EYFS best practice - All about supporting adopted and looked-after children

Adoption stories abound in the media - from celebrity adoptions and tales of 'joyful' reunions with biological parents, to sad stories of children returned to social services or their countries of origin because of their behaviour, to the adoption or care histories of high-profile criminals and mass killers.

Calls for early intervention into the lives of children at risk of neglect or abuse emphasise that local authority care and adoption is seen as a key solution to keeping children safe.

Of the 60,900 children who were in the care of local authorities in England in March 2009, 23,200 (38 per cent) were aged nine or younger. Of the 3,300 children who were adopted from care in that year, 3,220 (97 per cent) were in that age group and 2,300 (72 per cent) were aged between one and four years old. (Figures for Scotland, Wales and Northern Ireland are also available on the BAAF website.) There are thought to be about 300 inter-country adoptions every year, with the largest numbers of children adopted from China and Russia.

Adoption first became legally recognised in Britain in the 1920s, when it was seen as a way of providing security for children born to unmarried mothers and those orphaned by war. Improved birth control and changes in attitude, beginning in the 1960s, dramatically reduced the number of so-called 'relinquished' babies.

Since then, the focus of adoption practice has increasingly shifted to finding homes for children fostered and 'looked after' by local authorities because their families are deemed unable to provide adequate parenting. These children may have experienced neglect or abuse, and all will have experienced the trauma of being removed from their birth families. They may also have had several changes of carer before being placed for adoption.

IS LOVE ENOUGH?

The work of Bowlby and others in the field of attachment theory has had a big impact on fostering and adoption practice. Advances in neuroscience have also given us greater understanding of the effects of trauma on the developing brain. And yet there is still a general belief that by simply removing a child from harm and placing them with a loving, caring family, all their difficulties will be over. Sadly, it is not that simple.

We are all rightly outraged and full of sympathy when headlines scream about children dying at the hands of their abusive families. However, there is much less sympathy for the children fortunate enough to be 'saved', who are taken into care or adopted and then act out their distress in anti-social and challenging ways as they grow older.

Perhaps you would, too, in similar circumstances. Many of the behaviours shown by traumatised children in care are a direct (and in many ways rational) response to their experiences. Would you be able to relax and 'fit in' if you didn't know how long you were going to stay somewhere? In a place where the sounds and smells and expectations of you were very different from those you previously knew? When you don't really understand why you are there, and why the only people you knew are no longer around you and possibly gone for good? If you had been let down by the people who were supposed to keep you safe, would you find it easy to trust people again and to allow them to take control of your life?

As an adult in these circumstances, it would seem good sense to be wary of new people and not get too attached to them; to be hypervigilant and always watching out for danger and new threats to your well-being; to be self-sufficient and resist the help of others if you can't be sure you can trust them. And yet, society seems to expect children to just be happy to have a new mummy and daddy, to forget what went before and to embrace their new family life with as little fuss as possible.

THERAPEUTIC REPARENTING

This is not to suggest that all children in the care system or those who are adopted will have problems. However, we do these children and the families that care for them a disservice if we don't take into consideration the impact that such experiences may have on their well-being and their chances of fulfilling their potential. This is just as true of children adopted from overseas, who may have experienced institutionalised care and the likely loss of their first language.

The term 'therapeutic reparenting' is increasingly used to describe the complexity of the role of foster carer or adoptive parent, and social services ensure they receive training and preparation for this role. The quality of this can be varied, however, as can the training given to the social workers dealing with these families. Schools and settings have responsibilities to make special provision for 'Looked After Children' - though not for adopted children, whose needs, unfortunately, do not diminish on the day of their adoption.

As early years practitioners, we ourselves may have little or no training in supporting these children and their families. But we can apply our knowledge and understanding of attachment theory to help us relate to their needs and do our best to support them.

