The impact of disrupted attachment on

the emotional and interpersonal

development of looked after children
Jose Scott
That we are born with the ability to interact socially with the world around us is an accepted fact. Decades
of research posit the first 18 months to two years of a childs life as being critical for further development
and honing of these skills. Ultimately, human beings are social animals, and if this early development is
compromised the consequences may be far-reaching and significant for the life both of the individual and
the carers. Maltreatment may represent one such compromise and the majority of children in foster care will
have experienced abuse or neglect in their family of origin. However, removing children at a time when
important tasks of attachment and bonding are taking place may impact detrimentally on their
developmental outcomes. This paper reviews the literature with regards to the impact disrupted attachment
may have upon the emotional and interpersonal development of looked after children. Issues arise in
determining the effects of exposure to adversity prior to becoming looked after and negative experiences
whilst in foster care. The factors affecting the development of looked after children are complex and involve
the interaction of many different variables across times and situations. Conclusions are drawn about the
current unsatisfactory state of the care system as regards the emotional well-being of its charges, and the role
applied psychology can play in providing and informing interventions to support all those involved.

HILDREN in foster care are at heightened risk for a range of poor psychosocial outcomes including emotional
and interpersonal difficulties (Department
for Children, Schools and Families, 2009).
Research interest is increasing regarding the
reasons for this and suggestions include the
impact of pre-care adverse experiences (for
example, Sempik et al., 2008), and adverse
experiences within the care system itself (for
example, Ward, 2009). Investigation is
complicated by a lack of prospective longitudinal studies and inherent confounding variables such as the level of ongoing contact with
members of the family of origin (Schofield &
Beek, 2005), and the age of entry to the care
system (McAuley & Davis, 2009).
Government statistics relating to England
for year ending 31 March 2009 recorded
60,900 children as being in the care of local
authorities (Department for Education,
2010), commonly referred to as looked after
children. These are young people for whom
the local authority shares or has exclusive

Educational & Child Psychology Vol. 28 No. 3

The British Psychological Society, 2011

parental responsibility as a result of their

birth parents being unable to provide
ongoing, satisfactory care in either a temporary or permanent capacity (Rocco-Briggs,
2008). This responsibility is administered
through the foster care system, designed to
ameliorate adverse family and environmental conditions that may interfere with
typical child development (Lawrence et al.,
2006). Its effectiveness as an intervention,
however, is the subject of controversy.
Evidence suggests removing children from
their family of origin is associated with negative developmental sequelae, which may
place them at risk for many short-term and
long-term psychological and behavioural
problems (Curtis et al., 1999).
Sixty-two per cent of children being
looked after by the state have experienced
neglect or abuse in the course of the parents
inability to provide good enough care
(McAuley & Davis, 2009). It is posited that by
removing these children they are being safeguarded, affording them a better chance of
31

Jose Scott
healthy development with new, protective
and emotionally available carers (Howe,
2006a). However, the consequent disruption
in the attachment bond between the child
and primary caregiver may have a detrimental impact on the childs developmental
outcomes. Therefore, an important research
question is whether the removal of a child
from their primary caregiver results in better
or worse outcomes than if that child were to
remain in adverse family and environmental
conditions.
How children react to being separated
from their primary caregiver has been a
topic of research interest for many decades,
originating in the studies of John Bowlby
and the early formations of attachment
theory (Bowlby, 1969/1982). There can be
little else (except perhaps the death of both
parents and even in these cases it is usual for
contact with other family members to
remain) which matches the separation
necessitated by being taken into care. On the
basis of attachment theory it may be argued
that any such disruption has the potential to
have a negative impact and research findings
have influenced many legislative moves over
the years toward the recognition that
children have emotional as well as physical
needs which, if not met, will substantially
affect their development (Department for
Children Schools and Families, 2009).
This paper considers the impact of
disrupted attachment on the emotional and
interpersonal development of looked after
children. The attachment literature in relation to developmental outcomes is outlined
and the legislative framework summarised.
Difficulties in differentiating effects of
disrupted attachment are discussed,
including the relative contributions of two
key periods exposure to adversity prior to
being looked after, and exposure to adverse
experiences while in foster care. Practice
implications are explored, conclusions drawn
as to the role of applied psychology in the
emotional and interpersonal development of
looked after children and suggestions made
about directions for further research.
32

