1. Attachment Jo Lyons Rochdale Educational Psychology Service Jo.lyons@rochdale.gov.uk

2. Aims of session To develop an understanding of attachment, trauma and loss. To understand the importance of the quality of relationships in building secure attachments. To explore some useful approaches when working with children who have experienced trauma and who present with attachment difficulties.

3. Core concepts of attachment theory Babies are seen as having a biological drive to seek proximity to a protective adult. The goal of the drive is to feel safe, secure and protected. Secure Base – the significant attachment figure. ‘Containing quality’ of the Secure Base Empathic attunement. The baby learns about him/herself by being understood by another – the basis of empathy.

4. Attachment Attachment is biologically driven behaviour, which is triggered by external threats and dangers. Its primary function is to ensure that the child seeks protection at times of stress and danger. Babies are genetically predisposed to seek out attachment. Research shows that a child’s ability to form relationships and to learn is shaped by the child’s early experiences. [Bowlby – Attachment Theory] Attachments to caregivers lay the foundations for social and emotional well-being and the capacity to learn and develop. Abuse, neglect, loss and trauma have implications for the child’s internal working model [IWM]. Beliefs and expectations of self, others and the world. Research indicates the importance of the quality of attachment as a predictor of behaviour in pre-school.

5. Develops through childhood Babies – Proximity-promoting attachment behaviours attract attention positively [such as gurgling, smiling] or aversive attachment behaviours seeking soothing such as crying. Sensitive period. Early years Selective attachments. Object permanence - beginning to understand that people do not disappear when out of view. Develop idea of ‘holding in mind’. Primary years Secure/insecure internal working models outside the family into school. Attachment and exploration. Sensitive adults provide secure base in school and act as secondary attachment figures to help the child manage the challenges of school. Adolescence Separation from attachment figures towards independence. New attachments. Relationships. Adulthood Two-way relationships. Flexible.

6. Secure attachment cycle Baby experiences discomfort or needs Protests, crying, moaning, screaming Adult responds: talks, soothes, cuddles, eye contact, facial expressions Baby plays and interacts with carer. Baby calms and trust develops

7. Secure attachment cycle Cycle of arousal and relaxation. Adult’s capacity to think about the child’s behaviour and to be interested in the child’s feelings, to respond by meeting the child’s needs. This gives messages about the caregiver’s availability and their view of the adult as a safe attachment figure and a source of security is strengthened. So, the child: is not overwhelmed by anxiety or dangers; learns to self-manage a degree of anxiety. learns to trust and tolerate brief separation; learns to wait for needs to be satisfied. The secure base is strengthened. The child is free to explore the environment, interact confidently and learn.

8. Secure attachment has a positive impact on: Self-esteem, self-aware, self-knowledge Independence Resilience Ability to manage feelings/ impulses Increased quality and duration of learning Long-term friendships/ social skills / cooperation Academic success; problem solving; curiosity Empathy, compassion and conscience Positive and hopeful belief systems about self, family and society Secure attachments correlate strongly with higher academic attainment, better self-regulation and social competence

9. Insecure attachment cycle Baby experiences discomfort or need Baby protests usually by crying Carer does not respond to baby’s cry or responds inconsistently Baby protests louder Carer responds with anger or resentment or else does not respond Baby gives up, trust does not develop and rage instead develops Baby plays with self or becomes apathetic

10. Insecure attachments Feelings have often not been acknowledged or understood From infancy, overwhelmed by feelings that can’t be managed Feelings often mislabelled/distorted –what is the truth? Cannot appropriately express feelings – so excessively expressed or denied and repressed or dysregulated and chaotic or dissociated. Feelings expressed through their bodies in confused ways impact on functioning: Learning Health Emotional and social functioning and behaviour e.g. empathy, self-esteem, anxiety, anger

11. Still face experiment https://www.youtube.com/watch?v=apzXGEbZht0&feature=player_embedded

12. What are the risk factors for developing an insecure attachment? Who are the vulnerable children ?

13. Attachment types: Describe ways of relating to others. - Secure – ‘I’m ok, you’ re there for me and the world is ok’ - Insecure – 3 types: Insecure avoidant – ‘It’s not ok to be emotional’ Insecure ambivalent – ‘I want comfort but it doesn’t help me’ Insecure disorganised – ‘I’m frightened’ While ‘adaptive’ in neglectful, unsuitable and / or abusive environments, these styles can create significant difficulties for them, others and their development in supportive environments.