ATTACHMENT THEORY AND TRAUMA

Attachment is considered to be a bond or tie that develops from a child's need for safety, security and protection. Secure attachments provide a safe base for a child, reducing fearfulness and stress as they learn to trust that their needs will be met. As well as providing emotional security, positive attachment experiences bathe the brain in 'feel-good' chemicals and help build neural pathways in the brain that support the development of 'executive functioning'. These are high-level abilities that influence more basic abilities like attention, memory and impulse control.

When attachment is missing, however, a child has no sense of security, their neural development is suppressed and stress hormones constantly flood their brain. This means that they have a very small window of stress tolerance and are constantly on alert for threats to their survival. This is why experts now believe that neglect can have as profound an impact as abuse. Similarly, we have evidence to suggest that a child doesn't need to have a conscious memory of a trauma or loss to be negatively affected by it.

There is some debate as to whether the terms 'attachment disorder' and 'reactive attachment disorder' (RAD) accurately describe children who present with extreme behaviours related to their early experiences. Some specialists recommend the term 'severe attachment difficulties', and the world renowned trauma expert Bessel van der Kolk argues that RAD should be renamed 'developmental trauma disorder' to stress the links with post-traumatic stress disorder.

Acknowledging the trauma involved in being removed from one's birth family, no matter how early and in what circumstances, is a useful way of reminding ourselves of what these children and their families are battling with.

Although there is increasing awareness of the need for accurate information about a child's early life and experience, there are many aspects that may remain hidden, particularly about the child's history before birth. Pre-natal exposure to alcohol, drugs or the birth mother's mental health and levels of stress may also have a profound impact on the child's physical, neurological and cognitive well-being, affecting their behaviour and learning potential.

BEHAVIOURS 

This all paints a very gloomy picture, but we mustn't forget that these children have many strengths and survival skills. They have a lot to teach us about resilience and the 'plasticity' of the brain, which enables them, in the right environment, to relearn many of the things that were denied to them in their early life.

In the process, they will communicate their needs to us in the most powerful way they can, which is through their behaviours - some of which will be challenging and frustrating (see box, page 19). Put yourself in their shoes and try to understand the underlying fear and stress that triggers their behaviour.

• Whatever a child's chronological age, their neurological development is likely to be stuck at a much earlier stage. Responding to behaviour in the way you would with a much younger child is likely to create a better response. Remember that they are communicating to us the emotional age that they 'need' to be, in that moment.
• It helps also to see unwanted behaviour as evidence of the child's dysregulation and to recognise that often it is not that they 'won't' conform, but that they can't - their brains aren't yet wired up in a way that will allow them to.
• A lot of traditional behaviour approaches revolve around rewards and sanctions, and where love and affection is conditional on good behaviour. Think about how rewards and strategies such as 'time out' might affect a child who has experienced rejection and abandonment and doesn't believe themselves to be worthy of love and treats.
• What they need most of all is unconditional love and acceptance that slowly builds their concept of themselves as someone who is entitled to the nurture and care that they have missed out on, regardless of their behaviours.
• While they go through this process, they need the adults around them to provide 'emotional containment' to help them deal with the feelings that can completely overwhelm them.
• Learn to recognise their triggers and the signals that tell you that they are struggling to stay emotionally regulated, and find out what works best for them. Sometimes triggers will be hard to fathom, but at the root of most behaviours will lie fear and feelings of being unsafe.
• A child may have very real feelings of threat, which might be hard for us to appreciate - a sound, a smell, a raised voice. Some respond to perceived threats with an aggressive 'fight' reaction, but others may literally 'freeze' by glazing over or being very slow to respond.
• Some children's needs may be masked by their coping strategies. Over-compliance can be just as much of an indicator of need as aggression or defiance. The child's fear of rejection drives them to conform at all costs, and doesn't allow them to express their true feelings.
• Be aware of the possibility of sensory or food issues. These may be related to early experiences. For example, a child who wasn't weaned in a healthy way may have difficulties chewing, or they may associate certain textures or smells with uncomfortable, abusive or unhappy experiences.
• They may also have sensory integration difficulties relating to neglectful or institutionalised practice that simply didn't provide them with appropriate experiences, such as crawling, or being held and cuddled. They may resist the very thing that they need more of, as they have learned either to do without or to be fearful of it. Discuss with parents how best to address these issues, and seek expert advice where appropriate.
• Transitions and change of any kind can be unsettling for a child who has never experienced constancy and who may have traumatic memories of change. These memories may not always be conscious, particularly if they occurred when the child was pre-verbal, but they are powerful nonetheless. Think about how you organise the day so that routines help build security, and about how you make yourself physically and emotionally available at potentially stressful times of the day.
• It seems obvious, but be sensitive about classroom topics and projects that involve photos and information about family trees and babyhood. A child may not have photos from their early life, or those they have may trigger difficult emotions. Ask the advice of parents and carers, and adjust the topic so that they can be included in safe ways.

