changed as soon as wet Pulls away, squirms and whines when being washed or bathed fTenses and whines when bathed by an unfamiliar adult

^Becomes tense or upset when played with roughly Recovers readily from hurts Prolonged upset when hurt E Sulks or cries long after hurts attended to Responsive to cuddling Resents physical affection D Squirms, restless, pushes away from cuddling *Enjoys changes in environFearful of changes in environE fWithdraws, cries or becomes ment ment tense when environment changed *Enjoys unusual appearance of D fScreams, cries, withdraws at familiar figure unusual appearance of familiar figure *Amuses self with vocal play Enjoys physical activity Physically apathetic and listD Screams and cries when physiless cal activity interfered with Accepts interference to physical activity Enjoys car rides, outings in Unhappy in car or on outings E Screams or becomes ill in car carriage, expeditions or on outings Enjoys a crowd Frightened in crowd E fScreams, cries, turns to mother in crowd Unconcerned if mussy or dirty Upset if mussy or dirty E Insists upon being clean and tidy

INFANT SECURITY SCALE III, cont. Secure

Insecure

E Does not suck thumb or fingers E No rocking, ear pulling, hair pulling E Few temper tantrums E D E D E D E

Content to play alone Enjoys company of other people 'Responsive to social stimulation from a stranger Normally sensitive to tone of voice Enjoys the company of other children Can accept shared attention Stands up for self

Deputy Agents

E Sucks thumb or fingers E E

Miserable when left alone

E D E

Undue sensitivity to tone of voice Uneasy with other children

D E

Jealous of other children

D

Seems afraid to protect own rights

E E

Rocks, pulls own hair, pulls ear Frequent temper tantrums fCries or whines when left alone JFrets or turns to mother in the presence of others fCries at the advances of strangers Cries at unusual tone of voice fCries or whines whenever left to play with other children fCries, pushes other children whenever they are getting attention Lets other children bully him

D D

Enjoys chatting to others Accepts being left with strangers

Seems shy Needs familiar figure around if strangers present

D D

Cries when other children take his toys "Clams up" when spoken to Cries when left with stranger

E

Enthusiastic about toys

E

Uninterested in toys

E

E

E

Concentrates intently when playing with toys Eager for new toys

Physically apathetic and listless Fearful of new toys

E

D

Will relinquish a toy

D

E

Amuses self happily in fairly restricted play area

Feelings hurt when toys taken away Lacks interest in play material

Quickly loses interest in play materials Withdraws from, or ignores new toys Clings to own toys

E

Cries or whines when restricted in play area

INFANT SECURITY SCALE IV Age: 18-24 months Date....

Name

Secure D

*Accepts new foods readily

E

Enthusiastic about food

E D D

*Accepts opportunity to try to feed self Permits self to be fed when necessary Will wait for meals

Insecure D

Poor eater

E

Resents having to feed self

E

Resents being fed

D D

D

*Accepts food from anyone in charge Unconcerned if tray mussy

E

*Sleeps readily in new bed or new surroundings

Resistant attitude towards sleep

E

Accepts going to bed without protest

Deputy Agents

Unhappy at mealtime

Impatient about waiting for meals Needs a familiar figure around at mealtime Upset by mussy tray

E

Birthdate

Needs to have the same familiar toy in bed with him

D

E

E E D E

E

Sound sleeper

Poor sleeper

E

E

Relaxed in sleep

Restless sleeper

E E

D

*Accepts being put to bed by anyone

Needs familiar person around at bedtime

D

D

Co-operates when wet clothes changed

Resistant attitude to toileting

D

fUsually protests when new food offered: spits out, turns away, pushes hand, cries, fusses Coaxing or forcing necessary for child to complete meal fRefuses to feed self when expected to do so Refuses to eat if not permitted to feed himself Cries or whines if not fed as soon as food is in sight Accepts food from familiar person only Refuses to eat if tray mussy tCries when placed in unfamiliar bed or unfamiliar surroundings fClings to same familiar toy when going to bed Cries when put to bed Fusses and protests before going to sleep Wants door open, light on, drink, etc. Cries out in sleep Jumps, twitches, turns a lot in sleep Cries when put to bed by an unfamiliar person Refuses to co-operate, when being changed, cries, pushes away, pinches

