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Age group 0 to 5 years

Secure attachment

Positive, nurturing and stable relationships with caring adults that support carer-child attachment are essential for a child’s healthy development.1

Overview and areas of concern

No data is available on whether WA children aged 0 to 5 years have developed secure attachments. 

Overview

Children whose parents or caregivers respond to them in a nurturing, safe and consistent manner will develop secure attachments and have better long term health and wellbeing outcomes.1

Areas of concern

Recognising there are barriers to measurement, the lack of a screening or assessment process of parent-child attachment for vulnerable parents and children increases the risk that children with attachment issues are not identified and families not provided with timely support.

Measure: Parents and carers support secure attachment

Secure, nurturing and stable relationships with caring adults are essential for a child’s healthy development.1 Attachment is one component of the relationship between a child and their caregiver(s) which corresponds to the child feeling safe, secure and protected.2

Research shows that attachment is a strong predictor of a child’s later social and emotional outcomes.3,4 Children who experience insecure attachment are more likely to experience anxiety, behavioural issues, difficulties with emotion regulation and learning.5,6,7

The quality of a child’s sense of attachment is largely determined by the caregiver’s responses to the child in infancy. Infants (particularly in the first six months) whose caregiver consistently responds in a nurturing manner when the child is distressed, feel safe and secure and learn to approach their caregiver when upset or distressed.8 Conversely, an infant whose caregiver consistently responds to distress in a negative manner (for example, through rejection or annoyance) will learn to not approach their caregiver in times of need.9

While there has been limited research to date, there is some evidence to suggest that the increasing ubiquity of mobile phones and other technology could lead to more parents being distracted and unable to provide responsive caring to their young children.10 This is an area that requires further research.   

Attachment is usually established as a pattern by the time a child is 12 months-old, however, it can change over time.11

Disorganised or insecure attachment is correlated with a range of parenting issues that can negatively affect parent-child relationships. These include parental drug and alcohol issues and parents who are frequently withdrawn or detached due to loss or trauma.12

In global population studies, it is estimated that two-thirds of children have a secure pattern of attachment, although this is reduced to one-third of children in disadvantaged populations.13 Although attachment issues, especially disorganised attachment, may indicate a risk of later problems, they do not necessarily represent a disorder.14 Attachment disorders are a serious and uncommon form of mental illness, sometimes experienced by children who have been abused or neglected and/or had multiple caregivers (i.e. through the child protection system).15 

It is important to note that a child will develop an attachment with any caregiver who provides regular physical and emotional care – even a neglectful and abusive caregiver. The quality of the attachment between the caregiver and the child is therefore critical.16

There is no data available on WA children’s attachment experiences or WA parent’s attachment behaviours.

A recommended approach to measuring attachment is the laboratory-based Strange Situation (SS) procedure. In this test, the behaviours of the child are observed while in the presence of the parent, on separation from the parent, in the presence of a stranger and on re-union with the parent.17 An alternative measurement approach is the Attachment Q-sort which is carried out in the infant’s home. It is recommended that the process is carried out by observers on two to three visits for a total of two to six hours of observation in the home.18

Both of these measures require considerable time and have not been adapted for more general use by health professionals.19

Apart from this kind of specialised and structured assessment, health and other practitioners can obtain an indication of the quality and nature of a child’s relationship with their caregiver by observing parent-child interactions.20

For example, when new parents are experiencing mental health issues, the WA Department of Health practice guidelines suggest a preliminary assessment of attachment.21 This approach is, however, not recommended for all parent-infant dyads, but only when parental mental health issues exist.

Assessment of infant-caregiver attachment by a health professional should also be culturally specific and appropriate.22

Culturally and linguistically diverse families and Aboriginal families can have different cultural perspectives on caregiving which can influence how attachment is expressed and formed.23,24  

For example, while most research on, and assessment of, attachment considers the relationship between a parent (often mother) and child (as is traditional in western culture), attachment can also involve multiple caregivers such as siblings and extended family members where they are consistent care providers.25,26

While Aboriginal caregiving includes the universal components of security and protection, individual caregiving practices can differ from western approaches.27 These differences may mean that a ‘standard’ assessment checklist may not properly evaluate the attachment of an Aboriginal child. For example, Aboriginal children often have multiple regular female caregivers and are often discouraged from ‘exploring’ until over two years-old. They may, therefore, react differently when separated from their parent (mother).28

For a detailed discussion of attachment theory and Aboriginal caregiving practices refer to:

Ryan F 2011, Kanyininpa (Holding): A Way of Nurturing Children in Aboriginal Australia, Australian Social Work, Vol 64, No 2.

