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Introduction
Attachment is as basic a life requirement as the
more traditionally cited food, shelter, and clothing.
Attachment involves a state of mutual dependence felt by
individuals, experienced but not necessarily manifested
behaviorally. Attachment provides a sense of rootedness. Genuine
attachment experiences are vital for sound development; in fact, for
mental health and life everywhere. Attachment behaviours , as
contrasted to feelings of attachment, are really frantic efforts to
obtain close attachment.
From Maier, H. W. Development Group Care of
Children and Youth. New York: Haworth Press. p22
Definitions
WHAT IS ATTACHMENT DISORDER?
More and more children are failing to develop secure attachments to
loving, protective caregivers. These children are left without the
most important foundation for healthy development. They are flooding
our child welfare system with an overwhelming array of problems -
emotional, behavioral, social, cognitive, developmental, physical
and moral - and growing up to perpetuate the cycle with their own
children. Research has shown that up to 80% of high risk families
(abuse and neglect, poverty, substance abuse, domestic violence,
history of maltreatment in parents’ childhood, depression and other
psychological disorders in parents) create severe attachment
disorders in their children. Since there are one million
substantiated cases of serious abuse and neglect in the U.S. each
year, the statistics indicate that there are 800,000 children with
severe attachment disorder coming to the attention of the child
welfare system each year. This does not include thousands of
children with attachment disorder adopted from other countries.
Disrupted and anxious attachment not only leads to emotional and
social problems, but also results in biochemical consequences in the
developing brain. Infants raised without loving touch and security
have abnormally high levels of stress hormones, which can impair the
growth and development of their brains and bodies. The
neurobiological consequences of emotional neglect can leave children
behaviorally disordered, depressed, apathetic, slow to learn, and
prone to chronic illness. Compared to securely attached children,
attachment disordered children are significantly more likely to be
aggressive, disruptive and antisocial. Teenage boys, for example,
who have experienced attachment difficulties early in life, are
three times more likely to commit violent crimes. Disruption of
attachment during the crucial first three years can lead to what has
been called "affectionless psychopathy", the inability to form
meaningful emotional relationships, coupled with chronic anger, poor
impulse control, and a lack of remorse.
Attachment disorder is transmitted intergenerationally. Children
lacking secure attachments with caregivers commonly grow up to be
parents who are incapable of establishing this crucial foundation
with their own children. Instead of following the instinct to
protect, nurture and love their children, they abuse, neglect and
abandon. The situation is out of control. Consider the following:
The number of children seriously injured by maltreatment quadrupled
from 1986 (140,000) to 1993 (600,000).
Three million cases of maltreatment were investigated by Child
Protective Services in 1995. Over one million were confirmed as
serious abuse and/or neglect with risk for continued maltreatment.
Surveys indicated the actual number of cases are 10 to 16 times
higher.
Child Protective Services are unable to handle the vast increases;
only 28% of seriously maltreated children were evaluated in 1993
compared to 45% in 1986.
Children who begin their lives with compromised and disrupted
attachment are at risk for serious problems as development unfolds:
Low self-esteem.
Needy, clingy or pseudoindependent.
Decompensate when faced with stress and adversity.
Lack of self-control.
Unable to develop and maintain friendships.
Alienated from and oppositional with parents, caregivers, and other
authority figures.
Antisocial attitudes and behaviors.
Aggression and violence.
Difficulty with genuine trust, intimacy and affection.
Negative, hopeless and pessimistic view of self, family and society.
Lack empathy, compassion and remorse.
Behavioral and academic problems at school.
Perpetuate the cycle of maltreatment and attachment disorder in
their own children when they reach adulthood.
Traits and symptoms
Attachment disorder affects all aspect of a child’s functioning. A
child may display some combination of the following primary
symptoms:
Behavior: oppositional and defiant, impulsive, destructive, lie and
steal, aggressive and abusive, hyperactive, self-destructive, cruel
to animals, irresponsible, fire setting.
Emotions: intense anger and temper, sad, depressed and hopeless,
moody, fearful and anxious (although often hidden), irritable,
inappropriate emotional reactions.
Thoughts: negative beliefs about self, relationships, and life in
general ("negative working model"), lack of cause-and-effect
thinking, attention and learning problems.
Relationships: lacks trust, controlling ("bossy"), manipulative,
does not give or receive genuine affection and love,
indiscriminately affectionate with strangers, unstable peer
relationships, blames others for own mistakes or problems,
victimizes others/victimized.
Physical: poor hygiene, tactilely defensive, enuresis and encopresis,
accident prone, high pain tolerance, genetic predispositions (e.g.,
depression, hyperactivity).
Moral/Spiritual: lack of faith, compassion, remorse, meaning and
other prosocial values, identification with evil and the dark side
of life.