INFANT SECURITY SCALE IV, cont. D E E

Secure Accepts toilet routine

Insecure

E

Anxious about wetting

E

Not upset by wet bed Indicates when movement completed Indicates need for toilet

E

Indicates need for dry clothes

Discontented if clothing wet

E

E

Enjoys bath or washing

Dislikes being bathed or washed

E

Needs a familiar person to minister bathing needs

D

D

*Relaxed when bathed or washed by unfamiliar person

E E

E

D

Enjoys rough play

Seems timid physically

D

D

Responsive to cuddling

Resents physical affection

D

Fearful of changes in environment

E

E

Recovers readily from hurts

E

*Enjoys change in environment

E

*Enjoys a grotesque or unusual figure Enjoys physical activity Accepts interference to physical activity Enjoys car rides, outings, walks Enjoys a crowd

E D E E

E

E

E

Unconcerned if mussy or dirty

No rocking, ear pulling, hair pulling Few temper tantrums

Prolonged upset when hurt

E

E Physically apathetic and listless

D

Unhappy in car or on outings and walks Frightened in a crowd

E

Upset if mussy or dirty

E

E E E

E

Deputy Agents Screams when placed on "toidy" Wakens crying for toilet Deliberate wetting or soiling

Constantly demands to go to toilet Cries if clothes not changed as soon as wet Pulls away, squirms and whines when being washed or bathed Tense and uncertain when bathed by an unfamiliar person

fCries or withdraws when played with roughy fSulks or cries long after hurt attended to Squirms, restless, pushes away from cuddling fWithdraws, cries or becomes tense when environment changed Fearful of grotesque or unusual figure Screams and cries when physical activity interfered with Screams or becomes ill in car or on outings fScreams, cries, turns to mother in a crowd Insists on being clean and tidy Sucks thumb or finger Rocks, pulls own hair, pulls ear Frequent temper tantrums

INFANT SECURITY SCALE IV, cont. Secure E D E D E D

Content to play alone Enjoys company of other people *Responsive to social stimulation from a stranger Normally sensitive to tone of voice Enjoys the company of other children Can accept shared attention

Insecure Miserable when left alone

Deputy Agents E D E

_ Undue sensitivity to tone of voice Uneasy with other children

E

Jealous of other children

D

D

fCries or whines when left alone fFrets or turns to mother in the presence of others fCries at the advances of strangers Cries at unusual tone of voice fCries or whines whenever left to play with other children fCries, pushes other children whenever they are getting attention Lets other children bully him Cries when other children take his toys "Clams up" when spoken to Cries when left with stranger

E

Stands up for self

Seems afraid to protect own rights

E E

D D

Enjoys chatting to others Accepts being left with strangers

Seems shy Needs familiar figure around if strangers present

D D

E

Enthusiastic about toys

E

Uninterested in toys

E

E

E

Concentrates intently when playing with toys Eager for new toys

Physically apathetic and listless

D

Will relinquish a toy

Quickly loses interest in play materials Withdraws from or ignores new toys Clings to own toys

E

Amuses self happily in fairly restricted play area

Fearful of new toys

E

Feelings hurt when toys taken away Lacks interest in play material

D E

Cries or whines when restricted in play area

Appendix IV ANALYSIS OF SCORES TABLE I* SECURITY SCORES OF GROUP OF WELL-ADJUSTED CHILDREN Child AG (a)

0-6 months —

DGa (a)

—

RG

6-12 months +.40 + .46

+ .39 + .43

12-18 months 18-24 months + .47 + .45 + .44 + .45

+ .09

+ .35

+ .38 + .41

+ .43 + .40

JG(a)

—

+.30 + .42

NK(a)

+ .43

+.42

—

+.40

LP(a)

+ .43

+.43 + .38

BS(a)

—

—

—

DGe

+ .34

+ .17 + .27 + .25

+ .17 + .22

PQ

+ .34 + .43

+.41 + .36 + .31

+.32

+ .42 + .43

+ .42 + .42 + .39

DP

DU (a)

—

+.43 +.46

RB JD

—

+.34

(o) girl.