Refugees are at a higher risk of experiencing attachment issues where the family has been exposed to trauma, however, there has been limited research specifically on refugee children.29

There is no data on the prevalence of attachment issues for WA children.

Endnotes

  1. National Scientific Council on the Developing Child 2004, Young children develop in an environment of relationships, Working Paper No. 1, Center on the Developing Child, Harvard University.
  2. Benoit D 2004, Infant-parent attachment: Definition, types, antecedents, measurement and outcome, Paediatric Child Health, Vol 9, No 8.
  3. Ibid.
  4. McLean S 2016, Children’s attachment needs in the context of out-of-home care, Child Family Community Australia, Australian Institute of Family Studies.
  5. Kerns KA and Brumariu LE 2014, Is Insecure Parent-Child Attachment a Risk Factor for the Development of Anxiety in Childhood or Adolescence?, Child development perspectives, Vol 8, No 1.
  6. Stefan J et al 2009, Healthy mother-infant relationship: Assessment of risk in mothers with serious mental illness, North Metropolitan Area Health Service, Mental Health, WA Department of Health, p. 4.
  7. McLean S 2016, Children’s attachment needs in the context of out-of-home care, Child Family Community Australia, Australian Institute of Family Studies.
  8. It should be noted that it is not possible for a caregiver to respond ideally every time – a caregiver who responds promptly and warmly most of the time to the baby’s cries, will most likely create secure, organised attachment (Source: Benoit D 2004, Infant-parent attachment: Definition, types, antecedents, measurement and outcome, Paediatric Child Health, Vol 9, No 8).
  9. Benoit D 2004, Infant-parent attachment: Definition, types, antecedents, measurement and outcome, Paediatric Child Health, Vol 9, No 8.
  10. McDaniel B 2019, Parent distraction with phones, reasons for use, and impacts on parenting and child outcomes: A review of the emerging research, Human Behaviour and Emerging Technologies, Vol 1, No 2.
  11. Stefan J et al 2009, Healthy mother-infant relationship: Assessment of risk in mothers with serious mental illness, North Metropolitan Area Health Service, Mental Health, WA Department of Health, p. 4.
  12. McLean S 2016, Children’s attachment needs in the context of out-of-home care, Child Family Community Australia, Australian Institute of Family Studies.
  13. National Collaborating Centre for Mental Health (UK) 2015, Children's Attachment: Attachment in Children and Young People Who Are Adopted from Care, in Care or at High Risk of Going into Care, National Institute for Health and Care Excellence (UK).
  14. Ibid.
  15. Ibid.
  16. Benoit D 2004, Infant-parent attachment: Definition, types, antecedents, measurement and outcome, Paediatric Child Health, Vol 9, No 8.
  17. Stefan J et al 2009, Healthy mother-infant relationship: Assessment of risk in mothers with serious mental illness, North Metropolitan Area Health Service, Mental Health, WA Department of Health.
  18. Solomon J and George C 2016, The Measurement of Attachment Security and Related Constructs in Infancy and Early Childhood, in Cassidy J and Shaver P (Eds), Handbook of Attachment: Theory, research and clinical applications, The Guildford Press.
  19. Ibid.
  20. McLean S 2016, Children’s attachment needs in the context of out-of-home care, Child Family Community Australia, Australian Institute of Family Studies.
  21. WA Child and Adolescent Health Service 2018, Guideline: Perinatal and infant mental health, Community Health Manual, WA Government.
  22. McLean S 2016, Children’s attachment needs in the context of out-of-home care, Child Family Community Australia, Australian Institute of Family Studies.
  23. Ibid.
  24. Ryan F 2011, Kanyininpa (Holding): A Way of Nurturing Children in Aboriginal Australia, Australian Social Work, Vol 64, No 2.
  25. Ibid.
  26. Neckoway R et al 2007, Is Attachment Theory Consistent with Aboriginal Parenting Realities?, First Peoples Child & Family Review, Vol 3, No 2.
  27. Ryan F 2011, Kanyininpa (Holding): A Way of Nurturing Children in Aboriginal Australia, Australian Social Work, Vol 64, No 2.
  28. Ibid.
  29. Morina N et al 2016, Attachment style and interpersonal trauma in refugees, The Australian and New Zealand Journal of Psychiatry, Vol 50, No 12.
Children in care

