Ira J. Chasnoff, M.D.

Ira J. Chasnoff M.D.

Aristotle's Child

The Dance of Attunement

Attunement between parent and child creates a balanced primary relationship.

Posted Apr 30, 2011

My grandmother was thirty-seven years old when she became pregnant with what was to be her seventh child. She had no medical care during pregnancy, and when the time came she called the local midwife who attended the delivery at home. Without much fanfare, my uncle was born, though what followed was something no one had expected. 

As the midwife packed up her bags, my grandmother yelled out that another child was on the way.  The midwife hurried over just in time to deliver my father.  She again began packing up when my grandmother alerted her to the fact there was another child coming.  The midwife examined her, told her everything was fine, and left. 

The next morning, my aunt was born: a set of triplets with two different birth dates. Many years after this momentous birth, I had the opportunity to ask my then-ninety-six-year-old grandmother what it was like having triplets. 'It shouldn't happen to a dog," as her quick reply. Apparently the labor and delivery were still fresh in her mind.

Any way of looking at it, this was a "high-risk" pregnancy-a home birth in an aging woman who had been through multiple pregnancies and had received no prenatal care.  My father, aunt and uncle most assuredly were "high-risk" infants.  But they all lived to celebrate birthdays well into their seventies.  So what did the label "high risk" really mean?

The concept of risk is broad-ranging and difficult to define. From my perspective, a child's risk is embedded in early social and emotional experiences that are filtered through the child's innate biological system.  I like to think about a child's emotional growth as an interactive dance between the child and his loving and supportive world. At the ballet, when dancers stumble, they will quickly recover, and the dance will continue to the rhythm of the music. But there is an ongoing, underlying tension that does not allow the dancer-or the audience- to relax. In the same way, when loving interactions between the parent and child are disrupted, tension and anxiety interfere with the child's development of emotional and relational health.     

Parents shape a young child's maturation through a meaningful system of communication that provides their infant cues to guide interactions. Under ideal circumstances, the infant interprets the parent's guiding hand and responds appropriately; the parents, for their part, read the infant's behavior and take the next step in a well-choreographed system of interaction. It is this "dance of attunement" that creates a balanced primary relationship that introduces the child to a trustworthy world and enables the child to take risks and grow.   

Problems on either side of the equation, however, disrupt the growing relationship between parent and child. In my clinical work, I've met relaxed, confident parents at one end of the spectrum and anxious, depressed parents at the other. How comfortably and effectively the parents are able to orchestrate the dialogue between themselves and their child is key; however, communication is a two way street and is just as dependent on the infant's ability to interpret, interact, and respond to the parents' cues.

Multiple kinds of experiences may cause damage to the child's developing brain, so that he is not able to receive and read his parents' cues. An infant's exposure to alcohol or drugs during pregnancy, emotional or physical trauma in early childhood, the child's separation from his family, lack of appropriate attention-any of these stumbles may damage the child's foundation for the long-term development of motor and language skills, emotional and relational health, and learning. This is the child "at risk."

 So why do some children do just fine in spite of risk? For now, suffice it to say that most children can thrive if they have two or less risk factors. It's when there are three or more risk factors in a single child that the greatest problems emerge.  Unfortunately, children often come to our clinic in Chicago with multiple risk factors: poverty, abuse, neglect, violence and substance abuse in the family, disruption of primary relationships, and on and on.  We can't do anything about poverty, and we can't erase the history of abuse or neglect.  But we can reach out and say, "Let me take at least one risk factor away." We can protect children from violence and from the ongoing ravages of substance abuse; we can salvage families and help them mend; and most of all, we can give children a sense of security and stability by building on the positive relationships that do exist in their lives.      

I think this is something my grandmother certainly knew.  Although the triplets were a surprise and certainly an economic burden, they each received the loving attention they needed to leave any labels of risk behind.