*Table I is continued on p. 124. 123

+ .48 + .42 + .34

+ .35 + .43

+ .38 + .29

+ .36

+ .40 + .44

+ .40 + .44

+ .45 + .40

+ .40 + .34 + .37

+ .21 + .20

+ .44 + .43

+ .44 + .43

+ .40 + .32

+ .32 + .36

+ .39 + .40

+ .28 + .42

124

APPENDIX IV TABLE I, cont.

Child

JL(«)

MM (o)

0-6 months

~

6-12 months

~

12-18 months

+ .30 + .33

+ .40 + .39

+ .33 + .41

+ .39

KJ(a)

~

+ .43 + .37

+ .46 + .42

+ .43

+ .37 + .43

BP(o)

+ .44

DG(o)

+ .43 + .31

+ .32 + .47

—

—

+ .38

—

+ .43 + .40

+ .41 + .43

+ .39

+ .38

MS(o) JC(«) Median* Mean*

+ .43 + .39

+ .40

+ .33 + .38

+ .40

18-24 months + .34 + .45 + .45

+ .41 + .33 + .39 + .44

+ .41

+ .40 + .37 + .37

+ .395

+ .36

*Means and Medians were calculated on the first score recorded for each child within each age level.

TABLE II SECURITY SCORES OF GROUP OF POORLY ADJUSTED CHILDREN Child 1

2 (a) 3 (a)

0-6 months + .12 + .20

6-12 months +.37 +.34

—

—

+ .28

4

—

5 (a)

—

6 (a)

—

(a) girl.

+.35

+.23 + .39 +.27 + .34 + .22 —

12-18 months 18-24 months + .37 + .39 + .39 + .21

+ .17

+ .20

+ .22

+ .07 + .27

125

APPENDIX IV TABLE II, cont. Child

0-6 months

6-12 months

8

—

-.01

9 (a)

—

—

+ .01

10 (a)

—

—

+ .40 + .38

—

11 (a)

—

+.28 + .36

+ .17 + .11

+ .32

+ .32 + .21 + .20

7

—

12-18 months

—

+.35

Median* Mean*

+ .20 + .20

+.34 +.26

+ .25

+ .42 + .45

+ .03 + .21

12 (a) 13 (a)

18-24 months

+ .26 + .24

—

+ .25 + .245 + .20

+ .25 + .28

*Means and Medians were calculated on the first score recorded for each child within each age level.

TABLE III NUMBERS OF CHILDREN HAVING Two TO NINE TESTS

Well-adjusted children Poorly adjusted children

2

2 6

3

2 4

NumlDer of tests given 4

2 1

5

3 1

6

6 0

7 1 0

8

3 1

9

1 0

126

APPENDIX IV

TABLE IV RAW SCORES FOR WELL-ADJUSTED AND POORLY ADJUSTED CHILDREN

Child

DG PQ LP BP MM NK KJ DGe 1 2a 4 5a Ha 13a JD JC AG RG DP DU 8 JG RB MS 12a 9a 6a DGa 3a 7 10a JL fe

Range of experience

I

23/54* 17/50 — — 18/61 — — — 6/50 — — — — — — — — — — — —

z

—

— .— — — .— —

At 0-6 months

II

19/61 27/63 27/63 27/61 20/60 27/63 23/59 16/47 10/49 16/57 — — — — — — — — — — —.