14. Insecure-avoidant Caregiver’s responses can be rejecting, indifferent, rigid, hostile. Avoidant children have experienced parenting that is: rejecting of their emotional demands; intrusive and insensitive to their needs: minimises / devalues feelings; gives the message — don’t make trouble. not supportive of exploration, co-operation, Child’s behaviour: Self-reliant Suppresses feelings Avoids intimacy Achievement-orientated Controlling

15. Insecure-ambivalent / anxious dependent Caregiver’s responses can be: Inconsistent, unpredictable. Children have experienced parenting that is: insensitive and only intermittently available Uncertain, unpredictable, angry sentimental but preoccupied with own emotional concerns not conducive to building self-esteem, cooperation. Child’s behaviour: Attention needy angry Demanding Negative thoughts Emotional reactions to incidents which prevent problem solving Negative perception of events

16. Insecure-disorganised and disorientated Caregiver’s responses can be: frightening; unpredictable. Disorganised children have experienced parenting that is: frightened or frightening; insensitive and unavailable; Helpless / hostile; intrusive; not supportive of exploration, effectiveness and co-operation; Negative about the child and self. Child’s behaviour: Hypervigilant Overwhelming level of fear and anxiety Controlling behaviour to cope with helplessness Extreme sensitivity to perceived criticism Lack of trust in authority / adults

17. Neuroscience. Attachment and stress Attachment serves to regulate emotion, calming anxiety and stress. Securely attached children have emotionally available and responsive carers who enable them to regulate stress. Responsive relationships and interactions build children’s brains and help them learn to self-regulate. When children do not have their attachment needs met they suffer unregulated stress and do not develop stress regulation. This overwhelming stress can lead to stress injuries. These injuries can lead to additional developmental impairment. The automatic response to trauma involves the production of toxic amounts of stress hormones which can lead to significant difficulties in brain function, body systems and social functioning. Connections in the brain are reduced and lost through ‘toxic’ stress.

18. Neuroscience. Impact on brain and development Brain development relies on “appropriate input and sensitive interaction with the primary caregivers at the sensitive period”. Recent research suggests that there are critical stages of development when lack of input will result in delay, or the absence of certain skills. Connections in the brain are thought to develop on a ‘use it or lose it’ principle. Traumatic event – prolonged exposure to stress hormones – altered neural systems.

19. Functional impairments Lasting effects of traumatic stress injuries: Brain development, functioning, processing Physiological / Regulatory [behaviour, hyperarousal] Physical Emotional [dissociation, shame] Social [understanding others, empathy, self-esteem, fun]

20. Developmental impairment Children may be stuck in age-inappropriate response patterns. The resulting behaviours do not represent regression but are indicators that development has been impeded or distorted.

21. How might a securely attached and an insecurely attached child experience life differently in our context? In what ways does our context provide a ‘safe haven’ for children? When might it not be a ‘safe haven’ for some children?

22. attachment and trauma developmental support 1.Safety first. 2.Engaging. 3.Trusting and feeling. 4.Self-management: regulating impulse and the body. 5.Managing feelings. 6.Taking responsibility. Rights. 7.Social awareness and self-control. 8.Reflectivity and self-esteem 9.Reciprocal relationships and enjoyment. Adapted from Cairns.

23. Safety ‘5 senses tour of the environment’. Safe spaces. Voice, gestures, expression. Step back - Safety first. Relationship may be threatening. Physical space. Safe place. What can you call this secure base? Task focus. Simple / mechanical activities. Aggression is the ‘fight or flight’ response to perceived danger or threat, but without the cause and effect thinking. The ‘Feel, Think, Act’ becomes ‘Feel --- Act’. The child is likely to already be experiencing high levels of arousal, and poor ability to self - regulate emotions. Physical activity to bring down arousal level.

24. Summary: role of Key Attachment figure Creating a secure base: The key person as an active presence. Helping the child to become dependent before becoming independent. Tune in (attunement) and be available. Develop capacity for enjoyment. Kept ‘in mind’. Initiate and supervise games, activities and conversations between the child and her peers.

