Attachment in children and young people

Attachment in children and young people

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Author David Shemmings OBE PhD

Additional material for 2016 edition Gwynne Rayns, Chrissie Rickman, Gary Mountain

Editing Steve Flood and Susannah Bowyer

Cover photograph Harmit Kambo

Thank you Thank you to the following researchers and practitioners who offered comment or advice at various stages of producing this online briefing and accompanying reference chart: Roger Aitken, Susannah Bowyer, Lynnette Chapman, Simon Claridge, David Howe, Caroline Humberstone-Rico, Brynna Kroll, Andrew Lister, Alison McLeod, Graham Music, Janine Newbury, Jenny Sanders, Sian Stevens and Kath Wilkinson.

About the author David Shemmings is Professor of Child Protection Research at the University of Kent and Co-Director of the University's Centre for Child Protection. He is also visiting Professor of Child Protection Research at Royal Holloway College, University of London. David is Director of the Attachment and Relationship-based Practice programme, and author of more than 60 articles, books and chapters on relationally-based practice, theory and research.

2 Research in Practice Attachment in children and young people

Contents

Key messages...................................................................................................................................................4 Introduction...................................................................................................................................................... 5 1 What is attachment and why is it so important?..............................................................................................6 Attachment theory and its origins.......................................................................................................................................6 Understanding universal attachment behaviours.................................................................................................................6 Developments in attachment theory....................................................................................................................................7 Pre-birth and early years foundations of attachment...........................................................................................................7 The baby's first year........................................................................................................................................................... 8 Messages for practice........................................................................................................................................................ 8 2 What does the research on attachment tell us?...............................................................................................9 Mentalisation or reflective functioning................................................................................................................................9 Understanding mentalisation..............................................................................................................................................9 The Strange Situation Procedure and patterns of attachment behaviour...............................................................................9 Table 2.1 Attachment behaviours displayed during the Strange Situation Procedure............................................................11 A note about attachment disorders................................................................................................................................... 12 Disorganised attachment: a note of caution....................................................................................................................... 12 The developing brain and maltreatment............................................................................................................................13 Predictors of maltreatment............................................................................................................................................... 14 Parental behaviour which may lead to disorganised attachment........................................................................................ 14 A note about attachment disorders................................................................................................................................... 16 Inter-generational cycles of attachment.............................................................................................................................17 Fathers..............................................................................................................................................................................17 Messages for practice....................................................................................................................................................... 18 3 Attachment and outcomes............................................................................................................................ 19 Secure attachment and resilience..................................................................................................................................... 19 Attachment and children with disabilities........................................................................................................................ 19 Disorganised attachment behaviour and subsequent mental health problems...................................................................20 Messages for practice....................................................................................................................................................... 21 4 Assessing attachment.................................................................................................................................. 22 Pre-birth risk assessments................................................................................................................................................ 22 Attachment assessment measures and tools...................................................................................................................... 23 Attachment assessment tools for pre-birth and infancy..................................................................................................... 23 Assessment measures and tools for children.....................................................................................................................24 Assessing caregiver behaviours and representations.........................................................................................................24 Messages for practice.......................................................................................................................................................25 5 Interventions............................................................................................................................................... 26 What works: a brief overview of research findings.............................................................................................................26 Examples of early attachment-based interventions............................................................................................................28 What can practitioners do? How to approach your work with children...............................................................................28 Helping children develop empathy....................................................................................................................................30 Maintaining professional self-awareness and insight........................................................................................................30 Supporting mentalisation: working with adults likely to have experienced unremitting stress as children..............................31 Working with children who display traumatised behaviour................................................................................................35 Messages for practice.......................................................................................................................................................36 Conclusion...................................................................................................................................................... 37 References...................................................................................................................................................... 38

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Key messages

> Although behaviour and rituals vary across cultures, all humans share a common set of attachment needs ? to have people close (primary carers) who act as a secure base and safe haven, with whom they want to spend time and separation from whom causes upset. Using carers as a safe base from which to explore captures the essence of secure attachment.

