Focusing on attachment and stability
What's Important To Us
All children need to have strong and stable attachments with adults who care about them. Having these attachments will give them a sense of security in all aspects of their lives and help them grow up to be healthy and productive adults.
Children who have been abused or neglected in some way may have trouble forming safe and healthy attachments. It is important that the adults who care for them are aware of the importance of attachment, know the signs of disordered attachment, and have the skills and knowledge to build a secure attachment with them.
What is attachment?
In the field of infant development, attachment refers to a special and enduring ‘emotional' relationship that exists between a child and their primary caregiver which brings safety, comfort, soothing and pleasure to both parties (Perry, 2001). It is through healthy ‘bonding' experiences (i.e. face-to-face interaction, eye contact, and physical touch) that positive attachments are formed. These experiences are critical to shaping a child's capacity to form healthy future relationships.
Children with a secure attachment to their primary caregiver will look to them for comfort when they are distressed, and use them as a secure base from which to explore their environment. The securely attached child trusts that they will be cared for, their needs will be met consistently, they will be helped to learn self regulation, and they will be encouraged to learn and explore their environment. Because they feel safe and secure, they have the confidence and sense of competence they need to try new things and to learn.
Insecure attachment may develop if the primary caregiver does not consistently respond to the infant in warm, affectionate, loving, dependable and sensitive ways. Insecurely attached children will display a range of behaviours and emotions including aggression, fear, impulsivity, destructiveness, hopelessness, cruelty to animals and younger children, and lack of empathy. Children who lack secure attachments with their caregivers commonly grow up to be parents who are incapable of establishing this crucial foundation with their own children.
For more information about the different attachment styles, read Wendy Kelly's article ‘Understanding the patterns and relationships' in the August 2006 edition of Social Work Now.
Why is attachment important?
"Attachment experiences lay the foundation for the child's perception of self, others and the world around them" (Atwool, 2007: 11). A secure attachment shapes a child's sense of security, their resistance to stress, and their ability to balance their emotions. It promotes trust and confidence in other humans which leads to more skilled social interactions later in life (Kail & Cavanaugh, 2010), while also helping them develop a positive self-image and cope better with fears and worries.
Common causes of disordered attachment
According to Babb & Laws (1997), a child may have attachment-related difficulties if they have experienced any of the following:
- Sudden or traumatic separation from a primary caregiver (through death, illness, hospitalisation of the caregiver, or removal of the child)
- Physical, emotional or sexual abuse
- Illness or pain which was not alleviated by their caregiver
- Hospitalisation of the child, causing separation from their caregiver
- Frequent moves and/or placements
- Inconsistent or inadequate care at home
- Chronic maternal depression or post-partum depression during the child's first year
- Neurological problems in the child which interferes with their ability to receive nurturing (commonly seen in babies exposed to drugs in the womb)
- Caregivers who are themselves attachment disordered.
Can it ever be too late for a child to form attachments?
During the first three years of life, the brain develops quickly (up to 90 percent of adult size) and puts in place the majority of systems and structures that will be responsible for all future emotional, behavioural, social and physiological functioning. A critical period for a child is in their first year of life, when bonding experiences must be present for the brain systems responsible for attachment to develop normally (Perry, 2001). The future impact of impaired bonding in a child's early childhood will vary according to how early in life, how prolonged and how severe the neglect has been.
"Early intervention when there are difficulties has a significantly great chance of success" (Atwool, 2007: 17). However, this does not mean that older children with disordered attachments have no hope of developing healthy relationships. Research shows that improvement can occur, but it can be a difficult and often frustrating process and may take many years of hard work to help repair the damage caused by only a few months of neglect in infancy (Perry, 2001).
Can a child be attached to multiple caregivers?
Research shows that children can, and do, form attachments to many caregivers at the same time (Bowlby, 1982). This means it is possible for a child to maintain contact with their birth parents without this contact compromising the development of new attachments to their caregivers. Other research suggests that continuing contact with birth parents after a separation may well help a child come to terms with the separation and could play a crucial role in preparing the child to accept their new caregiver (Haight, Kagle & Black, 2003). Contact with birth parents may also alleviate divided loyalty in children by showing that the parents accept the new placement.
It is important to remember that for a secure attachment to form there must be quality and quantity time spent with the child. Being attached to more than one person does not necessarily dilute the quality of the attachment, but if there are too many people there may not be enough time for a secure attachment to form (Smith, 1988).
Keep in mind that if the plan is for the child to return home, make sure that they have plenty of quality contact with their family to help strengthen the attachment that exists. Professional help may also be needed to improve the attachment.
Assessing the attachment needs of children in care
Assessing children's attachment needs is vital, and the accuracy of the attachment assessment has a firm bearing on the success of the intervention plan - the more accurate the assessment, the more successful the plan is likely to be. It may be entirely appropriate for you to do the assessment yourself, or you might ask a psychologist. If you are unsure how to proceed, talk to your supervisor. Don't forget that you will often know more about the child and family than any other professional and will therefore likely have more insight into their attachment type and needs.
Two ways in which attachment can be assessed are as follows:
The "Strange Situation Test"
Developed by Ainsworth and Bell (1970), this test is completed by bringing a child into an unfamiliar room containing various toys and activities. The child can play freely with these while the caregiver is present. After a while, a stranger to the child enters the room and talks to the caregiver. The caregiver then leaves the room and re-enters after about one minute. The following responses may be noted in the child:
- Secure: Distressed by separation but quickly comforted by the caregiver on their return
- Insecure avoidant: Little distress on separation and ignores their caregiver's return. Watchful of caregiver and inhibited in play. Later in life shows relatively low levels of empathy, inappropriate aggression and oppositional behaviours.
