The separation of children from their families at the U.S. southern border, drafted as policy by the Trump administration, has attracted widespread notoriety in this country and abroad. The political and cultural firestorm that ensued was too often untethered to the actual science of child development and trauma. Hence, a review of salient theory and research regarding attachment, as well as the biological correlates of trauma related to separation and other major stressors in children, may illuminate the present discourse on a controversial immigration policy.

U.S. immigration laws have gradually become more restrictive since the 1990’s, accelerating again after 9/11, as the legislation enacted has made it easier to arrest, detain and deport noncitizens. There is an emerging literature on the effects of family separation on relatives remaining in the host countries and on new immigrants in the Unites States, yet relatively sparse research concerning the specific impact of separation on the children of undocumented immigrants attempting to cross the border.

On its surface, the forced separation of children from their mothers and families, seems at best ill-advised and at worst barbaric. Basic theories of child development beginning in the mid-20th century have addressed the importance of the mother-infant bond. Attachment theory as advanced by John Bowlby, and object relations theory as branch of psychoanalysis (Melanie Klein, D.W. Winnicott and others), as well as later theories of infant and child development that built on the earlier work, almost universally discuss the separation of an infant or young child from its mother as a pivotal event. Furthermore, psychobiological correlates have been described (in many cases by studying the foster care population).

John Bowlby (1950s-1970s) writes of the infant’s need for an unbroken/secure early attachment to the mother. A child with a disrupted/severed attachment relationship was likely to show signs of partial or complete deprivation leading to depression and developmental retardation. He proposed a framework of reactions to separation: protest, despair, and detachment. Even after reunification, the child is likely to behave in abnormal ways, such as spurning or not recognizing the mother, and/or intense clinginess. These reactions to maternal abandonment can persist.

D.W. Winnicott (1960s) made important contributions to the field of object relations and the importance of the mother in creating a holding environment. Impingements (environmental failures) can lead to aggression (antisocial behavior), and the development of a “false self” which can have lasting impact on the individual’s capacity for healthy relationships. He also wrote of the “infantile agony” that occurs when the mother leaves and the absence is experienced as an infinite, unbearable abandonment. This phenomenon can be seen as replicated in a somewhat lessened form, in older children. Melanie Klein, another founder of object relations theory, highlighted the importance of the mother/infant bond, with disruption and/or maternal lapses resulting in lasting maladaptive ego defenses.

Later researchers in infant and child psychology investigated the importance of attachment in early life, and the effect of disruptions, usually having to do with the psychic availability of the mother, but by extension physical separations as well. Margaret Mahler studied the behavior of young children and developed a framework of developmental stages through which the growing infant and toddler progresses toward individuation/separation from the mother. Any major event such as an extended physical separation/lapse in her presence, would be bound to seriously impact the normal course of development.

Recent media coverage has focused on some of the sensational aspects of the detention of the children of illegal immigrants, such as the inadequate facilities, insufficient staffing, and a lack of provision of basic needs. Reports indicate there may be as many as 11,000 unaccompanied children in the custody of HHS. Ample research on the psychobiology of the stress response, has shown that there are lasting neurologic effects of remaining in a heightened state of arousal for extended periods. These effects on the brains of younger children are even more pronounced.

Parent-child relationships support a range of regulatory processes, including thermoregulation, food intake, tactile stimulation, imitation, and emotional attunement. When a child is separated from a parent, all of these external regulatory supports are withdrawn, and the child must rely on self-regulation. Studies have shown the long-term consequences of separation (mostly in foster care populations) in both the long and short term: personality and behavior, cognitive development, and specific negative outcomes in the areas of poverty, education, physical health, etc.

The polyvagal theory of autonomic reactions as proposed by Stephen Porges (2001, 2009) suggests a hierarchy of three systems involved in attachment-related responses: the immobilization system, the mobilization system, and the social engagement system. The immobilization system is the phylogenetically oldest and involves the unmyelinated branch of the vagus. This system is designed to limit physical damage, and involves phenomenon such as vasoconstriction, freezing and behavioral shutdown. The mobilization system depends on the sympathetic adrenal system, and produces increased cardiac output, decreased growth and immune system activity, and increased activity of the HPA axis. These responses produce a state of arousal, which can result in psychological states such as panic and rage, leading in turn to avoidance and escape.

The social engagement system is the phylogenetically newest system. Its function is to limit interference in normal body processes involving growth, restoration and social activities. This system involves the myelinated branch of the vagus and originates in the nucleus ambiguous (the “smart vagus”). For most persons, presence of familiar individuals gives way to activity in the social engagement system (and deactivation of the other systems). Porges proposed that if “neuroception” (usual monitoring of the environment for safety and presence of familiarity) goes awry, disordered social behavior may occur including autism, social anxiety, PTSD, and reactive attachment disorder.

In summary, core tenets of child development/attachment theory, as well as more recent research into the psychobiology of trauma, support the damaging effects of the disruption of attachment relationships on youth, especially infants and very young children. Responsibility ultimately lies with health care professionals, and particularly specialists in the fields of child psychology/psychiatry/development, to educate politicians and the lay public, on the humane treatment of children of undocumented immigrants attempting to cross the U.S. southern border.

By Stephen Kramer, MD, Child/Adolescent Psychiatrist, SBH