> Research since the 1960s has developed `attachment theory' which identifies a number of `attachment patterns'. Secure attachment and insecure (ie, avoidant or ambivalent) attachment are organised attachment patterns ? each is a consistent and predictable way for children to keep carer(s) nearby. Insecure attachment is very common; although it is not optimal, and children may benefit from support and more sensitive parenting, insecure attachment is not in itself cause for alarm.

> Securely attached children are more resilient and better placed to deal with `ups and downs' across the lifespan. Parents' own attachment patterns (established through early childhood experience) inform but do not determine their parenting capacity (Dayton et al, 2010).

> Severely disabled children often have more secure attachments than other children. However, some children with disabilities are at increased risk of abuse and neglect ? this is particularly so for children with speech or language difficulties.

> Disorganised attachment behaviour is relationship-specific. The person the child turns to for security is perceived as frightening (or frightened). Children who are abused may show signs of disorganised attachment behaviour ? especially `fear without solution' when the attachment system is activated ? so an indication of disorganised attachment behaviour patterns in children suggest the need for further assessment. Disorganised attachment behaviour manifests itself differently at different ages.

> Disorganised attachment behaviour can result from a child being frightened of a carer or for a carer ? for example, when a parent takes drugs and becomes, untypically, emotionally unavailable: `the lights are on ... but no one is home'.

> Disorganised attachment behaviours are not always the result of abuse or maltreatment. They may result from frightening behaviour from the parent (and there are other non-abusive pathways to the behaviour) that may be unconsciously displayed ? for example, as the result of post-natal depression.

> Attachment classification cannot be considered stable before a child is one year old; however, research demonstrates that attachment patterns are evident in infant behaviour from as early as four months old (Beebe et al, 2010).

> Disorganised attachment behaviour in childhood can lead to dissociative symptoms in adolescence and early adulthood ? including severe panic attacks, blanking out and difficulty remembering events, or conversely, an inability to keep intrusive thoughts/ images out of one's mind.

4 Research in Practice Attachment in children and young people

Introduction

> Children who show disorganised

This research briefing is aimed at practitioners who

attachment behaviour are likely

work with children and their parents or carers. It

to do things to make adults reject

will be of interest to social workers, family support

them. Practitioners must work hard

workers, foster carers, educational welfare officers,

to be available, caring, sensitive and teachers, after-school club and pupil referral unit

trustworthy. Practitioners must also

staff, youth workers, midwives, health visitors and

maintain awareness of the potential for children's centre staff. The briefing is particularly

their own attachment experiences to relevant to those involved in child protection.

impact on their work.

The briefing:

> Practitioners who work with

> identifies a range of attachment

children and carers should be alert

behaviours in children and caregivers,

to attachment-based behaviours,

highlighting findings from research

especially where there are child

that are of particular significance for

protection concerns. Assessing

practitioners

attachment is complex and different techniques are appropriate for children of different ages or stages of development. A growing range of evidence-based tools for frontline workers is available.

> provides information about observing, supporting and assessing parents' caregiving capacity and children's attachment-seeking behaviour, with a focus on identifying signs of worrying parent-child interactions and behaviours

> Research to fully understand

that may require further assessment.

intergenerational transmission of abuse and disorganised attachment behaviours is still ongoing, particularly in relation to parents' unresolved

The briefing is divided into five sections:

1. What attachment is ? and why it is important for practitioners.

trauma, which compromises their caregiving and attunement to babies' needs and feelings. Adults who experienced disorganised attachment

2. Research on attachment behaviours and prevalence ? particularly where it may indicate maltreatment.

as children are likely to find caring and

3. The role of attachment in outcomes for

supportive relationships frightening

children.

and perplexing, and hence avoid them.

4. How attachment can be assessed and

> The most effective interventions aim

some of the most relevant techniques.

directly to increase parental or carer sensitivity and to increase parents' capacity to mentalise ? to become more accurately attuned to their child's needs and to promote synchronised and

5. What research tells us about attachmentbased interventions, focusing on what practitioners can do to support children and families.

contingent behaviour.

Messages for practice are summarised at the end of each section.

Accompanying reference tool

A reference chart that summarises key signs or behaviours associated with the attachment patterns mentioned in this briefing is available to download: .uk/frontline

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