^ _ — —. — — — —

47-63 (16)

Total number of endorsements Total number of items applying

Tests III

I

— — — — — — — — — — — — — — — — — — — — — —

24/76 30/69 31/72 25/68 27/69 32/75 29/67 29/71 25/67 26/73 14/61 16/60 21/74 24/68 25/73 31/72 27/68 26/66 30/74 22/65 -1/70 19/64

— — .—— —. — —

— — — — — — — —

At 6-12 months II

36/76 33/72 29/76 31/74 29/74 — 25/67 27/74 24/71 — 26/67 22/65 27/75 — — 28/70 32/70 30/69 — 19/56

— 31/73 —.

— — — — — —

56-76 (20)

III — — — — — — —22/71 — — — 15/68 — — — — — — — — — — — — — — — — —

APPENDIX IV

127

TABLE IV, cow/. Tests I 40/92 39/88 41/92 31/88 29/87 34/85 40/87 14/84 36/89 — 17/57 — 20/80 32/78 37/90 39/82 30/78 34/89 33/79 3/92 36/84 33/81 — 29/92 1/88 20/91 8/86 15/87 — — — —

At 12-18 months II

III

— 39/90 38/90 35/92 36/88 40/92 36/85 23/84 34/92 —

— — — — — — — 20/84 — —

I . —. 39/92 38/96 37/91 37/91 38/95 33/83 15/88 20/90 —

— — 33/84 39/90 37/85 35/85 26/90 31/82 9/71 39/90 27/86 34/92 29/92 — — — — — — — •— 57-92 (35)

— — — — — — — — 19/92 30/89 — — — — — — — — — — —

— — — 27/95 35/95 42/94 40/94 34/94 39/92 40/95 33/93 33/92 37/93 20/93 38/95 6/84 — 17/95 23/92 15/89 30/84 23/87

At 18-24 months II 38/92 33/96 — 31/93 41/94 37/85 19/90 38/96 — — — — 37/96

—

41/92 37/92 — 35/90 43/95 40/92 33/91 34/96 18/92 35/92 25/91 — — — 11/96 37/83

18/88 83-96 (13)

III — 34/92 — — — — — — —

Child DG PO LP BP MM NK KJ DGe 1 2a 5a

—

— 40/96

—

lia

13a JD

jc

AG

— — — —

RG DP DU 8

-

JG

— — — — — — —

RB MS 12a 9a 6a DGa 3a

7

— 38/88 —

lOa JL BS Range of experience

128

APPENDIX IV

TABLE V PERCENTAGE ENDORSEMENTS OF DEPUTY AGENTS AND REGRESSIVE ITEMS OF TOTAL NUMBER POSSIBLE At 0-6 months

I

Child DG PQ

BP MM NK KJ DGe 1 2a 4 5a lia 13a JD JC AG RG DP DU 8 JG

D.A.

4 9 7.5 0 17 7 8 15 45 23

Tests

II

Reg. 0 4 0 o 0 o 20 o 25 o

D.A. Reg. 7 7 — — 15 — — — 24 —

0 0 — — 20 — — — 25 —

PR

III

D.A. — — — — — — — — — —

At 6-12 imonths

I

II

Reg. D.A. Reg. D.A. Reg. D.A . Reg. — 16 10 0 — 0 — 9 10 8 0 — 9 — — 9 12 8 4 9 — — 9 18 21 0 12 0 — — — 4 9 — 10 17 0 — 5 4 — 18 17 9 22 18 11 17 0 — — 21 — 24 0

41 21 17 22 16 9 13 18 16 9 50 20

0 0 55 10 10 10 11 11 10 40 80 44

13 19 8

0 10 4

— 38 —

9 13

10 0

— —

TV/fC

to*

Oî»

r*r*a riiwf niT

r*t SF •pp RP

}iríawMP n

TT JJRÇ

TOTAL D.A. AVERAGE D.A. TOTAL RIÍG. AVERAGE REG.

