Attachment Theory

Attachment – Who Makes the Diagnosis?

Sarah Phillimore writes

My post on a general guide to attachment theory – what it means and its importance in care proceedings, remains one of the most popular posts ever on this site. There is also a useful discussion from the perspective of a social worker by guest poster Kate Wells. 

Basically ‘attachment’ is a theory developed by psychologists to explain how a child interacts with the adults looking after him or her. If a child has a healthy attachment, this means the child can be confident that the adults will respond to the child’s needs, for example if he is hungry, tired or frightened, the adult caregiver will respond to meet his needs or reassure and comfort him.

This gives the child confidence to explore his environment and develop a good sense of self-esteem. This will help the child grow up to be a happy and functioning adult.

If a child can’t rely on his carers to look after him and respond consistently, this has been noted to have potentially very serious and damaging consequences for the adult that child will become. If adults are seriously inconsistent or unresponsive in their behaviour to the child, he may become very anxious as he is not able to predict how the adults around him will act; the child may even give up trying to get his needs met.

So Its clearly an issue of interest; unsurprisingly as it often takes centre stage in discussions about children’s welfare in care proceedings.  In this post I will look at at more particular question – who are the people the court rely on to give evidence about attachment?

I am grateful to everyone who took the time out to consider my question – there is clearly a lot to think about and I am increasingly concerned that the knowledge base of the lawyers may not be sufficient to allow us to navigate this area with ease.

Assessing attachment for the court.

Mostyn J was pretty dismissive about the idea that he needed an expert (or indeed anyone!) to help him understand a child’s attachments – see his judgment in GM v Carmarthenshire County Council & Anor [2018] EWFC 36 (06 June 2018). He said at para 18

Second, the theory is only a theory. It might be regarded as a statement of the obvious, namely that primate infants develop attachments to familiar caregivers as a result of evolutionary pressures, since attachment behaviour would facilitate the infant’s survival in the face of dangers such as predation or exposure to the elements. Certainly, this was the view of John Bowlby, the psychologist, psychiatrist, and psychoanalyst and originator of the theory in the 1960s. It might be thought to be obvious that the better the quality of the care given by the primary caregiver the better the chance of the recipient of that care forming stable relationships later in life. However, it must also be recognised that some people who have received highly abusive care in childhood have developed into completely well-adjusted adults. Further, the central premise of the theory – that quality attachments depend on quality care from a primary caregiver – begins to fall down when you consider that plenty of children are brought up collectively (whether in a boarding school, a kibbutz or a village in Africa) and yet develop into perfectly normal and well-adjusted adults

For my part I would say with all due respect that I do not need a social worker to give me evidence based on this theory to help me form a judgment about L’s attachments.

I am not sure I would share Mostyn J’s confidence that he was able to assess a child’s attachment without any help. I have certainly had my fair share of cases where opinions about attachment were bandied around the court and often relied upon as very important. If what is being discussed is some serious psychological problem which is having a detrimental impact on the child’s ability to live happily in the world, then I think most would agree we need some clear and reliable evidence about the how, the why, and what can be done to remedy this – if anything.

Which raises the interesting and particular question of this post – what expertise precisely?  I asked the experts of Twitter this question.

One poster helpfully provided a link to the Family Relations institute They offer a guide to assessments and reporting to the court which look very useful. They note:

Attachment has long been considered relevant to care proceedings. Nevertheless, its usefulness, as compared for example to medical evidence, has been limited by the diverse ways in which attachment is assessed, the different training of experts, and the lack of verifiable evidence upon which to base opinions. In an effort to move from expert opinion to verifiable evidence, The International Association for the Study of Attachment (IASA) has developed a protocol for assessment and formulation of issues related to attachment. The purpose of the protocol is to act as a guide to good practice and to begin a process of improving the application of attachment to family court proceedings.

So it does seem clear that the situation about who assesses and how is currently a little opaque.    What was the general advice from the Twitter experts?

https://twitter.com/ProfSueWhite/status/1151526085588336640

This was opening doors into worlds I hadn’t anticipated – that ‘attachment disorders’ may not actually be anything to do with ‘attachment’ in the classic Bowlby sense but more a problem with neurodevelopment – which clearly needs expertise to identify and assess.

The point was echoed by others – assessment of attachment is not linked to a specific profession.

I received an interesting message from a student on a MSc course in attachment studies

You definitely need to have undertaken specialist training in attachment to state what ‘type’ of attachment a child has in relationship with their primary carer. You’ve already been sent links to some, such as the Anna Freud centre and I’m doing my training at Roehampton University who use Pat Crittendens Dynamic Maturation Model (DMM). It’s a funny area though as we don’t really have a specific title. I’m on a course with social workers, psychologists and OT’s. We will all come away being able to use and possibly code the attachment procedures but will all still come from and work within different professions. We won’t belong to a different ‘attachment’ profession as such but will have had specific training in the area of attachment. (I suppose a bit like social workers can be trained to undertake ABE interviews and so can the police. I couldn’t however ‘diagnose’ an Attachment disorder. It’s a very different thing to diagnose a psychiatric disorder to being trained to observe and analyse a specific type of attachment strategy.

