Attachment/Attachment disorders/Nurture

This unit examines attachment theory as a framework for understanding and responding to pupils with BESD. It provides:

  • An overview of attachment theory and its history.
  • Insight into how it relates to pupils with BESD.
  • Criticism of attachment theory, or elements thereof, within the health community. 
  • Information on nurture groups and how they can help students with BESD.

Attachment theory overview

Pioneered by John Bowlby in 1969, attachment theory engages with the processes of bonding between a carer and a child, and examines how these processes affect psychological development throughout later life. Attachment theory:

  • Views attachment-seeking behaviour in infants – such as crying and grasping – as a response to a biological need for proximity with carers.
  • Examines the "lasting psychological connectedness" (Bowlby, 1969) that is formed through behavioural interactions between infants and carers.
  • Explores how this connectedness affects child development, and how it goes on to affect the child’s relationships in later life.
Mother/child attachment imageMother/child attachment

Attachment theory

In two major works entitled Attachment and Loss: Volume 1. Attachment (1969) and Volume 2. Separation: Anxiety and anger (1973), Bowlby argued that:

  • A loving early relationship leads to...

    Carers who are sensitive to a child’s needs in early life provide them with a deep-seated sense of security.

  • ...a positive model of social relationships...

    Secure bonds allow infants to form a positive idea of relationships, and they learn to see carers as providers of safe space. This safety becomes a “secure base” (Bowlby, 1973) from which to explore the world, helping children to develop independence and self-reliance.

  • ...enabling children to develop secure attachments in later life.

    The bond between infants and caregivers goes on to form a template for supportive and intimate attachments in adulthood.

Four major types of attachment

Secure attachment

Securely attached infants:

  • Are happy in the company of their primary caregiver, and become visibly upset when he or she leaves the room.
  • Will tend to seek comfort from a caregiver when distressed, and readily accept contact initiated by familiar carers.
  • Are more likely to develop trusting, long-term relationships in adult life.

Move the marker along the bar to see how attachment changes from infancy to adulthood.


Secure attachment in children

  1. 1.5 years old

    A 1988 study by Karin and Klaus Grossmann found that children identified as being securely attached at 1.5 years of age were rated by pre-school teachers as being less aggressive or dependent.

  2. 6 years old

    Securely attached children demonstrate increased concentration, independence, ego control and resiliency when compared with children that have been classified as insecurely attached.

  3. 22 years old

    Another study by Karin and Klaus Grossmann in 2005 successfully predicted the stability and perceived security of individuals’ relationships at the age of 22, using information on attachments collated during their childhood and adolescence.

  1. 1.5 years old
  2. 6 years old
  3. 22 years old

Maternal separation and care quality

A study carried out by the US Department of Health and Human Services examined the effects of non-maternal care on children’s cognitive and behavioural development.

It found that children who received care from sources other than their primary caregiver were able to develop just as well as children who received care exclusively from a primary caregiver.

The study did find, however, that the quality of childcare – that is, the attentiveness, sensitivity and positivity of carers – had a greater effect on developmental rates and the occurrence of behavioural problems.

A 2003 study by John Love et al., entitled Child care quality matters (PDF, 470KB) , examined the association between childcare approaches and outcomes. Love also concluded that care quality, rather than carer contact time, was the most important factor in influencing child development.

Maternal separation image

Stress in infancy

A 1996 study by Professor Megan Gunnar of Stanford University examined levels of the stress hormone cortisol in children throughout various stages of development.

  • Gunnar found that infants classified as insecurely attached at 18 months old had elevated levels of cortisol in the brain.
  • These same children appeared more fearful and inhibited than their peers throughout infanthood and into young childhood.
  • Gunnar concluded that the stress levels experienced by children in infancy may permanently shape stress responses in the brain, affecting a child’s memory, attention and emotions in later life.

Aims of nurture groups

Nurture groups are special focus groups based in schools, which help pupils whose difficulties may relate to the nature and quality of their experiences with primary caregivers.

Select a circle to find out more about the aims of nurture groups.

  1. To meet pupils' potential
  2. To nurture emotional growth
  3. To stimulate learning experiences
  4. To offer broad-based experiences

To meet pupils' potential

A secure and predictable social learning environment enables students to develop a positive internal picture of the world and their place within it. With a positive self-image, pupils can be encouraged to achieve their full potential in both social and academic pursuits.

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To nurture emotional growth

The groups emphasise the importance of emotional growth, providing pupils with strong, trusting attachments to adults such as a teachers or teaching assistants. Studies have shown that many children enter school without the social skills necessary for classroom interaction and cooperation. Strong social attachments can help children to develop emotional competencies and avoid behavioural problems which could be detrimental to the learning process.