At 30 June 2019, there were 1,341 WA children in care aged between 0 and four years, more than one-half of whom (56.8%) were Aboriginal.1

Children in care are far less likely to have developed secure attachments, as the majority of these children have been abused or neglected and have experienced disrupted care.2 Physical and emotional abuse and neglect are strongly associated with disorganised attachment and can also lead to attachment disorders.3  

Children in care are particularly vulnerable and it is well established that they have a higher risk of involvement with drugs, alcohol, youth justice and long-term disadvantage over their lifetime.4 Ensuring children in care are exposed to safe, reliable and responsive caregiving as early as possible is essential.5   

Assessment of child-caregiver attachment requires specialist training. It is, however, possible for child protection or other health professionals to obtain an indication of the quality and nature of a child’s relationship with their caregiver by observing the child-caregiver interactions.6 Where an attachment difficulty is deemed possible, the child should be referred for diagnosis and, if necessary, treatment. As Aboriginal children represent more than 50 per cent of children in care, any assessment of attachment issues needs to be culturally specific and appropriate.

Robust policies and procedures should be in place so that child protection workers are supported to provide children with appropriate care as part of the child’s care and health plan. Carers should also be given the guidance and necessary supports to provide the child with appropriate caregiving. This support may be financial or in the form of training and development.

Wherever safe and appropriate, children in care should be supported to maintain a connection to their family. It is essential that biological parents are provided with appropriate support to manage any unresolved trauma and grief and address parenting issues.7     

There is no data available on the support in place to assist children in out of home care who may have attachment issues and their carers.

For more information on attachment and children in care refer to:

McLean S 2016, Children’s attachment needs in the context of out-of-home care, Child Family Community Australia, Australian Institute of Family Studies.

Endnotes

  1. Department of Communities 2019, Annual Report: 2018-19, WA Government p. 26.
  2. National Collaborating Centre for Mental Health (UK) 2015, Children's Attachment: Attachment in Children and Young People Who Are Adopted from Care, in Care or at High Risk of Going into Care, Section 2.3 Types of attachment difficulties, National Institute for Health and Care Excellence (UK).
  3. Ibid.
  4. Cameron N et al 2019, Research Briefing: Good Practice in Supporting Young People Leaving Care, Australian Childhood Foundation: Centre for Excellence in Therapeutic Care, Southern Cross University.
  5. McLean S 2016, Children’s attachment needs in the context of out-of-home care, Child Family Community Australia, Australian Institute of Family Studies.
  6. Ibid.
  7. Ibid.
Children with disability

The Australian Bureau of Statistics Disability, Ageing and Carers data collection reports that approximately 5,100 WA children (3.0%) aged 0 to four years had reported disability in 2015.1,2

Research suggests that the presence of disability in a child does not on its own predict insecure attachment. However, where disability increases the demands on a parent/caregiver and that parent is also experiencing unresolved trauma, loss or other challenges, then these children are at greater risk of developing attachment issues.3

Different types of disability also have different levels of risk of attachment difficulties. Developing secure attachment can be hindered where the parent/carer is unable to accurately recognise and interpret their child’s behaviour, body language and speech.4  For example, children with autism spectrum disorder have difficulties expressing their emotions and responding to other’s emotions, and there is evidence to suggest that having autism can increase the risk of attachment difficulties.5,6  

There is emerging evidence to suggest that siblings of children with disability also have a higher risk of mental health issues. In recent Australian research, 70.5 per cent of (adult) siblings of children with disability reported missing out on time or attention as children, due to the time required for their parents to care for their sibling.7 Of the now-adult siblings, 65.7 per cent reported anxiety issues and 53.7 per cent reported depression that they related to their experiences of family stress as children.8

There is no data on whether siblings of children with disability are more likely than other children to experience attachment issues.