188

13

94 7

III

616 16 454 12

18

APPENDIX IV

129

TABLE V, cont. Tests

At 12-18 months

I

II

III

At 18-24 months

II

I

D.A. Reg. D.A. Reg. D.A. Reg. D.A. Reg. D.A. Reg. 7 3 10 16 10 7 3 21 10

3 0 0 7 8 15 0 25 7

__

7 13 12 15 10 7 24 16

0 0 7 7 0 0 17 7

— — 23 — — — — —

— — 0 — — — — —

0 11 6 3 8 3 28 26

6 0 0 15 8 9 15 15

8 19 14 11 6 0 21 5

6 7 0 15 0 0 23 7

III

D.A.

Reg.

—.

—8 — — — — — —

14 — — — — — —

Child

DG PQ LP BP MM NK KJ DGe

1

9a £t&

5a

21 8 3 0 8 15 11

25 0 0 7 23 0 0

10 13 3 26 50 35 33 30 31 16 26 23 32 19 41 26 — — — —

0 0 6 7 64 7 66 42 0 7 21 8 3 15 36 14 — — — —

11 3 7 3 27 7

0 8 7 7 0 9

— — — — — —

— — — — — —

8 —0 3 — 6

— 15 —0 0 —0

—0 —0 3 — 12

8 —0 0 — 0

7 26 13 22 — — — — 33 — — —

0 0 7 7 — — — —8 — — —

23 — — — — — — — — — — —

10 — — — — — — — — — — —

0 11 6 30 13 32 — 33 29 — — —

15 0 0 8 0 50 — 17 8 — —

3 6 12 31 6 14 — — — — — ~

0 0 17 15 15 30 — — — — — —

— — — — —

— — — — —

— — — —. —

— —

— — — 11 34 12 26

— — —. 0 16 7 16

— — — — — — —

876 16 527 10

— — — — — — —

— —

— —_

— —

z —

— —

—

—

625 13 329 9

—3 — — —-

— —

llid ia

0 — — — — — —

— —

— — — — — — — — -— —

— — — — 38 6 34

— —

— — — — — — — —

— — 15 0 25

13a JD JC AG RG DP DU JG RB MS 12a 9a 6a DGa 3a 7 DM DK CJ SF RE BC JO JMC 10a JL BS

TOTAL D.A. AVERAGE D.A. TOTAL REG. AVERAGE REG.

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REFERENCES

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References 1. ADJSWORTH, M., and BOWLBY, J. "Research Strategy in the Study of Mother Child Separation," Courrier, IV (1954). 2. BAKWJN, H. "Loneliness in Infants," American Journal of Diseases in Children, LXIII (1942), 30-40. 3. BAKWIN, H. "Emotional Deprivation in Infants," Journal of Pediatrics, XXXV (1949), 512-21. 4. BLATZ, W. E. "Curing and Preventing," Bulletin of the Institute of Child Study, XIX (June 1957). 5. BLATZ, W. E. Understanding the Young Child. Toronto: Clarke Irwin & Co., 1944. 6. BENDER, L. "Psychopathic Behaviour Disorders in Children," in Handbook of Correctional Psychology, edited by R. M. Lindner and R. V. Seliger, pp. 360-76. New York: Philosophical Library, 1947. 7. BOWLBY, J. Maternal Care and Mental Health. Geneva: World Health Organization, 1952. 8. BOWLBY, J. "The Influence of Early Environment in the Development of Neurosis and Neurotic Character," International Journal of Psycho-Analysis, XXI (1940), 154-78. 9. BRODY, S. Patterns of Motliering. New York: International Universities Press, 1956. 10. FREUD, S. The Basic Writings of Sigmund Freud, edited by A. A. Brill. New York: Random House, 1938. 11. CESELL, A., and ARMATRUDA, C. Developmental Diagnosis: Normal and Abnormal Child Development. New York: Hoeber, 1945. 12. CESELL, A. (narrator). The Embryology of Human Behaviour. 16 mm. film. Chicago: International Film Bureau. 13. GESELL, A., and ILG, F. Infant and Child in the Culture of Today. New York & London: Harper Brothers, 1942. 14. GOLDFARB, W. "Infant Rearing and Problem Behavior," American Journal of Orthopsychiatry, XIII (1943), 249-65. 15. GOLDFARB, W. "Rorschach Test Differences between Family-reared, Institution-reared, and Schizophrenic Children," American Journal of Orthopsychiatry, XIX ( 1949), 624-33. 16. GOLDFARB, W. "The Effects of Early Institutional Care on Adolescent Personality," Child Development, XIV (Dec. 1943), 213-23. 17. GRAPKO, M. F. "The Relation of Certain Psychological Variables to Security." Unpublished Ph.D. Thesis, University of Toronto Library. "The Development of Security in Children," Bulletin of the Institute of Child Study, XIX (June 1957). 18. INSTITUTE OF CHILD STUDY STAFF. Twenty-Five Years of Child Study. Toronto: University of Toronto Press, 1951. See Studies on Security, T66 and T67, p. 171; T70 and T71, p. 175. 19. INSTITUTE OF CHILD STUDY STAFF. Well Children. Toronto: University of Toronto Press, 1956. Pp. 7-14. 20. MAHLER, M. S. "Ego Psychology," in Modem Trends in Child Psychiatry. New York: International Universities Press, 1946. 21. PINNEAU, S. R. "A Critique on the Articles by Margaret Ribble," Child Development, XXI (Dec. 1950). 133