25. The cycle of caregiving [adapted from Schofield, UEA] Child’s needs / behaviour Carer thinking and feeling Parenting behaviour Child thinking and feeling Effect on child’s development

26. Being available [adapted from Schofield] Child’s needs/ behaviour What does this child expect from adults? How can I show this child that I will not let him down? Alert to child’s needs/signals Verbal and non- verbal messages of availability I matter, I am safe Other people can be trusted Helping children to trust Carer thinking/ feeling Adult behaviour Child thinking/feeling

27. TRUST Child thinking: I am safe. I can explore and return. I can trust and rely on my carer. Other people can be trusted. I matter. Child behaviour: Uses adult as a secure base when anxious Can tolerate waiting. Trusts in the goodwill of others. Exploration, learning and activity.

28. Trust – what does the child need Adult thinking: What does the child expect from adults? Why? How can I show this child that I will not let him/her down? I need to keep the child in mind at all times, even when we are apart. I trust in my capacity to look after the child. Adult behaviour: Remains alert and available, physically, emotionally and mentally to child’s needs and signals. Signals availability to the child in age-appropriate verbal and non-verbal ways. Supports exploration.

29. Managing behaviour Child thinking: My feelings and behaviour (past and present) make sense. I am understood. I can manage my feelings. Other people have thoughts and feelings that need to be taking into account Child behaviour: Reflects on feelings of self and others. Empathic. Can pause for thought before acting. Expresses / regulates feelings. Has a coherent life narrative.

30. Managing behaviour needs Adult thinking: What might this child be thinking/feeling? Why? In the shoes of the child. Past / present. What are my feelings? Adult behaviour: Tunes in to the child. Helps child to understand. Helps child to express and manage feelings appropriately. Provides scaffolding and helps child make sense of experience, past and present.

31. Self-esteem Child thinking: I am accepted and values for who I am. All people have some good and bad parts. Repair and forgiveness is possible. Child behaviour: Approaches and enjoys activities with confidence. Relationships with confidence. Enjoys success. Copes with failure. Shows realistic but positive appraisal of self.

32. Accepting the child and building self-esteem Adult thinking: I value and accept myself – strengths and difficulties. I value and accept the whole child – strengths and difficulties, similarities and differences to me. I trust in the child’s potential for good. Adult behaviour: Helps the child to fulfil potential and feel good about himself. Promotes positives and enables child to be and feel successful. Tackles difficulties and enables child to repair damage. Promotes child’s acceptance by others.

33. What difficulties might someone experience when trying to build a relationship with a child with attachment issues?

34. Supporting ourselves Managing our anger. Anger is dangerous. It may keep the child feeling safe, and powerful, as it keeps people at a distance. Use internal / external supports — family members, friends, support Recognise your own personal triggers. This relationship will be activating your own attachment system. Is this how the child feels most of the time? How can I manage these uncomfortable feelings in myself? It is hard not to take a child’s behaviour personally — it is directed at you, even though the roots of it are elsewhere. But there is an attachment building. Being self-aware may help you to feel differently — more in control and less vulnerable. Problem-solving groups

35. Relational framework and key adults Nurturing empathic relationships. Significant adults in a child’s life can provide important attachments. Need to experience empathy in order to show it to others. Need to be able to depend on someone else before can be independent. Being available – helping children to trust. Relationships help buffer children Emotional resilience links with the ability to learn. Use of commentaries/ wondering aloud require adult attention. Relaxation. Adults set the emotional tone. Encourage and enable the child to see significant adults as a source of help. Support for adults working with these children. Feeling safe and secure physically and emotionally. Helping children to feel effective and be co-operative.

36. PLACE Playful. Positive experiences allow child develop self-worth. Relaxation. Liking, even when they misbehave. Overcome rejection. Accepting, even when we don’t accept their behaviour. Regulated. Curiosity. Wondering aloud about behaviour. Stop, think, make sense. Empathy. Before discipline. Behaviour as communication? Dan Hughes

37. Managing feelings Learning mediated by language. Stories / narrative. Role play. Regulate arousal levels through attunement. Tune in – reading signals, containing anxiety. Naming thoughts and feelings. Use ‘commentary’. Building self esteem. Restrict choice-making to least stressful situations. Encourage recognition of learning from mistakes. We take responsibility to repair relationships.

38. Shame “ I’m worthless. I’m powerless. I’m bad” Low self-esteem. Repair and rebuild [need to feel healthy guilt]. Impact on behaviour and accepting responsibility Learning boundaries Developmentally ‘stuck’ overwhelmed in competitive settings find making choices difficult experience global instead of specific shame avoid shame through, e.g. blaming, lying or denying

39. Lying Cause and effect thinking, and the development of a conscience are delayed. ‘primary process lying’. It is usually seen in very young children, as they begin to tell ‘stories’. Older children would usually use lying to protect themselves rather than to cause themselves trouble. A child with insecure attachments has a strong sense of shame.