From: Attachment Treatment and Training
Institute, PLLC
Issues
Reactive Attachment Disorder DSM-IV
A markedly disturbed and developmentally inappropriate social
relatedness in most contexts, beginning before age five, as evidenced
by either:
Inhibited Type: persistent failure to initiate or respond in a
developmentally appropriate fashion to most social interactions, as
manifest by excessively inhibited, hypervigilant, or highly ambivalent
and contradictory responses (e.g. responds to caregivers with
approach, avoidance, and resistance to comforting, or frozen
watchfulness); or
Disinhibted Type: diffuse attachment as manifest by
indiscriminate sociability with marked inability to exhibit
appropriate selective attachments (e.g. excessive familiarity with
relative strangers or lack of selectability of attachment figures).
Experts in the field of attachment make reference to particular
characteristics, or symptoms found in children with RAD.
From: 2002 Pediatric Behavioral Health
Resources
Readings
The following readings and other relevant material are accessible on this site:
What does it take to care ?
Attachment and Youth at risk
Establishing meaningful contacts
with children and youth
No-touch Policy
“All he wants
... ”
Difficult behaviours
Attachment and attachment
behaviors.
Mary Ainsworth: Our
guide to attachment research
References
Attachment Disorders
Ainsworth, Frank. (1997). Place as a source of attachment and identity across
the life course. Journal of Child and Youth Care Work. 12-13. pp. 58-67.
The concept of place attachment and the bonding of people to places relates to
the way individual and communal aspects of identity are shaped by the
sociophysical environment. This paper refers to child and adult populations;
indigenous peoples, migrants, and refugees; former residents of institutional
programs and the homeless. It is argued that for all these populations security
and identity are influenced by place attachment, which is a form of attachment
that warrants our close attention.
Ainsworth, M., S. Bell, et al. (1971). Individual differences in
strange-situation behavior of one-year-olds. The origins of human social
relations. H. Schaffer. New York, Academic Press: 17-57.
Ainsworth, M. (1973). The development of infant-mother attachment. Review
of child development research. B. Caldwell and H. Ricciuti. Chicago, University
Press. 3: 1-99.
Ainsworth, M., M. C. Blehar, et al. (1978). Patterns of attachment: A
psychological study of strange situation. Hillsdale, NJ, Erlbaum.
Ainsworth, M. (1989). “Attachments beyond infancy.” American Psychologist
44: 709-716.
Association, A. P. (1987). Diagnostic and statistical manual of mental
disorders. Washington, D.C., Author.
Association, A. P. (1994). Diagnostic and statistical manual of mental
disorders: DSM-IV. Washington, D.C., American Psychiatric Association. Research
and Therapy. Encino, CA, Phillips Graduate Institute. 5: 83-98
Beek, Mary . (1999). Parenting children with attachment difficulties: Views
of adoptive parents and implications for post-adoption services Adoption and
fostering, 23/1. pp.16-23.
A growing number of children placed for adoption are found to have attachment
difficulties. Such difficulties can be profound, leading to disruptive behaviour
which adoptive parents often find hard to cope with and understand. As Mary Beek
contends in this paper, one of the challenges for adoption agencies is to offer
such families appropriate support. In examining a project carried out by the
Norfolk-based Adoption and Family Finding Unit's post-adoption service, she
demonstrates how specialised help involving parents and post-adoption social
workers can dramatically improve the quality of care for adopted children - and
indeed the quality of life for all the family. She also underlines the value of
attachment theory as a tool for helping adoptive parents understand their
children's behaviour.
Belsky, J. and R. Isabella (1988). Maternal, infant, and social-contextual
determinants of attachment security. Clinical applications of attachment. J. Belsky and T. Nezworski. Hillsdale, NJ, Lawrence Erlbaum Associates, Inc.:
41-94.
Belsky, J. (1999). Modern evolutionary theory and patterns of attachment.
Handbook of attachment: Theory, research and clinical applications. J. Cassidy
and P. Shaver. New York, The Guilford Press: 141-161.
Belsky, J. (1999). Interactional and contextual determinants of
attachment security. Handbook of attachment: Theory, research, and clinical
applications. J. Cassidy and P. Shaver. New York, The Guilford Press: 249-264.
Berlin, Irving N. Attachment Theory: Its Use in Milieu Therapy and in
Psychotherapy with Children in Residential Treatment. Residential Treatment
for Children & Youth, Vol. 15(2), 29-37.
I intend to present first a brief history of attachment theory, then a concise
review of transference and countertransference as it applies to child care
workers. Out of my experiences as the Medical Director of Namaste Family & Child
Development Treatment Program, I would like to discuss the effectiveness of
using attachment theory in milieu treatment and psychotherapy with severely
neglected, physically and sexually abused young children.
Boris, N. and C. Zeanah (1999). “Disturbances and disorders of
attachment in infancy: An overview.” Infant Mental Health Journal 20(1): 1-9.
Bowlby, J. (1969). Attachment and loss: Vol 1: Attachment. New York,
Basic Books.
Bowlby, J. (1973). Attachment and loss: Vol. 2: Separation. New York,
Basic Books.
Bowlby, J. (1979). The making and breaking of affectionate bonds. London,
Tavistock Publications.
Bowlby, J. (1988). A secure base: Parent-child attachment and healthy
human development. New York, Basic Books.
Campbell, S. (1990). Behavior problems in preschool children: Clinical
and developmental issues. New York, The Guilford Press.
