1. A child or young person in mind
Think about a particular child or young person who you can hold in mind throughout the training session (you might think of more than one!)
Knowledge
How would everything you hear today enable those who work with this child or young person to understand more about them
Recognising the needs
Change
How could this understanding of attachment and trauma change how adults work with this child or young person?
Identifying interventions that meet the needs
Action
How can you take this back into your school or setting?

2. What is attachment?
John Bowlby’s theory of attachment is the most integrative theory of child development available to us
Attachment is a survival mechanism to ensure the protection and survival of the otherwise helpless baby
This survival mechanism persists throughout life as a need for connection to safe others when we feel unsafe
Attachment theory is supported by current neuroscience
More than 90% of what we now know about the human brain in terms of its development, structure and function has been discovered in the last twenty years

3. Why does attachment matter?
Research shows that brains work best when people feel safe
The key to optimal brain function lies in regulation of stress hormones
Brains develop in response to challenge
The brain enables us to process and make sense of experience
Challenge leads to the production of stress hormones
Healthy if regulated, toxic if unregulated
Toxic stress closes down key brain functions
When brain function closes down people cannot learn well
Humans are not born able to regulate stress
Attachment relationships with adults are essential for children

4. Attachment theory: secure attachment
Adults who:
Are able to self-regulate, are emotionally available, and are responsive to the emotional needs of the child
About 60% of the population at any given time
Children who:
Have an appropriate sense of personal safety and identity
Are not driven to be in control
Can self-regulate and manage stress
Find change interesting and enjoy learning
What about staff in your school?
Is emotional intelligence encouraged and supported?

5. Insecure anxious avoidant attachment
Adults who:
Are dismissive of and disconnected from their own childhood, may be committed to the child and reward success, but are emotionally unavailable and not responsive to the emotional needs of the child
Children who:
Lack a sense of emotional safety and personal identity
Are driven to be in control of people and events
Cannot self-regulate and manage stress, but dissociate when stressed
What about staff in your school?
Do schools mirror this adult attachment style?
How can staff develop and maintain resilience?

6. Insecure anxious ambivalent attachment
Adults who:
Are preoccupied with issues from their own childhood (although not actively traumatised), are inconsistently emotionally available and inconsistently responsive to the needs of the child
Children who:
Lack a consistent sense of personal safety and identity
Are either compliant and dependent or angrily resistant
Cannot self-regulate and manage stress, but blame others for stress
Are triggered to panic or rage by uncertainty or change
What about staff in your school?
All of us at times will have unmet attachment needs and need to recover our ability to self-regulate
What happens when work issues trigger unmet needs?

7. Disorganised attachment
Adults who:
Are themselves traumatised, cannot self-regulate and cannot offer emotional availability to the child or be responsive to the child's emotional needs
Children who:
Do not understand personal safety and identity
Shift between controlling, compliance and resistance
Have no strategy to self-regulate and manage stress
Are predictably unpredictable, and may freeze, panic or fly into a rage when faced with uncertainty
What about your staff, and your wider community networks?
Secondary trauma can lead to collapse of individuals and networks

8. Attachment and brain function
If for any reason we are unable to regulate stress we need access to an adult who will:
Hold us in their own mind
Mindful awareness
Connect with us and self-regulate
Co-regulation, soothing
Stimulate our brain to integrated activity
Co-learning, teaching
What do you do, or what could you do, to promote mindful awareness, co-regulation and co-learning in your school, setting or service?

9. Survival from the start
Living things want to go on living and are born with survival behaviours
Human babies cannot survive without adult care
They are born with behaviours that grab the attention of adults to make sure the baby survives
ATTACHMENT BEHAVIOURS

10. So what are attachment behaviours?
The baby produces attachment behaviours for survival
Aversive – adult acts in order to get the baby to stop it
At first only aversive behaviours are available to the baby
Crying, screaming, breath-holding, back-arching, and so on
We never lose our capacity to produce aversive behaviours
Attractive – adult acts in order to get the baby to do it more
Babies begin to experiment with different ways to get a response
Smiling, cooing, gurgling, laughing, reaching, and so on
Attractive behaviours are readily extinguished if no response
How the adult responds to these behaviours will pattern the baby brain, producing patterns that may persist lifelong (but can change!)
What do these behaviours look like in your child or young person?