Attachment
In addressing the issue of disrupted attachment, it is necessary to consider the term
attachment. Attachment theory developed
in the late 1950s with John Bowlbys interest
in the effects of separation and loss on
children (Bowlby, 1969/1982). Holmes
(1993), in summarising Bowlbys view of
attachment stated that in separating parent
from child a delicate mechanism has been
disrupted, a fundamental bond broken
linking one human being to another (p.62).
Bowlbys original questions, about the nature
of attachment and the mechanisms by which
it develops, still shape the direction of
research today, and attachment is recognised
as being fundamental to child development.
Another useful definition of attachment
was provided by Mary Ainsworth, working
alongside Bowlby in the 1950s, who defined
it as an affectional bond. The attachment
figure is described as unique and one which
is never wholly interchangeable with or
replaceable by another, although she
acknowledges one can be attached to more
than one person (Ainsworth, 1991, p.38).
This unique affectional bond is described
as: a relatively long-enduring tie in which
the partner is important as a unique individual, while inexplicable separation tends
to cause distress, and permanent loss would
cause grief (p.38).
An important determining variable in the
effect this separation will have is how the
child experiences it. Within the context of a
history of parental unavailability it is
commonly experienced as significant rejection or loss and the potential for problems in
adjusting and attaching to future caregivers
is substantial (Bowlby, 1969/1982). Therefore, although the attachment experiences
of looked after children are typically less
than optimal, separation from or the loss of
this primary caregiver may risk a detrimental
impact on the child. The quality of this
primary attachment has an important
bearing on the separation experience and it
is the pattern set by it which has been found
greatly to influence subsequent behaviour
Educational & Child Psychology Vol. 28 No. 3

The impact of disrupted attachment on the emotional and interpersonal development of looked after children
with other caregivers (for example, Howe,
2006b).
Patterns of attachment
Attachment pattern classification in children
is the culmination of decades of research
pioneered by Ainsworth. The development
of the Strange Situation (Ainsworth & Wittig,
1969), a laboratory-based procedure, facilitated translation of infant attachment behaviour into a standardised classification system.
This procedure is still the worldwide standard for defining childrens attachment
behaviour, and although exact terminology
for the resultant classification types has
varied over the years, the main types are:
secure, insecure (avoidant or anxious) and
disorganised (or controlling).
As Figure 1 illustrates, attachment behaviour can more usefully be seen as an internal
system tasked with maintaining the delicate
balance between two activities vital for
survival and development: exploration
(needed for learning), and proximity-seeking
of the caregiver (needed for protection).

In optimal environments this will enable

a secure attachment, with activation as
needed to promote proximity-seeking behaviour (for example, when hurt) until balance
is restored and exploration can recommence. However, exposure to less than
optimal environments (as depicted by the
bracketed elements of Figure 1) disrupts this
balance. In a world experienced as unsafe,
the system is repeatedly activated, prompting
proximity-seeking of the secure base, which
itself is experienced as frightening and reactivates the attachment system. The
resulting dilemma often leads to alternating
between proximity-seeking and withdrawal
in attempts to cope with an unpredictable
caregiver environment a disorganised
attachment pattern.
Disorganised attachment is the pattern
most associated with poor psychosocial
outcomes and is more prevalent in fostered
and adopted children (31 per cent
compared with 15 per cent of non-adopted:
Van den Dries et al., 2009). Conversely,
similar numbers of looked after children

Figure 1: The secure and disorganised (in brackets) attachment patterns

(adapted from Golding, 2008).

Educational & Child Psychology Vol. 28 No. 3

33

Jose Scott

Figure 2: Common Assessment Framework

(reproduced from Department for Children, Schools and Families, 2010).

show secure attachment, although both

fostered and adopted children compared
favourably with their institutionalised peers,
of whom 73 per cent were classified as disorganised and only 11 per cent as securely
attached (Van den Dries et al., 2009).
Further investigation is needed to explore
the complex interplay between risk and
protective factors for these groups of
children.
Predictive validity and stability of attachment
behaviour
Interest is growing in the role of attachment
patterns in long-term outcomes for looked
after children, and findings suggest early
intervention to prevent the development of
insecure and disorganised patterns may be
easier than later trying to alter maladaptive
34

patterns. Since attachment theory evolved in

the 1950s, predictive validity of early attachment behaviour has remained a controversial area of research. Two broad perspectives
have been proposed by Fraley (2002).The
prototype perspective supports the idea of
attachment classification being a stable characteristic, whilst the revisionist perspective
suggests it is malleable. Fraleys meta-analysis
reported moderate stability of attachment
from infancy to adulthood, leading him to
propose that attachment patterns are best
accounted for by prototype dynamics and
that there is an enduring tendency for
people to remain relatively close to their
original routes (p.142). Nevertheless, it was
recognised that individuals remain only as
stable as their environment. This highlights
the potential role of the environment in
Educational & Child Psychology Vol. 28 No. 3

