Family and Children's
19, No. 3
Child Welfare Practice When Children Have Attachment Issues
What can child welfare professionals do to help children who have insecure or disorganized attachment? The primary goal is to give the child a chance to create a secure attachment with a safe, consistent, sensitive primary caregiver. Once you identify a birth or foster parent who could provide the loving, reciprocal relationship the child needs, there are two challenges that often need addressing (Dozier, et al., 2009; Speltz, 2002):
- Caregivers' own attachment and loss issues can make it hard for them to focus on the child's needs.
- Children with attachment issues tend to send confusing signals. Even well-attuned, empathic parents sometimes struggle to figure out what the child needs and how to comfort or calm the child.
Here are suggestions for overcoming these challenges, along with information about attachment-informed mental health treatments, which are often a critical part of effective intervention.
Help caregivers address their own attachment and trauma histories.
People who are wounded or overwhelmed by their own histories may not have developed the capacity to read and respond to their children's cues (Dozier, et al., 2009; Speltz, 2002). A parent's history of trauma has many implications for their ability to regulate their emotions, maintain their physical and emotional health, parent effectively, and maintain family stability (NCTSN, 2011). Parents with unaddressed trauma histories are likely to treat their own children the way they were treated, and often have difficulty forming healthy attachments with their children (Chadwick, 2013).
As a child welfare professional, it's important to ask caregivers about their history of trauma and to get a sense of what their primary attachments were like as a child. The box below provides a link to a short, simple, free trauma screening tool for adults.
Many caregivers never have the chance to think about their own parenting and the way they were raised (Dozier, et al., 2009). Asking open-ended questions and exploring their own and their parents' discipline methods, communication styles, and relationships can help caregivers gain valuable insights. Once parents acknowledge their histories, they may be ready to explore how their past affects their current functioning and parenting.
Being involved with the child welfare system can be re-traumatizing for parents. For example, parents' anger or avoidance may be a reaction to their own traumatic experiences, not to their child welfare worker. Involvement with CPS may inadvertently return parents to a position of vulnerability and fear (CWIG, 2013).
Parents involved with child welfare may need treatment to address their trauma and attachment histories. According to the National Child Traumatic Stress Network (2011), "interventions that do not take into account parent's underlying trauma issues--such as parenting classes, anger management classes, counseling, or substance abuse groups--may not be effective."
SAMSHA's National Registry of Effective Programs and Practices states that the following models integrate issues of trauma, mental health problems, and substance abuse for more effective comprehensive treatment:
- Seeking Safety
- The Trauma Recovery Empowerment Model (TREM)
- Trauma Affect Regulation: Guide for Education and Therapy (TARGET)
- Helping Women Recover/Beyond Trauma/Helping Men Recover
To learn more, visit the Registry at http://www.nrepp.samhsa.gov/
If they are not viewed through this "trauma lens," parents' behaviors can be easily misunderstood. The more you can be attuned to the fear beneath the parent's response, the more you will help them do the same for their children. Once parents feel accepted and can build trust, they may be more willing to develop a different sense of themselves and their children.
Help caregivers respond sensitively, even if children seem to reject them.
Even well-attuned, empathic caregivers can struggle to understand and respond sensitively to children who have attachment issues. When children have experienced trauma, their fear remains even when the risk of physical harm is gone. A certain sensation or situation can trigger a memory or flashback of their original trauma. These trauma triggers cause children to have a physical and emotional fear response. Sometimes the child may not even be fully aware of the response or why it's happening (Klain & White, 2013).
When caregivers see a child's distress and try to provide comfort, this can feel threatening to the child, escalating their fear response. As a result, the child may behave in confusing and contradictory ways that leave caregivers uncertain and frustrated. For example, a child may react with anger or recoil when a foster parent tries to hug them. The foster parent may then feel angry and rejected, straining the relationship and continuing the cycle of insecure attachment and rejection (Dozier, et al., 2005).
Helping Break the Cycle
Here are some things child welfare professionals can do to help break this cycle:
Help caregivers see the world from the child's point of view. Some caregivers need to learn to be aware of their child's physical and mental state. You want the caregiver to begin asking herself, "Why is my child doing this?" To encourage this, notice out loud what the child is doing and why he or she is doing it.