40. Fear / Control. Securely attached children’s fear of parental consequences keeps them safely on the right track until they develop a conscience over time. They learn that parental control = safety and comfort. Children with insecure attachments are different. They are scared of losing control. They are scared of being controlled by others. They believe that: Co-operation = Losing. Control = Winning = Survival.

41. focus on play Developing a sense of self and others different roles within the interaction Safe context Self-esteem self-efficacy / control shared meanings Sense of being valued Fun is important

42. Food issues Basic survival need Poor recognition of the cycle of hunger pains – feeding – satisfaction Over-fed /under-fed / poor food choices unhealthy established patterns of feeding Immediate gratification / self-satisfaction misinterpretation

43. Transitions What happens if we don’t pay attention to transitions? Anxieties increase. Why? They feel: Out of control. Uncertain. Overwhelmed with issues of loss. Paying attention to change helps: Sense of predictability / control / safety Focus Trust others ‘Contain’ anxieties Allowing time for processing and reflection.

44. Support the transitions Home to school — beginnings, meet and greet, [use a transitional object from home to ease the transition?] Daily movement in settings. How much? If change imminent, we need to give the child as much information as possible to prepare them. Visuals – e.g. Waiting — set up the use of memory cards or other visual reminders of what is yet to come. Staff - particular children with familiar adults, as anxiety will increase a lot more for them than the majority of their peers. prepare the child for major changes in whatever ways you can. Practise routines. responding sensitively around endings / goodbyes. Verbalise what is going on if you experience rejection behavior when an end or goodbye is approaching. Provide commentary. Your feelings and the child’s feelings.

45. Working with children with multiple difficulties Autism Interpreting others’ communications / emotions difficult to interpret their signals Vulnerable due to high parenting demands ADHD Poor attention / impulse control Cause and effect? Early experiences Demanding of adult time

46. Resilience Young child: Responsive to people and objects Cheerful Easily soothed Pre-school: self-confident self-help involved in play seek appropriate help realistic risks relate well to adults and peers

47. Resilience Long-term: self-esteem, fun, humour, receiving stability and continuity in care; Positive community influences, School aspects (especially adult expectations, peer influences and the level of support available) Language learning; Interest from other significant adults about education; attendance.

48. General approaches Importance of consistency Thinking carefully and planning for any transitions- to avoid feelings of rejection and increase consistency Explain any changes to routine Support to develop self-esteem (may need to be written) Social skills input and Differentiate tasks. Awareness of any specific triggers for anxiety Getting key information from home / care context. Let them know that relationships are still intact after incidents Encourage dependence. Expectations need to match the child’s emotional age, not necessarily the chronological age. Strategies to let child know they are being kept in mind after they have moved on.

49. Providing emotional support provide security - physical / verbal / feelings. Set the emotional tone. Provide relationship repair following problems. Give experiences of feeling safe and lovable. Calm area for rest and relaxation. Support and build relationships. Emotional age.

50. Providing behavioural support Avoid confrontation. Reflect on the possible underlying causes. Be clear, supportive and empathic. Use ‘time in’ rather than ‘time out’. Ignore, redirect and distract. Wonder aloud.

51. Providing learning support Predictable and consistent routines. Prepare child for any change in routine. Provide boundaries to help a child feel safe. Be flexible and adapt to the child’s needs. Give the child short periods to practise independence. Give consistent, clear and simple instructions. Use a visual timetable to reinforce instructions. Look for opportunities to build self-esteem. Celebrate success and good choices.

52. Thinking for your context Think of your group of children. How might an understanding of attachment affect how you support them to develop more effectively? What does a basic understanding of attachment tell you about your setting’s approach to interpreting children's behaviour? Why might some behaviour management systems not work for children with unmet attachment needs or trauma? What changes would you need to make to policies within your setting for ‘behaviour management’ for children and young people who present with insecure attachment behaviours?

53. Next steps. What will be important for you? Awareness for staff. Confidentiality? Safety tours and contingency planning. Transitions. Pupils causing concern. Consider attachment difficulties Involve other professionals Behaviour systems to emotional support. Summary: Children are significantly harmed by abuse, neglect, separation and loss. Many children will suffer to some extent and this can be persistent. Having an understanding of attachment can help us think about what is going on for these children and how we can help them.