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To stimulate learning experiences

Carefully planned, repetitive learning routines encourage academic progress and help build confidence in learning. Learning experiences are supported by a teacher and teaching assistant, who aim to maintain strong emotional attachments with pupils.

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To offer broad-based experiences

Nurture rooms provide pupils with a secure, supportive environment in which they can learn to develop social attachments. Once attachments have been formed, pupils are exposed to a broad range of experiences that reflect the structured conditions of normal early development. These experiences may include shared meal times, social interactions and simple, directed activities.

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  • A nurture group in a secondary setting

    Almondbury High School in Huddersfield shows us its nurture group, which offers a calm, homely environment to Year 7 to 10 pupils, particularly those with BESD. These pupils are released from classes three or four times a week to participate, engaging in structured conversations and group work.

    This video clip is referenced immediately prior to the list of tasks, and in task 3, in your PDF of unit 16.

    Show transcript


    Almondbury High School in Huddersfield West Yorkshire runs a nurture group for children in Year Seven to Ten who are having difficulties in mainstream class. It’s particularly aimed at those pupils with behavioural, emotional and social difficulties or BESD.

    Trevor Bowen - Deputy Head Teacher:

    We have in our community quite a few pupils who have BESD. Originally, the Special Needs Department comprised of 2 big rooms, and we did lots of work in terms of literacy and numeracy intervention. But I felt at the time that what we didn’t do, was we didn’t really get under the skin of children to find out what it was that was causing the behaviour. We were being more reactive. Doing some work on say SEAL Emotional Health. But we felt there was an opportunity to create a specialised resource which would get under the skin and look at the behaviours from the child’s perspective.


    Pupils are released from classes to come to the nurture group three or four times a week for structured group work with two members of staff, during which they are encouraged to discuss how they feel about their lives, both at school and at home.

    Sue Green: Nurture Group Leader:

    The nurture group is a calm environment, it’s a homely environment. We take the pressure off the curriculum and we work in a different way in here. Because we are a High School and we’re not a Primary School, we can’t have the children for such a length of time, so what we do is we rotate our timetable every Friday so that it means in a term they’ll only miss the same lesson once. So we might have a double session and two single sessions, but you’re getting to see them four times a week. That way, you’re able to make that attachment, you’re able to build the relationship, and they’ve got contact with you each day.

    The routine runs that we always meet and greet, so the children always feel welcome.

    Nurture group interaction:

    Pupil: Hi Miss, nice to see you.

    Sue: Nice to see you.


    They shake hands with each other and they say hello. It’s a structured environment, we may have ADHD trouble, we might have children with speech and language difficulties. We have children with social and emotional behaviour problems.

    Nurture Group interaction:

    Sue: Right guys, do you want to put your feelings on the feelings tree?


    The children go and put their feelings on the feelings tree. That gives me the opportunity to be able to look at the feelings tree, and then to speak to them about how they are feeling at that moment. We have a thing called the speaking stone, and the speaking stone gives a child the opportunities to speak. Whoever holds the speaking stone, it is their turn to talk.

    Nurture Group interaction

    Sue: Kirsty, you’ve put happy, what are you happy about? Why are you happy?

    Kirsty: Because I’m well.

    Sue: You’re feeling well, you’ve been ill haven’t you for the past couple of days? And you’re feeling a lot better now?

    Kirsty: Yes.

    Sue: And then I’ve got Shane on angry. Why are you feeling angry?

    Shane: Because of yesterday.

    Sue: Oh dear, what happened yesterday?

    Shane: My thought was to go out with Sam I think.

    Sue: Did you talk to mum about it?

    Shane: I don’t know.

    Sue: You don’t know. Well you need to do that don’t you, talk to mum and tell her why you’re feeling angry...


    We have a thing called the “speaking stone”, and the speaking stone gives the child the opportunity to speak, whoever holds the speaking stone it is their chance to talk.

    Nurture group interaction

    Sue: So Gemma, are you on report this week?

    Gemma: No.

    Sue: How are things going in lesson?

    Gemma: Shaky.

    Sue: In what way are they shaky?

    Gemma: Because I’ve got a few problems with friends and they’re in most of my lessons so it’s kind of mixed feelings because one minute we’re friends and one minute we’re not so it’s just...


    The others need to be listening, so that the children are aware of what a good listener is we use little cue cards. So we have a cue card of “good listener”, “good eye contact”, “good sitting”, and I actually make the children in charge of that, so they are looking for who is a good listener rather than me just looking for that.

