John Bowlby: Attachment theory
The British psychologist John Bowlby is fairly synonymous with attachment theory. From his clinical work with ‘juvenile delinquents’ over the course of World War II be began formulating ideas about the role of early and prolonged separation from parents and caregivers in the development of problems in those children’s social and emotional development.
The core of his theory is that attachment is an evolutionary adaptation which is characterised by a child seeking proximity to caregiver when that child perceives a threat or suffers discomfort. Given the intense needs of human infants, it is perhaps unsurprising that the formation of a “deep and enduring emotional bond that connects one person to another across time and space” evolved to improve the chances of an infant’s survival.
Over the first year of life, an infant begins to develop attachments with parents or carers. As these attachments form we tend to see characteristic behaviour in infant interactions with their attachment figure:
- Stranger Anxiety – the infant responds with fear or distress to arrival of a stranger.
- Separation Anxiety – when separated from parent or carer the infant shows distress and upon that attachment figure’s return a degree of proximity seeking for comfort.
- Social Referencing – the infant looks at the parent or carer to see how they respond to something novel in the environment. The infant looks at the facial expressions of the parent or carer (e.g. smiling or fearful) which influences how they behave in an uncertain situation.
Attachment figures aren’t simply individuals who spend a lot of time with the infant, or the one who feeds them, but typically the individuals who responds the most sensitively, for example often playing and communicating with the infant. For many infants the principal attachment figure is their mother, but fathers, grandparents or siblings may also fulfil this role. By about 18 months, most infants enjoy multiple attachments though these may be somewhat hierarchical with a primary attachment figure of particular importance. The behaviour relating to attachment develops over early childhood, for example babies tend to cry because of fear or pain, whereas by about two-years-old they may cry to beckon their caregiver (and cry louder or shout if that doesn’t work!).
Bowlby believed these early experiences of attachment formed an internal ‘working model’ which the child used to form relationships with secondary attachment figures, later friendships with peers and eventually romantic and parenting relationships in adult life.
Mary Ainsworth: Types of attachment
There are individual differences in the behaviour related to attachment. Famous observation studies by Mary Ainsworth (who worked with John Bowlby during the 1950s) identified that in normal children there were a range of attachment types:
Secure attachment: The majority of infants, across different cultures, tend to have an attachment style typified by strong stranger and separation anxiety along with enthusiastic proximity seeking with the parent upon reunion.
Insecure –avoidant: Slightly more common in western cultures, an insecure-avoidant attachment tends to be characterised by avoiding or ignoring the caregiver and showing little emotion (whilst experiencing inward anxiety) when the caregiver leaves the room, and displaying little enthusiasm when the caregiver returns.
Insecure-resistant: Perhaps more common in ‘collectivist cultures’, an insecure-resistant (sometimes also called insecure-ambivalent) attachment tends to be characterised as showing intense distress during separation, and being difficult to comfort when the caregiver returns. Infants with this attachment type may also show some rejection or resentment towards the caregiver after a separation.
Disorganised attachment: Added in the 1990s, infants with a disorganised attachment tend to show no consistent pattern in behaviour towards their caregiver. For example, they may show intense proximity seeking behaviour one moment, then avoid or ignore the caregiver the next.
If you you’re interested in some of the history and the origins of attachment theory, the work of John Bowlby and Mary Ainsworth are good places to start. There’s a nice summary here – Bretherton, I. (1992). The origins of attachment theory: John Bowlby and Mary Ainsworth. Developmental psychology, 28(5), 759.
Many children may display behaviour suggesting an ‘insecure’ attachment type which may make it a harder to form peer friendships, and this likely underlies an association between insecure and disorganised attachment and higher levels of behaviour problems. However, it’s not certain that differences in attachment are specifically the cause of behaviour problems. For example, a meta-analysis by Fearnon, et al (2010) found that socio-economic status accounted for a considerable portion of the variance in behaviour problems in childhood.
Fearon, R. P., Bakermans‐Kranenburg, M. J., Van IJzendoorn, M. H., Lapsley, A. M., & Roisman, G. I. (2010). The significance of insecure attachment and disorganization in the development of children’s externalizing behavior: a meta‐analytic study. Child development, 81(2), 435-456.
So, whilst there’s reasonable evidence to suggest that these individual differences in attachment correlate to differences in behaviour within school, it is very important to note that these differences are not ‘pathological’ in a clinical sense. Given that about 30-35% of representative populations have an ‘insecure’ attachment, NICE suggests that it is unhelpful to view insecure attachment as an ‘attachment problem’.
Reactive Attachment Disorder
A popular misconception about attachment is a conflation between the ‘types of attachment’ that children possess and an ‘attachment disorder’. CoramBAAF, a leading charity working within adoption and fostering, suggests that even when used by those trained to do so, attachment classifications cannot be equated with a clinical diagnosis of disorder. While the insecure patterns may indicate a risk factor in a child’s development, they do not by themselves identify disorders. The term ‘attachment disorder’ refers to a highly atypical set of behaviours indicative of children who experience extreme difficulty in forming close attachments. NICE suggests that the prevalence of attachment disorders in the general population is not well established, but is likely to be low. However there are substantially higher rates among young children raised in institutional care or who have been exposed to abuse or neglect. The Office for National Statistics (2002) report for the Department of Health estimated that somewhere between 2.5% to 20% of looked after children had an attachment disorder (depending on whether a broad or narrow definition was used).