Cicchetti, D. and D. Barnett (1991). “Attachment organization in
maltreated preschoolers.” Development and Psychopathology 7: 283-294.
DeAngelis, T. (1997). When children don't bond with parents, APA.
Fonagy, P. (2000). Attachment in infancy and the problem of conduct
disorders in adolescence: The role of reflective function. International
Association of Adolescent Psychiatry, San Francisco, CA.
Gordon, Christine. (Winter 1999). A parenting programme for parents of
children with disturbed attachment patterns . Adoption and Fostering, 23/4. pp.
49-56 .
It is widely accepted that early experiences colour the way in which children
view the world and in particular their relationships with other people. In this
article, the author describes a programme of intervention with children who have
attachment difficulties as a result of living in trauma during infancy. The
article looks at developing a theoretical framework for understanding the ways
in which early trauma affects a child at psychological, emotional and
physiological levels. It describes an approach to parenting which is more
effective than the traditional methods which tend to work better with children
who have had healthy and relatively trauma-free early childhoods. The author
briefly examines how this approach can be used with other forms of intervention
which work more directly with children in helping them to untangle early
experiences and make sense of their history.
Hanson, R. F. and E. G. Spratt (2000). “Reactive attachment disorder:
What we know about the disorder and implications for treatment.” Child
Maltreatment 5(2): 137-145.
Howe, David. ( Winter 1995). Adoption and attachment. Adoption and fostering,
19/4. pp.7-15.
Children's early attachment experiences can have a dramatic effect on their
day-to-day behaviour, as well as on their social development in later life.
Drawing from extensive interviews with adoptive parents, all of whose children
were in late adolescence or young adulthood at the time of the research, the
author asserts the value of understanding the influence of past care on present
placements.
Karen, R. (1994). Becoming attached. New York, Warner Books.
Lanyado, Monica. (Spring 2001). Daring to try again: The hope and pain of
forming new attachments. Therapeutic communities, 22/1. pp.5-18.
The difficulties
and fears about forming new attachment relationships for children suffering from
multiple traumatic losses are explored in this paper. Clinical illustrations are
given fmm the psychotherapy of children who moved from long-term fostering to
adoption, and parallels drawn with processes taking place within therapeutic
communities. There is also discussion of the way in which these children 's
fears that the newly acquired roots of a secure emotional base will be damaged
or uprooted altogether, can be expressed within the organisational dynamics of
the therapeutic community.
Magid, K. and C. A. McKelvey (1987). High Risk: Children without a
conscience. Golden, CO, M. & M.
Moore, Ken; Moretti, Marlene M.; Holland, Roy. (1998). A New
Perspective on Youth Care Programs: Using Attachment Theory to Guide
Interventions for Troubled Youth. Residential Treatment For Children & Youth,
15/3. pp.1-24.
Traditional models of residential care for troubled youth are based on the
assumption that their difficult and threatening behaviour needs to be contained
and controlled. These models typically adhere to a behavioral or social learning
perspective. Treatment is geared toward changing reinforcement schedules to
reduce undesired behaviour as well as toward teaching social skills to increase
the likelihood that youth will use socially appropriate strategies to have their
needs met. In this paper we argue that, despite the usefulness of some
traditional treatment strategies when employed within certain contexts, these
interventions are often of limited value in working with youth who have
developed internal working models of adults as rejecting, punitive and
untrustworthy. The reliance of traditional treatment programs on behavioral
strategies that emphasize control and containment of behaviour can, in effect,
undermine already fragile attachments of troubled youth to adults and instigate
power struggles that inevitably fall in helping youth to develop a sense of
personal responsibility for and control of their actions. We propose that
attachment theory offers a framework for a fundamentally different approach to
working with troubled youth; an approach that begins with an appreciation of the
youth's internal working models of self and other. This article reviews the
process of transformation of a "traditional" control-focused program into a
program that is guided by attachment theory.
Munroe, Catherine. (1993); The Child Within; The Children’s Society,
London
Owusu-Bempah, J; Howitt, Dennis. (1997). Socio-genealogical
connectedness, attachment theory, and childcare practice. Child and family
social work, 2/4. pp.199-207.
At the heart of child welfare policy and practice are issues of loss and
separation, issues of loss and discontinuity of parent-child or carer-child
ties. Consequently, John Bowlby's ideas concerning attachment have been
influential in this field over the past 50 years. This paper argues that the
society in which Bowlby, originally developed his ideas has altered greatly; in
Western societies, family dynamics have changed remarkably, and continue to
change. The present paper therefore argues that these ideas may not adequately
address the developmental needs of today's children. Hence, it puts forward the
notion of socio-genealogical connectedness to complement our existing knowledge
and understanding of the psycho-social developmental needs of modern-day
children. The notion's implications for policy and practice are also
highlighted.
Reber, K. (1996). Children at risk for reactive attachment disorder:
Assessment, diagnosis, and treatment. Progress: Family Systems R
Internet
http://www.earlychildhoodbehavioralhealth.com/Articles/AttachSymptoms
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