Which in turn leads to the even wider question about the point and purpose of diagnosis – as Roger Smith pointed out, an ‘attachment disorder’ could be seen as a rational choice to avoid relationships after a life time of being ‘let down’.

 

And of course I could rely on the lawyers to continue the proud tradition of Mostynesque cynicism

 

Autistic Children In Care – uninformed decision making leading to poor outcomes.

This is a guest post from a parent. She is concerned about the high numbers of children with autism entering the care system and considers what the explanation is for this. Are the professionals working in the CP system as well informed as they need to be? Does the failure to identify autistic children in care lead to bad decisions being made for them?

My son entered Care in his teens during a deep crisis when he was given an autism (ASD/ASC) diagnosis. When he entered Care it was devastating for our family but I was comforted that ‘the experts’ were now supporting him. It took a while to realise that, when trying to help him, experienced and committed social workers had very little to fall back on in terms of training about understanding what it means to be autistic.

It may seem unreasonable that I expected hard-pressed professionals to take account of his needs in their practice but if my son were to make decisions about where to live or what to do with his life post-18, how could he be expected to make informed decisions without professionals meeting his communication needs and understanding how to adjust their practice to address the core features of autism? I was shocked that there seemed little appreciation that an autistic person without a learning disability is likely to have these needs, irrespective of the number of words in his/her vocabulary or ability to repeat the words of professionals to other professionals. Their practice also needed to take account of ‘theory of mind’ difficulties and very high anxiety levels when faced with uncertainty (eg delayed decision making about placements etc) or attempts to ‘control’ rather than ‘agree’.

I began to read widely about the Care system and eventually concluded based on what we know about the difficulties of children in care around behaviour and poor mental health that there are likely to be much higher numbers of autistic children in Care than generally acknowledged and that these children are largely invisible in policy or research into the Care system. There are well known links between being in Care and entering prison and having a learning disability. Young people entering prison are also screened for traumatic brain injuries and cognitive difference, unlike children entering Care who are only screened for ‘emotional and behavioural problems’. Training or continuing practice development for social workers, independent reviewing officers, solicitors, CAFCASS officials around disabilities is minimal.

Evidence for much higher numbers of children in Care with autism than in their equivalent non looked after cohort of peers has begun to emerge. A recent study has identified variance between local authorities in the numbers of children in Care with an autism diagnosis from 0% to 12% of its looked after children. Recent clinical studies of adoptive children have also identified high numbers of adopted children with undiagnosed autism. 27% of the sample group were assessed as autistic (10%) or having significant autistic traits (17%)

Possible reasons for high numbers of autistic children in/from Care, many without diagnosis?

These are some thoughts: –

• Acknowledged difficulties accessing appropriate support where children have a diagnosis may lead to extreme crises within families particularly as a child reaches adolescence and unsupported autistic children may develop poor mental health.

• Children with behavioural difficulties (anti-social, unsafe and violent) may come to the notice of social care and other professionals and these behaviours can overshadow a undiagnosed child’s difficulties. Problems with multi-agency working means there are few routes to ‘late diagnosis’ for the child.

• On entering Care, guidance for clinicians carrying out looked-after-children’s health checks promotes an approach where disabilities including autism are seen in the context of educational need so autistic children who do not have learning disabilities are not systematically ‘picked up’ and diagnoses for non-school age children are not identified because a toddler has no educational need. The list of conditions that health professionals should be alert to does not include autism. 

• Autistic parents have an increased probability of having autistic children and may have high levels of vulnerability and inadequate support to enable them to an increase their parenting capacity leading to their children entering Care as a result of neglect.

• Autistic mums of autistic children’s have a natural inclination to ‘tell truth to power’ and other traits that could easily be misunderstood as non-engagement with professionals. “I understand that my autism makes me a difficult person to deal with: I don’t know when to back off when I know I’m right. Maybe I can’t always look people in the eye, so perhaps I come over as being shifty. Autistic people do hyper-focus, but they mistook my obsession as a sign I was unstable.’’

• Many professionals have training in child-development that focuses almost exclusively on attachment theory. Attachment theory is ‘normative’. It does not acknowledge that a child’s development may deviate from the norm for many reasons including genetic inheritance, pre and post-natal substance and medicine exposure, post birth accident or illness for example. Linked to this, experts have identified a phenomenon of over-diagnosis of attachment difficulties as a result of the ‘allure of diagnosis of rare disorders in maltreated children’.

• Professionals may see vulnerability/ difference of autistic child or parent and worry about the child. When it comes to working with ‘autism families’ they do not have any context to’ fit this worry within’ unless they have very close links with experienced clinical support. .

Professionals are likely to be short of time and resources and risk-averse so may ‘err on the safe side’ by removing autistic children.

Should professionals involved in Child Protection be concerned?

At the very least a failure to identify autistic children within Care points to uninformed decision-making about children at the edge of and within Care and this uninformed decision making is likely to be a considerable factor in poor outcomes for many children who enter Care.

