Professor Carlo Schuengel opened his CEDAR seminar series talk by reflecting on the pandemic and what a special time it is to be talking about relationships. It has shown us how we as humans are affected when relationships are as constrained as they have been this past year and has highlighted the undeniable importance of relationship quality on wellbeing. The central focus of the talk surrounded attachment theory (Bowlby 1969; Ainsworth et al. 1978), and questions about what we have learned from the substantial body of research and some initiatives that have developed from this theory. He specifically focussed on the lessons learned and how we can make better use of our learning to be more useful for families, professionals and policy makers for the future.
Research has confirmed the universal importance of parent-child relationships for children and their families optimal socio-emotional functioning, and has focussed in on the study of relationships for cohorts representing a diversity of individual differences (typical and atypical development) within society and what these differences might mean for development. However, the use of research for families is still scant.
Professor Schuengel brought to the audience’s attention, the United Nations 2030 agenda for sustainable development and the Sustainable Development Goals, contained there-in, that aim by 2030 to ‘Leave no one behind’. The agenda and goals make a commitment to reaching the world’s most marginalised people amongst other important goals for the health of the planet. Children with developmental disabilities are an important part of this agenda, and must not be forgotten. Particular focus on this group is of paramount importance, because they are at a disadvantage for many of the development goals, as highlighted in the UN Flagship Report on Sustainable Development Goals and persons with Disabilities.
He went on to ask the question, ‘What can we do, as scientists, professionals and non-governmental organisations (NGOs) to work towards this agenda – what targets should we address?’. The Nurturing Care Framework for Early Child Development provides a roadmap for ensuring attainment of the Sustainable Development Goals and Survive, Thrive and Transform goals of the Global Strategy on Women’s, Children’s and Adolescents’ Health 2016-2030. Parental nurturing care is highlighted to be of particular importance for child development and overcoming adversity. Nurturing care is considered to comprise of five components: good health, adequate nutrition, safety and security, responsive caregiving and opportunities for learning.
It was stressed that it is important to think about where families are and what specific challenges they face. What help is already there and what else do children need to thrive and develop? How can we promote responsive caregiving particularly for families of disabled children and making nurturing care easier for these families to provide? The Nurturing Care Framework outlines that parents are most able to provide nurturing care when they are secure – emotionally, financially and socially. And stresses that ‘caregivers need to be able to participate in social networks, be empowered to make decisions in the best interest of their child and receive affirmation about the important role they play in their children’s lives’ (p 12).
Professsor Schuengel highlighted the importance of caregivers being encouraged to take care of themselves so they can take good care of their child, and how much of an issue this is for families of disabled children. Three messages of particular importance emerged from this talk for families of disabled children 1) support parents to take care of themselves, 2) be supportive, and 3) don’t put them under stress.
When reflecting on these messages, I believe that most professionals with disability related expertise intrinsically know these points are of paramount importance for the health and well-being of disabled children and their families. It is frustrating to see these messages are not at the forefront of the guidance provided for statutory support services for disabled children and their families in the UK. Current usual practice within some statutory services has created a culture in which the exact opposite of ‘support’ often occurs, creating stressful experiences for already disadvantaged families. The hard hitting report recently published by Cerebra ‘institutionalising parent carer blame’, lays bare the problems families have been facing when trying to access the support they are entitled to for their child and family. Parents need to be supported to expend their energies on providing the nurturing care that is so crucial for their disabled child’s development, rather than battling services that are meant to be there to ‘help’. It is clear that better guidance, resources and training more fit for purpose must be provided for the sector to turn things around and earn the trust of these families. The support they are entitled to must be provided in a straightforward way.
Science Mapping Analyses – Understanding the Impact of Research in Different Areas of Developmental Science
Professor Schuengel moved on to talk about recent science mapping analysis studies undertaken in the field. The first study was a bibliographic mapping exercise focusing on the impact of attachment research on the wider literature, and how it feeds different areas of developmental science. There is a move away from attachment research that focussed on attachment theory and an increase in uptake in the intervention field, which is positive. Click here to read the study.
He discussed a science mapping study undertaken with researchers, from the University of Warwick here in the UK, focussing on the impact of research about the early development of children with an intellectual disability. The study found that publications have increasingly mentioned parents and parenting stress. Research is now focussing more on the immediate social context of children. Click here to read the study.
Professor Schuengel then talked about the timing of social intervention – ‘The earlier the better?’ or ‘never too late?’. Early intervention is promoted, as it is believed that the return on investment will be greater, addressing the issues later in life is proposed to be more difficult and the investment can be well justified earlier in life. However, he suggested that The Heckman Curve this is based upon is not borne out by the data for children with developmental disabilities. Research shows a wide range of benefits across ages. He suggested that perhaps the 5-15-year age group show slightly greater benefits, but not dramatic differences depending on age of intervention as the Heckman graph suggests.
Been there, done that!
It was highlighted that interventions focussing on early parental sensitivity and effects on child behaviour problems have unfortunately not yielded great effects. The interventions are based on attachment theory and in theory should achieve good results, however, this isn’t often the case.