11. The first step in attachment: claiming
Human babies are born completely helpless
They must be claimed by, and lay claim to, their birth community
The ABCD of claiming
Attention, Bonding, Control, Dependency
To survive babies must gain the attention of their parents
Parents and babies bond together through scent, taste, touch, sound and parental gaze, with the baby checking that these are present
To feel safe, babies must gain control of their parents
As babies develop a sense of safety they become less controlling and develop a healthy dependency

12. Recognising and addressing unmet needs for claiming
They may, compared with their peers:
Be profoundly puzzled by relationships
Lack any fundamental sense of safety
Be very demanding of attention, and/or have bonding difficulties, and/or be very controlling, and/or be very dependent on other people
Children with unmet needs for claiming may be unable to form a core sense of identity
Noticeably different from their peers
How do children and young people in your setting develop a sense of belonging?
What skills do attachment figures need?

13. The neuroscience of human development
Behaviour is the evidence that a brain is working
Understanding how brains develop and function helps us to understand behaviour
The brain is made up of cells called neurons
The brain grows as neurons connect – neurons connect based on what we experience
Brains are always changing and adapting

14. Building brains Humans are born to connect, mirror and match
If attachment needs are met babies feel safe and secure
The brain and nervous system of the baby mirrors the state of the brain and nervous system in the adult (attunement)
This attunement patterns the baby brain
It takes twenty five years for the human brain to reach maturity
Attachment needs are lifelong to keep brains working well

15. The brain develops from the bottom up and the inside out
Lower brain – basic life-support
Limbic system – amygdala, hippocampus, emotions, impulses
Cerebral cortex – the pre-frontal cortex and executive functions
Right hemisphere: social and emotional, intuitive, unconscious
Left hemisphere: cognitive and rational, language, conscious
2. Limbic system
3. Cerebral cortex
1. Lower brain

16. Head to toe: the brain and nervous system
In human beings energy constantly flows.
Our mind manages the flow and converts it into information
Brain
Body
Connected people pick up this energy flow information.
Humans are born to connect, mirror and match
Brain
Body

17. Does this ever happen in your school?
ATTUNEMENT
‘A’ leads
‘B’ follows
‘A’ follows
‘B’ leads
CO-REGULATION
Does this ever happen in your school?

18. How does self-regulation work?
Escalation
HPA (stress) axis
adrenaline, cortisol, etc.
rising blood pressure
shallow breathing
increased muscle tension
The limbic brain is in charge
De-escalation
Vagus nerve
oxytocin, dopamine, etc.
lowering blood pressure
deeper breathing
reduced muscle tension
The cerebral cortex is back in action

19. The Vagus Nerve: Runs from the brain throughout the body and acts on all organs
The benefits of good vagal tone:
Clear thinking
Better emotional balance
Greater resilience
More efficient immune system
Improved attention

20. What do we need from other brains?
Building baby brains
- early childhood development
Mindful awareness
Holding the child in mind
Being aware of the mind of the child
Soothing
Settling the nervous system
Stimulation
Activating brain function
Maintaining healthy brains
- lifelong development
Mindful awareness
Holding the person in mind
Being aware of the mind of the other person
Co-regulation
Settling the nervous system
Co-learning
Activating brain function

21. What is trauma? Trauma means injury
In the context of recent research on brain function, trauma has a specialised meaning – it means acquired brain injury as a result of unregulated stress
Usually stress is good for us – when we can regulate stress it enables us to function at our best
When for any reason we are not able to regulate stress the overdose of stress hormones is toxic to the brain
Toxic stress is the signal to the brain that we are under threat
All functions that take time automatically close down
Changed blood supply to key brain areas leads to lasting injuries from which we then need to recover
Trauma is a normal part of human life

22. Behaviour – states – needs Our behaviour communicates our inner state
Calm and alert
Active and outgoing
Connected
Needing maintenance
Dissociative
Distressed
Disconnected
Needing intervention

23. Use your hands to imagine your brain
Hand model courtesy of Dan Siegel

24. If we flip our lid… … the downstairs brain - instantaneous response
Fight
Remove the threat
Flight
Remove self!
Freeze
Infantilise to attract adult help
Immobility, big eyes, smiles, perhaps incontinence
… and the upstairs brain
- strategies and behaviours
Aggression
Safety through dominance
Absence
Safety through concealment
Appeasement
Safety through manipulation
… SURVIVING not thriving

25. What causes stress to become toxic?
Two key factors:
The nature of the stressor
Our vulnerability or resilience – on that day at that time
Some stressors are so severe that almost anyone will be injured by them…
…some people are so vulnerable that almost any stress can injure them

26. What makes children vulnerable?
Adverse Childhood Experiences (ACEs)
Ander and Felitti (1997) – surveyed more than 17,000 American adults
Similar large scale UK studies such as that in Wales in 2015
Verbal abuse
Physical abuse
Sexual abuse
Physical neglect
Emotional neglect
Domestic violence
Substance misuse in the home
Separated/divorced parents
Family member incarcerated
Family member mental illness/suicidal
Ander and Felitti found 60% at least one ACE, 20% 3 or more ACEs