134

REFERENCES

22. PiNNEAU, S. R. "The Infantile Disorders of Hospitalism and Anaclytic Depression," Psychological Bulletin, LII (Sept. 1955). 23. PINNEAU, S. R. "A Reply to Dr. Spitz," Psychological Bulletin, LII (Sept. 1955), 459-62. 24. READ, G. D. Childbirth without Fear: The Principles and Practices of Natural Childbirth. New York: Harper Brothers, 1944, 1953. 25. RHEINGOLD, H. L. The Modification of Social Responsiveness in Institutional Babies. Monograph of the Society for Research in Child Development. Lafayette, Ind.: Child Development Publications, Purdue University. Vol. 21, no. 2, 1956. 26. REBELE, M. A. "Infantile Experience in Relation to Personality Development"; in J. McV. Hunt, Personality and Behaviour Disorders, II. New York: Roland, 1944. 27. RIBBLE, M. A. The Rights of Infants. New York: Columbia University Press, 1943. 28. RIBBLE, M. A. "Anxiety in Infants," in Modern Trends of Child Psychiatry, edited by Nolan D. C. Lewis and B. L. Pacell. New York: International Universities Press, 1946. 29. SALTER, M. D. An Evaluation of Adjustment Based upon the Concept of Security. Child Development Series, no. 18. Toronto: University of Toronto Press, 1940. 30. SENN, MILTON (éd.). Problems of Infancy and Childhood: Transactions of the South Conference. New York: Josiah Macy Jr. Foundation, 1953. Report on film, "A Two Year Old Goes to Hospital' by J. Bowlby, J. Robertson, D. Rosenbluth; the original report appeared in Psychoanalytic Study of the Child, Volume VII. New York: International Universities Press, 1952. 31. SPITZ, R. A. "Hospitalism: An Inquiry into the Genesis of Psychiatric Conditions in Early Childhood"; Psychoanalytic Study of the Child, I (New York: International Universities Press, 1945), 53-72. 32. SPITZ, R. A. "Psychiatric Therapy in Infancy," American Journal of Orthopsychiatry, XX ( July 1950 ), 623-33. 33. SPITZ, R. A. "A Reply to Dr. Pinneau," Psychological Bulletin, LII (Sept. 1955), 453-9. 34. SPITZ, R. A., and WOLF, K. M. "Anaclytic Depression: An Inquiry into the Genesis of Psychiatric Conditions in Early Childhood," Psychoanalytic Study of the Child, II (New York: International Universities Press, 1946), 313-41.