The origins of attachment theory

Bowlby (1978) was the first theorist to identify the significance of the child’s relationship with their primary caregiver for healthy overall development. While he emphasised the importance of a mother figure, later research and practice has led practitioners to consider attachments to all significant primary carers. Observations of young children’s behaviours under stress revealed several different patterns of response. These have influenced the way practitioners have framed their understanding of attachment dynamics.

Patterns or styles of attachment

Drawing upon Bowlby’s concept, attachment theory evolved. Ainsworth and colleagues (1978) developed The Strange Situation Procedure approach to assessment. This focussed on the influence of a caregiver’s emotional availability and involved observing infants when briefly separated from their main caregiver. The test has been criticised for cultural bias and for artificiality. Taken in isolation, observations from the test could distort appreciation of attachment. Additionally, not all who use the procedure have been trained in its use.

However, patterns of response to important adults can help practitioners tune into the child’s emotional predicament. If a child seems routinely unable to approach their caregiver at times of stress, this may indicate the need for a focus on helping the adult to reassure and soothe the child.

A pattern which successfully sustains emotional availability from an attachment figure is sometimes termed an ‘organised response’. These learned ‘survival strategies’ can become like a script, to be retained and transferred into other relationships. It may take an alternative experience of closeness to reshape the persistence of this ‘internal working model’.

By contrast, a child who is unable to find a strategy which achieves safety and soothing may develop ‘disorganised’ behaviours which may be experienced as confused or confusing.

A journey into fostering or adoption

In this interview Kenny Toshack explains how taking adults on a journey into fostering or adoption and encouraging them to understand themselves first, then how to it is their job to make appropriate matches between the adults and the young people.

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Insecure avoidant responses

Consistent rejection or ignoring of a child’s distress and reaching out for comfort may shape insecure avoidant attachment responses. This survival strategy is characterised by suppression of need for fear of loss of relationship (Ainsworth and colleagues,1978**)**. The cost to the child is the suppression of distress. Opportunity for shared emotion is denied. Potential for learning the language of feelings is restricted.

Avoidant behaviours can be seen in children of all ages and can be functional. However, they can be associated with problems in school and community if behaviours are extreme and if the child’s ability to cooperate is compromised. Schofield and Beek (2006) caution that children who have learned an avoidant style may give the impression of being resilient and healthily independent when in fact they have learned to hide their emotional needs.

Careful observation can guide purposeful, supportive work with parents or other primary caregivers. However, the more extreme their learned strategy is, the more the child’s overall healthy development may be compromised.

Insecure ambivalent attachment

Other children experience emotionally unpredictable carers who are sometimes available and responsive and at other times unaware or unresponsive. Repeated experiences of variable sensitivity may lead the child to be highly vigilant about shifting availability. This can lead to high levels of expressed emotion in an attempt to bring the adult close.

The cost for the child is that their preoccupation with the adult’s availability often leads the child to inhibit their exploration, play and learning. These children are often experienced by their parents or carers as highly demanding. They are not easily soothed. Continuation of the relationship may be threatened. In school, preoccupation with adult responsiveness and availability may lead to angry, demanding behaviour. They may be experienced or labelled as disruptive.

Anxious insecure attachment

In research about young people in foster care, Downes (1992) discovered a pattern characterised by intense need for closeness at a stage when they might be expected to seek independence. This dominant preoccupation with the availability of significant adults can have destructive or restrictive impact upon learning and relationships.

Schofield and Beek (2006) remind us that practitioners may see clinging behaviours in children of all ages. These could be mistakenly described as ‘strong’ attachment. When in their inner world, the child is not feeling safe to explore. Understanding a pattern from the child’s perspective may provide a window to support strategies that may encourage reliability and growth of trust.

Disorganised attachment

In contrast to children with ambivalent and avoidant styles of response, those showing disorganised behaviours struggle to find a strategy which secures reliable nurturing (Main and Solomon, 1986). Such children may have been parented by a caregiver who is unable to be reliably responsive, is frightened and/or experienced as frightening.

Resultant high anxiety in the child may cause acute concern for parents and professionals.

A confusing combination of seemingly contradictory behaviours may unfold, sometimes controlling or excessively compliant and sometimes ‘parentified’, attempting to offer care to the adult.

Contradictory behaviours and ‘freezing’ may be of great concern to practitioners. These features are indicative of emotional experience and need. However, practitioners are cautioned not to assume maltreatment. There are other pathways to disorganised attachment, such as a parent’s unresolved trauma or loss.

Such experiences may lead a parent to display subtly frightening, frightened, or dissociative behaviours toward their infant. (Granqvist and colleagues, 2017, p536)

Attachment difficulties may derive from an interaction of factors. These include the child’s genetic or temperamental susceptibility; contextual influences in the ecology and history of their relationships and development.

