Suffering in silence


How can we help troubled children who seem to be fine?

When most people think about attachment disorder they think about angry children; these are the ones who are aggressive, attention seeking and controlling. This is certainly one side of attachment disorder, but there are also other ways that these children can present themselves, some of which can make it almost impossible to spot that anything is wrong.

Attachment disorder occurs in children who have not had their needs met as babies. Children who are in the care system, are adopted and those who have suffered abuse and neglect are particularly at risk.

Attachment refers to how a child’s early needs were met, or not, and the specific responses a child develops based on this. For example, children who experience good care will believe they are worthwhile, wanted, and lovable, and their caregivers are trustworthy. However, children who experience poor care will believe they are bad, worthless and unlovable, and that their caregivers are untrustworthy.

Children will develop an attachment style depending on the type of care they received as infants. There are four different types of attachment styles, one secure and three types of insecure. These are typically characterised by the following types of beliefs and behaviours.

Secure attachment
These are typically well grounded children, keen to interact with adults and peers alike, who feel happy that the world is a good place. When upset, they will seek comfort from their primary caregiver and feel confident that they will receive this.

Ambivalent insecure attachment
These children do not trust that adults will keep them safe and therefore show attention seeking behaviours to ensure they are noticed and their needs are met. They will feel unable to depend on their caregiver when upset or frightened.

Avoidant insecure attachment
Often quiet and unassuming, these children typically appear well behaved and compliant. They do not believe that adults can keep them safe so avoid having to rely on them whenever possible.

Disorganised insecure attachment
These children can show very confusing and extreme behaviour with little pattern. They often have a “push/pull” approach to caregivers with the feelings of “I need you but I can’t cope with you”.

Hidden problems

Children who exhibit ambivalent and disorganised attachment styles are often the children people will know and remember. Their loud, hyperactive and attention seeking behaviours can quickly become a cause for concern due to the disruptive impact this can have within learning environments. These children want to be noticed and often this aim is achieved.

However, when it comes to children with avoidant attachment, the situation is often very different. They are the children that no-one really notices. They are the ones who suffer in silence.

It is very common for children with avoidant attachment issues to slip under the radar, particularly within school settings. Understandably, many professionals will believe that the behaviour they are seeing on the surface means that the child must be alright. I often hear phrases such as “We don’t have any children like that at this school” or “Despite all the abuse and frequent care moves, John is fine and his behaviour is great”. However, for many of these children, far from being “fine”, they are actually storing immense feelings of fear, hurt and rage. These children have a deep-rooted mistrust of adults and will hide their feelings at all costs. The fact that any issues are not being noticed is exactly what they are aiming for.

As well as learning the right phrases to keep adults at a distance, such as “I’m okay” or “yes, I’m fine”, children with an avoidant attachment style may show some of the following signs:

  • poor eye contact
  • little reaction to praise or punishments
  • no preference for familiar adults
  • an inability to express emotions such as anger or joy
  • avoiding interaction with others
  • interaction that feels empty or fake
  • does not pester adults for things they want, such as toys, sweets or games
  • a lack of cause/effect thinking
  • frequently complaining of feeling ill
  • freezing or becoming tearful when feeling out of control, but unable to explain why
  • a smile or laugh that lacks genuine expression
  • low self-esteem
  • poor short-term memory
  • poor organisation skills
  • having pupils that are frequently dilated.

Due to the very subtle nature of many of these signs it can be very confusing to support a child with an avoidant attachment style. There is little doubt that this role requires patience and empathy. Some might say that you even need to be a mind-reader!

Supporting those with avoidant attachment styles

It should also be remembered that children with an avoidant attachment style are not waiting to be helped or “rescued”. In fact, these children, like most with attachment difficulties, will be bizarrely comfortable with the strategies they have developed for surviving in what to them will feel like a very scary world – and will rarely give them up easily.

Below are some ideas for strategies that can be used for supporting children with avoidant attachment styles:

Routine can help build a sense of security and familiarity for children who are dealing with anxiety. Use visual schedules and reminders wherever possible to reinforce these routines and try to give as much notice as possible for any changes that will be happening. Ensure that parents/carers are kept fully informed of any changes.

Thinking out loud
Thinking out loud about the child’s behaviour can help them recognise the feelings they may be having and give them the message that it is OK to have and express their feelings. For example, you might say: “I think you might be worried about going into assembly today because we have singing practice. I think I will ask Ms Smith to sit next to you so she can help you if you feel worried”. Or you might say: “I’ve noticed you look sad whenever I say it is time for numeracy. It’s okay to feel sad sometimes.” It should be remembered that these are comments, and not questions, so do not expect a response as this can add pressure to their already anxious state.

