Identifying attachment and trauma with children at risk of sexual exploitation

As professionals, we all remember the Bowlby Attachment Theory (The British Journal of Psychiatry, 1977 - cambridge.org) talks about the importance of positive attachment in early childhood. However, it is worth revisiting this when working with children who have suffered some type of trauma, particularly when working with forms of exploitation.

2400 children were victims of CSE between August 2010 and October 2011.

Source: Berelowitz, S. et al (2012)

When working within the field of childhood sexual exploitation, professionals will come across children who lack positive attachment to their primary caregiver, thus seeking out what we call ‘positive negative attachment’ to perpetrators. The perpetrators, as part of the coercion, will allow the child to become positively attached by demonstrating caregiver’s traits - for example showing an understanding, the giving of gifts, and positive physical attention, i.e. hugs. The child will not see this as positive negative emotions, but as someone who cares for them and understands them.

Bowlby (1969, 1988) postulated that the fear of strangers represents an important survival mechanism, built-in by nature, so quite often the child will not identify this relationship as exploitative. In the early stages of exploitation, the child will probably think they are in control, that they are able to enter into a relationship safely and consensually.

“I thought I was the only one. The only one in the world.”

The Office of the Children’s Commissioner’s inquiry into child sexual exploitation in gangs and groups: interim report (PDF).

Children at risk or experiencing exploitation will not have a secure attachment from primary caregiver’s; securely attached children have experienced sensitive and attuned caregiving - they are able to trust and rely on other significant adults to meet their needs. As a result, they feel confident to form meaningful relationships with others, to make the most of learning opportunities, to engage in productive activities, problem-solve and explore the wider world. These children are emotionally resilient and self-aware; this is sometimes known as positive attachment.

Children who are most at risk of any form of exploitation fall into the following attachment categories:

Insecure-ambivalent attachment

Ambivalent-attached children have experienced inconsistent and largely unresponsive caregiving. They are easily frustrated and may present as either clingy or rejecting of another adult as they seek both comfort from, but are unable to be comforted by, adults. They may present as immature, fussy, helpless, passive, or whiney, or they may be angry or petulant. They may also present as attention-seeking, hyperactive, and having difficulty recovering from upset.

Insecure-avoidant attachment

Avoidant-attached children have experienced insensitive, intrusive or rejecting caregiving. They appear to be independent of adults and seek to meet their needs on their own, as they have not been able to trust or rely on their caregiver. They are task-orientated, self-reliant and high achieving in some aspects but are generally socially uncomfortable, exhibit indifference and avoid close relationships. They may find it difficult to seek help, have limited creativity and may be prone to sudden outbursts.

Insecure disorganised attachment

Disorganised attached children are usually from neglected, abusive and/or chaotic homes. The child is likely to feel confused by adults and experience them as frightening or frightened. These children are often highly vigilant, easily distracted, have a strong sense of fear, panic, or helplessness, and may present with bizarre, extreme, unpredictable or distressing behaviour which adults may find shocking and difficult to manage. They often present as sensitive to criticism, defiant and/or controlling, and are easily overwhelmed.

Children who have suffered sexual exploitation will have experienced trauma. Trauma can dramatically alter a child’s cognitive, emotional, physical and behavioural functioning. Neurological changes due to trauma leave younger children more vulnerable to persistent functional difficulties.

Repeated exposure to trauma can magnify the effect on brain and nervous system development, resulting in developmental impacts on all levels. Physical damage can be either short-term or long-term. Neuro-chemical imbalance means the brain will focus on survival and responding to threats, fear response regions frequently activated, complex thought and abstract thought less activated. This alters the child’s ability to interact positively with others – appearing lonesome, aloof, rude etc, and could permanently alter the ability to produce serotonin (which helps feelings of emotional ability and well-being) – appearing cold, non-emotional etc.

The emotional responses to trauma mean a high state of anxiety, panic, irritability, hyperarousal and overgeneralisation, extreme reactions, feelings of being paralysed or frozen, and disassociation. The person seems dazed and vacant, has feelings of isolation, hopelessness and helplessness, depression, feelings of guilt, abrupt mood swings and grief. And it is important to remember these, as this could be why the child is reluctant to engage with professional services.

Identifying the attachment style both pre-trauma and post will enable the professional to gain a better understanding of the risks and behaviours, and by understanding the brain, its development both pre- and post-trauma will enable us to observe behaviour and help us to support with the child’s needs.

Attachment impacts future behaviour and brain development impacts on future learning, but we must remember that traumatised events impact on both.