There is a broad distinction between two classifications of RAD:
Inhibited attachment disorders: Characterised by significant difficulties with social interactions such as extremely detached or withdrawn – usually attributed to early and severe abuse from ‘attachment figures’ such as parents.
Disinhibited attachment disorders: Characterised by diffuse attachments, as shown by indiscriminate familiarity and affection without the usual selectivity in choice of attachment figures – often attributed to frequent changes of caregiver in the early years.
Reactive Attachment Disorder is a psychiatric condition and often accompanied by other psychiatric disorders. CoramBAAF argues that the lack of clarity about the use of attachment concepts in describing children’s relationship difficulties can create confusion and advises extreme caution. A diagnosis of an attachment disorder can only be undertaken by a psychiatrist.
Unfortunately, there are also no widely applicable, evidence-based set of therapies for RAD. However, there has been significant concern expressed about some therapies. One example is “Holding therapy” involving holding a child in a position which prevents escape whilst engaging in an intense physical and emotional confrontation. CoramBAAF argues there is nothing in attachment theory to suggest that holding therapy is either justifiable or effective for the treatment of attachment disorders. Less controversial therapies involve counselling to address the issues that are affecting the carer’s relationship with the child and teaching parenting skills to help develop attachment.
What should teachers be doing?
This is why I don’t really understand all the apparent excitement about attachment theory at the moment: there’s nothing a teacher should be doing that they shouldn’t already be doing.
Firstly, given the relationship between attachment disorders and abusive or neglectful relationships, perhaps some teachers are worried that they need to know about attachment disorder in order to fulfil their statutory safeguarding responsibilities. However, it’s important to note that whilst some children with RAD have suffered abuse or neglect, that doesn’t mean that problematic behaviour is evidence of such. The teacher isn’t in a position to make either the clinical judgement or investigate the cause of problematic behaviour they suspect may relate to a safeguarding concern. If a student is behaving in a way which concerns you, then report that concerns to your designated member of SLT (as you would any safeguarding concern). Whether or not you might think a child has an insecure attachment or a disordered attachment isn’t really your professional call.
Secondly, it may be that some teachers feel they need to know more about attachment in order to support students with behaviour problems in school. However, the advice for working with RAD students isn’t really any different to good behaviour management generally. Teachers should not confuse their role in loco parentis with being the primary caregiver for a child. For example, the Center for Family Development is an attachment centre based in New York specializing in the treatment of adopted and foster families with trauma and attachment disorder. In their ‘Overview of Reactive Attachment Disorder for Teachers’ they point out that, as a teacher, you are not the primary caregiver for a child you teach.
“You cannot parent this child. You are the child’s teacher, not therapist, nor parent. Teachers are left behind each year, its normal. These children need to learn that lesson.”
They recommend approaching behaviour through explicit teaching of consequences: that there’s a consequence associated with good behaviour and there’s a consequence for poor behaviour.
- Creating a structured environment with extremely consistent rules
- Being consistent and specific when giving praise or confronting poor behaviour
- Providing the child with choices, but choices provided by you, the teacher.
- Maintaining your professional boundaries (avoid attempting to create ‘friendship’ or ‘intimacy’ with the child).
- Keep your calm and avoid losing your temper; communicate directly, positively, and firmly.
- When implementing consequences, remain unemotional and assume a tone that says, effectively, “That’s just the way business is done – nothing personal.”
In short, there’s nothing that teachers shouldn’t do when working with any student with challenging behaviour. Whether the challenging behaviour is due to an issue with attachment isn’t really the issue.
Whilst there’s a relationship between insecure attachment and behaviour problems in the classroom, teachers are not qualified to ‘diagnose’ a student’s attachment type nor engage in any kind of ‘therapy’ with that student. There is a condition called ‘Reactive Attachment Disorder’ which has a higher incidence within ‘looked after’ students. Again, teachers are not qualified to make this psychiatric diagnosis.
There is an important difference between the professional role of a teacher and the role of a primary caregiver, and it’s vital that recent interest in attachment theory within the profession doesn’t blur that line. Where teachers are concerned that behaviour presented in the classroom might indicate abuse or neglect, then they are already obliged by law to report these concerns (but not investigate them or try to involve themselves in resolving them).
In terms of managing the behaviour of students with attachment problems, so that they can overcome the difficulties of their family background and experience success within school, the guidance suggests things like a structured environment, consistent rules, professional distance and focusing feedback on behaviour not the child: Advice that forms the basis of good behaviour management regardless of the cause of problematic behaviour.
It may be the case that specific children with RAD will have different strategies which will help them achieve in school. However, that’s also the case for any student with SEND. Perhaps what is important for teachers is not specific ‘training’ in attachment theory to help them ‘diagnose’ attachments, but a clear understanding of their school’s SEND system and time to read, implement and work with SEND coordinators to ensure any specific strategies suggested by an educational psychologist or child psychiatrist are employed effectively.