The policy context on Attachment and Neglect

In recent years there has been a growing recognition of the scale of child neglect, its long-term effect on children's wellbeing and how interventions can prevent and repair the damage caused to children's ability to form strong attachments with parents and carers.

Working Together to Safeguard Children 2013 guidance describes neglect as the "persistent failure to meet a child's basic physical and/or psychological needs, likely to result in the serious impairment of the child's health or development". This can manifest itself in a parent or carer failing to provide adequate food, clothing or shelter; protect a child from physical or emotional harm; ensure adequate supervision; access to appropriate medical care; and be unresponsive to basic emotional needs.

The Serious Crime Act 2015 updated the legal definition of neglect, and the forms it takes:

  • Physical neglect - failing to meet a child's basic needs including a safe environment
  • Emotional neglect - the omission of love and lack of nurture
  • Educational neglect - failing to ensure a child receives an education
  • Medical neglect - failing to provide appropriate healthcare
  • Emotional abuse - the persistent emotional maltreatment of a child

Government figures suggest the number of children experiencing neglect, as defined by police and social work, has risen in the past five years. Recorded offences of cruelty to children and young people - the category in which neglect is included - have risen from 6,087 in 2010/11 to 8,935 in 2014/15, a 46 per cent increase (see graphic). The rise in cruelty offences has been even greater over the past decade, with today's figures 77 per cent higher than in 2005/06.

In addition, the number of children subject to child protection plans due to neglect has risen from 18,600 in 2010/11 to 22,230 in 2014/15 (see graphic). The Department for Education data shows that the percentage of child protection plans linked to neglect has also grown from 43.6 to 44.9 per cent of the total.

These increases have come despite local authority thresholds used to assess whether a child is "in need" rising due to stretched resources. Children's services leaders say demographic changes and greater awareness of the issue among children's professionals mean the numbers are likely to continue rising for some time (see expert view, p19).

Early intervention to tackle neglect

There has been a general drive from policymakers to intervene earlier in families showing signs of neglect or where risk factors suggest it could occur. Bringing child health and early years workforces closer together - often based at children's centres - to deliver infant developmental checks has helped to identify problems earlier. The close links these centres have with local authorities has also helped to link families to specialist social care support when concerns over neglect are identified by health and childcare staff.

The Early Years Foundation Stage (EYFS) statutory guidance for childcare settings outlines the types of concerning behaviour that might indicate a child is being neglected and what childcare practitioners should do if they have concerns. It also sets out the early learning goals that children should be achieving and the behaviours a neglected child might display.

Working Together to Safeguard Children also puts the emphasis firmly on the need to prioritise early help when safeguarding problems first come to the attention of children's services.

It provides a framework to support professionals across all children's services, including health, education, social care and early years, to identify children in need and ensure an appropriate response is made, whether that be providing an intervention or referring a child to a specialist service.

Government policy over the past five years has prioritised parenting support as a way of improving skills in vulnerable first-time parents and offering more intensive help for families already struggling. Local projects, such as Action for Children's On the Ball programme (see case study, p28), have been funded to deliver courses for parents of young children aimed at improving the relationships in disadvantaged families. Meanwhile, the Troubled Families programme, introduced in England in 2011, has delivered intensive support for families with poor parenting skills to break the intergenerational cycle of neglect.

International models of parenting interventions, such as the Family Nurse Partnership (FNP), have also received government backing. However, to date, the results have been mixed - recent research on the effectiveness of FNP found that it failed to have a lasting impact on parents' behaviour.

Applying attachment theory

In early childhood, the impact of neglect is often seen in children failing to form attachments to parents and carers. Ciccetti & Barnett's 1991 study found that up to 80 per cent of neglected children could suffer from attachment disorder. Research into the early life experiences of child delinquents by psychiatrist and psychoanalyst John Bowlby first highlighted the importance of these bonds to the development of the child.

Researchers applying Bowlby's theories to child protection practice have found that the damage neglect causes to an infant's early brain development and ability to form attachments can be so severe that it can be in their best interest to be taken into care (see research study 1).

Robin Balbernie, clinical director of the Parent Infant Partnership, explains that the foundations of secure attachment are laid down in the first six months of life by "sensitive and responsive parenting… in a way that communicates a sense of being understood".