The impact of disrupted attachment on the emotional and interpersonal development of looked after children
determining outcomes, a prominent and
ever-changing variable in the lives of looked
after children.
Predictive validity of attachment behaviour in relation to later social and emotional
functioning has also been evidenced with
positive associations found between secure
attachment and self-esteem, and classifications in infancy predicting level of socialemotional competence at 24 months,
3 years, and 8- to 9-years-old (Ranson &
Urichuk, 2008). In contrast, an earlier metaanalytic study found only small effect sizes
for the predictive validity of attachment classification
in
interpersonal
relations
(Schneider et al., 2001), perhaps highlighting the complexity of processes
involved. More agreement exists regarding
the association between attachment and
subsequent mental health problems. Insecurely attached children are more likely to
experience depression and anxiety disorders
as adults than their securely attached peers
(Mickelson, Kessler & Shaver, 1997), a
finding also replicated with looked after
children (Millward et al., 2006).
Overall the literature suggests that
disrupted attachment potentially has significant implications for the physical and mental
health of looked after children, with attachment being seen as predictive of general
long-term psychological well-being. This
serves to highlight the need for targeted
attachment-based interventions as early as
possible in the care process, but more
evidence from longitudinal studies is needed
to explore this.

Framework for the protection of child

welfare
Attachment is disrupted when the decision is
made to remove a child from the family of
origin. In England and Wales the Green
paper, Every Child Matters, laid out five priority
outcomes: being healthy; staying safe;
enjoying and achieving; making a positive
contribution; and achieving economic wellbeing (Department for Education and Skills,
2004), with a similar framework in Scotland
Educational & Child Psychology Vol. 28 No. 3

set out in Getting it Right for Every Child

(GIRFEC) (Scottish Executive, 2006).
A national Common Assessment Framework
(Department for Children, Schools and Families, 2010) has been established to facilitate
these outcomes for children identified as
being in need. Local authorities have a duty
to promote and safeguard the welfare of these
children in their area. Where significant
concerns exist, a complex procedure (see
Department for Children, Schools and Families, 2008, 2010) is put into action. Ultimately
this may result in the child being placed elsewhere (Department for Children Schools and
Families, 2010) and in these cases children
may be voluntarily looked after (with their
parents agreement) or the local authority
may apply for a court order to remove the
child. The main threshold condition to be
satisfied in cases of the latter is that the child
is suffering significant harm. However, the
meaning of this is not clearly defined in the
literature. Reference to the areas covered by
the Common Assessment Framework (Figure
2) gives some indication as to what an assessment of reasonable care might encompass.

Outcomes for looked after children

The rationale behind deciding to remove a
child from the family of origin is generally
well thought out and based on comprehensive assessment. Therefore it is expected that
an intervention of this magnitude would be
preferable for a childs social and emotional
developmental outcomes than would continuing to receive inadequate care from birth
parents. However, the literature regarding
this is inconclusive and outcome data
regarding care-leavers is not encouraging: 34
per cent leave school with no formal qualifications (GCSEs in England and Wales),
compared with 1.2 per cent of all children,
and only six per cent enter higher education,
compared with 39 per cent of the general
population (McAuley & Davis, 2009). Conclusive reasons for these differences are yet to be
established, but may include the impact of
foster care on subsequent emotional and
interpersonal development.
35