    Ian Hepworth: Educational Psychologist

    It’s important to select the right individuals, but it’s even more important that the groups that you’re comprising have a real genuine variety of children, and needs, and strengths, and problems within that group, because you’re always using each of the childrens’ strengths as what you’re aiming for the others to achieve. So there’s no point in having a group with say six ADHD children in it, you want a quiet, withdrawn, child, you want a dominant child, you want a hyperactive child, you want a child that needs bringing out of their shell. So getting that mix is absolutely vital.

    Nurture group interaction

    Sue: You need to spread all your cups out to one side, because you are going to build yourself a tower.


    We will then have a main activity and the main activity could be anything from a matching pairs game, where they will have to again take turns, join in, they may lose in a game and they’ve got to deal with the losing in a game. We might have a social skills board game where they get to ask each other questions and solve problems.

    Nurture group interaction

    Sue: Right this is our team challenge for today, it’s a game about communication. In this game you’re only allowed to use a string and an elastic band.


    They work in small groups, solving problems, talking to each other, learning to listen to each other. Then they can take these skills that they learn from the nurture group and take them back into the classroom, and it makes them more confident learners.

    Nurture group interaction

    Gemma: Which one?

    Pupil 1: This one here.

    Gemma: Alright then.

    Pupil 1: I was going to use my hand then!

    Sue: Good lad, you didn’t, you remembered the rules.

    Gemma: Where are we putting this one?

    Sue: We’ll put it on top, so we’ve built a pyramid.

    Pupil 1: Careful not to knock them off.

    Gemma: Shall we push them two in because they look a bit like a big gap?

    Sue: You decide, your decision.

    Gemma: Let’s do it, just do it slow.


    Whilst they’re within the nurture group, you’re looking for a movement, you’re looking for those gaps between where the child is now and what you would expect of your average 12 year old, or 13 year old, or 14 year old. If you can see the gaps closing, month by month, term by term, you know that what you’re doing is having the desired effect. If you don’t see those gaps closing, then you question what you’re doing, you may change the activities, you may tinker with the group composition, because you’ve simply chosen a child who is not going to respond to what you can offer within the nurture group.

    Nurture group interaction

    Pupils: Yes!

    Sue: Well done.


    We always, every session we have tea and toast. For the children it’s probably the most important part of the session. They don’t realise what they’re actually learning with this tea and toast. They’re learning to interact with their peers in a correct manner, they’re learning good table manners, they’re looking after one another.

    Nurture group interaction

    Sue: So is anybody else going anywhere this weekend? Alex is going to Blackpool, he’s taking his friend.

    Gemma: I’m off to my dad’s.

    Sue: You’re going to your dad’s?

    Gemma: And then to Linton next weekend.

    Sue: Are you?

    Gemma: I’m going to visit my grandad and gran, and my aunty and uncle.

    Pupil: On your own?

    Sue: She’ll be going on the train on her own and then probably be met at the other end.

    Pupil: Oh right.


    I get lots of positive feedback from the children that they’re doing better in lessons, or that they’re getting nice comments in lessons, they’re not being sent out of lessons, or even they’re not taking themselves out of lessons, but many a time, the children I’ve been working with couldn’t handle the lesson and they would get up and just walk out of class.

    One of the pupils, Otis, it’s ADHD. He’s a complete character. I’ve seen a massive improvement in Otis. He’s a happy boy. When I first met Otis, he’d come in crying, he was taken out of most lessons, he would be climbing on windowsills, doing lots of inappropriate behaviour in a classroom. He’s now able to control himself more, he comes in session, he will talk if he’s been angry. He waits and he comes in and he tells us in session. “I’m angry today miss, and I’m angry because of”, again, the children, myself, we give him resources or strategies that he can use, he gets the chance to vent those feelings, he’s no longer shouting out at staff. He’s sort of venting his feelings in here with us, in a controlled environment, and with somebody who can remain calm with him and talk him through that process.

    Nurture group interaction:

    Sue: Otis, how have you got on this week?

    Otis: Good.

    Sue: Any green slips?

    Otis: A few.

    Sue: Right and what were they for?

    Otis: Not doing proper working, say like if I wasn’t concentrating properly.

    Sue: Were you messing about? Were you paying attention?

    Otis: I was looking out of the window.

    Sue: So that didn’t help. Would it maybe help if you sat somewhere else away from the window?

    Otis: Yes.

    Ashley – Father of Otis

    It’s made him more aware of himself, and if you like, it’s made him a little bit more self-controlled. And it does affect how he is as a person, and how he’s developing. So I’m hoping he’ll do great in the future, and we’re learning to handle the issues that he’s having. So, I’m hoping it’s going to be great for him.


