Title: thepresentationpeople.com
1Child Protection and Social Work What Needs to
Change? Professor David Shemmings
2 the critical aspect of social work practice
- concerns the assessment of risk
- 350 Serious Case Reviews (over 4 years)
- Most cases were too complex for serious injury
and death to be predictable - Children who were abused usually become abusers
(?) - Analogy with flu
3new developments in attachment theory offer
another lens
4Strange Situation
5strange situation
- Provides information about
- An infant's confidence in the availability and
responsiveness of a primary caregiver - The way that caregiver is used as a secure base
from which to explore and as a haven of safety - what Howard Steele refers to as our ability to
know that we are heard, seen, held and
understood
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8Unclassified behaviours Hesse and Main (2000)
- Unclassifiable infants exhibited inexplicable,
odd, disorganised, disoriented, or overtly
conflictual behaviours in the parents presence - For example (dont panic!)
- Moving away from the parent to the wall when
apparently frightened by the stranger - Screaming by the door upon separation from the
parent and then moving silently away upon reunion - Raising hand to mouth in an apprehensive gesture
immediately upon seeing the parent - While in an apparently good mood, swiping at the
parents face with a trance-like expression
9Darwins experiment
10DA - fear without solution
- Bowlby in a letter to his wife, Ursula on 3 May
1958 - Most people think of fear as running away from
something. But there is another side to it. We
run TO someone, usually a person Its
screamingly obvious, but I believe it to be a new
idea, and quite revolutionary - When frightened, animals go to a place whereas
humans go to people - Child showing DA is frightened by its haven of
safety inexplicably afraid and unable to do
anything about it - Effect of abuse and neglect on the mind
- unloveable? (chronically unloved)
11What is known about DA? Hesse and Main (2000)
- About 77 of D children experienced abuse and/or
neglect - Cortisol levels of D infants significantly higher
in Strange Situation procedure - Meta-analytic review of 13 studies of
neurologically normal infants - no relation between difficult temperament, or
even severe health problems, and DA - DA observed in low risk groups (c15)- almost
always connected with the infant being frightened
by - or of - the parent in very bizarre ways
12frightening, frightened and anomalous parental
behaviour non-risk groups
- Predatory stalking, creeping silent (cat-like),
mauling, teeth-baring (remember to an infant
and not playfully) - Child pushing toy car
- Mother screams OH NO, theres gonna have an
accident everyones gonna get KILLED - Backing away while stammering in an unusual and
frightening voice - D-dont follow me, d-dont
- Another parent jerked her head away with an
extremely fearful grimace, and with her eyes wide
open, when the infant reached out to pat her face
in an exploratory manner
13frightening, frightened and anomalous parental
behaviour non-risk groups
- Changing very quickly into normal voice mode
- Accompanying dissociation
- All of the above parental behaviours were
strongly associated with unresolved loss in the
adult and D classified infants/children - Repeating what we cant remember
14example of unresolved loss
- Immediately upon being asked about loss, one
woman responded Yes, there was a little man
and then began to cry. The person lost was an
elderly workman who had been employed briefly by
her parents when she was eight years old.
Jokingly, he had asked her to marry him when she
grew up, and she replied No youd be dead. - killed him with one sentence (unmonitored)
- Own child coded D
15To recap Hesse and Main (2000)
- DA may appear not only as a result of an infants
traumatic experience of maltreatment, but also as
a second generation effect of more subtle
behaviours resulting from the parents own
frightened or frightening memories of trauma - 77/15 (possible overlap)
- Virtually impossible to coach a child
- Risk factor for developing severe psychological
problems later
16Assessment of Disorganised Attachment and
Maltreatment (ADAM) Project
- Three London boroughs
- Enfield, Lewisham and Merton
- Exploring how these methods and ideas translate
into social work practice in child protection - PhD scholar (Patricia Ruiz de Azua)
- New Book (Jessica Kingsley, Jan 2010)
- New MA in Advanced Social Work with Children and
Families (2010)
17The ADAM Project Methods
- Naturally-occurring observable behaviours (all
ages) - Troubled reunion behaviour when an abusing
caregiver leaves the child for a short period and
then returns (c.12-36 months) - Story-stem completion tasks and analysis of
picture response attachment-related drawings
(c.4-9 years) - The Child Attachment Interview (c.8-15 years)
- The Adult Attachment Interview (adults and
caregivers) - Infants (i.e. below 12 months)
- Assessment of Parental Sensitivity
18Use of story-stem completion tasks and analysis
of picture response attachment-related drawings
(c.4-9 years)
- Babysitter Stem
- Examples of narratives shown a photo of a
parent-child separation - Catastrophic fantasies
- Probably gonna lock himself up (lock himself
up?) Yeah, probably in his room (then what will
he do?) Probably kill himself - Disorganisation in language
- Happy (whats he happy about?) Cos he likes his
grandfather coming (child jumps on back of
stuffed animal and hits it) Bad lion! (hits it
more) Bad lion!