PARENTS AND CARERS

Practitioners have an important role to play in supporting foster and adoptive families as they strive to build new attachments with their children. Parents and carers themselves may become traumatised as they attune with their children and 'hold' the distress and fear as it is being acted out and projected on to them. Some families may be well prepared for this, but sadly, others may be less so, while support from health, social services and other agencies may be patchy at best.

• Be pro-active in your support, but sensitive to the needs and wishes of the family. Their children may be settling well, and issues or challenges may not be evident, but an openness and sensitive interest will provide a supportive and reassuring atmosphere if issues come up at a later stage.
• Some families may well be stressed and uncertain about what help is available and how to go about getting it. It is now recognised that some adoptive parents experience 'post-adoption depression', which can be very debilitating and can be hard for others to understand. Parents may have spent several years being assessed and waiting for a child, and the early stages of placement are not always straightforwardly joyful. The complexity is even greater when siblings are placed together and the needs of the children are varied.
• Parents will decide what information is relevant to share with you about a child's background. Some information may be useful in planning to meet the child's specific needs, but be sensitive to the parent's concerns and ensure appropriate confidentiality.
• New parents, in particular, may be grateful for tactful, supportive suggestions and advice on child development. Be very careful, though, about dismissing behaviours with comments such as 'they all do that' in an attempt to normalise things. Sometimes it's reassuring, but it doesn't take into account the impact that such behaviours may be having on family life, particularly if they are more frequent or intense than is the norm.
• Some children will behave differently in different contexts. They may hold it together at school all day, and only feel safe enough to 'let it all out' at home. Be sensitive to parents and carers who struggle with challenging behaviour. Don't dismiss their concerns and the difficulties they face. A flippant 'they're fine when they're here' might be reassuring, but isn't helpful in the long run.
• Encourage parents to share with you their understanding of the child's triggers and signs of distress. In particular, be aware that contact visits with birth family members, birthdays and other anniversaries of traumatic events may trigger changes in behaviour, so agree on appropriate responses and soothing strategies.
• Ask parents to share their successful strategies for soothing and regulating behaviour. Many of the most successful approaches are unconventional, so be prepared to challenge your perspectives and professional judgements. Ask to borrow books and support materials they have found useful (see list), and not only will you gain valuable insights into how best to work with these children, but it will help guarantee you don't get in the way of the valuable work the parents are doing in rebuilding their children's lives. They will be thrilled and relieved to know that you want to work in partnership with them. It is a sad truth that for many adoptive and foster families, it is school issues that tip them over the edge and ultimately threaten their relationship with their children.

HELD IN MIND

A baby needs the presence of their attachment figures to feel safe, but if the care is continuous and predictable, the feelings of being safe grow and persist even when the child is alone. A securely attached child carries with them the sense of being nurtured and cared for. They know that they are held in the mind of their parents and wider family. This feeling of safety and ultimately not being alone in the world is something that is probably at the heart of all human emotion - and yet it is taken for granted, when it is there.

For some children, however, there is no certainty that they are held in mind by the people that matter to them, and the world is, therefore, a very scary and stressful place. Foster carers, in particular, have the tricky task of creating new attachments with children while helping them hold their birth families in mind, in the hope that they will soon return to them. Adoptive families, too, will hold birth families and previous carers in mind for children as they help them to understand why they are no longer parented by them.