    The group helps us to not butt in when people are speaking, and say if we have a short temper sometimes, it teaches us to be a bit more patient.


    You need a room with sofas, you need a table to work at, you need a kitchen area. In our nurture group, we made it as good as we possibly could, and we did this simply because we felt the children were worth it, and if you could give them something that was a good environment, then they would look after this environment, that’s exactly what they do. This nurture group now has been running 3 years, and things still seem brand new.


    We spent £12,000, on the room. We said that this room should be the best that we can make it for those children. We went through four days, myself and the two nurture group staff, four days of intensive training on nurture groups, which was really really good.

    Staff have been encourage by the impact that this room has had. They have seen those children change. Part of the argument is, yes, it’s not a dumping ground, but oh look at the impact it’s having on these children, and they’re recognising that, and there’s an encouragement that goes on there, it’s sort of a two way process. When children start to change their behaviours, that’s when staff start to think this has got a real impact and has real value. And we have got, be under no illusions, clear cut protocols that children can be withdrawn from any lesson in lower school, to come to nurture group, because our feeling would be, that if we can deal with the way that they are behaving in classrooms, their attainment will increase dramatically.

Wider school policies and BESD

This clip gives insight into the policies of three primary schools in North London, Blackpool, and Leeds. These include focusing on delivering fast-paced lessons to retain pupils’ attention, using programmes such as SEAL to support emotional resilience, and dealing with behavioural issues through sanctions and boundaries, rather than exclusion.

This audio clip relates to task 3 in your PDF of unit 16.

Show transcript

Doris Law – Deputy Head and Inclusion Manager:

My name is Doris Law. I’m the Deputy Head Inclusion Manager at West Green Primary School.

I think one of the main links between children with behavioural problems and children with other difficulties is their lack of retaining attentions, and retaining focus. So it’s talking to class teachers about making sessions interesting, making them active, making them quick paced, making them easy for children to reach the success criteria of the session, for all children, giving them all a chance to feel that they’re improving, and then praising them at the end by saying, well done, you’ve managed to reach the success criteria, and you’ve proved it by doing whatever they’re supposed to be doing.

Gill Holt:

My name is Gill Holt. I’m Inclusion Manager at Hawes Side Primary School.

There’s a strong correlation between children with behavioural difficulties, and reading and writing. If children go undiagnosed, if dyslexia is not diagnosed, if they do not receive the support they require, then there’ll be resulting frustration, they’ll struggle with their self esteem, confidence levels, they’ll find school an extremely stressful experience and this will result in behavioural problems.

In school we have lots of programmes to support children with emotional resilience. We do lots of work with SEAL, and our learning mentors deliver programmes around self-esteem, self-confidence and self-awareness. These have worked very successfully for the children, but the key to supporting these children is identify their needs, and supporting their needs in school.

At Hawes Side School we get a lot of non-routine admissions. When they enter school we do lots of assessments with these children to identify their needs - if they have any weaknesses. And from then on, they move into class, and we monitor them very carefully.

Zoe Adams:

My name is Zoe Adams. I’m Head Teacher at West Wood Primary School here in Leeds.

I don’t think you can be an excellent school if you’re excluding pupils, because I really don’t understand the logic behind exclusion, I don’t know what’s to be gained out of excluding a child. It’s not something that would come into anyone’s mind for any behaviour whatsoever.

If children do behave in an extreme way, then we think about how they’ve behaved, what they’ve done, who that child is, where the behaviour has come from and what we should do to make that not happen again, and to work with the children as to why it happened, we don’t exclude them. We sanction and we have very clear boundaries, but we don’t exclude.

I think the whole thing with exclusion is not starting at the end, on the exclusion part, but thinking about how you get really good behaviour from the beginning. So our behaviour management is all based on excellent relationships, knowing every child really, really well, having a school that’s set up to deliver personalised education so every child gets what they need. So if they’re finding it really difficult to access the curriculum, or the school, or even play time, or whatever, we’re working with them at an early stage to make sure they can manage that. So hopefully we never hit those really extreme behaviours that you hear about in some schools because we know where the children come from and what they need, and we try to deal with that all the time. And the children know they’re listened to, they know everything’s fair, and that it’s going to be dealt with.