Observations of disorganised behaviours in the child tend to be specific to a particular relationship. It should not be assumed that they are indicative of a trait in the child.

Even though the caregiver may not be doing anything abusive to the infant, a caregiver who is himself or herself in some way alarming to the child can create a paradoxical predicament for a child because the parent who is the source of safety is then also the source of alarm, increasing the chances of disorganised attachment being displayed by the infant. (Granqvist and colleagues, 2017, p541)

It is therefore imperative that thought is given to each parent’s own attachment history and the possibility that intensive parenting support, alongside the opportunity for guided reflection, could enhance the child’s security.

These authors add ‘It is important to recognise that ‘blaming’ these caregivers for their behaviour, or engaging in punitive responses to them, is therefore mistaken and likely counterproductive - understanding the development of attachments changes the clinical imperative from retribution for errors to efforts in assisting parents to adopt caregiving behaviours that promote feelings of safety and security in the child_._(p541_)._

While agreeing that stable foster or adoptive care may be justified in particular circumstances, they add that children should only be removed from parental care if

there is both compelling evidence of maltreatment and

fully adequate provision of supportive services has been exhausted or can be judged with confidence to be futile. (p549)

Such work requires the closest possible inter-agency collaboration within a relationship-based approach if expectations of change are to be both fair and realisable within the child’s timescale. This will include collaboration between practitioners in health and education, and social work and clinical expertise may be needed.

Multi-disciplinary assessment and a whole family approach are recommended for those children for whom high anxiety and persistent attachment difficulties are apparent.

This should integrate observation of the child in a variety of settings as possible; and with each primary caregiver in order to inform shared understanding about how to support, and perhaps challenge, patterns of relationship.

Exploring risk and relationships

Here Corry McDonald explains how her service explores areas of risk and relationships with parents.

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Implications for focused work with parents

Helpful interventions (Granqvist and colleagues, 2017) include helping the caregiver to:

• Follow the child’s need
• Avoid alarming behaviour
• Provide nurturance
• Make sense of traumatic experiences
• Break social isolation
• Learn strategies to remain with the child in the moment, rather than become lost in painful, traumatic memories

The Contact Action Plan

Corry McDonald talks about a tool called the Contact Action Plan that explores with parents what the needs of the child are and what they can do to fulfil those needs.

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In summary, practitioners should be careful about attributing single causes to attachment difficulties. Contextual and intersecting influences may include the impact upon a caregiver of poverty, abuse, loss and trauma, affecting the regulation of their own emotions, and impacting on the experience of a dependent child. Sensitive intervention should avoid attribution of blame.

• Howe (2005) applies attachment theory to practice examples through different stages of childhood development.
• Geddes (2006) and Bomber and Hughes (2011) have developed resources which can be used in school to both understand the underlying reasons for the child’s behaviour and provide constructive techniques for engaging them in learning.
• Scottish Attachment in Action is a multi-disciplinary professional group committed to promoting better experience of attachment in the Scottish population, working for positive changes in social policy, education and mental health. The group organises seminars and conferences for professionals from all disciplines in Scotland.
• Bath Spa University) has developed an online resource which provides insight from research and practice in relation to support of children with varied attachment styles.

Attachment and neurobiological development

Healthy neurological development has been closely associated with the child’s relationships with key attachment figures (Perry, 2008; Siegel, 1999; Gerhardt, 2004). Schore and Schore (2008) describe the way in which the child’s experience of the relationship with a responsive caregiver not only provides them with the basis for both emotional regulation but also influences physical development of the brain. The experience of emotional attunement in the adult’s responses and initiatives increases growth in the brain’s limbic system, promoting healthy socio-emotional development. Through repeated attuned interactions, a very young child learns to understand his/her own emotions and gradually the feelings of others.

However, children who experience maltreatment are left to regulate their own emotions and impulses. Hughes (2009) emphasises that the experience of abuse and/or neglect negatively affects brain development, reducing their ability to regulate their emotions and sustain trusting relationships.

As Gerhardt (2004) observes:

the quality of the relationship between parent and child influences both the biochemistry and structure of the brain. The most frequent behaviours of the parental figures, both mother and father, will be etched in the baby’s neural pathways as guides to relating. (p211)

She emphasises the importance of repeated, attuned initiatives and responses from the adult for the child’s capacity to cope with fear and arousal. These experiences of attunement are vital for their later capacity to regulate strong impulses and feeling states.

The child’s experiences in the first year of life are a guide to the nature of support needed to reduce the child’s anxiety, through work with caregivers. The goal is to promote security and predictability of emotional containment and reassurance.

Reparative care offers the child a relationship with at least one adult who is attuned to their underlying feelings as they emerge in behaviour. It includes the experience of emotional containment helping the child, through empathic connection, to begin to express and name their feelings. It may be needed if the child is to learn to trust adults to offer soothing responses and initiatives, reversing the child’s view of adults as unreliable or even unsafe, and the self as unlovable.