Evidence of under-identification of autistic children within Care is also a damming indictment of health care provision for looked-after-children.

It also raises the possibility that some children with both diagnosed and undiagnosed autism have been removed from loving families who with earlier diagnosis, more understanding and targeted help could have delivered better outcomes for their children without needing the State to intervene within a family in the most draconian way imaginable.

 

What needs to change?

The implications for the Care system are profound.
It is likely to impact:

and raises many questions including:-

What does good support look like for autistic children in Care given their greatest need is likely to be around ‘placement’ stability rather than around education as would be the case for most other autistic children?

 

Attachment Theory – the Basics

We are grateful to Kate Wells for this piece outlining the basics of ‘attachment theory’. This is a very important concept in care proceedings as often conclusions reached about a child’s attachment or lack of will be very influential in determining the direction of a case. But it is often  a concept which seems poorly understood and misapplied by many. 

I think it is absolutely essential that social workers have a basic understanding of attachment theory and the importance of the early relationship between baby and mother (again used as shorthand) from the first moments of birth, and even in utero as there is evidence that babies can be adversely affected if there is tension, hostility, domestic violence etc., and how this insecure attachment pattern will affect the children as they grow through the ages and stages of childhood.

Attachment theory in psychology originates with the seminal work of John Bowlby (1958). In the 1930’s John Bowlby worked as a psychiatrist in a Child Guidance Clinic in London, where he treated many emotionally disturbed children. This experience led Bowlby to consider the importance of the child’s relationship with their mother in terms of their social, emotional and cognitive development. Specifically, it shaped his belief about the link between early infant separations with the mother and later maladjustment, and led Bowlby to formulate his attachment theory.
Evolutionary theory of attachment (e.g. Bowlby, Harlow, Lorenz) suggests that children come into the world biologically pre-programmed to form attachments with others, because this will help them to survive. The infant produces innate ‘social releaser’ behaviors such as crying and smiling that stimulate innate caregiving responses from adults. The determinant of attachment is not food but care and responsiveness.

Bowlby suggested that a child would initially form only one primary attachment (monotropy) and that the attachment figure acted as a secure base for exploring the world. The attachment relationship acts as a prototype for all future social relationships so disrupting it can have severe consequences.

This theory also suggests that there is a critical period for developing an attachment (about 0 -5 years). If an attachment has not developed during this period then the child will suffer from irreversible developmental consequences, such as reduced resilience and aggression
I don’t propose to give any further background details as there is so much more information since Bowlby’s works in the 1950s that it would be a mammoth task and as my aim is to provide some very BASIC information on attachment theory, further detail would not be helpful.

However there is a huge amount of published information on Attachment Theory readily available for anyone wishing to gain a greater understanding of the theory.

I do NOT claim to be any sort of expert in this theory, although I do have a basic understanding of the theory and have in the past been involved in collaboration with a clinical psychologist and play therapist, in delivering training to prospective foster carers and adopters.

 

‘Attachment’ is often used in a meaningless way

The word “attachment” is often used by social workers in my experience in a way that is meaningless e.g. “He’s attached to his mother” I ask “In what way?” and the usual response is along the lines of “well he goes to her at contact and isn’t upset by seeing her…” I then ask “Is he upset when the mother leaves at the end of contact?” “Oh no, he’s fine, sometimes he waves bye bye” Hence there is a misunderstanding of attachment theory. The word is used in almost the same way as “I am attached to these old slippers.” We read of “strong” attachments, “good” attachments, and even “solid” attachments. Sometimes the term “bonding” is used in much the same way we read “There is a good bond between X and his mother.”

Incidentally I am using the term “mother” as shorthand, but of course it could be father or any other caregiver.

Attachment theory holds that within close relationships young children acquire mental representations or internal working models of their own worthiness based on other people’s availability and their ability and willingness to provide care and protection (Ainsworth et al 1978).

 

Attachments can be SECURE or INSECURE/ANXIOUS

A SECURE attachment pattern between baby and mother develops when the mother has an ability and willingness to try to understand behaviours and emotions from her baby’s point of view. She is attuned to his needs, e.g. responds to his crying by picking the baby up and soothing him, either by feeding, or changing him, or simply holding him. She learns to differentiate his cries, sometimes hunger, pain, boredom, tired etc and responds appropriately. She talks to the baby, maybe sings to him and smiles at him and as the baby grows she is rewarded by his response, in that he smiles back and they can engage in “conversation” e.g. the baby “coos” and laughs/gurgles in response to the mother’s attention and often tries to mimic her sounds. Within this attuned, coordinated relationship, the baby learns to regulate his own feelings and behaviours. The mother’s love is unconditional, and this provides the growing child with a sense of security and trust in his mother (often referred to as his attachment figure)

Babies can of course have secure attachment patterns with fathers, and other adults, so long as those adults are able to be emotionally available to the child (as outlined above) as well as physically present.

A secure attachment pattern will be a protective factor for the child throughout the lifespan. He will have learned that he is loved, effective, autonomous and competent and will have an expectation that other people will be available, co-operative and dependable, as he progresses through life.