I think that’s where extreme behaviour comes from, if children think things aren’t fair, or they’re not listened to, then they can behave in an extreme way. And they don’t tend to here. We’re very proud, we do actually get a lot of children come here that have got funding because of behavioural needs or they’ve been excluded from other schools, and we’ve got an incredibly successful, success story really about how we’ve dealt with them because they come here, and we seem to manage them well, and they seem to have a fresh start, and I know it can be, I’m not saying it’s just as bad, I do think the whole ethos about how we deal with children and respect them and listen to them, and don’t judge them, and try to make the school work for them instead of them work for our school, means they succeed.

Otis’s story

Nurture group leader Sue Green explains how she uses ‘the four Ps’ when working with Otis, a pupil with ADHD who attends the group. Otis, his father and associated assistant head teacher Sandra Quarmby describe how group work helps him progress and develop.

This audio clip relates to task 3 in your PDF of unit 16.

Show transcript

Sue Green – Nurture Group Leader:

I’m Sue Green and I’m the Nurture Group Leader of Almondbury High School in Huddersfield.

The children benefit from being part of a nurture group. They are taken away from the curriculum and they’re brought into an environment which is a calmer environment, for a more homely space. They work out solving problems, talking to each other, learning to listen to each other, then they can take these skills that they learn from the nurture group and take them back into the classroom. It makes them more confident learners.

One of our pupils Otis, it’s ADHD, he is a complete character, we absolutely love Otis. How do you handle Otis? I look and I think, in my head, 4 Ps. So I think, P is keep things in perspective, be positive, if I’ve got a positive attitude with Otis, then he’s got a positive attitude with me. The other thing is, petite. I think little things, the little things don’t matter. When Otis is in here and he’s fiddling about, he is still listening to me, even though he’s fiddling, we give him something that he can fiddle about with, he is still listening - it doesn’t mean he’s not paying attention. And patience, just be patient with him. I take my time with Otis, it slows him down, and I can’t expect him to do as asked first time, he’s not going to do that, so I’ve got to just be patient. I give him the target of, do as asked with no more than 3 reminders, which then after a period of time, will go down to with no more than 2 reminders. So eventually, he can work his way to doing as asked first time.


The group helps us to not butt in when people are speaking, and say if we have a short temper sometimes, the teachers can be a bit more patient, like if we get really annoyed in a class, you come here and you can like sort your problem out.

Ashley – Father of Otis:

My names is Ashley, I’m the father of Otis. At home there’s just me and his brother. Otis comes to the nurture group because of issues with his behaviour, because he’s hyper and easily distracted. Bright kid, but he needs a little support and the nurture group has been helping him. It’s made him more aware of himself and, if you like, it’s made him a little bit more self-controlled, teach him to help, to handle it a little. But obviously, as well, because people are understanding where he’s coming from. It helps because their approach, you know, be a little more understanding, and it does affect how he is as a person, and how he’s developing.

Sandra Quarmby – Associated Assistant Head:

My name is Sandra Quarmby. I am one of the Associated Assistant Head Teachers with responsibility for community, links and parental engagement. I also teach music and personal skills. I coordinate both subjects and I’m also the Kirklee’s advance skills teacher for citizenship.


Otis is an interesting character. He knows he can be quite challenging but he loves music, and he’s a natural musician, and he’s now having one-to-one guitar lessons, electric guitar -he’s learning how to play James Bond power chords at the moment and he’s absolutely loving it, and that’s given him another way into the classroom. You talk to him about it, he’s got something that he can share with you because he’s loving it so much. So it’s a nice way to get him interested in the subject that he’s actually naturally talented in.

The last two assessment tracking cycles we’ve done, there has been a marked difference because he’s actually now well on target. In fact he’s actually beyond target in music which is absolutely wonderful. Now partly because I do so much group work in music, it’s helping him socialise better with others, it’s helping him develop his team work skills, and that’s, you know, that’s really, really good for learning.

Sue Green:

I’ve seen a massive improvement in Otis, he’s a happy boy. When I first met Otis, he’d be coming in crying, he was taken out of most lessons, he would be climbing on window sills, doing lots of inappropriate behaviour in a classroom. He’s now able to control himself more, he comes in session, and he will talk if he’s been angry, he waits and he comes in, and he tells us in session, “I am angry today Miss and I’m angry because of…”, again, the children, myself, we give him resources or strategies that he can use, he gets the chance to vent those feelings, he’s no longer shouting out at staff, he sort of vents his feelings in here with us, in a controlled environment, with somebody who can remain calm with him and talk him through that process.


The future for Otis, hopefully good, because we’re learning to handle the issues he’s having, it’s not going to be easy, I think he’s going to have a hard and a tough time up ahead, I’m probably going to have a few hard and tough times with him in the future myself. But, if his personality stays the way he is, he’ll do great I think.