Adult attachment issues

Consideration of each parent’s or main carer’s own early attachment history for later parenting is an important aspect of effective family assessments. Practice frameworks developed from attachment theory can be helpful in making sense of the implications of the parents’ account of their early attachments for their ability to prioritise their children’s needs (Reder and Lucey, 2003; Baim and Morrison, 2011; Fowler, 2002).

Adult attachment research indicates that even if parents have experienced significant maltreatment in childhood, they may reach a point of ‘mature reflection,’ or benefit from later nurturing relationships, which prevents a re-enactment of their own traumatic experiences when they become parents. They may be newly able to construct a ‘coherent narrative’ of their own history, demonstrating a balance between emotion and thought when reflecting on the past, which is indicative of ‘earned security’ with respect to their current attachment status.

A supportive and empathetic environment

Kenny Toshack explains how he feels that it is often those adults who have experienced trauma in their past, and recovered from it, that can provide a supportive and empathetic environment for the young people they care for.

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As a result, many parents who have experienced highly chaotic and/or abusive care may nevertheless be able to offer high quality care to their children.

The more traumatic the adult’s history and the less opportunity they have had so far for reflection, the higher the likelihood that unprocessed, distressing memories may interfere with their parenting. The resonance and impact of loss and/or trauma may impact on parental stability and emotional security. Assessment should consider the parent’s potential to reflect, process such memories, and influence and stabilise coherence within a timescale which considers the child’s needs. Again, assessment should consider the whole situation and the relevance of interacting strengths and concerns.

Baim and Morrison (2011) have developed a framework, drawn from the work of Crittenden (2008), which helps practitioners to apply learning from adult attachment research to support the wellbeing of children within their families. For example, these authors suggest that parents are asked to choose five adjectives which summarise their view of each attachment figure, offering specific memories which illustrate each adjective. The nature of the account of past experiences, as well as the way it is offered, can offer clues about the way in which the memories have been processed. Some adults may recall precise factual details while omitting emotion. Others may appear preoccupied with their own feelings and seem to resist reflection.

Parents may offer confused narratives, descriptions of trauma while denying any impact or fixations with certain memories which dominate their current experience. For some, a process of guided reflection may be helpful. Practitioners require appropriate training, experience and supervision in such work.

Parents reflections on their own experiences

Corry McDonald explains how their service works with parents to reflect on their own experiences from their childhood.

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Sibling attachments

The significance of sibling attachment relationships and connections in care planning following removal from home was underlined by Kosonen (1996) and this has been brought sharply back in focus by the Independent Care Review in Scotland (2020). Brothers and sisters have often been separated because of the chance availability of temporary foster placements. Short-term decisions often lead to long-term separations between siblings.

Placement and contact arrangements for looked after siblings are still frequently given low priority when brothers and sisters were removed from home. Recommendations from recent Scottish research by Jones and Henderson (2017) include:

• The need for specific recruitment of foster carers capable of caring for sibling groups, suitably trained and supported to contribute to assessments and work to enhance existing relationships.
• Targeted recruitment of adopters specifically capable of caring for sibling groups.
• Clear practice and recording of childrens’ views.
• A review of legislative guidance to ensure that it ‘fully reflects the needs of looked after children with regards to assessment, placement, contact arrangements and the promotion of wellbeing.’ (p3)

Local authorities are expected to work to avoid separation of brothers and sisters, unless skilled, well-evidenced assessments indicate that shared placement is not in their best interests. The Children (Scotland) Bill, which currently is before Parliament, lays out legislation and the Independent Care Review (2020) states: ‘Where living with their family is not possible, children must stay with their brothers and sisters where safe to do so and belong to a loving home, staying there for as long as is needed.’ (p16).

When separation of brothers and sisters for permanent care away from home is being considered, a discrete assessment should be undertaken since this is such a serious decision with lifelong implications. Exploring salient factors in placement and contact decisions, Beckett (2018) provides a framework for such assessments, commonly known as a ’together or apart’ assessment. This framework is used widely by practitioners in Scotland.

The Scottish pressure group Stand Up For Siblings follows the work of Jones and Henderson (2017). This group campaigns for enhanced attention to these relationships at all stages of care planning, direct consultation with the children and young people themselves being seen as a key feature of best practice.

Practice points

• Sibling relationships should be assessed at the earliest possible stage following removal from home.
• Shared placements should be sought wherever possible and attempts made to reunite temporarily separated brothers and sisters when a shared placement becomes available.
• Siblings should be seen together in as many different circumstances as possible, outwith parental contact arrangements, when assessing their attachments to one another.
• If the siblings are already placed separately, observation of interaction in one another’s care placement may be especially helpful.
• A discrete sibling assessment should be completed prior to permanent placement being considered in order to inform both placement choice and purposeful contact arrangements, should joint placement not be recommended, after full and careful assessment.