Child protection and family support social workers really need to have it all: a strong political analysis, an understanding of organisations and a decent handle on relevant micro theories. In service of the latter, a rather obscure recent announcement was made about attachment theory. This is of interest to the child protection and family support communities due to the dominance of the theory in education and practise, and its usefulness in understanding some aspects of adult-child relationships.
Without getting too much into the basic premises of attachment theory and its critiques (see footnote caveats!), this announcement was interesting for several reasons. It was made by around forty academics who have worked in the area for many years, and who have historically disagreed about the nature of a particular type of attachment: a disorganised attachment. The announcement, and excellent accompanying academic paper, conclude that the common view that disorganised attachment was always an indicator of child abuse is not, well, true (Granqvist et al., 2017).
Just what is a disorganised attachment? At first, it was a bit of a ‘dumping ground’ category for those children who clearly had some kind of attachment problem, but couldn’t be classified in one of the other categories: insecure – anxious/avoidant, or insecure – ambivalent. They tended to freeze in the strange situation test, and literally had no ‘organised’ or patterned response to ordinary situations where attachment behaviours might be expected – when caregivers leave or arrive, or where the child is upset or frightened. It was deduced that where children had no discernible reaction and seemed to be paralysed, caught between their own fear and fear of the caregiver, that this was always related to the fact that the parental response had been so frightening or unpredictable, that the child was paralysed by conflicting emotions. This was often called the third ‘f’ of attachment categories, with an avoidant style equating to ‘flight’, ambivalent as ‘fight’ and disorganised as ‘freeze’. Increasing levels of careful research into disorganised attachment styles have concluded that the reverse inferential process often used (this child has a disorganised attachment, therefore they have been abused) doesn’t always hold true. The joint statement is this:
There has been a growth in recent years of social workers and clinicians using assessment of disorganised attachment to screen for child abuse. Disorganised attachment in young children does not necessarily indicate abuse of the child; and many children who have been abused do not show signs of disorganised attachment. Social workers and clinical psychologists must not rely on a classification of disorganised attachment alone to decide whether to initiate child protection proceedings. In fact disorganised attachment is as likely to be caused by compounded family adversity. (Professor Granqvist, 2017)
Instead, as the research highlights, all sorts of things can contribute to a disorganized attachment (not in and of itself a diagnosis of a specific child, but of aspecific relationship). In a seminal study by Chantal Cyr and colleagues, (Cyr, Euser, Bakermans-Kranenburg, & Van Ijzendoorn, 2010) it was found that where families had five or more socio-economic risk factors, they had rates of disorganized attachment as high as children in families where abuse had occurred. These included things like poverty, drug abuse or not graduating high school. She proposes that such circumstances can affect the parent child relationship due to the level of dangers or stressors faced in parent’s own lives, rather than due to direct abuse. Other studies confirm that several pathways can result in disorganised attachment relationships, not just abuse – offering other primarily social factors such as mental health difficulties, domestic violence and poor housing (see the neat infographic to the left and click it to download).
Of extra interest was the classification of domestic violence (DV) as a socio-economic or contextual factor, rather than a type of abuse. This reflects the much more European view of DV as a family or parental issue related to social conditions as much as anything else, while we have adopted the US and increasingly UK view that it should count as a type of direct child abuse with limited connection to social context. It’s a big debate. Perhaps we can agree that exposure to DV harms children, but responding to it in a traditional ‘child abuse’ paradigm doesn’t tend to work out well for anyone, and reinforces the criminalisation of oppressed groups (see Hester, 2011 and Kim, 2013 on this).
Another study informing this announcement examined the surprisingly high rate of disorganized attachment behaviours among a low-risk sample (39% compared to an expected 15 – 18%). They concluded that participation in previous strange situation tests and heightened stress on the day of the test were pushing up findings of disorganised attachment, even with experienced coders: another reason not to assume that disorganized behaviours necessarily indicate abuse (Granqvist et al., 2016). This study highlights another reason to critically examine attachment theory and its categories: there are clear tensions between realistic, everyday experiences of children’s behaviour and efforts to interpret and categorise it within the attachment theory paradigm (Keddell, 2017). Most parents or people who have worked with children would immediately understand that a young child who had an earlier ‘strange situation’ test (where they were left with a stranger) might be more distressed the second time around because they knew what was coming. It’s disturbing to imagine that an expert ‘coder’ might come to a conclusion that was so wrong, because they allowed the theory and what they thought they were seeing, to lead to a conclusion of child abuse. While attachment theory does have insights to offer, an understanding of the everyday reactions of specific children requires a contextualisation of the theory to particular people and their cultural and personal contexts. As humans we don’t always fit neatly into theories, and in this area we should make sure that the theory is used to inform and understand, rather than dictate an assessment of specific children and their carers. Theories are always culturally-specific ways of understanding human behavior, and should be used with the tentativeness this realization demands (Rothbaum et al., 2000).
