Attachment Disorder
Unattached children become full of rage, "a sense of helplessness and hopelessness and anger." The roots of the problem are established as early as the first six months of life. Unattachment impacts the entire family. A high level of commitment is demanded of the foster family and should be considered when deciding to bring an attachment disordered child into the home.
A new therapeutic model must be used for an unattached child. Under the traditional model, the therapist establishes a trusting alliance with the child and out of that relationship flows healing. However, unattached children do not trust. They can be charming and give the appearance of health, but they manipulate and control relationships. They do not act out as long as they are in control and are not threatened by close relationships.
The importance of attachment
During the first two years of life and individual attains his or her full intellectual potential. They develop logical thinking ability, they understand how the world works, and they understand cause and effect. "Because I take action, certain results happen." During this time, they develop coping skills and relational skills. If their physical and affectional needs are unmet, they will find themselves in a hyper-vigilant, survival mode. In that mode, the brain does not develop normally, and attachment does not occur because the child learns to rely only on himself. The emotions associated with this are stored in a primitive part of the brain that is not reached during ordinary talk therapy.
During the first year, children usually learn to trust their primary care giver and then others. They learn to trust when their physical needs are met, but also through eye contact, touch, movement, and smiles. When the children have a need, they have a rage reaction. The care givers meet the need, so the children experience gratification; trust develops.
During the second year conduct disorders can begin. In normal development the children want something, but their parents limit fulfillment. As children accept the limits, the parents expand them. Unfortunately, the child whose basic trust was not formed in the first year remains in rage.
The events of life form attitudes, beliefs, and perceptions--a filter through which the individual interprets the world. This in turn leads to thoughts, feelings, and active responses. If the child is unattached, the filter distorts reality and leads to trouble.
Attachment Disorder. What Is It?
Attachment disorder is a condition in which individuals have difficulty forming loving, lasting, intimate relationships. Attachment disorders vary in severity, but the term is usually reserved for individuals who show a nearly complete lack of ability to be genuinely affectionate with others. Attachment is the result of the bonding process that occurs between a child and caregiver during the first 2 year's of the child’s life. When the caretaker recognizes and attends to the child's needs innumerable times a year, the child learns the world is a safe place and trust develops. The emotional connection also forms. The child feels empowered in their environment, and develops a secure base from which to explore the world. Attachment is reciprocal, the baby and caretaker create this deep, nurturing connection together. It takes two to connect. It is imperative for optimal brain development and emotional health, and its effects are felt physiologically, emotionally, cognitively, and socially.
Children without proper care in the first few years of life have an unusually high level of stress hormones, which adversely effect the crucial aspects of how brain and body develop. Conscience development is dependent upon brain development and follows attachment. Therefore, these children lack prosocial values and morality as well as demonstrating aggressive, disruptive and antisocial behaviors.
There are many reasons why the development of this connection and attachment can be disrupted:
- Premature birth
- Prenatal trauma, such as exposure to alcohol or drugs
- Unwanted pregnancy
- Separation from birth mother
- Postpartum depression in mother
- Severe abuse and/or neglect in the first years of life
- Multiple caretakers
- Hospitalizations
- Unresolved pain
- Painful or invasive medical procedures
- Insensitive Parenting
These children have learned at a preverbal stage that the world is a scary and distrustful place. This lesson has taken place at a biochemical level in the brain. For this reason, these children do not respond well to traditional therapy or parenting since both rely on the child's ability to form relationships that require trust and respect. These children have Reactive Attachment disorder, and it requires a different type of therapy to address these early attachment difficulties.
There is a range of attachment problems resulting in varying degrees of emotional disturbances in the child. Some of these children may have concurrent diagnoses such as Oppositional Defiant Disorder, Conduct Disorder, ADHD, Mood Disorders such as Depression or Bipolar Disorder, and Posttraumatic Stress Disorder. Unfortunately, many children with RAD are often misdiagnosed and receive inadequate therapy for years. Without proper treatment, these children and the societies in which they reside will pay a very high price indeed.