Parents (particularly mothers) of children with disability are at a greater risk of experiencing mental health issues.9 A mother with poor mental health can be less able to parent effectively and may not provide their children with appropriate cues for secure attachment. It is critical that parents of children with disability are supported through appropriate services designed for parents of children with disability.

There is no data available on the attachment experiences of WA children with disability or their parent’s attachment behaviours.

Endnotes

  1. ABS uses the following definition of disability: ‘In the context of health experience, the International Classification of Functioning, Disability and Health (ICFDH) defines disability as an umbrella term for impairments, activity limitations and participation restrictions… In this survey, a person has a disability if they report they have a limitation, restriction or impairment, which has lasted, or is likely to last, for at least six months and restricts everyday activities.’ Australian Bureau of Statistics 2016, Disability, Ageing and Carers, Australia, 2015, Glossary.
  2. Estimate is to be to be used with caution as it has a relative standard error of between 25 and 50 per cent. Australian Bureau of Statistics 2016, Disability, Ageing and Carers, Australia, 2015: WA, Table 1.1 Persons with disability, by age and sex, 2012 and 2015 estimate, and Table 1.3 Persons with disability, by age and sex, 2012 and 2015, proportion of persons.
  3. Howe D 2006, Disabled children, parent–child interaction and attachment, Child and Family Social Work, Vol 11.
  4. Ibid.
  5. Ibid, p. 100-101.
  6. Rutgers AH et al 2007, Autism, Attachment and Parenting: A Comparison of Children with Autism Spectrum Disorder, Mental Retardation, Language Disorder, and Non-clinical Children, Journal of Abnormal Child Psychology, Vol 35.
  7. Siblings Australia Inc. 2018, Mapping Project: Support for Siblings of Children and Adults with Disability, Siblings Australia Inc., p. 10.
  8. Ibid, p. 5, 10.
  9. Davis E and Gilson KM 2018, Paying attention to the mental health of parents of children with a disability, Australian Institute of Family Studies.
Policy implications

All WA infants should be supported to develop secure attachment and therefore have the best opportunity for a healthy and happy life.

Children who do not develop secure attachment are more likely to have learning and developmental difficulties, mental health issues and behavioural problems during childhood and into adulthood.1,2,3 Early intervention is not only critical for the individual child but will also be a lower-cost option for governments over the long term. 

Screening for potential attachment issues is important for the health and wellbeing of individual children and their families. At the same time, data should be collected on screening and diagnosis to provide population-level measurement of whether policies related to improving children’s attachment across WA are working.

Health policies and programs should support healthy parent/child relationships, particularly during infancy, to reduce the likelihood of WA children experiencing attachment issues.

It is essential that all new parents are provided with information about the importance of responsive parenting practices, with additional counselling and support for parents experiencing adversity and disadvantage.

Where a child health nurse or other health professional identifies a caregiver and/or infant is at risk of experiencing attachment difficulties, a process for formal assessment should be instigated. While this is currently part of perinatal guidelines for parents with mental health issues, it should be explored whether a preliminary assessment could be carried out for all infants through the child-health check process. 

Any policy and/or guideline should be developed in collaboration with Aboriginal and culturally and linguistically diverse health professionals, taking into account different cultural expressions of attachment.

Some parents and children are more vulnerable to experiencing attachment issues and programs and services should be targeted to these groups. All new parents experiencing vulnerabilities such as mental health issues, drug and alcohol issues or trauma should be provided with additional support to facilitate secure attachment. This could include parenting services or counselling and other services targeted to assist parents with their own issues.

Where appropriate, parents experiencing vulnerabilities could be encouraged to engage their child in specialised early childhood education and care programs which can provide alternative stable relationships. 

Emerging research shows that children with an incarcerated parent are at particular risk of developmental issues. Children whose parent had either served a community order or been incarcerated were at risk of poor development across all developmental domains, even after adjusting for sociodemographic factors.4 While this research did not consider attachment patterns, this finding highlights that these children are at particular risk. On average 1,544 WA children were affected by parental incarceration each year across 2003–2011.5

While there is general agreement that improving parent responsiveness is critical to developing attachment, there has been limited evaluation of programs and services specifically focused on developing or improving attachment for vulnerable populations.