Jose Scott
The importance of attachment for
emotional development may be particularly
salient for looked after children as emotion
understanding and theory of mind are
linked to later social competence (Capage &
Watson, 2001) and to a secure attachment
between mother and child (Fonagy et al.,
1997). A comparative study found deficits in
these abilities for maltreated 3- to 5-year-old
looked after children compared with nonmaltreated children in the care of their
biological families (Pears & Fisher, 2005).
This is perhaps unsurprising. However, these
deficits were of a similar level to those previously found in maltreated children in
general (Smith & Walden, 1999), suggesting
that the attachment disruption inherent in
being taken into foster care had little additive impact for maltreated children in terms
of emotional development. Therefore, early
exposure to adversity may have the greatest
effect on long-term outcomes, over and
above that of disrupted attachment.
However, as the authors themselves
conclude, it is not possible to determine
from these results how much of this effect
results from maltreatment versus the experience of disrupted attachment and multiple
placements. Further research is needed.
Age at removal may also be important.
Optimal outcome has been associated with
placements made before one year of age
(McAuley & Davis, 2009) and it is perhaps
logical that the longer the duration of exposure to an adverse environment, the more
detrimental the impact. However, the age at
which the attachment process is disrupted
may also be critical. Between six and 18
months of age has been highlighted as a
period when neurological changes implicated in attachment are most easily influenced (see Gerhardt, 2004, for a
comprehensive overview of findings). Therefore, this neurological malleability may
afford younger placed children a developmental advantage in the opportunity to
attach satisfactorily to subsequent caregivers,
an advantage perhaps lost to older placed
children.
36

The impact of age at removal becomes

more significant with the current profile of
looked after children in Britain. Recent
statistics give an age range at entry to foster
care of birth to 18 years of age. However, the
largest proportion (41 per cent) were aged
between 10 and 15 years, and importantly
only five per cent were under one year of
age, while 21 per cent were 16 years or older,
17 per cent were aged between 5 and 9 years
and 16 per cent between one and four years
old (Department for Education, 2010). It is
likely, therefore, that the majority of
children in the foster care system will be
suffering from cumulative effects of both the
primary loss of their attachment figure and
many years of exposure to adversity. The
difficult situation this poses for researchers is
discussed next.

Early exposure to adversity

Investigation of variables affecting long-term
outcomes for looked after children, and,
therefore, the impact of disrupted attachment on their development, is complicated
by inherent difficulties in separating out the
effects of exposure to adversity prior to
becoming looked after. To address this, one
large-scale study looked at emotional and
behavioural difficulties of children and
young people at entry to care (Sempik et al.,
2008). Social work case files were retrospectively examined for 453 children from six
local authorities in the UK who had been in
care for at least one year. Inclusion criteria
relied on identification of a mental health or
behavioural problem of concern to a current
or previous carer. Case file notes were subsequently assessed by psychologists and prevalence rates compared with those of the
general population and those from a
previous study of the mental health of
looked after children (Table 1).
Prevalence rates for children at entry to
care far exceeded those of previous findings
and were over seven times higher than that
found in the general population. However,
in addition to factors in the methodology of
the study which may partially account for
Educational & Child Psychology Vol. 28 No. 3

The impact of disrupted attachment on the emotional and interpersonal development of looked after children

Table 1: The prevalence of mental and behavioural problems in 5- to 15-year-olds

in the general populationa, in those looked afterb, and at point of entry into care
or accommodationc.
General
populationa
%

Mental and behavioural disorder or problem

Looked after
childrenb
%

Looked after
childrenc
%

Emotional disorder/problem

12

23

Conduct disorder/problem

39

50

Any mental or behavioural disorder or problem

10

46

72

10,310

828

249

N
a

Meltzer et al., 2000; b Meltzer et al., 2003; c Sempik et al., 2008

Source: Sempik et al. (2008)

this, previous research had only identified

children with formal mental health diagnoses for inclusion (Meltzer et al., 2003),
whereas this study looked at a much wider
range of mental health difficulties. Nevertheless, the picture presented by Sempik and
colleagues may more accurately reflect the
real situation for looked after children and
their carers. In addition, as data represented
difficulties already present at the point of
entry to first care experience, findings
clearly reflected the impact of adverse experiences in the home environment as
opposed to experience of the care system
itself. However, it is impossible to determine
the extent to which the attachment disruption inherent in being taken into care might
contribute to any subsequent impact of
those adverse experiences on outcomes.
A potential solution to this problem can
be found in a Greek comparative study of
children in long-term residential group care
with a control group of children from twoparent families (Vorria et al., 1998).
Children taken into care as a result of financial difficulties, who had not experienced
adversity, were found to be at no higher risk
for emotional and behavioural difficulties
than the control group. In stark contrast was
the increased risk shown by children who
had experienced adversity (serious family
disruption) prior to being taken into care.
Both groups would have experienced attachEducational & Child Psychology Vol. 28 No. 3