INSECURE/ANXIOUS ATTACHMENTS.

These attachment patterns are broken down into Avoidant or Ambivalent attachments. Children who show these insecure attachment patterns have learned that there are conditions attached to their gaining proximity to their mother.

Interestingly these children develop appropriate strategies that a) increase the mother’s emotional availability and do not cause her to withdraw and b) bring care and protection. These strategies are of course devised for survival and can be effective, but the feelings of anxiety and insecurity remain in relation to the mother.

However both secure and insecure attachment patterns represent efforts by children to ORGANISE their behaviour, to achieve some kind of proximity to their mother and with it a “felt security” – and when there is an insecure attachment pattern, these behaviours in children have varying degrees of success.

AVOIDANT ATTACHMENT

This attachment pattern is sometimes referred to as dismissive. The mother (or parents) of these babies are often rejecting and controlling. If the baby cries it annoys or agitates the parents, and they lack sensitivity to the child, are unreliable and largely disinterested in the baby. These babies are often “prop fed” a bottle put into their mouth propped up by a towel (or something similar) while they are lying in the pram. The parents do not get any pleasure from the baby.

Hence at times when the baby is in need of comfort, care, protection, and this is manifested by crying, clinging, following, demanding, it actually brings the opposite reaction to what the child needs, in that the parents are rejecting or controlling.

The child’s strategy in this attachment pattern is often to minimise their needs and deny or not communicate their distress. Strong feelings are defensively excluded and emotional self-containment is established. This allows the child to stay in reasonable proximity to the attachment figure without causing him or her too much irritation, thus reducing the chances of being rejected. This strategy can be seen as the psychological defence of flight, rather than fight, e.g. a child may sit close to his mother, gradually moving nearer and if not rejected, attempting some kind of physical contact. Maybe they sit on the floor next to their mother’s chair, and then stand up and lean on the arm of the chair, and eventually chance getting into a mild form of physical contact e.g. putting their arm around their mother or laying their head on her arm. If they are not rejected they may try to sit on their mother’s lap and if the mother is not rejecting but not responsive either, the child will usually remain as long as possible.

These children are often described by foster carers and adopters as difficult to “reach” emotionally, “detached” “can’t make him out” “never know what he’s thinking” and in extreme cases, unable to show any affection other than very superficially. One adopter described her child as “fine on the outside, mostly pleasant and co-operative, but “hollow” – he has no middle.” Emotional self-containment was learned very early on in his life as a way of survival.

 

AMBIVALENT ATTACHMENT

This attachment pattern forms when parents are insensitive, unreliable and inconsistently responsive. Children very often adapt the psychological defence of fight, and show angry behaviour, crying, whining, fretting, clinging, demanding, shouting and tantrums. This is an attempt to break through the emotional neglect, unavailability and lack of responsivity. Needless to say this generally doesn’t bring the desired response, and these children grow up feeling that they are not worthy of automatic interest. Other adults are seen as inconsistent and not always able to soothe and provide comfort. These children grow up to be particularly vulnerable to stress and are very frustrated (sub consciously of course) that the mother is emotionally desired but emotionally unreliable. At any one times these children’s relationships with their mother are guided by strong feelings of either love or anger.

It’s important to recognise that even when children are insecurely or anxiously attached to their mother, they can adapt their behaviour (or organise themselves) in an attempt to get physically and emotionally close to their attachment figure, with varying degrees of success.

There is however a type of insecure attachment that is so severe that children are unable to organise their behaviour or develop a defensive strategy to achieve proximity or security, and their distress remains heightened and unregulated. The parents of these children are often dangerous (abusive) or emotionally unreachable because of severe mental illness, and/or abuse of drugs and alcohol. If one parent is the abuser, the other fails to protect. Children are severely neglected and/or abused. Without an organised strategy children may freeze, either physically or psychologically. These children have an attachment disorder and are going to need a great deal of understanding and resilience by the foster carers or adopters, who have a full understanding of how their early life experiences have affected these children.

By definition therefore ALL children who are removed from their parents by a Court Order are going to have one type or another of insecure or anxious attachments with their mother or parents/step-parents.

Frozen Awareness

I appreciate that this notion of babies and children being able to organise their behaviours in order to get the best they can from their mothers, might seem strange, even bizarre. However I have observed this happening and it can be very chilling. I remember reading about “frozen awareness” in a very young child and was I admit sceptical, until I actually saw a 4 month baby lying quiet and still in the pram but with eyes wide open, like a rabbit caught in the headlights, fearing (quite rightly) that danger was nearby. I was to see this many more times, but the memory of that first baby has never left me. The step-father had been shaking the baby and twisting her arms (this was relayed to me by the mother who had a mild learning difficulty and was afraid of her partner.) Fortunately the court agreed that the baby should be removed and she was subsequently adopted and thrived in the care of the adopters.

Likewise I have seen the “frozen” child crouched in the space between his bed and the wall. This was a little boy not yet 2 years, and the bruising to his face and ears was very visible. When I picked him up the child was rigid, frozen, traumatised. I have observed toddlers sitting still on a chair, casting fearful glances at the abuser, again keeping very quiet so as not to attract the attention of the abuser. These are definite strategies that the child sub-consciously employs for survival.