Reducing verbal language 
Children with avoidant attachment styles are often described as not wanting to ask for help, whereas the reality is that they can’t ask for help because they are unaware they have a need to be met. Asking a child what is wrong, what is worrying them or if they are OK will not work in this case. As well as the thinking out loud technique described above, also try to give them other means to communicate, such as using pictures to point at to choose what activity they want to do, or having visual emotions pictures they can use. A book for yourself and the child to write comments in can also encourage gentle two-way communication.By the adult writing occasional short comments – such as “I liked the new pencil case you had today” or “I noticed that you ate an apple today for lunch today. I like pears, what about you?” – can gently encourage responses from the child but without high expectation or pressure. Try using this method rather than a “feelings diary”, which can put pressure on to think of and describe feelings that they may not have the language or understanding for.

Using comments books, you could, for example ask them to name their funniest moment or favourite food eaten that week. In addition, you could use fun questionnaires to find out information such as what they enjoyed watching on TV last night.

Rethinking rewards and sanctions 
Traditional behaviour approaches focus quite clearly on rewards and sanctions. Children with an avoidant attachment style will be unlikely to show many unwanted behaviours, meaning sanctions will rarely be required. However, it is also unlikely you will see many praiseworthy behaviours either. Instead, a “middle of the road” approach ensures that the child stands out for neither good, nor bad behaviour. Therefore, trying to use traditional behaviour strategies such as reward charts will rarely prove successful.

Children who have missed out on vital care as infants will have poorly developed cause and effect thinking skills. This means that they will struggle to understand many of the common reward systems that are used in schools. Rather than becoming a structured form of praise or punishment, such techniques can instead become a source of confusion which reinforces a child’s view of themselves as bad and unworthy.

Instead, try talking through any changes in positive or negative behaviour, explaining why this has been a good or bad thing. Help the child to come up with a solution which is linked to what they did; for example, if they ripped a page out of a book, they could help to stick this back together. If they did a good piece of numeracy work they could choose a sticker to either wear or take home to show their parent/carer.

Try to avoid over-the-top praise as this can again cause confusion and create a conflict in terms of what you are telling them they are (for example, good) and how they see themselves (bad). Low-key praise such as a thumbs up, sticker left in their tray or certificates that get sent home (instead of given out in assembly) may work better.

Working as a team

A common behaviour pattern seen in children with avoidant attachment is that they will appear happy and content whilst at school, but then have meltdowns as soon as they get home.

Situations such as this can be a common factor in communication breakdown between parents/carers and school staff. It should be remembered that a child’s change in behaviour is not a reflection on any particular person or environment but could be about transition, storing up fear for long periods of time and general confusion about day-to-day events.

Communication is vitally important in these cases. Parents/carers and school staff need to work together to identify trigger points; for example, if the child always has a meltdown on a Wednesday evening after school, could this be linked to the fact that this is when their teacher has planning, preparation and assessment time?

Use a home/school diary to share information and discuss any day-to-day issues, but plan regular meetings to talk about bigger issues and discuss strategies. Also try to give the child an opportunity to air any worries before going home. Five minutes to talk through an issue that happened on the playground at lunchtime could help to avoid a two-hour tantrum when the child gets home. Parents or carers can do the same before bringing a child to school in a morning.

Ongoing learning and development

Due to the nature of avoidant attachment, it is often parents/carers who first notice that their child is having difficulties. They can often become upset or frustrated when they think professionals are not supporting their child. Acknowledge a parent/carers concerns and be honest with them about how the child behaves within school. It is important to remember that just because you do not see any issues within school, it does not mean there aren’t any.

Try to increase your own knowledge of attachment by reading books and attending training courses.

There is no doubt that trying to put strategies in place for a child with an avoidant attachment can be difficult. A child who is unable to express their feelings will not be able to tell you what might help them, and even when strategies are put in place they may appear quite unresponsive to them for some time. My advice to this is simple: do it anyway. Providing additional emotional support, security and nurture will not cause any harm to children, but not providing these could do.

Further information

Jennifer Jones is the adoptive mother of three children and has many years of experience working with children in the education and health sectors. Jennifer is a panel member for a number of adoption boards and she is the founder of Inspired Foundations, which supports those living or working with looked-after, adopted and vulnerable children:

Jennifer Jones
Author: Jennifer Jones

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