An important aspect of helping these children settle into daycare or school is keeping the family in mind for the child at the same time as reassuring them that they also exist for their parents and carers when away from them. Families may have different ways of doing this - it might include the child carrying a photo or memento around with them, wearing the parent's scent, or having little rituals like paper kisses or imaginary heart strings, as well as the usual comforters (some of which may be considered unusual for their age - for example, a baby bottle, sippy blanket or dummy). Be respectful of these; they help make attachment tangible for children who live with the constant fear of loss and abandonment.

Case study: Joseph

Joseph was born ten weeks premature and was not expected to survive. His mother was 17 and just about to leave the care system. Although not a drug user, she had drunk alcohol throughout her pregnancy. She had been adopted as a baby, but was taken back into care at age 13 when her parents could no longer cope with her disruptive behaviour.

Joseph was a very sick baby but survived his first year living with mum, although their home circumstances were chaotic and she often left him to be minded by strangers. The hospital contacted social services because Joseph wasn't being brought for his check-ups.

Social services were concerned about his mother's ability to parent Joseph and he was considered to be 'at risk'. He spent the next year of his life having respite care with several different foster families, in between short periods of time with his mother. Social services gathered evidence to suggest that he would not be able to return home permanently and placed him with a long-term foster carer.

A guardian ad litem (legal guardian) was appointed by the court to make decisions about Joseph's welfare. She felt that rehabilitation with his birth mother should continue to be an option, so contact was maintained, although his mother often failed to show up. It was not until two years later, when Joseph was four, that a psychologist's report finally convinced the guardian ad litem that returning to his birth family was not an option, and social services were allowed to begin the adoption process.

Josepth was placed for adoption at age four and a half, and his adoptive family were advised to begin the statementing process as soon as he started school. He had very little speech and suffered regular bouts of ear and chest infections. When distressed, which was often, he would scratch himself until he bled and bang his head on the floor.

Now, as his speech has improved, he talks relentlessly, asking the same questions over and over again. He has no sense of personal safety and seems to have boundless energy. He has explosive tantrums and has to be monitored very closely when playing with other children.

He loves stories and watching DVDs and asks for the same ones repeatedly. He is beginning to play with small-world toys and likes to collect them and keep them by him. He resists affection and comfort, rarely crying, even when he hurts himself badly. He constantly attempts to run off, on one occasion climbing the fence to escape and run home.

Joseph is particularly unsettled during transitions within the day, when routines are changed and when his key person is away. He refuses to go to the toilet until the very last minute, so that he is often physically as well as emotionally agitated. He talks about his 'different mummies' and tells his adoptive mum that 'when I go to my next mummy, you will be my different mummy and then I will miss you too'.

Think about ...

• What emotions does Joseph's story evoke in you?
• If you didn't know his story, how would you react to a child who behaves as he does?
• What are the factors in his story that might point to difficulties with physical, social, emotional and intellectual developments? How will you balance this knowledge with a positive outlook and hopefulness for his future?
• How equipped do you feel to deal with the needs of Joseph and his family? What other agencies will you involve in making sure that their needs are met?
• How would you manage his behaviour? What will you need to do to allow him to express his rage and distress? How will you keep him and the other children safe? Is your behaviour policy flexible enough to allow you to respond to his needs without having to enforce sanctions and exclusions?
• How will you respond to his constant need for reassurance? How will you provide emotional as well as physical containment?
• Why do you think Joseph finds transitions difficult? How can you reduce the amount of change he experiences and help him build resilience to cope with it?
• Why do you think he withholds going to the toilet? How can you help him with this?
• How will you support each other to stay calm and regulated with him when his behaviour threatens the smooth running of your session, alarms other parents and challenges your usual approaches to behaviour management?
• How will you support his adoptive family, particularly his mother, who bears the brunt of most of his aggression and his emotional neediness?
• How will you ensure that you are able to acknowledge his survival skills and recognise his achievements, no matter how small?
• How will you respond when he talks about his 'different mummies'? How can you help him 'hold in mind' his new family and reassure him that he is 'held in mind' too?