ment disruptions by going into care and

these results again suggest the experience of
adversity had the greater effect on risk
factors.
All the evidence suggests looked after
children experience significantly heightened risks for developing behaviour problems. Experience of early adversity clearly
has an influence on this but the severity and
frequency of these problems has been found
to exceed considerably the norm for
children not looked after but with exposure
to similarly adverse backgrounds (Lawrence
et al., 2006). Therefore, it is also important
to examine the impact of entering and
remaining in foster care itself on these
already vulnerable children who are perhaps
less well-equipped to cope with such a difficult process.
Disrupted attachment and experiences whilst
in care
Although all looked after children will have
experienced attachment disruption, specific
exploration of the impact this may have on
subsequent care experiences is lacking.
More commonly addressed is the separation
of the relative contributions from pre-care
exposure to adversity and experiences whilst
in care. In one longitudinal study, the direct
effects of foster care on behaviour problems
were examined, over and above risks associated with baseline developmental adaptation
37

Jose Scott
and socioeconomic status, therefore
excluding effects attributable to pre-care
adversity (Lawrence et al., 2006). All
children and families were identified as
high-risk and divided into three subgroups:
children who entered the foster care system,
children who remained with a maltreating
caregiver in the family of origin and nonmaltreated children who lived with their
family of origin.
While pre-placement analyses found no
differences in behaviour problems between
the looked after children and maltreatment
groups, immediately following placement an
increase was exhibited by the looked after
children group. This increase was observed
again following departure from foster care
and significantly exceeded change in behaviour problems among those reared by
maltreating parental figures. Analysis of findings suggested an exacerbation of problem
behaviour in the context of foster care with
significantly raised levels during this time,
exceeding those of the maltreated and
control groups assessed during the same
developmental periods. Although both
looked after children and maltreated groups
showed similarly high levels of behaviour
problems in the longer term, it is difficult to
know whether these findings reflect the
influence of further exposure to risk factors
within the home environment, or the
lingering impact of historical foster care
placement
on
long-term
outcomes
(Lawrence et al., 2006).
The value of this study was in its comparison of looked after children with a sample
of children who were maltreated but
remained with their primary caregiver. An
attachment-based interpretation of these
findings is that a maltreating caregiver may
be preferable to the experience of an unfamiliar caregiver in foster care. The results of
a recent meta-analysis of attachment studies
suggest otherwise. Maltreated children in
high-risk families showed significantly more
disorganised and fewer secure attachments
than non-maltreated (but nonetheless highrisk) children (Cyr et al., 2010). Although no
38

comparison was made with children in foster

care, this provides further evidence of the
detrimental impact maltreatment has upon
attachment, and highlights the need for
intervention as early as possible. It is likely
that the combined risk experiences of
disrupted attachment and foster care
interact with protective factors to increase or
decrease the likelihood of a positive
outcome. Overall, it is again clear that more
large-scale longitudinal studies are needed.
The evidence suggests foster care significantly impacts on those who experience it,
particularly through an increase in behaviour problems that continues to be present
after leaving the system. It might be
expected, therefore, that key aspects of the
foster care experience may be related to the
development of such problems. However, no
such associations were found by Lawrence
and colleagues regarding variables such as
length of time in care, age of first placement
and risks associated with multiple placements (Lawrence et al., 2006). Similarly,
Pears and Fisher (2005) found no influence
of the number of transitions or the time
spent in foster care on the development of
understanding of emotion and theory of
mind abilities. However, before any influence of these variables can be ruled out, the
limitation of small sample size in the former
study needs to be considered, and given the
young age of the research sample in the
latter (and the relatively older age of
children in foster care), further exploration
is needed with children placed when they
are older.
An obviously important element of foster
care is the carers themselves, a role which
may mediate the impact of such a difficult
process on their foster child. Findings
showing that children exiting unrelated
foster care exhibited higher rates of internalising behaviour problems than those of
children exiting familiar kinship care
(Lawrence et al., 2006) suggest that so-called
kinship carers may represent a better
choice for placement, and this needs further
exploration. There is a potential role for
Educational & Child Psychology Vol. 28 No. 3