He adds: "The newborn will pull the parent in by mimicking facial expressions and even simple hand gestures, and in return the sensitive parent responds as if the baby has intentionality."

The Wave Trust and others have shown how video feedback can be used to identify how insecurely attached infants struggle to recognise facial expressions and cues that form the basis of early communication and bonding with parents and carers. The approach is also being used as a therapeutic intervention (see research case study 4, p24).

While Bowlby's theory on attachment focused on the relationship between parent and child, other work in the field has looked at the impact of wider environmental and social factors. Radke-Yarrow found that half of children whose mothers suffered from depression were insecurely attached, while this figure rose to 80 per cent for families living in poverty. De Wolff and Van Ijzendoorn found that while 15 to 19 per cent of all children displayed disorganised attachment, the rate doubled for disadvantaged children and quadrupled for those maltreated.

Impact on safeguarding practice

Despite policymakers' recent efforts to encourage earlier intervention in tackling neglect, the findings from the LARC5 (Local Authority Research Consoritum) study (2013) suggest that this is not always filtering through to practice on the ground. Practitioners and families across nine English local authorities that took part in the study said more help needs to be offered to families early on, instead of waiting for problems to escalate as is currently the case. The researchers made a number of recommendations for improvements, including the need for frontline staff in universal services to have core skills to help develop and enhance relationships with families. This is because the effects of neglect at a young age can last into adolescence and adulthood, affecting a person's ability to form healthy relationships.

It is not uncommon for neglected children to suffer from a range of physical, emotional and developmental problems. Recent research by Adriana Schimmenti and Antonia Bifulco identified the scale of anxiety disorders in neglected children (see research study 3, p23).

For children at risk of being taken into care because their parents' problems have led to them being neglected, policymakers have been developing intensive interventions through specialist courts. The family drug and alcohol court aims to give parents with addiction problems a chance to tackle their substance misuse and form stronger bonds with their children. The intensive support offered through the courts is delivering encouraging results, with the proportion of children removed from the care of parents involved in the programmes lower than those going through the standard family court process.

Looked-after children who have suffered severe neglect and abuse are likely to have been left significantly scarred by their experience. Statutory guidance for local authorities and clinical commissioning groups on promoting the health and wellbeing of looked-after children emphasises the importance of assessing the emotional and behavioural needs of children in care and commissioning support services that can help address the problems caused by attachment disorders. Providers such as Mulberry Bush offer specialist therapy for looked-after children with severe behavioural problems and also help children on the edge of care form stronger bonds with birth parents (see case study, p28).

Other programmes, such as AMBIT, which is being developed in more than 80 councils, focus on building strong attachments between support workers and young people who have multiple problems linked to neglect in childhood.

The problems caused by poor attachment may also follow a child after they have been taken into care and adopted. Three in 100 adoptions break down, many because of the long-term damage caused by a child's early life experiences. Services such as the specialist child and adolescent mental health service for adopted children in East Sussex aim to help this group of young people work through problems and prevent breakdowns (see case study, p29). While policymakers have been keen to increase adoptions, the creation in 2015 of a specialist post-adoption support fund is recognition by government that children's problems do not disappear when they join a new permanent family.

The Children and Families Act 2014 also includes a range of measures, such as the right to 12 months of parenting leave and shared parenting, to help newly adopted children form strong attachments to adopters.

Looked-after children policy has also recently begun to reflect the need for children's services to tackle attachment disorders. Since 2014, all councils have had a virtual school headteacher in post responsible for overseeing the education of looked-after children and vulnerable young people. Virtual heads have prioritised improving recognition of attachment among teachers and schools (see box left), and been at the forefront of creating attachment-aware schools, which train teachers in attachment theory so they can tackle disruptive classroom behaviour by creating nurturing relationships with children. The model recognises that looked-after children's poor education outcomes will not be improved without being able to forge strong relationships with teachers, and a pilot delivered by Bath & North East Somerset and Stoke-on-Trent councils has already seen improvements in pupils' reading and maths ability, as well as a decrease in exclusions.