GOOD PRACTICE FOR ALL

It's important to remember that approaches that work well for these children are also good practice for every child. Behaviour policies that are built around an understanding of all behaviour as communication and the importance of relationship do not need to depend on rewards and sanctions, rules and punishments. Settings and schools that put care and nurture at the heart of their curriculum make the best environments for all our children, and especially for those who are most vulnerable.

DYSREGULATION

A lot of repetitive and frustrating behaviours are actually signals of distress, at varying levels. A child with 'good enough' attachment experiences will know that if they are out of sorts, a caring adult will help them regulate. A child without those positive experiences is likely to feel dysregulated often, and to have had to find ways to soothe themselves.

Some examples seem obvious, such as rocking, head banging, scratching or skin picking. But burping and spitting, constant chattering, baby talk, humming or strange noises, hoarding or stealing, and frenzied physical activity are also common and often not recognised as symptoms of distress. They are also attention-seeking behaviours in the most literal sense - these children need to know that we won't forget about them! Their early experiences have taught them that for survival, any kind of attention is better than no attention.

Now imagine how you might feel if you were repeatedly told to stop doing something that you knew helped to make you feel better? Your stress levels would immediately rise, and inevitably you'd feel compelled to do it even more! It is really important to tune in to these children to find out what's going on for them and to respond - not react - to these signals, tiresome and frustrating though some of them may be.

Look for safe ways to allow the child to do what they need to do, while you gently provide them with alternative soothing strategies and ways to self-regulate:

• - Sit together in a rocking chair
• - Engage in affectionate, playful, 'baby type' interactions - cuddling, cradling, tickling, peek a boo, etc - but only if the child is comfortable with close, physical contact
• - Push the child on a swing face to face
• - Distract them using a favoured activity or toy
• - Provide water or sand play - on their own or with an adult, where there is no pressure to share.
• - Provide spaces for thrashing around safely, or for snuggling up with cuddly toys
• - Create safe, contained space for running, rolling, jumping, etc
• - Let the child bound on a trampette
• - Give the child the opportunity to continue talking or making noise without disturbing others.

REFERENCES AND FURTHER READING

About attachment and brain development

• Maria Robinson (2003) From Birth to One. Open University Press

• Sue Gerhardt (2004) Why Love Matters. Routledge

• Jerree Pawl 'Being held in another's mind' available at www.wested.org/online_pubs/ccfs-06-01-chapter1.pdf

• 'The Wonder Year' by Siren Films (www.sirenfilms.co.uk)

• Margot Sunderland What Every Parent Needs to Know: The incredible effects of love, nurture and play on your child's development (Dorling Kindersley)

• Nursery World's five-part series on attachment by Anne O'Connor is at: www.nurseryworld.co.uk/go/attachment

About adoption

• www.baaf.org.uk

• www.adoptionoverseas.org

• www.adoptionuk.org.uk

• www.afteradoption.org.uk

• www.postadoptioncentre.org.uk

Understanding the needs of looked after and adopted children

• Heather Forbes Post, 'Beyond Consequences, Logic and Control - A lovebased approach to helping attachment challenged children with severe behaviours' (www.beyondconsequences.com)

• Caroline Archer (1999) First Steps in Parenting the Child Who Hurts. Jessica Kingsley

• Kate Cairns Attachment, Trauma and Resilience: Therapeutic Caring for Children. BAAF

Supporting them in school

• Sue Gott (2009) Teach to Inspire Better Behaviour: Coping with aggressive, disruptive and unpredictable behaviours. Optimus Education

• Louise Bomber Inside I'm Hurting: Practical Strategies for Supporting Children with Attachment Difficulties in Schools

• www.postinstitute.com

• www.dcsf.gov.uk/intercountryadoption/downloads/applications.pdf

• Solihull Approach Resource Pack, The First Five Years. Solihull NHS Care Trust and University of Central England