Excerpt

This guideline has been developed to advise on attachment difficulties in children and young people who are adopted from care, in care or at high risk of going into care. Children’s attachment and its impact, particularly where children are looked after or for whom being adopted from care is the long-term plan for them, is poorly understood among a range of professionals. The purpose of this guideline is to help professionals ensure that children presenting with characteristics that suggest difficulties with attachment are diagnosed accurately and that their needs are addressed quickly. The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, care leavers who have had attachment difficulties, carers and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high-quality care for children with attachment difficulties while also emphasising the importance of the experience of care for children with attachment difficulties and their carers.

Although the evidence base is rapidly expanding, there are a number of major gaps. The guideline makes a number of research recommendations specifically to address gaps in the evidence base. In the meantime, it is hoped that the guideline will assist clinicians, and children with attachment difficulties and their carers, by identifying the merits of particular treatment approaches where the evidence from research and clinical experience exists.

Contents

• Guideline Committee members and National Collaborating Centre for Mental Health (NCCMH) review team
• Acknowledgments
• 1. Preface
  • 1.1. National clinical guideline
  • 1.2. The national Children's Attachment guideline
• 2. Introduction to children's attachment
  • 2.1. What is attachment?
  • 2.2. Terminology used in this guideline
  • 2.3. Types of attachment difficulties
  • 2.4. Assessment and measures of attachment in childhood and adolescence
  • 2.5. How common are attachment difficulties?
  • 2.6. The causes of attachment difficulties
  • 2.7. When do attachment difficulties start and how long do they last?
  • 2.8. What mental health problems and behaviours are associated with attachment difficulties?
  • 2.9. How do attachment difficulties manifest in education, healthcare, social care and criminal justice settings?
  • 2.10. Perspectives and experiences of care-leavers and carers: daily life, family and relationships
  • 2.11. Treatment and management of attachment difficulties in England and Wales
  • 2.12. The economic cost
• 3. Methods used to develop this guideline
  • 3.1. Overview
  • 3.2. The scope
  • 3.3. The Guideline Committee
  • 3.4. Review protocols
  • 3.5. Clinical review methods
  • 3.6. Health economics methods
  • 3.7. From evidence to recommendations
  • 3.8. Stakeholder contributions
  • 3.9. Validation of the guideline
• 4. Biological factors associated with the development of attachment difficulties in children and young people
  • 4.1. Introduction
  • 4.2. Review question: What familial biological factors are associated with the development of attachment difficulties in children and young people?
  • 4.3. Recommendations and link to evidence
• 5. Environmental factors associated with the development of attachment difficulties in children and young people
  • 5.1. Introduction
  • 5.2. Review question: What environmental factors are associated with the development of attachment difficulties in children and young people?
  • 5.3. Recommendations and link to evidence
• 6. Process and arrangement features for taking children and young people into local authority care associated with an increased or decreased risk of developing or worsening attachment difficulties
  • 6.1. Introduction
  • 6.2. Review question: What process and arrangement features for taking children and young people into local authority care are associated with an increased or decreased risk of developing or worsening attachment difficulties?
  • 6.3. Recommendations and link to evidence
• 7. Prediction of attachment difficulties
  • 7.1. Introduction
  • 7.2. Review question: What measurements/tools can be used to predict children and young people at risk of developing attachment difficulties? How valid and reliable are they?
  • 7.3. Recommendations and link to evidence
• 8. Identification and assessment of attachment difficulties
  • 8.1. Introduction
  • 8.2. Review question: What measurements/tools can be used to identify/assess attachment difficulties in children and young people? How valid and reliable are they?
  • 8.3. Review question: What measurements/tools can be used to identify/assess attachment disorders in children and young people? How valid and reliable are they?
  • 8.4. Recommendations and link to evidence
• 9. Interventions for children and young people on the edge of care
  • 9.1. Introduction
  • 9.2. Review question: What interventions are effective in promoting attachment in children and young people on the edge of care?
  • 9.3. Recommendations and link to evidence
• 10. Interventions for children and young people who are in care
  • 10.1. Introduction
  • 10.2. Review question: What interventions are effective in the prevention and treatment of attachment difficulties in children and young people in the early stages of being looked after? What are the adverse effects associated with each intervention?
  • 10.3. Recommendations and link to evidence
• 11. Interventions for children and young people who have been adopted
  • 11.1. Introduction
  • 11.3. Review question: What interventions are effective at promoting attachment in children and young people who have been adopted? What are the adverse effects associated with each intervention?
  • 11.4. Recommendations and link to evidence
• 12. Pharmacological interventions
  • 12.1. Introduction
  • 12.2. Review question: what pharmacological interventions are effective in the treatment of children and young people with attachment difficulties? What are the adverse effects associated with each intervention?
  • 12.3. Recommendations and link to evidence
• 13. Summary of recommendations
  • 13.1. Principles of care in all contexts
  • 13.2. Supporting children and young people with attachment difficulties in schools and other education settings (including early years)
  • 13.3. Assessing attachment difficulties in children and young people in all health and social care settings
  • 13.4. Interventions for attachment difficulties in children and young people on the edge of care
  • 13.5. Interventions for attachment difficulties in children and young people in the care system, subject to special guardianship orders and adopted from care
  • 13.6. Interventions for attachment difficulties in children and young people in residential care
• 14. Abbreviations
• 15. References
• Appendices
  • Appendix A. Scope for the development of the clinical guideline
  • Appendix B. Declarations of interests by Guideline Committee members
  • Appendix C. Special advisors to the Guideline Committee
  • Appendix D. Stakeholders who submitted comments in response to the consultation draft of the guideline
  • Appendix E. Researchers contacted to request information about unpublished or soon-to-be published studies
  • Appendix F. Analytical framework, review questions and protocols
  • Appendix G. High-priority research recommendations
  • Appendix H. Clinical evidence – search strategies
  • Appendix I. Health economic evidence – search strategies
  • Appendix J. Clinical evidence – study characteristics and quality checklists for associated factors
  • Appendix K. Clinical evidence – study characteristics and quality checklists for prediction and identification
  • Appendix L. Clinical evidence – study characteristics and quality for all intervention studies
  • Appendix M. Clinical evidence – excluded studies
  • Appendix N. Clinical evidence – GRADE tables
  • Appendix O. Clinical evidence – forest plots
  • Appendix P. Clinical evidence – flow diagrams
  • Appendix Q. Health economic evidence – completed health economics checklists
  • Appendix R. Health economic evidence – evidence tables

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.