A recent evaluation of the right@home nurse home visiting program, which offered pregnant women experiencing adversity in Victoria and Tasmania 25 nurse visits at home until the child was aged two years, found that the program improved parenting and home environment determinants of children’s health and development. Parents under Pressure is an existing program available in WA, designed for families where there is a high risk of child maltreatment. Programs of this nature should be considered for all mothers and infants deemed at risk.6

The Early Years Education Program (EYEP) is a specialised program in Victoria targeting the needs of children who are exposed to significant family stress and social disadvantage. A component of this program is to foster ‘supplementary significant and secure attachment relationships for children who are likely to be experiencing disrupted and compromised attachment relationships in their home environments’.7 A recent evaluation of the EYEP found significant impacts on children at 24 months for protective factors related to cognitive outcomes, resilience and social-emotional development.8 Programs of this nature should be considered in WA.

Children engaged with the child protection system are a particularly vulnerable cohort. It is therefore even more critical to ensure these children are provided with consistent, safe, responsive and predictable caregiving in a stable care environment either at home or in care, as early as possible.9 This could be by providing the biological family with intensive services including a home visiting program to support vulnerable parents to change their parenting behaviours, while also enrolling the child in a structured early education and care program, if available. Recognising that a high proportion of children in the child protection system in WA are Aboriginal, it is essential that any recommended services or programs are culturally safe and appropriate.

All children removed from their parents should be assessed to determine whether the child needs specific support related to any attachment issues. Where a child is deemed at risk of attachment issues, the child and the carer should be provided with additional support and access to specialised programs. 

Research suggests that the children who are adopted or fostered can form appropriate attachments with their carers once placed in a secure, stable new care arrangement.10 However, this may not be possible if the child is transferred between multiple care arrangements.

It is also important to recognise that children can form attachments with multiple caregivers simultaneously and ongoing relationships with biological parents should not impact their ability to develop secure attachments with foster parents.11

Recognising that the goal of child protection should be to reunite children with their families if safe and in their best interests, it is recommended that biological parents are supported to address issues that interfere with their parenting.12

Parents of children with disability should also be seen as a potentially vulnerable group who may require additional parenting support. This should be focused not only on the child with disability, but also any siblings who may be missing out on responsive caregiving.

Data gaps

There is a lack of data on WA children’s attachment experiences or WA parent’s attachment behaviours.

Endnotes

  1. Kerns KA and Brumariu LE 2014, Is Insecure Parent-Child Attachment a Risk Factor for the Development of Anxiety in Childhood or Adolescence?, Child development perspectives, Vol 8, No 1.
  2. Stefan J et al 2009, Healthy mother-infant relationship: Assessment of risk in mothers with serious mental illness, North Metropolitan Area Health Service, WA Department of Health, p. 4.
  3. McLean S 2016, Children’s attachment needs in the context of out-of-home care, Child Family Community Australia, Australian Institute of Family Studies.
  4. Bell M et al 2018, Using Linked Data to Investigate Developmental Vulnerabilities in Children of Convicted Parents, Developmental Psychology, Vol 54, No 7.
  5. Dowell CM et al 2016, Quantifying maternal incarceration: a whole‐population linked data study of Western Australian children born 1985–2011, Australia and New Zealand Journal of Public Health, Vol 41, No 2.
  6. Goldfeld S et al 2019, Nurse Home Visiting for Families Experiencing Adversity: A Randomized Trial, Pediatrics, Vol 143, No 1.
  7. Tseng Y et al 2019, Changing the Life Trajectories of Australia’s Most Vulnerable Children: Report No. 4 24 months in the Early Years Education Program: Assessment of the impact on children and their primary caregivers, Melbourne Institute of Applied Economic and Social Research, University of Melbourne.
  8. Ibid.
  9. McLean S 2016, Children’s attachment needs in the context of out-of-home care, Child Family Community Australia, Australian Institute of Family Studies.
  10. Ibid.
  11. Ibid.
  12. Ibid.
Further resources

For further information on parent-infant attachment, refer to the following resources:

Endnotes

  1. Benoit D 2004, Infant-parent attachment: Definition, types, antecedents, measurement and outcome, Paediatric Child Health, Vol 9, No 8.
  2. Ibid.