Coming back to the declaration that disorganized attachment is not necessarily a sign of abuse, on the other side of the bad inference equation, about a third of children who have been abused don’t show signs of disorganized attachment. In brief, concluding a child has a disorganized attachment shouldn’t be used as a shorthand for abuse. This means that attention to the adversity facing parents in their social environments is just as important as working on parent- child relationships. Turns out even in the most intimate of relationships, we need to understand both the individual and the social context. Who knew.
PS Those looking for good micro interventions to support the parent-child relationship should also check out the NICE guidelines, the developments in video feedback techniques and see Dr Chantal Cyr on the use of attachment-based video feedback as an assessment and intervention
PPS Those looking for good macro interventions for the social stressors on family life should work on supporting the new government to follow through on its commitment to reduce child poverty and improve housing and mental health services – all key to improving child-adult relationships and mental health.
Image credit: Wyncliffe
 But for some excellent alternatives to attachment theory see Smith et al., 2017 on Honneth’s ‘recognition’ (Smith, Cameron, & Reimer, 2017) which I love for its strong claim on everyday understandings of parenting and care, its point that attachment theory can be used to support conservative family and gender arrangements, and the totalising dominance attachment theory has assumed, noting, for example, that “The reification of attachment theory in policy and practice betrays a greater certainty about the concept than Bowlby himself ever claimed for it. By 1956, he acknowledged that he and others had overstated the inevitable deleterious consequences of poor early attachment” (p.1608). It can be used to mean all sorts of things in an uncritical and far too universal manner (ie every conceivable problem anyone has is all about attachment), it can be used to pathologise women and their children, and it requires an interpretive process that is often unstated and tied up with the ‘interpreter’s’ own values, culture and beliefs – see for eg Rothbaum, Weisz, Pott, Miyake, & Morelli, 2000.
Cyr, C., Euser, E. M., Bakermans-Kranenburg, M. J., & Van Ijzendoorn, M. H. (2010). Attachment security and disorganization in maltreating and high-risk families: A series of meta-analyses. Development and Psychopathology, 22(1), 87-108. doi: 10.1017/S0954579409990289
Granqvist, P., Hesse, E., Fransson, M., Main, M., Hagekull, B., & Bohlin, G. (2016). Prior participation in the strange situation and overstress jointly facilitate disorganized behaviours: Implications for theory, research and practice. Attachment & Human Development, 18(3), 235-249. doi: 10.1080/14616734.2016.1151061
Granqvist, P., Sroufe, L. A., Dozier, M., Hesse, E., Steele, M., van Ijzendoorn, M., . . . Duschinsky, R. (2017). Disorganized attachment in infancy: A review of the phenomenon and its implications for clinicians and policy-makers. Attachment & Human Development, 19(6), 534-558. doi: 10.1080/14616734.2017.1354040
Hester, M. (2011). The three planet model: Towards an understanding of contradictions in approaches to women and children’s safety in contexts of domestic violence. British Journal of Social Work, 41(5), 837-853. doi: 10.1093/bjsw/bcr095
Keddell, E. (2017). Interpreting children’s best interests: Needs, attachment and decision-making. Journal of Social Work, 17(3), 324 – 342. doi: 10.1177/1468017316644694
Kim, M. E. (2013). Challenging the pursuit of criminalisation in an era of mass incarceration: The limitations of social work responses to domestic violence in the USA. British Journal of Social Work, 43(7), 1276-1293. doi: 10.1093/bjsw/bcs060
Rothbaum, F., Weisz, J., Pott, M., Miyake, K., & Morelli, G. (2000). Attachment and culture: Security in the united states and japan. American Psychologist, 55(10), 1093-1104. doi: 10.1037/0003-066X.55.10.1093
Smith, M., Cameron, C., & Reimer, D. (2017). From attachment to recognition for children in care. The British Journal of Social Work, 47(6), 1606-1623. doi: 10.1093/bjsw/bcx096 free to read