27. Consequences of adverse childhood experiences
Chronic health problems:
Heart disease
Cancer
Diabetes
Hepatitis
Fractures
Mental health problems:
Depression
Anxiety
Panic attacks
Across large populations – the more ACEs experienced, the worse the outcomes
Risky behaviours:
Smoking
Obesity
Alcohol/drug misuse
But research shows that future outcomes for health and wellbeing are NOT prescribed by past experience

28. What can we do to promote such compensatory experiences?
PACEs
Protective And Compensatory Experience buffers stress and trauma
Direct experiences
Unconditional love
A best friend
Helping others in community projects
Being involved in interest groups – sports, drama, music, other social activities
Environmental factors
Access to an available trusted adult (not a parent)
Access to appropriate education
Clean and safe living environment
Engaging in hobbies
What can we do to promote such compensatory experiences?

29. The impact of trauma
Until they recover people affected by toxic stress struggle to:
Self-regulate – stress, impulses, shame
Regulatory disorders
Process information accurately – make sense of the world around them or their own internal world of feelings
Processing disorders
Make and maintain relationships – understand and be interested in the world of others
Social function disorders
It is possible to recover from these disorders
Restoring integrated function actually builds resilience
We grow stronger through recovery from toxic stress

30. Reduced ability to self-regulate
Regulatory disorders – challenging behaviour
Stress
Hyperarousal: panic, rage, aggression, impaired memory, etc. …
… or dissociation: switched off, avoidant, controlling, etc. …
… or alternating between these
Impulse
Impaired ability to manage or account for behaviour
Not able to benefit directly from rewards and sanctions
Shame
Hypersensitive to criticism or praise, or apparent lack of remorse
What does this look like in your child or young person?

31. What helps? Creating a safe space at school
Attachment-related ideas
Provide and sustain a relaxing environment
Ensure that adults set the emotional tone
Encourage and enable the child to turn to adults for soothing
Bring relaxation into the awareness of the child and encourage practice
Discourage dependence on high stimulus activities
Trauma-related ideas
Stay aware of the child’s fear
Think first of the physical environment
Balance between soothing and stimulating
Simple changes can help – lighting, sound …
Use self appropriately to deal with a terrified flight animal
Voice, gestures, expression
Remember that adults are frightening
How do you create a safe space at school?

32. Reduced ability to make sense of the world
Processing disorders – impaired understanding
The world around them
Difficulty making sense of sensory information
hot or cold, hungry or full, tired or energetic, comfortable or in pain (or locating where in the body any pain might be)
Misunderstanding or misrepresenting everyday events and experiences
Their inner world
Difficulty making sense of feelings in self or others
Not able to put feelings into words
What does this look like in your child or young person?

33. What helps? Stimulating interest and teaching about trauma
Attachment-related ideas
Provide appropriate environmental stimulation for adults and children
Use storytelling and activities requiring use of the imagination
Encourage expression of experience and development of emotional intelligence
Trauma-related ideas
Learning about the effects of trauma is part of recovery
Everyone around the child can contribute to this
Each child needs us to learn how to teach them what they need to know
Stories and metaphors are powerful tools for teaching about surviving overwhelming events
Folk tales, literature, poetry, drama, television
What do you do to engage children’s interest?

34. Reduced ability to make sense of social interaction
Social function disorders – social exclusion
Understanding others
Difficulty with empathy: processing incoming information about the emotional state of other people
Reduced motivation, and ability, to engage positively with others
Anhedonia
Loss of the capacity for joy
Reduced or impaired ability to remember joyful experiences
Feelings of worthlessness
Difficulties with self-esteem
Global sense of shame triggered by minor events
What does this look like in your child or young person?

35. Recovery and resilience
People recover and develop resilience through building and strengthening new connections in the brain
Brain connections develop through:
Relationship – mindful co-regulation and mindful co-learning
Iteration – experience repeated over and over again
Relationship
Safe and trusted people who connect, co-regulate and co-learn
Iteration – three cyclical phases of recovery
Stabilisation – feeling safe/feeling supported/feeling understood
Integration – self-regulation/emotional processing/narrative
Adaptation – social skills/joy in living/self-esteem

36. Calm and alert Active and outgoing Dissociative Distressed
From disconnected to connected – intervention … and staying connected – maintenance
Calm and alert
Active and outgoing
Connected
Needing maintenance
Dissociative
Distressed
Disconnected
Needing intervention