I recall a 6 year old boy after a phone call from his mother, dancing around the room of the foster carer, repeatedly calling out “she loves me, she loves me” – clearly the mother had said this to him on the phone and it may well be the first time that the child had heard this from his mother and his delight was both sad but very moving. When one of the foster carer’s older children returned home, the little boy immediately pounced on him and said “my mom loves me….” And of course the older child looked bewildered, failing of course to understand the significance of the little boy’s delight.

Obviously I could go on to give many more examples but I don’t think that is necessary.

 

Attachment patterns throughout childhood

Looking at attachment patterns through the ages and stages of childhood Robert Karen (Becoming Attached) provides a chart of typical patterns of secure and anxious attachment. Before doing so he makes a very important point:

The following chart is meant only as a convenient guide and does not take into account many of the complexities and exceptions found in the research. It should be remembered that insecure attachments (avoidant and ambivalent) is not always associated with the style of parenting described here, but can sometimes come about for other reasons; that a child often has a different pattern of attachment to mother and father; and that attachment patterns can change, so that while many avoidant babies for example, continue in their early pattern, others do not end up behaving like an avoidant 6 year old or develop later into a dismissive adult and parent.

I believe this is largely because these babies are adopted at a young age and the adopters have a good understanding of attachment theory and practice, and can therefore help the child to develop a secure attachment pattern. This takes time, patience and resilience. The adopters need to understand that there will be a gap between the child’s emotional and chronological age, (sometimes called arrested development) and that they will need to allow the child to regress and gradually gain confidence and a sense that he is in fact loved and valued by his parents, and this is unconditional.

Robert Karen’s chart is extensive and so I don’t propose to reproduce it in full. But he describes a secure attachment pattern between mother and baby – mother is warm, sensitively attuned, and consistent. Readily attends to baby’s cries. Baby readily explores, using mother as secure base, compliant with mother. Pre-school: easily makes friends, popular, resilient under stress, good self esteem. Teachers treat him in warm, matter of fact, age appropriate way. Aged 6 with parents: Warm and enthusiastic, comfortable with physical contact. Middle childhood: Forms close friendships and is able to sustain them in larger peer groups. In adulthood: Easy access to wide range of feelings and memories, positive and negative. Balanced view of parents. If insecure in childhood has worked through hurt and anger. Usually has securely attached child.

Avoidantly attached baby. Mother is often emotionally unavailable or rejecting. Dislikes neediness, may applaud independence. By end of 1st year baby seeks little physical contact with mother, randomly angry with her, unresponsive to being held, but often upset when put down. Pre school: Often angry, aggressive, defiant, may be isolated/disliked by peers. Teachers become controlling and angry. Age 6 with parents: Abrupt, neutral, unenthusiastic exchanges. Absence of warm physical contact. Middle childhood: No close friends or friendships marked by exclusivity, jealousy. Often isolated from group. In adulthood: Dismissing of importance of love and connection. Often idealises parents, but actual memories don’t corroborate. Shallow if any self-reflection. Usually has avoidantly attached child.

Ambivalently attached baby: Mother is unpredictable or chaotic. Often attentive but out of sych with baby. Baby cries a lot, is clingy, demanding, often angry, upset by small separations, chronically anxious in relation to mother. Limited in exploration. Pre School: Fretful and easily over whelmed by anxiety. Immature, overly dependent on teacher, maybe be bullied. Teachers indulge, excuse, and infantalize. Age 6 with parents: Mixes intimacy seeking with hostility. Affectedly cute or ingratiating. May be worried about mother when apart. Middle childhood: Trouble functioning in peer groups. Difficulty sustaining friendships when in larger groups. In adulthood: Still embroiled with anger and hurt at parents. Unable to see own responsibility in relationships. Dreads abandonment. Usually has ambivalently attached child.

WHAT THEN DOES ALL THIS MEAN FOR SOCIAL WORKERS IN THEIR WORK WITH CHILDREN WHO HAVE INSECURE/ANXIOUS ATTACHMENTS WITH MOTHERS, FATHERS, STEP-PARENTS/CAREGIVERS.

I think it is absolutely essential that social workers have a basic understanding of attachment theory and the importance of the early relationship between baby and mother (again used as shorthand) from the first moments of birth, and even in utero as there is evidence that babies can be adversely affected if there is tension, hostility, domestic violence etc., and how this insecure attachment pattern will affect the children as they grow through the ages and stages of childhood. They need to understand that attachment patterns are secure or insecure/anxious, not “strong” or any of the other adjectives that are often used. However it is only by observing the interaction between the mother and child that can demonstrate the attachment pattern. Having said that, great care should be taken not to jump to conclusions, and indeed I don’t think it fair that social workers should be expected to determine the exact attachment pattern between mother and child. This is more the work of clinical psychologists and play therapists, often working collaboratively.

