1. Themed Breakout: Understanding the Emergent Learning in Attachment Early Years Collaborative Learning Session Two Day 2 Dr Helen Minnis Senior Lecturer in Child and Adolescent Psychiatry University of Glasgow Elizabeth N King Principal Psychologist South Lanarkshire Council

2. Definition of Attachment We are all born with attachment seeking behaviours such as crying, clinging, imitation and smiling. These behaviours are designed to keep carers close ensuring that the baby’s needs for survival, safety and sensitive care are met.

3. Definition of Attachment Attachment is a process. When a baby needs something – food, comfort, play – he feels stressed and signals his discomfort through, for example, crying, seeking to have his needs met. Parents/carers ‘tune in’ (attune) to their baby’s unique cries and signals for different needs. This ongoing attachment process, in the first few years of life, is crucial in shaping how we grow and develop through childhood and into adulthood – neurologically, physically, emotionally, socially and psychologically.

4. Attachment theory and Attachment Informed Practice promote Stretch Aims 2 and 3 To ensure that 85% of all children within each Community Planning Partnership have reached all of the expected developmental milestones at the time of the child’s 27-30 month child health review, by end-2016. To ensure that 90% of all children within each Community Planning Partnership have reached all of the expected developmental milestones at the time the child starts primary school, by end-2017. Linking to the Stretch Aim

5. Neuro-science revolution Most complex structure…on earth Human brain has …one hundred billion neurons, which are collectively over two million miles long. Each neuron has an average of ten thousand connections that directly link itself to other neurons. Thus there are thought to be about one million billion of these connections, making it “the most complex structure, natural or artificial, on earth” (Green et al, 1998).

6. Rapid Development in Early Years We can’t do what makes us human from within the womb – it has to be done in the context of attunement with special adults: Our brain doubles in weight in first 12 months 3 year old’s brain is 2.5 times more active than adults (Sunderland, 2007) 4 year old’s brain is 80% of adults’ size (Perry, 1997) Cortex develops almost entirely post-natally Brain continues to develop but never as rapidly or effortlessly.

7. Experience-Dependent Development Brain is being organised during early years Neurons that fire together, wire together Periods of growth are also periods of vulnerability Sequential development Hence early years’ experiences have life-long impact (Perry 2006, 2012)

8. What if early experience is harsh or neglectful? Childhood aggression is strongly associated with harsh parenting and the 10% of children with early onset persistent aggression, as adults, commit 50% of the crime Moffit and Caspi 2001 Children with conduct disorder cost society 10 times as much by adulthood Scott and Knapp 2001 Young offenders have 10 times the “all cause mortality” compared to general population Coffey et al 2003 The risk of psychosis in adult life is increased almost 3 fold for those who have been maltreated in early life Varese et al 2012

9. Our brain is a relational organ (Perry 1996)

10. Scottish Attachment in Action Scottish Attachment in Action (SAIA) is a multi- professional group constituted in August 2009. It is committed to promoting better experiences of attachment in the Scottish population and effecting positive changes in social policy, education and mental health. The group believes that altering the existing understanding of, and attitudes towards attachment, is essential for improving Scotland’s current record on poor health and socially destructive behaviours. http://www.saia.org.uk/

11. SAIA aims to:  promote positive experiences of attachment in Scotland.  advocate for attachment theory and practice to be a fundamental element of the education of all professionals.  develop training opportunities on attachment.  advance effective attachment-informed practice.  develop, promote and disseminate research into attachment. Scottish Attachment in Action

12. Attachment Matters For All An Attachment Mapping Exercise for Children's Services in Scotland, commissioned by the Scottish Government 2012 Recommendations and conclusions A greater focus on understanding attachment and supporting attachment informed practice can support the delivery of key Scottish central and local government policies (page 5) Developing an attachment informed approach for all professionals working with children, including those within the universal services, offers the best prospect for effective early intervention for children whatever their age and family situation (page 6).

13. Attachment Matters For All An Attachment Mapping Exercise for Children's Services in Scotland, commissioned by the Scottish Government 2012 Attachment theory should form a core underpinning framework for all work with children in universal services as well as specialist provision (page 54). Wherever possible birth parents should be supported in developing the capacity to become secure attachment figures for their children. This requires investment in attachment focused parenting programmes for the most vulnerable parents rather than an emphasis on behavioural methods (page 57).

14. What’s new? A total population of children aged 6 and 7 in 29 Glasgow primary schools were screened for attachment disorders. Very deprived part of the city Despite this, the great majority of children had normal mental health The prevalence of attachment disorder was 1.4% - much higher than previously realised Minnis et al 2013

15. 1.4% Of those children with Attachment disorder: ALL had at least one other diagnosis including ADHD (54%) PTSD (15%) What’s new? RAD prevalence study

16. What’s new? A randomised controlled trial of an attachment- informed infant mental health service is going on in Glasgow (Best Services Trial) A randomised controlled trial of the attachment- informed therapeutic intervention for maltreated children, Dyadic Developmental Psychotherapy, is at the planning stage in Glasgow and Lanarkshire Watch this space!

17. What’s new? Research in South Lanarkshire Council into the most effective methods of building capacity in the workforce with regard to attachment informed practice PDSA in one primary school nursery class - How Early Attachment Relationships support Transition (H.E.A.R.T.) Multi agency steering group overseeing H.E.A.R.T., looking at training and practice in attachment informed practice Benchmarking with the Jeely Piece Club in Glasgow For information: email enquiries@slcpsych.org.ukenquiries@slcpsych.org.uk

18. Measures What can we test? Information sharing regarding attachment difficulties, especially at point of transition Common language regarding attachment used in communicating the needs of children Impact of awareness-raising raining on Attachment Informed Practice Impact of attachment focused parenting programmes and therapies