Attachment security, children with disabilities, and the role of early childhood intervention professionals

What is meant by attachment and why is this an important concept in children’s mental health?

Attachment behaviour refers to the instinctive actions of infants and young children to seek comfort from their parent or caregiver when they are ‘frightened, tired or ill’.³ Sensitive and responsive caregiving is thought to underlie the development of a secure attachment relationship, as the infant comes to expect from previous experience that their needs for comfort will be readily met.⁴

The creation of a secure attachment relationship between a child and their parents/caregivers is important for the development of all children, as secure attachment supports language, social skills, resilience and emotional wellbeing. Insecure attachment, on the other hand, increases the likelihood of a child experiencing behavioural and mental health problems. Secure or insecure attachment relationships do not guarantee particular outcomes for children, but can have a significant influence.⁵

Attachment in children with a disability

A child with a disability has an increased risk of forming an insecure attachment which can compound their existing developmental challenges. The increased risk is created by a range of factors including:

• the emotional impact of the diagnosis on the family⁶
• the increased stress families may experience⁶
• the increased likelihood of living in poverty⁷
• the child’s ability to express their needs and feelings.⁶

The role of ECI professionals in the lives of children with disabilities and their families

ECI professionals work with the families of infants and young children with disabilities to enhance their development and wellbeing. They build trusting relationships with families, sometimes with the same worker visiting them for many years. ECI professionals thus have an excellent opportunity to support and enhance positive and responsive caregiving. However, prior to this study little was known about what knowledge ECI professionals have of attachment; how they view attachment in relation to their role; and what, if anything they do in their practice to address attachment security.

The current study

The current study surveyed 49 ECI professionals at a not-for-profit provider of ECI services in Australia. This organisation had endeavoured to build the skills and knowledge of ECI staff regarding attachment for several years through the provision of training. Results of the questionnaire indicated that:

• respondents were knowledgeable regarding attachment
• most respondents saw this knowledge as essential in their role; and
• almost all respondents used this knowledge regularly in their work.

ECI professionals come from a wide range of allied health and teaching professions. Less than half of respondents (42%) had learned about attachment in their undergraduate training and despite the knowledge they have acquired since, just over half (56%) felt comfortable to address attachment issues with families.

What are the implications of the current study for ECI training and practice, as well as for approaches to children’s mental health?

There are implications regarding the training of professionals as they enter the field of ECI. It is vital that ECI professionals have the opportunity to build their skills and knowledge of attachment principles to enable the clear focus on responsive parent-child relationships recommended by the National ECI Guidelines.⁸ This may help foster positive outcomes for children’s emotional wellbeing and mental health, as research has suggested that children’s experiences of attachment lay the foundations for the development of emotional regulation skills⁹ and can influence mental health outcomes later in life.¹⁰

Upcoming research

The lead author is currently undertaking research to develop an evidence-informed practice framework for ECI professionals to assist with improving attachment security, including through consultation with ECI professionals. Learnings will be shared along the way through publication and presentations. Once the practice framework is drafted, focus groups will be conducted with ECI professionals to work through the materials to ensure they are meaningful and useful. The overall aim is to enhance the skills, knowledge and practice of ECI professionals so that they can make best use of the opportunity they have to improve the attachment security of the children they work with.

²Disability is defined here as any physical or cognitive impairment significantly impacting functional capacity

References

¹ Alexander, S., Frederico, M., & Long, M. (2018). Attachment and children with disabilities: Knowledge and views of Early Intervention professionals. Children Australia, 43(4), 245-254. doi:10.1017/cha.2018.38
³ Bowlby, J. (1982). Attachment (2nd ed. Vol. 1). New York: Basic Books, p. 371.
⁴ Ainsworth, M. (2015). Patterns of attachment : A psychological study of the Strange Situation. In M. Blehar, E. Waters, & S. Wall (Eds.): London: Taylor and Francis.
⁵ Sroufe, L. (2005). Attachment and development: A prospective, longitudinal study from birth to adulthood. Attachment and Human Development, 7(4), 349-367.
⁶ Howe, D. (2006). Disabled children, parent-child interaction and attachment. Child and Family Social Work, 11, 95-106.
⁷ Leonard, H., Petterson, B., De Klerk, N., Zubrick, S. R., Glasson, E., Sanders, R., & Bower, C. (2005). Association of sociodemographic characteristics of children with intellectual disability in Western Australia. Social Science & Medicine, 60(7), 1499-1513. doi:10.1016/j.socscimed.2004.08.014
⁸ Early Childhood Intervention Australia. (2016). National Guidelines: Best Practice in Early Childhood Intervention. Retrieved from https://www.ecia.org.au/Resources/National-Guidelines-for-Best-Practice-in-ECI
⁹ McLean, S. (2016). Children’s attachment needs in the context of out-of-home care (CFCA Practice Resource, November 2016). Melbourne, Australia: Child Family Community Australia, Australian Institute of Family Studies; DeKlyen, M., & Greenberg, M. T. (2008). Attachment and psychopathology in childhood. In J. Cassidy and P. R. Shaver (Eds.). Handbook of Attachment: Theory, research and clinical applications (2nd ed.) pp. 637–665. New York: Guilford Press
¹⁰ McLean, S. (2016). Children’s attachment needs in the context of out-of-home care (CFCA Practice Resource, November 2016). Melbourne, Australia: Child Family Community Australia, Australian Institute of Family Studies; van Ijzendoorn, M. H., Schuengel, C., & Bakermans-Kranenburg, M. J. (1999). Disorganised attachment in early childhood: Meta-analysis of precursors, concomitants, and sequelae. Development and Psychopathology, 11, 225–249.