The other important point is that LAs should make it a priority to ensure that all prospective and approved foster carers and adopters are given the opportunity to learn about attachment theory and practice. These children with insecure attachment patterns, or an attachment disorder are going to be in their care, and it can only be positive for them to have an understanding of the reasons for the child’s often difficult and challenging behaviour.

Adopters need to know that “love is not enough” (a commonly held view, and not unreasonable) but the child who has an insecure/anxious attachment with his mother, or an attachment disorder is going to prove a huge challenge for the adopters, especially in the case of the attachment disordered child. Indeed these children should be able to receive play therapy and the adopters should be assisted/guided by the therapist as to the best way of caring for the child, to enable the adverse effects of his early life to be minimised, and for him to begin to feel loved and valued for who he is, and that love and care is not conditional. There is no “quick fix” and sadly LAs are so cash strapped that they are highly unlikely to pay for play therapists. Some LAs have clinical psychologists who are able to offer training on attachment to social workers, managers, foster carers and adopters.

Many foster carers and adopters in the LA in which I worked said that it was “like the scales falling from their eyes” as they recognised the child who was insecurely attached to his mother, and the behaviours that were manifested as a result. Many of them went on to read and study the topic further and in turn were able to share their knowledge with other foster carers and adopters.

REPORT WRITING.

I have only been able to give a very basic introduction to the topic in this piece, and it is not within the social worker’s remit in my view to be able to define the particular type of insecure attachment pattern between mother and child in written or oral evidence in court. To do so would require a thorough understanding of the topic in order to be credible and able to handle cross examination.

I think the best way of dealing with this matter is for social workers to talk of children who have “learned that adults can’t always be trusted to care for them” and be able to give an example of a mother not attending to the cries of the baby or failing to give him attention and this in turn causing the baby to feel insecure and anxious, and these feelings may well persist throughout his childhood and into adulthood. I am sure a lawyer acting for birthparents would challenge such an assertion and this could be problematic for an inexperienced social worker who was nervous in court in any event.

I once had a barrister say something like “So you’re saying Ms W that unless a baby is picked up the moment he cries, his future is doomed to failure – is that what you’re saying….” I was experienced and competent enough to deal with this kind of comment, but I can imagine it could be intimidating for a newly qualified social worker.

This piece is far longer than I anticipated but I hope it has provided a very basic understanding of the importance of the mother/child relationship and what can go wrong in the absence of a secure attachment pattern established between mother and child. ……………..Kate Wells.

 

Further reading

See the guidelines from NICE published in November 2015: Children’s attachment: attachment in children and young people who are adopted from care, in care or at high risk of going into care.

What is Attachment Theory? Why is it important?

Attachment is a theory about danger and how we organize in the face of it

Crittenden and Clausson 2000

We hear a lot about ‘attachment’ and its important in care proceedings.

Basically ‘attachment’ is a theory developed by psychologists to explain how a child interacts with the adults looking after him or her. If a child has a healthy attachment, this means the child can be confident that the adults will respond to the child’s needs, for example if he is hungry, tired or frightened, the adult caregiver will respond to meet his needs or reassure and comfort him.

This gives the child confidence to explore his environment and develop a good sense of self-esteem. This will help the child grow up to be a happy and functioning adult.

If a child can’t rely on his carers to look after him and respond consistently, this has been noted to have potentially very serious and damaging consequences for the adult that child will become. If adults are seriously inconsistent or unresponsive in their behaviour to the child, he may become very anxious as he is not able to predict how the adults around him will act; the child may even give up trying to get his needs met.

Therefore, identifying how a child responds to the adults trying to look after him, can be very important information when you are trying to work out what is the best thing to do for that child. If the attachment relationship is very poor and there are worries it won’t improve quickly enough for the child then this may have a significant influence on any decision to remove the child from those adult carers.

The National Institute for Health and Care Excellence (NICE) described ‘attachment’ in this way in their November 2015 guidelines regarding children’s attachment:

Children whose caregivers respond sensitively to the child’s needs at times of distress and fear in infancy and early childhood develop secure attachments to their primary caregivers. These children can also use their caregivers as a secure base from which to explore their environment. They have better outcomes than non-securely attached children in social and emotional development, educational achievement and mental health. Early attachment relations are thought to be crucial for later social relationships and for the development of capacities for emotional and stress regulation, self-control and metallisation…

Where did attachment theory come from?

John Bowlby

The psychoanalyst John Bowlby (1907 – 1990) investigated how what happened to us as children could contribute to later problems as adults  – in the way we behave and interact with other people.

He developed the concept of a ‘theory of attachment’, suggesting that we are born pre-programmed to form attachments to others, as without this babies could not survive. This followed on from the work of Lorenz in 1935 where he investigated ‘imprinting’ in ducklings and geese and showed that the birds would attach to the first large moving object they met in the first few hours of life.

Mary Ainsworth

Attachment theory was further developed by Mary Ainsworth (1913 – 1999) and her assessment technique called the Strange Situation Classification (SSC). Babies and toddlers can’t use words to tell us how they feel so Mary Ainsworth needed to find a way to allow them to show her.

Children were observed through a one-way mirror and the researchers noted the children’s reactions in a range of different circumstances.