Advocates for greater recognition of attachment theory in children's services believe the publication in late 2015 of Nice (National Institute for Health and Care Excellence) guidelines on attachment in children and young people could prove pivotal. The guidelines recommend that all children and young people and their parents or carers get equal access to interventions for attachment difficulties. It calls specifically for service providers to assess attachment difficulties in children and young people in all health and social care settings, to ensure that professionals working with children, including those on the edge of care, are trained in recognising attachment difficulties, the social factors that can lead to attachment difficulties and knowing when and how to refer children for evidence-based interventions. In addition, it recommends the use of video feedback programmes for parents and foster carers of under-fives, as well as the support that should be provided to special guardians and adoptive parents of school-age children.

With the likely rise in the number of neglected children coming to the attention of children's services departments, the Nice guidance could be instrumental in ensuring those that have suffered attachment difficulties get the support they need.



Neglect, attachment and our professional responses

By Alison O'Sullivan, former president, Association of Directors of Children's Services

Maltreatment by primary care givers is one of the main contributors to attachment difficulties in children and young people but what if that caregiver was themselves neglected and is unable to provide the most basic levels of support?

A significant body of research shows that a child's ability to form relationships and to learn is shaped by their early experiences - those struggling with attachment are more likely to misbehave, underachieve in school or even be excluded, meaning that they may not fulfil their potential as adults, either in employment or relationships.

It is a complex picture and we know that good attachments can help children and young people feel safe and secure, and that negative early experiences can have a long-lasting impact on development.

That is why a growing number of local authorities are putting better relationships at the heart of the design and delivery of services to children and young people.

By integrating youth support services, for example, young people can access help and advice on issues from employment and substance misuse to mental health services from a single or smaller number of key workers.

Trusted adults can play a key role in the lives of adolescents and we need to help our social workers, youth offending teams and virtual school heads to develop the skills and creative responses to grow and sustain authentic relationships.

Too often, we find ourselves dealing with individual episodes or shoehorning the responses we make into frameworks that were not designed with the specific needs of adolescents in mind.

Previous research ADCS has collaborated on highlighted how issues such as neglect as well as missing episodes, exploitation and offending behaviours are often thought of separately, not together.

Considering all of these vulnerabilities in the round and involving young people, and where appropriate their parents, in our professional responses can increase their resilience to life events and change.

These young people are the next generation of parents, so we have a duty to get this right now, for their benefit and that of the children of tomorrow.

The latest iteration of our regular Safeguarding Pressures research shows that neglect continues to be the most common category of abuse cited in child protection plans, and three-quarters of respondents reported changes in needs or demands on services for 16- and 17-year-olds.

Sadly, I suspect this trend will be maintained when the fifth iteration of this research is published later this year.

Attachment-aware schools can boost achievements

By Tony Clifford, head of the Virtual School for Children in Care, Stoke-on-Trent

I remember, as head of a special school, peeling back the layers in the tragic story of a young person with multiple school and care placement breakdowns and finding that the pattern of this young person's behaviour was the same at 15, as it had been when he was first permanently excluded at the age of five. In that time, no one had got to grips with it.

At the heart of that pattern was the damaged attachment to birth parents, the domestic violence and trauma that it had created, and the lack of capacity and understanding from adults around him to contain these issues.

Virtual Headteachers for Children in Care, a statutory post in local authorities since 2014, recognise that a key part of their role is to ensure that schools and other education settings understand the unmet attachment needs and childhood trauma that affect the learning of children in care and many others.

The term "attachment-aware schools" is used to encompass a range of programmes to support this critical work and the education settings that take these approaches on board.

Developing secure attachment and successful learning are inextricably linked.

Great teaching often involves attachment, such as relationships between teacher and pupils: the teacher and class co-operating to build their understanding of the world.

We know that not all children, and for that matter not all the adults working with them, find this "brain-building" process easy and that is why in the face of the challenge of being in the classroom and learning, some go into a state of "fight, flight or freeze".

Attachment is at the core of learning and it needs to be built into the whole school's learning approach and into teacher training, so we reduce the worrying dropout rate of new teachers. The good news is that "attachment-aware" approaches work well for children in care and for the estimated 40 per cent of children who will find the experience of learning difficult because of unmet attachment needs and childhood trauma and they are also great for learning in general.

This is a "hearts and minds" issue: as well as advocating for the individual child, we know we need to produce clear evidence that using a school's resources to address attachment issues makes a difference.

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