Attachment disorder is a term often used in reference to children who have been in care. What is it, where did the term come from and how do you deal with it?
Richard Field is an educational psychologist, foster carer and carer for the Albert Kennedy Trust. He shares his knowledge with us.
After the Second World War psychologist and psychiatrist John Bowlby looked into the impact that family separation had on young children and their long-term development. Triggered by the massive incidents of separation and loss within the Jewish community after the Holocaust and the sudden separation of war-time evacuations, Bowlby called his theory Attachment Theory. This was further developed by others, including psychologist Mary Ainsworth in the ’70s. The theory highlights the importance of the relationship between children and their primary caregiver. In infancy children seek comfort and support from a key adult in times of distress or need. When these needs are consistently met and they are emotionally reassured, a ‘secure attachment’ is formed. Feeling safe, the child can explore the world around them and is well-equipped to manage challenges, anxieties and conflict which arises as they continue to develop, in Bowlby’s words, ‘lasting psychological connectedness between human beings’.
Conversely if this does not happen, an ‘insecure attachment’ may form. Mary Ainsworth defined three main forms of insecure attachment or ‘attachment disorders’.
Triggered primarily by neglect when the adult has been unavailable. The child becomes self-sufficient, meeting their needs by themselves. They then cut off from other children and avoid adults, appearing emotionally detached. They show little interest in relationships with others and actively ignore adult support. They’re so well-tuned to looking after themselves that adults can forget the child needs them as they seem fine by themselves. Engaging with adults or developing relationships may only be possible through tasks and activities.
Generally resulting from inconsistent responses to early needs. Sometimes the key adult was loving and caring and other times the child was totally forgotten. This results in children who don’t feel ‘thought about’ or ‘kept in mind’. They’re constantly worried that the adults looking after them will forget about them or not be there. Their behaviour ensures that they are not forgotten: they may constantly talk, interrupt or make noises to attract attention. They are focused entirely on relationships, making getting anything done very difficult. There is a close correlation between these behaviours and those of attention deficit hyperactivity disorder (ADHD). These children often present as
charming or ‘in your face’ – useful strategies to get their
basic needs met.
Often a result of severe neglect from chaotic, abusive or emotionally turbulent environments. Adults can be either useless or helpless but also frightening.
The child doesn’t know whether to seek adult attention or to keep away. Parents with severe mental illnesses, domestic violence situations or homes where drug and alcohol abuse are present. The children develop a mixed sense of trust and negative self-perception, feeling everything is their fault or that they are innately bad. Being vulnerable or needy is dangerous for these children. Staying in control is paramount as they must not become the victim. They can avoid adult direction and react adversely to controlling adults.
Risk-taking is very scary and they present as hyper-vigilant and wanting everything on their own terms. Creating problems can help them avoid becoming the victim. They are at risk of getting involved in bullying and crime and being behaviourally challenging. Children with attachment disorders can go on to more home and family breakdowns, have low attainment, a higher prevalence of school exclusion and risk of criminal behaviour.
So what can we do if children come into our lives with insecure attachments?
According to Dr Paul Holmes a Consultant child and adolescent psychiatrist, ‘Attachment theory provides us with a way of understanding their behaviour as a communication of distress, and as such, gives us the possibility of reflecting on how best to respond to facilitate their inclusion, rather than simply react and give up.’
Over time our involvement and support can be reparative and make an incredible difference. However, simply providing a safe and happy home will not solve the problems. It takes time to heal the damage.
These children will not have the self-awareness to express how they feel. Suggesting some of the things they may be feeling helps them to connect behaviour with emotions. For example, saying ‘I wonder whether you might be angry with me because I…’ or ‘I wonder if you are worried that I might forget about you when I…’. Change comes over time, with a high level of consistency, repetition and reflection. They are likely to find body language and tone of voice associated with anger, frustration and disappointment difficult to identify. It’s vital that adults spell out what they are feeling and how they think the child might be feeling. Over time the child will begin to develop a sense of emotional awareness and empathy.
According to Louise Michelle Bomber, teacher, therapist and writer on the subject: ‘your wonderings will form the beginning of their journey towards a greater self-awareness, and later, emotional literacy acquisition.’
For children who have been forgotten about it is very important to build special adult time into their days, ideally in child-led imaginary play situations where behaviours and emotions can be explored safely. New ideas around behaviour and feelings can be gradually introduced. Suggestions, modelling and guidance in imaginary play present the child with a new script which over time they can use and explore in their own play with others. Adult time is also vital in helping these children to feel ‘kept in mind’ and some may need several timetabled slots with a key adult each day to reduce acting out.
Children who don’t feel ‘kept in mind’ can often create trouble when not with a key adult. Here the use of ‘transitional objects’ helps: an item which children take with them to remind them of key adults they feel safe with. This can be done through the use of a picture in a key place or a smell sprayed onto clothing. Looking after something important for someone until they return is also a good way of ensuring the child feels thought about until the adult returns. It also develops self-esteem as they’re taking responsibilities on.
This is a very brief overview of some of the ideas around attachment difficulties. Below is a list of further reading and resources. I have found Inside I’m Hurting, by Louise Michelle Bomber, particularly useful.
For further information
A Secure Base: Parent-Child Attachment and Healthy Human Development
John Bowlby, Routledge
Infancy in Uganda: Infant Care and the Growth of Love
Mary D. S. Ainsworth, Baltimore: Johns Hopkins University Press
Facilitating Developmental Attachment: The Road to Emotional Recovery and Behavioral Change in Foster and Adopted Children
Daniel A. Hughes, Jason Aronson Inc
Is There a Primary Mom? Parental Perceptions of Attachment Bond Hierarchies Within Lesbian Adoptive Families
Susan Bennett, Child and Adolescent Social Work Journal, Vol. 20, No. 3, June 2003
The Origins of Attachment Theory
John Bowlby and Mary Ainsworth in Developmental Psychology, Inge Bretherton. (1992), 28, 759-775
Inside I’m Hurting, Practical Strategies for Supporting Children with Attachment Difficulties in Schools
Louise Michelle Bomber, Worth Publishing
Why Love Matters, How Affection Shapes a Baby’s Brain
Sue Gerhardt. Routledge
Teenagers and Attachment, Helping Adolescents Engage with Life and Learning
edited by Andrea Perry, Worth Publishing
Courses and support
The Bowlby Centre, London
The Tavistock and Portman mental health trust, London
The Anna Freud Centre, London
British Association for Adoption and Fostering
Richard Field is an educational psychologist, foster carer and carer
for the Albert Kennedy Trust