19evidence base 1Van IJzendoorn et al (1999)
- Meta-analysis of nearly 80 studies involving more
than 6000 infant-parent pairs. - Established the reliability, and the discriminant
and predictive validity, of disorganised
attachment (DA) - Although DA is necessarily difficult to observe
and often subtle, many researchers have managed
to become reliable coders
20evidence base 2 - molecular genetics
Bakermans-Kranenburg and Van IJzendoorn (2008)
- (Early G-E interactions - non zero-sum)
- e.g. irritable infants can develop a different
emotional profile at 9 months and secure
attachment by 12 months - Connected to Jay Belskys (2008) notion of
differential susceptibility within
gene-environment (G-E) interactions - Leads to more negative outcomes for susceptible
children in unfavourable environments - but also positive outcomes for susceptible
children in favourable environments - Serotonin transporter (5-HTT) and oxytocin
receptor (OXTR) genes explains some of the
differences in sensitive parenting
21evidence base 2 - molecular genetics Van
IJzendoorn and Bakermans-Kranenburg (2006)
- Insensitive parenting and unresolved loss or
trauma are moderated by the dopamine DRD4 gene
receptor but frightening and anomalous
parenting isnt - Again, children are differentially susceptible to
unresolved loss or trauma dependent on the
presence of the DRD4 gene - Increase in externalising behaviours in children
with the DRD4 gene receptor exposed to
insensitive care, compared to children without
combined risks, was sixfold
22evidence base 3 - connectionsMadigan et al
(2006) mediational pathway (play without toys)
NB - satisfies all four of Baron and Kennys
conditions for mediation
23Finally, is early intervention effective?Bakerman
s-Kranenburg, M.J., Van IJzendoorn, M.H.,
Juffer, F. (2003)
- Meta-analysis
- 70 studies traced
- 88 intervention effects on sensitivity (n7,636)
and/or attachment (n1,503). - Randomized interventions effective in changing
- insensitive parenting (d0.33)
- infant attachment insecurity (d0.20).
- Interventions more effective in enhancing
parental sensitivity were also more effective in
enhancing attachment security, which supports the
notion of a causal role of sensitivity in shaping
attachment. - Most effective interventions used moderate number
of sessions and clear focus in families with (and
without) multiple problems.
24Child Protection and Social Work What Needs to
Change?
- Email
- d.shemmings_at_kent.ac.uk
- Website
- http//www.kent.ac.uk/sspssr/staff/academic/shemmi
ngs.html
25references
- Bakermans-Kranenburg, M.J., Van IJzendoorn, M.H.,
Juffer, F. (2003). - Bakermans-Kranenburg, M.J van IJzendoorn, M.H,
(2008) Oxytocin receptor (OXTR) and serotonin
transporter (5-HTT) genes associated with
observed parenting, Social Cognitive and
Affective Neuroscience 3(2)128-134 - Belsky, J. (2008). Origins of Attachment
Security Differential Susceptibility or Genetic
Vulnerability? Attachment Current Focus and
Future Directions. ACAMH Occasional Papers
Series, Number 29. London ACAMH. - Brandon, M., Belderson, P., Warren, C., Howe, D.,
Gardner, R., Dodsworth, J. Black, J (2008),
Analysing child deaths and serious injury through
abuse and neglect what can we learn? A biennial
analysis of serious case reviews
20032005http//www.childdeathreview.org/Reports/
7444DCSFAnalysingChildDeaths.pdf Research Report
DCSF-RR023 - Hesse, E. Main, M. (2000) Disorganized infant,
child and adult attachment Collapse in
behavioral and attentional strategies. Journal of
the American Psychoanalytic Association, 48,
1097-1127. - Madigan, S., Moran, G. Pederson, D.R. (2006)
Unresolved states of mind, disorganized
attachment relationships, and disrupted
interactions of adolescent mothers and their
infants Developmental Psychology, 42, 293304. - Van IJzendoorn, M. H., Schuengel, C. Bakermans-
Kranenburg, M.J. (1999) Disorganized attachment
in early childhood Meta-analysis of precursors,
concomitants and sequelae. Development and
Psychopathology, 11 225-250. - Van IJzendoorn. M. H. Bakermans-Kranenburg, M.
J. (2006). DRD4 7-repeat polymorphism moderates
the association between maternal unresolved loss
or trauma and infant disorganization. Attachment
and Human Development, 8, 291-307.