The impact of disrupted attachment on the emotional and interpersonal development of looked after children
attachment processes in that placement with
a familiar adult may attenuate the impact of
attachment disruption on subsequent developmental outcomes.
Other factors affecting outcome
Poor outcomes do not necessarily result for
every child exposed to maltreatment or
foster care and it is argued that the concept
of resilience is crucial (Rutter, 2000;
Schofield & Beek, 2005). Within the context
of child development resilience has been
defined as relative resistance to psychosocial
risk experiences (Rutter, 1999, p.119).
Research interest has shifted from identifying to promoting resilience in children.
Risk and protective factors interact in
complex ways for looked after children,
involving not only the child but also the
system around them. To explore why some
children make good progress in long-term
foster care while others continue to experience multiple developmental difficulties,
data from a longitudinal study of foster
children in the UK (The Growing Up in FosterCare study: Schofield et al., 2000) were
analysed to investigate the factors and
processes enhancing or threatening stability,
progress and resilience (Schofield & Beek,
2005). Three key areas identified as seemingly essential to positive development in
long-term foster care were a secure base
(reflected in behaviour and relationships in
the foster family), social functioning outside
the foster family and a sense of permanence
and belonging in the family. Dependent on
independently-rated level of success in these
areas, children were divided into three
groups as making good progress, uncertain progress or being in a downward
spiral. This last category included children
whose Phase 1 placements had ended and
who at Phase 2 were in temporary situations
and showing significant behavioural and
social difficulties. The good progress group
demonstrated progress in all three key areas,
and in particular an increased capacity to use
their foster carer as a secure base. The ability
to use a caregiver as a secure base is strongly
Educational & Child Psychology Vol. 28 No. 3

linked to secure attachment and has been

described as felt security (Rutter, 1999),
lending support to the influence of attachment processes for looked after children.
Consequently, these children demonstrated
more flexibility in thinking, feeling and
managing behaviour, thus enabling them to
gain more organised and less destructive
coping strategies (Schofield & Beek, 2005).
Not all children originally rated as making
good progress remained in this category,
some later moving into uncertain progress
and downward spiral.
A clear factor involved was the level of
professional support on offer. All of the
children with social worker contact defined
as regular (as opposed to minimal) were
in the good progress group at the second
phase. Conversely, the majority of children
in the other two, worse-faring, groups
reported an absence of an active and
supportive social worker. The social worker
potentially represented a stabilising figure in
an uncertain situation, both for the foster
parent and foster child. It was the reliability
and regularity of contact, not its frequency,
that facilitated joint working between the
foster carer and professionals.
Promotion of resilience in looked after
children is clearly important. All the children
in the above study were late-placed in foster
care, most had experienced maltreatment
and overall they were a high-risk group in
every respect. Nevertheless, only a small
number were rated as downward spiral at
follow-up. This serves to highlight the
complex and multi-systemic approach
needed when investigating outcomes for
children in foster care, with interactions
among child characteristics, systems and environments, across time and in the context of
the childs developmental stages. For
example, quality of attachment seems to
influence child resilience (Lieberman et al.,
2011) with insecure attachment found to be
a risk factor predictive of negative behavioural outcomes whilst secure attachment
operates as a resilience factor (Keller et al.,
2005). This further emphasises the impor39

Jose Scott
tance of pre-placement experiences, and
especially attachment, when considering
outcomes for looked after children. (For
further discussion of the risk and resilience
literature in general see, Luthar et al., 2000;
Masten, 2011.)

Practice implications
The majority of looked after children will
have experienced some form of maltreatment, a consequence of which is often disorganised attachment. Children classified as
having this attachment pattern are at the
greatest risk of developing maladaptive
behaviours and mental health problems.
Children placed when they are older are the
norm in foster care and are more likely to
present to mental health services with a
range of behavioural problems and psychological needs, typically following a history of
adversity (Howe & Fearnley, 2003). When to
this is added a growing awareness of looked
after children as a population at generally
greater risk of developing a range of problems, either owing to pre-care exposure to
adversity or maladaptive experiences while
in care, there is an obvious opportunity for
preventative work. However, the current
climate of financial constraints risks this
opportunity being missed, with pressures to
provide time-limited therapeutic interventions targeted at those deemed most in need.
Furthermore, the current trend for diagnosis-led services urgently needs reviewing in
light of the finding that mental health needs
of looked after children may be much
greater than rates reported in prevalence
studies based on diagnosed disorders
(Sempik et al., 2008).
Nevertheless, a valuable role exists for
applied psychology in providing and
informing interventions to support foster
carers and other professionals, who often
have to cope with difficult and distressing
behaviours shown by looked after children.
A greater presence from the profession in
the development and formation of practice
guidelines is needed. Of the 25 professionals
comprising the Programme Development
40