  • Parent and infant alone.
  • Stranger joins parent and infant.
  • Parent leaves infant and stranger alone.
  • Parent returns and stranger leaves.
  • Parent leaves; infant left completely alone.
  • Stranger returns.
  • Parent returns and stranger leaves.
This allowed four different categories of behaviour to be investigated:
  • Separation anxiety – what does the child do when the caregiver leaves?
  • Willingness to explore – was the child confident to explore his environment?
  • Stranger anxiety – how did the child react to the stranger?
  • Reunion behaviour – how did the child react when the carer/parent came back?
Results of the experiment.

See further this article from Simply Psychology

She identified three main attachment styles

  • Secure
  • Insecure avoidant
  • Insecure ambivalent.

A fourth attachment style has since been identified as ‘disorganized’.

The majority of the children were ‘secure’.

  Secure Attachment Ambivalent Attachment Avoidant Attachment
Separation Anxiety Distressed when mother leaves. Infant shows signs of intense distress when mother leaves. Infant shows no sign of distress when mother leaves.
Stranger Anxiety Avoidant of stranger when alone but friendly when mother present. Infant avoids the stranger – shows fear of stranger. Infant is okay with the stranger and plays normally when stranger is present.
Reunion behavior Positive and happy when mother returns. Child approaches mother but resists contact, may even push her away. Infant shows little interest when mother returns.
Other Will use the mother as a safe base to explore their environment. Infant cries more and explores less than the other 2 types. Mother and stranger are able to comfort infant equally well.
% of infants 70 15 15

Why is attachment theory so important in some court proceedings?

There is clearly room for debate about how attachment should be measured and what implications this has for trying to support families in crisis.

However, attachment theory will remain significant in care proceedings because of the large degree of expert consensus about why it is important. This is primarily because good attachment allows us to develop a well functioning internal working model. This is:

a cognitive framework comprising mental representations for understanding the world, self and others.  A person’s interaction with others is guided by memories and expectations from their internal model which influence and help evaluate their contact with others (Bretherton, & Munholland, 1999).

Having a healthy ‘internal working model’ is thus important for three main reasons

  • Your sense of self
  • Your sense of others
  • Your relationships with yourself and others

Research shows that attachment problems can have a big impact on later life. Attachment difficulties account for a significant percentage of reasons why adoptions break down for e.g.

Children who are securely attached can develop increasing independence, exploring their environment with confidence that they can return to a carer who will respond to their needs. Therefore securely attached children will develop good self esteem and know that they are considered worth looking after.

However, children who don’t get the chance to form good attachments run the risk of developing poor internal working models which can have very negative impacts on their view of themselves and their ability to form relationships with other people. John Bowlby was worried that the long-term impacts included increased aggression and even ‘affectionless psychopathy’ where a person cannot show affection or concern for others.

Some concerns about attachment theory

The Sutton Trust have estimated that 40% of the general population do NOT have secure attachments (see ‘Baby bonds: parenting, attachment and a secure base for children’). This claim, and the evidence cited to support it,  has caused some disquiet amongst academics.

There are criticisms of Mary Ainsworth’s experiments, not least the fact that her work is based on the assumption that  brief separations and reunions have the same meaning for all children, which may not give proper consideration to cultures where it is accepted that children will experience everyday  maternal separation.  See further ‘Clinical Implications of Attachment Concepts: Retrospect and Prospect’ Michael Rutter 2005.

Nicola Horsley, the research fellow of the Brain Science and Early Intervention Project at Southampton University comments:

Bandying about this figure of forty percent of the population not being securely attached, with the original source so deeply buried, is disingenuous enough. The Brain Science and Early Intervention study, funded by the Faraday Institute and conducted by researchers at the Weeks Centre and the University of Southampton is particularly concerned with how claims like these are being beefed up by ‘evidence’ from neuroscience, as in the Baby Bonds report’s section on ‘neurological pathways’ to developing secure attachment.

You might expect a claim like ‘there is a burst of brain development when attachment bonds are made’ to cite a neuroscientist but the reference supporting this quote is the work of Sue Gerhardt, a psychotherapist who is one of the founders of the OXPIP parenting programme; and her book Why Love Matters: how affection builds a baby’s brain, is core reading for practitioners delivering the programme. The Baby Bonds report features only one neuroscientist in its bibliography and that is Jack Shonkoff, director of the Harvard Center on the Developing Child, which is a partner of the UK’s Early Intervention Foundation. Increasingly, third sector organisations like the Early Intervention Foundation and ‘strategic philanthropists’ like the Sutton Trust, and not rigorous up-to-date studies or neuroscientific thinking, are providing the ‘evidence’ on which policy is based.

In selecting the research that is presented to policy makers, reports like Baby Bonds have the power to privilege certain agendas. It is crucial that their key messages are not based on distortions or misrepresentations of social life. If family policy is to deny the fundamental opposition to attachment theory feminists have articulated for at least twenty years, it should at least be cognisant of critiques of the highly questionable measurements of attachment.