Symptoms of Attachment Disorder
The Child may have some of the following behaviors/symptoms:
- Superficially charming, acts cute to get what he/she wants
- Indiscriminately affectionate with unfamiliar adults
- Resists genuine affection with primary caregivers, on parental terms (especially mother)
- Controlling, bossy, manipulative, defiant, argumentative, demanding
- Impulsive, no 'stops' on their behaviors
- Fascinated with fire, death, blood, weapons, evil or gore
- Cruelty to animals, destruction of property, aggression toward others or self
- Destructive, accident-prone
- Very concerned about tiny hurts, but brushes off big hurts
- Rages or has long temper tantrums, especially in response to adult authority, being told 'no'
- Poor eye contact except when lying will look you in the eye with the most innocent eyes
- Blames others for their problems
- Lacks self-control
- 'Crazy' lying (about the obvious), steals, shows no remorse, no conscience, defiant
- Food issues- hoards or sneaks food, gorges, refuses to eat, eats strange things, hides food
- Poor hygiene: wets or soils self
- Poor peer relationships
- Underachiever
- Persistent nonsense questions and incessant chatter
- Abnormal speech patterns or language problems
- Grandiose sense of self, lacks trust in others to care for him/her
The Parents' may exhibit some of the following symptoms:
- Feel helpless, demoralized, emotionally exhausted
- Appear angry, frustrated and hostile
- Feelings of inadequacy and guilt
- May look overly controlling and rigid
How to parent and help a child with Attachment Disorder?
- Find appropriate therapy: Traditional therapy is based on the belief that the child has the readiness and ability to form a therapeutic relationship. These kids are not capable of this. Use attachment therapy and skilled therapists with experience. Be present in the therapy!
- Spend a lot of time together, be physically close, take time off work. Parents need to help their child develop a secure attachment for the first time in their life – a 'psychological birth'. The parents can make many of the choices for the child and provide both a sense of safety and fewer consequences for misbehavior because there will be fewer misbehaviors, and the child is not repeatedly experiencing failure and shame.
- Parental attitude that communicates empathy, acceptance, affection, curiosity, and playfulness increases the child's ability to respond like a securely attached infant
- Learn to parent differently. Enlarge your 'bag of tricks'
- Get support for yourselves: support groups, on-line RAD parent groups,
- Use natural and logical consequences, accept the child's choices and show empathy for the consequences, striving to be 'sad for' his distress over the consequence rather than being 'mad at' him for his behavior.
- The behaviors may be more frequent, more intense and last longer you need to hang in there!
- Use respite care; find one who understand the nature and severity of the child's attachment problems, false allegations, need to follow parent's guidelines. Take care of yourself!
- Be prepared 'for the long haul.’ Often, 18-24 months may be required to see significant progress.
- Get in-home supportive services a few hours a week: must be knowledgeable of attachment.
Reactive Attachment Disorder Assessment Checklist (Cicchetti, 1989)
- How severe, chronic and pervasive were the child's experiences of neglect and abuse?
- How many caregivers did the child have? (Disrupted relationships with foster parents are each likely to be experienced as rejection and abandonment. With each subsequent disruption, a child's readiness to form an attachment with the next caregiver is likely to be less.)
- Were there any positive, continuing relationships during the first 2 years of the child's life?
- Has the child begun to show any significant improvements in his current family foster home?
- Is there any selectivity in the child's attachments?
- Has the child ever shown grief over loss?
- Does the child accept help and comforting?
- Can the child enjoy, without disrupting them, close and playful interactions that are similar to the attunement interactions mothers have with their infants?
- Can the child ever directly show shame over his behaviors?
- Does the child ever show sadness over the consequences of his behaviors, rather than being enraged over the perceived unfairness? Can the child experience and give expressions to sadness and to fears?