Attachment difficulties are characterised by persistent abnormalities in the child’s pattern of social relationships, which are associated with emotional disturbance and reactive to changes in environmental circumstances.
Fearfulness and hypervigilance that do not respond to comforting are characteristic, poor social interaction with peers is typical. Aggression towards to self and others is frequent. The disorder occurs as a direct result of severe parental neglect, abuse, or serious mishandling. These children show strong contradictory or ambivalent social responses that may be most evident at times of partings and reunions. In disinhibited attachment disorder children show an unusual spread of selective attachments during the first five years and this is associated with generally clinging behaviour in infancy and/or indiscriminately friendly, attention seeking behaviour in early or middle childhood.
Initial intervention from other Tier 1/2 services (Universal and Targeted services) prior to specialist CAMHS involvement
0-5yrs Health Visiting service to work with the family.
Family action and Children’s Centres can provide useful interventions for parents trying to establish a consistent empathic response including boundaries and rules.
Support and intervention from EP, including training from Educational Psychology Service on Attachment and Resilience. Also Nurture Group training.
Take action on any safeguarding concerns and consider initiating an Early Help.
For adopted children consider a referral to Post adoption support service
The intervention for attachment difficulties should follow a particular pattern:
- First a stable and non-anxiety provoking home environment;
- Secondly parenting work to ensure that boundaries and rules are consistently and thoughtfully applied and modelled;
- Thirdly an intervention to further promote the attunement of the primary caregiver and encourage the child/ young people’s relationship with that person;
- Fourthly an intervention to help deal with any residual effects of the trauma experienced.
A multi-agency approach is required.
Service provided by Specialist Child and Adolescent Mental Health Service – Tier 3
If their attachment difficulty has a severe impact on their daily functioning specialist mental health services may provide phased intervention to further promote the attunement of the primary caregiver and encourage the child/ young people’s relationship with that person; and an intervention to help deal with any residual effects of the trauma experienced.