It was explained that developmental scientists seem on the face of things to be discussing the same thing (attachment) but actually it is much more complicated. He highlighted a very informative book by Robbie Duschinsky, on the subject, titled ‘Cornerstones of attachment research’, that is free to download. This author and colleagues have also written a Journal publication that provides an overview of the typification of differences in conceptualisations of the term ‘attachment’: 1). Popular, 2). Developmental Science, 3). Psychotherapy, 4). Social Psychology, 5). Psychological diagnosis, 6). Table 1 within the publication describes examples of each, click here to read the study. Therefore, what professionals do with the term ‘attachment’, may mean different things to them and they might have different goals when using the term. In a nutshell, there is a lot of confusion about the term ‘attachment’ for this reason. Professor Schuengel noted that Bowlby and Ainsworth may have regretted using the term ‘attachment’ at all when conceptualising the theory as it elicits many associations. It is now very difficult to change the term into something that can be used in a more scientifically meaningful way. Clarifying the meaning is difficult and when trying to clarify, it is easy to cause more confusion! He stressed that this really matters if decisions are being made on the basis of these concepts.
Professor Schuengel then spoke about some different arenas that attachment theory has been used:
Attachment goes to court!
In child protection cases, attachment theory has given an understanding of important issues (despite complexities raised), including 3 principles 1. Safe havens are important growing up. 2. Children should be safe, care should be continuous and at the least good enough. 3. Child welfare should maintain existing safe havens if they do not pose a threat. Professor Schuengel stated some advice for the courts regarding the use of attachment principles, including that assessments of attachment are not the best idea as they lack validation (if they are used, should only be from a formally trained observer). Also, there is no evidence that decisions and interventions based on attachment principles lead to better outcomes in this scenario. The courts should not distinguish the quality of the relationship with the parent from the sensitivity of the parent. They are related but it is not a perfect relationship. Attachment quality (e.g. insecure attachment), does not indicate quality of parent-child relationship. And one off behaviours of children do not reliably indicate attachment quality. Evidence should always be gathered directly from experts.
Attachment goes to social care for people with intellectual disabilities
Professor Schuengel noted that there is no research about the use of attachment principles in social care. However, from his experience he noted that the 3 principles mentioned above are as important in social care issues as in court scenarios. For example, removing a child from the care of a parent with an intellectual disability is very risky without evidence of abusive care. Supporting parents with intellectual disabilities to take care of their own children should be the focus, for example, supporting the creation of a network of attachment relationships. Social care services primary focus should be to reduce stress rather than be a stressor in the families’ life.
Research was then described that provides evidence that it really does matter whether comfort is provided by parents rather than a stranger in children with severe or profound intellectual disabilities when regulating emotional response to stress. Click here to read the abstract of the study.
An additional study was discussed that shows the collateral damage for those with intellectual disabilities during the pandemic, especially those living away from their safe havens and attachment figures. These individuals might not always be able to use the phone or other methods of virtual social contact to keep in touch with caregivers. Therefore, special provisions may be necessary to facilitate this and prevent feelings of loneliness. Click here to read the study.
He offered 8 pieces of advice for social care for individuals with intellectual disabilities, similar to the advice for the courts with some adaptations. Four additions included the benefits of creating a network of attachment relationships as this can help families to share the load, when caring for a disabled child. Respite care is not inherently harmful for the relationship. Consider and reduce carer stress and exhaustion. Also address and reduce exposure to violence and abuse (especially in group settings). He added that professional care should be a collaborative relationship with the family to encourage reflection on their relationship with their child, with professional advice based upon what the parent is trying to achieve in the parent-child relationship, without offering a quick fix.
Goldilocks problems (in attachment research field)
Goldilocks problems are devised in order to bring about more use-inspired research that has not been prioritised historically due to the complex nature of social problems that are often multifaceted and solutions have often been difficult to evaluate. Watts et al (2017) published ‘Should the social sciences field be more solution orientated?’ and introduced the concept of Goldilocks problems. Click here to read the study.
Professor Schuengel ended his seminar discussing some goldilocks problems he and colleagues have devised when thinking about the attachment field, considering ‘what societal problems are difficult enough to advance the theory and methods, but not too difficult, so are amenable to incremental progress using our existing theoretical and empirical tools?’ They include 1. implementation of intervention components to increase responsive care, 2. development of culturally valid indicators of responsive care, 3. responsive caregiving within networks of formal and informal caregivers, 4. developing brief assessment and decision making protocols, 5. joining guideline development, 6. Establishing effective collaboration with stakeholders. Click here to read more in the study. More focus on use-inspired research may lead to better evidence of effectiveness and be better perceived than research that focusses solely on theory that only researchers with extensive training may understand. He stressed that the problems tackled should be driven by the people they affect.
Professor Carlo Schuengel is a Professor at Vrije Universiteit Amsterdam, in the Faculty of Behaviour and Movement Sciences, Clinical Child and Family Studies.
Jane Margetson is a Research Officer at the charity Cerebra and part-time PhD student at the University of Warwick.