I see that Johnny looks really sad right now. He went into the other room, has his head down on the table, and looks like he is going to cry. I wonder why?
If the caregiver has a negative interpretation of the child's behavior, point it out.
It must be frustrating when Johnny ignores you. I see why you would think it's because he doesn't respect you and wants to be the boss. I wonder why else he might be doing that?
Help the caregiver read cues to identify the child's states and moods. Help her feel more confident and competent as a parent.
How did you know that Sally was hungry? What does she do to let you know? What about when she's tired?
Encourage the caregiver to talk to and bond with the child with simple acts of caretaking, engaging, and playing. Point out what you see that shows the child responding positively.
Wow, Johnny just loves showing you what he's made! Look how proud he is!
Help the caregiver understand all children need nurturing, even if they don't show it. Children may turn away or seem angry when parents try to provide comfort or reassurance. This is because the child is used to people not responding to or taking care of them. Encourage caregivers to be patient, go slow, and see the need and fear underneath the behavior.
Children need a strong, secure attachment. If they're not confident they will be cared for and accepted, the risk of getting hurt again will be too great and behaviors won't change (Berliner, 2002). Teach caregivers to send the message, "You are part of our family. You are loved no matter what you do."
Ensure caregivers have support and respite. Children with insecure attachment can show extremely frustrating behavior. Caregivers need help, understanding, and time away to keep themselves healthy and energized (Berliner, 2002).
Many children with attachment difficulties need mental health treatment by clinicians trained to address attachment and trauma. Because attachment is all about relationships, a caregiver should be actively involved in the treatment, too.
The interventions below include a focus on attachment and are offered in our state. Each has enough evidence of effectiveness to have been rated by the California Evidence-Based Clearinghouse for Child Welfare.
Well-Supported by Research (highest possible evidence rating)
Nurse-Family Partnership. For children ages 0-5 and their caregivers. Provides home visits by registered nurses to first-time, low-income mothers, beginning during pregnancy and continuing through the child's second birthday. Available in many NC counties. www.nursefamilypartnership.org/locations/North-Carolina
Parent-Child Interaction Therapy (PCIT). For children ages 2.5 to 7.5 and their caregivers. Provides a behavioral intervention focused on decreasing the child's behavior problems (e.g., defiance, aggression), increasing the child's social skills and cooperation, and improving the parent-child attachment relationship. NC clinicians are being trained in PCIT through PCIT of the Carolinas. www.ccfhnc.org
Promising Research Evidence
Attachment and Biobehavioral Catch-Up (ABC). For foster parents of children ages 0-5. Provides home visits designed to enhance caregivers' ability to respond sensitively to children who have experienced early trauma or maltreatment. NC clinicians are being trained in ABC through the Center for Child and Family Health. www.ccfhnc.org
Parents as Teachers. For parents of children ages 0-5. Provides early childhood parent education, family support, and school readiness through home visiting by trained parent educators. Available in many NC counties. www.parentsasteachers.org/location
In addition, a number of evidence-based treatments for child trauma include components related to insecure attachment, such as helping clients safely acknowledge and understand their history and learn how to manage emotions (self-regulation) and improve psychological safety. These include:
Well-Supported by Research
Trauma Focused Cognitive-Behavioral Therapy (TF-CBT). For children ages 3-18. For a list of clinicians in your county certified in TF-CBT, visit the NC Child Treatment Program at http://ncctp.med.unc.edu or call 919/419-3474 ext. 300
Eye Movement Desensitization and Reprocessing for Children and Adolescents (EMDR). For children ages 2-17. According to the EMDR website, certified clinicians are available across NC. www.emdr.com/find-a-clinician.html
Supported by Research Evidence
Child-Parent Psychotherapy (CPP). For children age 0-5 and their caregivers. Clinicians are being trained in NC by the Center for Child and Family Health. www.ccfhnc.org
For more details on these programs, visit
Working with children and families struggling with attachment problems can be tough, but it can also be incredibly rewarding. By teaming with caregivers, mental health providers, and others, over time you can help bring about deep changes in children that will allow them to form positive relationships and lead healthy, successful lives.
References for this and other articles in this issue