At-Risk Youth and Attachment-Based Therapy: Implications for Clinical Practice/Les Jeunes À Risque et la Thérapie Basée Sur L'attachement : Implications Pour la Pratique Clinique

Mental health concerns in childhood can cause isolation, challenge daily functioning, and negatively impact developmental milestones in youth (Nowak, Gaweda, Jelonek, & JonahKozik, 2013; Weems & Carrion, 2003; White & Yellin, 2011). Academic and social development are also adversely affected by mental health issues, which can exacerbate stress and influence children's experiences with families, school staff, social service workers, and law enforcement personnel (Rapee, Bogels, van der Sluis, Craske, & Ollendick, 2012). Estimates reveal that 10-20% of American and Canadian children and adolescents suffer from one or more mental health disorders, with symptoms severe enough to influence their daily functioning (Ministry of Health, Statistics Canada, 2013; National Institute of Mental Health, U.S. Department of Health and Human Services, 2010). On a global scale, the World Health Organization estimates that 1 in 5 children internationally suffer from a diagnosable mental health concern (WHO, 2003). Of Canadian youth surveyed, 33% reported insufficient or complete lack of specialty support services (Ministry of Health, Statistics Canada, 2013). Limited services, which can positively influence emotional and behavioural challenges, are linked with limited opportunities for youth to realize their innate potential and decrease their involvement in risky behaviours (Rapee et ah, 2012).Developmental psychologists propose that neurological pathways to internalizing (such as anxiety, depression, social isolation, withdrawal, self-harming, and suicidal ideation) and externalizing disorders (such as aggression and oppositional defiance) are complex; however, once established, symptoms tend to be stable over time (Hunsley, Ronson, Cohen, & Lee, 2014; Keiley, Bates, Dodge, & Pettit, 2000). This trend places children with special needs vulnerable for various forms of future adversity. Researchers suggest that children with insecure attachments to significant adults are twice as likely to develop internalizing and/ or externalizing behaviours compared with children with secure attachments (Madigan, Atkinson, Laurin, & Benoit, 2013). At-risk youth are also susceptible to a variety of undesirable outcomes, such as school dropout, criminality, aggression, unsafe sexual practices, and abuse of alcohol and/or other substances (Rahim, 2014; Rapee et ah, 2012; Savage, 2014). Psychologists, school counsellors, teachers, school staff, caregivers, family members, law enforcement, and others can contribute in positive and supportive ways to ease the anxiety and confusion that youth face every day. To meaningfully connect with others, strengthen social skills, and build positive experiences, strong attachments to healthy relationships need to be established and reliable in times of need (Eyberg, Nelson, & Boggs, 2008; Ginot, 2012; Savage, 2014). The innate social demand for connection of at-risk youth cannot be ignored, as improved accommodations, adaptation, and interventions are beneficial for these individuals, their families, and society (Carr, 2005; Savage, 2014, Yanos, Roe, West, Smith, & Lysaker, 2012).Increasing the clinical knowledge of childhood, adolescent, and adult attachment patterns, as well as methods to promote positive adjustment, are central to understanding and treating at-risk youth and their high-risk behaviours (Carr, 2005; Walden & Beran, 2010). It is proposed in this article that attachmentbased interventions can provide a safe and effective approach for youth to express emotions and thoughts, build secure attachments to therapists and others, reflect on past family patterns, heal insecure attachment styles, and develop new outcomes. A review of attachment theory and therapy literature is provided, as well as current research strengths and limitations. Clinical applications of findings to therapeutic practice will also be offered in the form of individual, family, and group therapy interventions. …

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