The Attachment Issue

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I am a Consultant Child and Adolescent Psychiatrist working clinically in a North Yorkshire CAMHS team. I am Associate Director of Medical Education in the trust I work in, also Training Program director for CAMHS higher training in Yorkshire.

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Foreword from the Editor

Welcome to the May 2018 edition of the Bridge. This edition is themed around attachment in young children. There is a very moving piece from an adoptive parent who describes her experience of parenting a child who has experienced developmental trauma. Feelings of isolation and bewilderment are felt by parents particularly when they haven’t been able to obtain support easily. The debate about whether attachment difficulties in young children is “core business” for specialist CAMHS continues in some services, particularly in the face of greatly increasing referrals of older children with clear mental health disorder and difficulties determining thresholds into service and prioritisation.

Professor Jane Barlow outlines the emerging evidence base for interventions that improve attachment in young children and also highlights “the strong association between such disordered attachment patterns in young children and later problems”.  I know from my own clinical practice that taking a careful developmental history in an older young person presenting with an emotional difficulty, such as depression or self harm, often reveals concern about attachment relationships and behaviours early in life.  As the evidence base for what an effective intervention might be becomes clearer, the role of specialist CAMHS in prevention of longer term emotional difficulties, possibly by delivering some of these attachment based interventions, may also become clearer, as indeed may commissioning arrangements.

I do hope you find this edition helpful. This pdf has some of the articles from the Attachment edition of The Bridge, please feel free to share this and the direct links below with colleagues.

Articles from this edition

Positive parenting reduces risk of callous-unemotional traits

Can we improve attachment or attachment-related outcomes in young children?

Adoption and attachment: A parent’s perspective

Diagnostic framework for attachment disorders needs improving

A harsh parenting team?

Detaching RAD from DSED: the rationale and research requirements

Early adversity impacts on associative learning

Low activity levels affect child mental development

Rumination affects mother–infant interactions


I understand that CAMHS need to work to evidence based research. But what happens when common sense and real-time, on the ground experience is left out of the discussion. I think John Bowlby would invoke “faith and hope” here i.e. faith and hope that professionals will use their common sense and know in their hearts that mental illness is for sure a symptom of early trauma including attachment issues. If you are not going to the root of the challenge, you’re missing Mr. Bowlby’s point. If you’re only treating mental illness, you’re only treating the symptom.

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