Assessing Attachment In Young Children

Recently I’ve been posting about attachment after the National Institute for Health and Care Excellence (NICE) argued more should be done by health and social care providers to train key workers in assessing attachment difficulties and parenting quality. Firstly I outlined the origins of attachment theory and then went on to detail some of the current debates.

Over the years I have read many assessments of children and their families in which workers have assessed attachment as being ‘good’ as the child had been seen “happy and smiling”. In the serious case review of Peter Connelly it is noted that the social worker reported “he had a good attachment to his mother, smiles and is happy”. Two months later a second social worker reported “a good relationship between the child and his mother” despite him head-butting the floor and his mother several times. These behaviours in and of themselves are not indications of attachment. In instances of abuse, smiling may be a learned defence mechanism which they have developed to put their carer at ease thereby making them safer. It is, therefore, important that Social Workers develop skills to correctly assess attachment and its impact upon a child’s internal working model.

I have already touched upon Mary Ainsworth’s Strange Situation in my previous posts but will go into a little more detail here. NICE recommended in their draft guidance that practitioners should consider the use of the ‘Strange Situation Procedure’ for children aged 1-2 years, and a modified version for 2-4 year-olds. The procedure is used in a controlled setting and practitioners observe the child’s response to two brief separations from, and reunion with, the parent. The child’s responses are then categorised as fitting one of three patterns of behavioural organisation: 

1. Secure – The child shows signs of missing the parent upon separation, greets the parent actively upon reunification, then settles and returns to play.
   
2. Insecure-avoidant – The child shows little or no distress at separation from the parent, and actively avoids and ignores the parent upon reunification
   
3. Insecure-ambivalent/resistant – The child is highly distressed by separation and seeks or signals for contact on reunification, but cannot be settled by the parent and may show signs of strong resistance.  
   

Take a look at the following YouTube video by The New York Attachment Consortium to see how these behaviours manifest in practice.

Children’s’ responses in this situation are considered to reflect the history of interactions the child has experienced in the home. However, research has found that on occasion and child’s Strange-situation behaviour does not fit well into the criteria of any of the given classifications as described by Ainsworth. It is therefore, important that practitioners do not ‘force’ a child into the ‘best fitting’ attachment classification. It may, in fact, be that a number of different, coherent and distinct responses are possible.

Disorganised or disorientated behaviour is one further classification that has been identified and is seen by Social Workers in cases of abuse. These behaviours can be identified when a child finds themselves in anxiety-provoking situations into which an abusive caregiver enters. As the child does not know what to do they experience “fear without solution” and practitioners will observe simultaneous displays of contradictory behaviour patterns.   

NB. when using the Strange Situation procedure it is important Social Workers are mindful of the fact that behaviour could be a function or neurological or other difficulties experienced by the infant as an individual, having little to do with relational issues between parent and child.  

Recent research has moved away from observations of behavioural interactions between infants and parents, like the Strange Situation, and Social Workers should also be concerned with how attachment experiences become organised in memory into “models” of relationship expectations. This shift reflects a recognition of the important role that internal working models play throughout life. They form the “schemas” that predispose a child to perceive social relationships in terms of past experiences. Any assessment should also, therefore, be interested in understanding how children form and organise internal working models of attachment experiences. 

Social Workers have for many years relied on play as the primary medium of communication as it provides a compensating medium for limitations in children’s verbal abilities. Additionally, the expression of emotionally charged adverse experiences often makes direct verbal communication more difficult for children, and Social Workers are sensitive to this.

Using dolls, the Story Stem Assessment Profile asks children to respond to a set of narrative story stems where they are given the beginning of a ‘story’ highlighting everyday scenarios with an inherent dilemma.  Children are then asked to ‘show and tell” me what happens next?’  This allows some assessment of the child’s expectations and perceptions of family roles, attachments and relationships, without asking the child direct questions about their family which might cause them conflict or anxiety. 

If you are going to employ this technique I would recommend that you use dolls that are ‘neutral’ like these from Melissa and Doug. Using figures from known television programmes could encourage the child to script the story in a way that is congruent with the toys ‘character’ rather than their own internal working model. Clinical training in this technique is available through the Anna Freud Centre in London.

I hope you have found my posts helpful and interesting. They contain just a fraction of the information provided through professional training and I would recommend practitioners incorporate this into their continuing professional development plan. I will add a further post soon about assessing attachment in older children. Please follow me on facebook or twitter to catch it.  

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