Group for the NICE guidelines for looked

after children, only two were applied
psychologists (National Institute for Health
and Clinical Excellence, 2010).
Supporting the professionals who
support the foster carers is another important role for psychology, and it could be
argued this may be best placed within the
arena of social care, highlighting the importance of joined-up working between mental
health and social care services. The importance of a foster carers own attachment
patterns has received more attention over
the past decade and helping foster carers to
become aware of their own difficulties and
learn how to overcome them may prove
beneficial. Significantly less avoidant behaviour was shown by children whose foster
carers had received an intervention
designed to help them provide nurturance
even when it was not elicited (Dozier et al.,
2009). A current lack of such targeted
support may contribute to the poor
outcomes often associated with looked after
children.
Currently, however, the focus is on individual work with looked after children,
which may also present its own problems.
Children form expectations based on their
history of experiences with caregivers
(Bowlby, 1969/1982) and a child with experience of unresponsive or unavailable caregivers may be unlikely to turn readily to
others when in need. Formation of a therapeutic alliance, seen as vital to a positive
outcome, may be especially affected. On a
more practical level, problems around placement stability and consequent impact on
geographical eligibility for services may lead
to therapeutic work having to be terminated
unexpectedly. Such experiences are unlikely
to help a child learn how to cope adaptively
with separation and loss, potentially vital
skills for successful processing of their experiences while in care.
There is increasing awareness of the
significant issues presented by the mental
health needs of looked after children, as
reflected in the recent publication of NHS
Educational & Child Psychology Vol. 28 No. 3

The impact of disrupted attachment on the emotional and interpersonal development of looked after children
guidelines (National Institute for Health and
Clinical Excellence, 2010) and various
government papers, such as Care Matters
(Department for Education & Skills , 2006,
2007). The need for specialist services is
being recognised with several already developed (for a recent overview see Bunting,
2006). However, the need for better joinedup working, particularly between health and
social care, is a priority (McAuley & Davis,
2009).

Conclusions
In considering the impact of disrupted
attachment on the emotional and interpersonal development of looked after children,
it is important not just to look at the attachment relationship prior to removal, but also
to examine the complex process of the interaction between child, carer and environment once in a placement. Only with a
better understanding of the factors which
contribute to positive and negative outcomes
in foster care can decisions begin to be made
regarding what intervention is in the shortterm and long-term best interests of the
child. It is clear from the literature that the
effects of disrupted attachment and experiences whilst in care are closely intertwined in
their combined impact on the emotional
and interpersonal development of looked
after children. It is necessary, therefore, to
consider all of the complex factors which
may arise.
Further investigation of the impact of
variables such as foster carer qualities and
the caregiving environment are also needed
(Pears & Fisher, 2005) in order to identify
foster care conditions which may moderate
the effects of maltreatment and attachment
disruptions on these vulnerable children.
Findings such as those of Lawrence and
colleagues (2006) also highlight the importance of examining adaptation as well as risk
status prior to placement in order to define
more clearly any impact of subsequent foster
care experience.

Educational & Child Psychology Vol. 28 No. 3

The evidence so far leads to the conclusion that, while to safeguard a child against
further harm may be seen as the best intervention in the short term, in the longer term
the costs to psychological well-being of
removing an already vulnerable child from
the family of origin need very careful
appraisal. However, in the current worsening
climate of service cuts, and with media attention in recent cases such as Baby P (The
Lord Laming, 2009) and the Victoria
Climbi inquiry (House of Commons Health
Committee, 2003), the risks of leaving
children in their family of origin may be seen
as at best unsupportable and at worst negligent in terms of a duty to protect these atrisk children. On the other hand, it perhaps
highlights the difficulties that require to be
addressed in the existing foster care system
that to remain with maltreating parents may
at times make for better long-term outcomes. The importance of improving on the
current situation cannot be emphasised
enough for, in the words of PD James, What
a child does not receive, he can seldom later
give (James, 2000: p.8).

Address for correspondence

Jose Scott
49 Southern Road,
Basingstoke, RG21 3DY.
Email: jcrt1q08@soton.ac.uk

41

Jose Scott

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