- Insecure ambivalent/anxious: Highly distressed on separation and resists contact with the caregiver on their return. Later in life shows dependence on adults for assistance, little ability to attempt tasks for themselves.
- Insecure disorganised: Confused behaviours including freezing or stereotyped movements when reunited with parent. Most common in abused children.
This test was originally used with one year olds, but in recent years other ages have been trialled. The "Strange Situation Test" have been found to work effectively with children aged four years and under.
Attachment questions
Williamson (2002) has developed a set of questions that can be asked of a caregiver and child to give an indication of the attachment the child has formed with significant others in their life. He states that to properly apply these questions, the interviewer needs to have formed a rapport with the child and their family/caregivers and have an understanding of the basic attachments types and their implications. For a list of the questions, read his article ‘Attachment: Guidelines and procedures for assessment and intervention' in the December 2002 edition of Social Work Now.
What can caregivers do to help children with disordered attachment?
Caregivers need to understand that change is not going to happen overnight, and the process of creating attachment with a child who has been abused or neglected will take time and be challenging. Even when a child has been placed in a safe environment, they may still try to fight and push their caregiver away. Caregivers will undoubtedly feel like giving up, but they need to be encouraged to keep going - children with disordered attachment will likely have had people "give up" on them their entire lives which just confirms their own belief that they are "bad" and "not worth loving".
You need to keep in close contact with these caregivers and ensure that they have the support they need to manage any difficulties as they arise. This includes support from family and friends, but also support from professionals with a specialist interest and knowledge of attachment disorders. Some practical things caregivers can do to help these children include:
Nurture them
Children with disordered attachment need to be held, rocked and cuddled. Remember that these types of interactions may be foreign to them so take it slowly, and be attuned to their reactions. In many ways, caregivers are providing replacement experiences that should have happened when the children were in their infancy, but they are doing this when their brains are harder to change. This means they will need even more ‘bonding' experiences to help develop attachments.
Try to understand the behaviours before the consequences
The more that the caregiver can learn about attachment, bonding and brain development, the better for them and for the child in their care. Knowing what they are dealing with can prevent them from misunderstanding the child's behaviours. For example, when insecurely attached children hoard food, it should be not viewed as "stealing" but as a predictable response to being deprived of food when they were younger. Punishing the child for this behaviour may just increase the child's sense of insecurity and distress.
Parent the child based on their emotional age
Abused and neglected children with disordered attachment will often be emotionally and socially delayed, and whenever they are frustrated or fearful their behaviour will likely regress to their emotional age. This means that, at any given moment, a ten year old child may emotionally be a two year old. Although we may want them to act their age, they are simply not capable of doing this. When the child in their care is acting like a two year old, caregivers need to parent them as if they were actually that age - hold them, rock them and use soothing non-verbal interactions.
Be consistent, predictable and repetitive
Abused and neglected children with disordered attachment are often very sensitive to changes in daily routines. Any change will probably overwhelm them - even if the change is pleasant (i.e. a birthday party or family trip). Because of this, caregivers need to make every effort to be as predictable and consistent as possible. If change needs to happen, it will be important for the caregiver to prepare the child for this ahead of time - give them lots of notice and talk with them about what the change will look like (i.e. soccer practice is now on Thursday, but it will still be the same time and I will still be there to watch you).
Model and teach appropriate social behaviours
Social occasions can often be a very difficult and challenging time for children with disordered attachment. One of the best ways to teach these children about appropriate behaviour is for caregivers to model this in their own behaviours and tell the child what they are doing and why - i.e. "I am going to the sink to wash my hands before dinner because ...." An area that insecurely attached children can have problems with is physical contact. They may not know when to hug, how close to stand, and what are appropriate contexts to pick their nose and touch their genitals. They may also initiate physical contact with complete strangers. Caregivers often misinterpret this behaviour as affectionate but it isn't. Caregivers should never refuse to hug the child, nor should they lecture them about "appropriate" behaviour. Instead, they should gently guide the child on how to interact differently i.e. "Why don't you sit over here?"
References and further reading
Ainsworth, M.D.S. & Bell, S. M. (1970). Attachment, exploration and separation: Illustrated by the behaviour of one year olds in a strange situation. Child Development, 41, 49-67.
Atwool, N. (2007). The role of secure attachment as a protective factor for vulnerable infants. Social Work Now, December, pp. 11-20.
Babbs, L.A., & Laws, R. (1997). Adopting and Advocating for the Special Needs Child: A Guide for Parents and Professionals. USA: Greenwood Publishing Group.
Bowlby, J. (1982). Attachment and Loss: Vol 1. Attachment (2nd ed). New York, USA: Basic Books.
Haight, W.L., Kagle, J.D., & Black, J.E. (2003). Understanding and supporting parent-child relationships during foster care visits: Attachment theory and research. Social Work, April.
Kail, R.V. & Cavanaugh, J.C. (2010). Human Development: A Life-Span View. California: Cengage Learning.
Kelly, W. (2006). Understanding the patterns and relationships. Social Work Now, August, pp. 11-16.
Perry, B.D. (2001). Bonding attachment in maltreated children: Consequences of emotional neglect in childhood. The ChildTrauma Academy.
Smith, A.B. (1988). Understanding Children's Development (2nd ed). Wellington: Allen & Unwin/Port Nicholson Press.
Williamson, C. (2002). Attachment: guidelines and procedures for assessment and interventions. Social Work Now, December, pp. 23-28.