From the conflation of a dyadic relationship with an individual characteristic to the cherry-picking of psychological or biological terms depending on which makes the most compelling case, attempts to measure the quality of human relationships in this way are profoundly flawed.

Through the Brain Science and Early Intervention project, I have witnessed the effects of this discourse on practitioners who work with parents in need of support and these sloppy attributions of good and bad models of parenting have the potential to do real harm with their individualisation of risk factors for a panoply of social ills.

If the UK government is serious about investing in policy and practice that encourages children to flourish, its focus on deprivation should not be narrowed to the prefix of the maternal. When nurses tell us that they are under pressure for their delivery of a parenting programme to be seen to have a direct effect on future prison populations, it is clear that family life has become atomised beyond all recognition. We are left with a science of parenting where family support used to be and this can only serve to further isolate those who are consigned to the 40%.

GM v Carmarthenshire County Council & Anor [2018] EWFC 36 (06 June 2018) – now no longer good law!

This case makes for interesting reading regarding the judge’s comments about attachment. The case involved an 8 year old boy who had been in foster care for 2 years and his mother wanted to discharge the care order and have him return home. The court approved a report by an Independent Social Worker to report on the child’s attachment. The Judge made the following comments.

  1. A number of points may be made about this description of the theory. First, the theory, which I suppose is an aspect of psychology, is not stated in the report to be the subject of any specific recognised body of expertise governed by recognised standards and rules of conduct. Indeed, I asked the advocate for the guardian whether he was aware whether a student could undertake a degree in attachment theory, or otherwise study it at university or professionally. Mr Hussell was not able to answer my question. Therefore, it does not satisfy the first criterion for admissibility as expert evidence.

  2. Second, the theory is only a theory. It might be regarded as a statement of the obvious, namely that primate infants develop attachments to familiar caregivers as a result of evolutionary pressures, since attachment behaviour would facilitate the infant’s survival in the face of dangers such as predation or exposure to the elements. Certainly, this was the view of John Bowlby, the psychologist, psychiatrist, and psychoanalyst and originator of the theory in the 1960s. It might be thought to be obvious that the better the quality of the care given by the primary caregiver the better the chance of the recipient of that care forming stable relationships later in life. However, it must also be recognised that some people who have received highly abusive care in childhood have developed into completely well-adjusted adults. Further, the central premise of the theory – that quality attachments depend on quality care from a primary caregiver – begins to fall down when you consider that plenty of children are brought up collectively (whether in a boarding school, a kibbutz or a village in Africa) and yet develop into perfectly normal and well-adjusted adults.

  3. For my part I would say with all due respect that I do not need a social worker to give me evidence based on this theory to help me form a judgment about L’s attachments.

The lawyer and legal blogger suesspicious minds commented favourably on Mostyn J’s judgment

It seems that concern was growing about the possibly inapt use of attachment, particularly by those who see it synonymous with a ‘bond’. However, in 2021 in the case of TT (Children) [2021] EWCA Civ 742 (20 May 2021)the Court of Appeal issued a stern corrective to the judgment of Mostyn J, saying

It is one thing to find that a particular witness may not be qualified to give specific evidence about a child’s attachments, but it is another thing to question the validity of attachment theory as a whole or to state that it cannot be admissible in evidence. Nor is it correct to say that, if a child’s attachment to substitute carers is so strong as to lead a court to refuse an application to discharge a care order, that would deprive s. 39 of meaning. That approach risks looking at matters from the point of view of the parent at the expense of a rounded assessment of the welfare of the child. The decisions to which I have referred in the two preceding paragraphs make clear that the court has to give appropriate weight to all the relationships that are important to a child, and that there may be a role for expert advice about attachment in cases of difficulty. Insofar as the observations in GM v Carmarthenshire suggest otherwise, they cannot stand [para 49].

How can we deal with these concerns about attachment in practice?

David Shemmings, Professor of Child Protection Research at the University of Kent sets out seven principles for using attachment – based approaches in child protection work:

  • The main aim of using attachment-based principles is to help and support families stay together, whenever it is feasible to do so.
  • People can usually change and there is, as yet, no firm evidence that there are critical periods of a child’s development after which change is impossible, except in the most extreme forms of maltreatment – although the longer we leave things, the harder it is to overcome abuse and neglect.
  • It is preferable to think of disorganized attachment behaviour, not disorganized attachment per se. (These behaviours are temporary and fleeting, not an attachment ‘style’). The behaviours are not predictive of maltreatment: they indicate that additional questions need to be posed urgently, as the child may already have experienced ‘fear without solution’.
  • Practitioners need to make sure that they are not constrained by ‘confirmation bias’: forming a viewpoint too quickly and then only taking account of information, which confirms it – we need an ‘open mind, but not an empty head’.
  • Where there are concerns, they must be shared in the family (unless doing so might harm a child).
  • Practitioners must be ‘culturally competent’ when using attachment-based principles.
  • Approaches to help families are more likely to succeed if we demonstrate enhanced relationship skills, specifically ‘intelligent kindness’, ‘unsentimental compassion’ and ‘non-directive curiosity’.

Further reading.