Attachment disorder - a practical guide

original post by Daniel

Children with an attachment disorder struggle to form and maintain trusting relationships and as such will display unwanted and disruptive behaviour. It can be very challenging and difficult to understand, not only for teaching staff but for the child as well.

The reason children with this disorder display negative behaviour, is to protect themselves and to retain control. They are not thriving attention and so tactical ignoring will not work with these children, and can be very damaging. Attachment disorder in essence is when a child does not form a healthy attachment with an adult (normally a parent) and so they cannot regulate and negotiate friendships/relationships in a normal way. It is very easy to feel like you've had a breakthrough with these children, as they will have periods where everything is great and they are great with you. When the relationship gets to this stage, it is probable that the child will test the relationship by trying to shock or upset you. This is not personal, the intention is for the child to try and distance you.

Attachment disorder is more common in children that have had a traumatic upbringing. They may be looked after children that have been through the adoption/fostering process, or they could simply be in a damaging family environment.



Reducing anxiety

- Meet and greet in the morning.
- Predictable routines and warnings of upcoming changes.
- Visual timetable or plan of the day.
- Plan for triggers and hotspots during the day.
- Improving social skills
- Model appropriate interactions, and bear in mind that you set the tone for how the other children react to the child.
- Teach skills that seem obvious -
“I’m going to help you practice getting stronger at asking for help, sharing, waiting, having fun.” To help improve social interactions with peers, focus on the task or game as this is less threatening- say that you want them to go and play Connect 4 rather than go and play with Callum.

Giving instructions

- Use a very matter of fact tone.
- Say “Thank you for…”. rather than “Please get...”
- Allow the child some control by giving them two good choices– “ Do you want to use the red pen or the green pen?”
- Give explicit instructions to the child’s neighbour—the child may often prefer to mimic another child than be seen to follow an instruction from an adult.

Waiting/ being interrupted

The child finds it hard to trust that they will be allowed to finish an activity later or that a promised event will actually take place so:
- Use countdowns and timers.
- Try a memory card as a concrete promise to the child- “Alex can finish his picture after assembly”.
- Use memory cards to write reminders on- Emma can take the register on Tuesday”.

Lunchtimes

Many children with attachment difficulties find large groups quite threatening. They become hypervigilant and constantly scan the environment for danger.
They are not likely to be aware that they are doing this, as it is an automatic, subconscious response to being in a stressful situation. Food and eating can be very difficult for some children and in a stressful situation and they may lose their appetite or overeat for comfort. They may not be able to settle long enough to eat a meal (meals may previously have been erratic).

- Give mundane jobs and responsibility.
- Seat the child with his back to a wall or somewhere he may feel safer and have a good view of the room.
- Provide structured games or activities.

Low self esteem/ unwilling to try things

- “My book of success” - a scrapbook with photos, extracts of work,, comments from teachers.
- “I know you can do it, I have a picture of you doing it right here.” (This may seem time-consuming, but could easily be set up whilst the child doesn't need 1-1 support, and is seen as good practice as a PSHE assessment tool by OFSTED!)
- Use social stories and comic strip conversations for unfamiliar situations.

Making a relationship with the child

- Focus on the task or activity as a bridge to reach the child– this is less threatening for them.
- Find out small personal details– likes, dislikes, hobbies and mention them unprompted to show you have kept the child in mind.
- Establish private jokes between the two of you and use very gentle safe humour.

Calming down strategies

- Give soothing boring activities as mentioned above– colouring in , tidying up, sorting out.
- Have a calm box with activities and objects in to help the child calm themselves down. Ensure the use of the box is worker-led and that the child is not simply given it. Initially it would be best if the key worker did the activities too.
The calm box could contain:
“Calm cards” with a choice of calming activities that take less than 5 minutes: listen to a relaxing CD, stretch like a cat, make the longest playdough worm you can, deep breaths in and out.
- Fidget objects
- Cuddly toy (referred to as a “learning friend”)
- Hand cream
- Wet wipes eg put on the child’s forehead

Promoting attachments as a TA

- A key adult can offer the opportunity for “second chance learning” to emotionally damaged children. Within this relationship they can develop trust, learn and practice social skills, and have their feelings and needs reflected back to them. A Teaching Assistant can work in a variety of ways:-
- To help the child practice all that is new to them—eg asking for help, relaxing, resolving conflict, sharing, taking turns, showing affection and having fun.
- To meet and greet the child in the morning in order to reduce anxiety about coming to school.
- To go through a plan for the day or visual timetable.
- To be aware of the child’s specific triggers .
- To spot early signs of stress and take the child out to do some calming down activities.
- To do social stories and comic strip conversations with the child.
- To help them learn about themselves and their reactions by “wondering aloud” about what you think might be happening for the child and so putting their feelings into words for them. “I wonder if you are feeling anxious about the supply teacher and that’s why you are refusing to sit on your chair.”