An attachment disorder is a diagnosed condition where children and young people have difficulty forming loving, lasting emotionally intimate and meaningful relationships.
Attachment disorders vary in severity, but the term usually is reserved for disorders in children and young people who show a nearly complete lack of ability to be genuinely affectionate with others. They typically fail to develop a conscience and do not learn to trust.
Children with healthy attachments to a loving caregiver
- Feel secure and loved
- Can attain their potential
- Can develop reciprocal relationships
- Develop a conscience
- Cope with stress and anxiety
- Become self-reliant
Children who do not have healthy attachments with a loving caregiver
- Do not trust caregivers or adults in authority.
- Have extreme control problems, manifested in covertly manipulative or overtly hostile ways.
- Do not develop a moral foundation: no empathy, no remorse, no conscience, and/or no compassion for others.
- Lack the ability to give and receive genuine affection or love.
- Resist all efforts to nurture or guide them.
- Lack cause and effect thinking.
- Act out negatively, provoking anger in others.
- Lie, steal, cheat, and/or manipulate.
- Are destructive, cruel, argumentative and/or hostile.
- Lack self-control – are impulsive.
- Are superficially charming and engaging.
The process of developing healthy attachments can be disrupted by abuse, neglect, abandonment, multiple changes in primary and main carers, painful illness, parental rejection, exposure to alcohol/drugs in the womb, maternal depression, and/or inconsistent day care.
The core marker of attachment disorder is a significantly disturbed and in child development terms inappropriate social connection with other children, young people and adults in every environment and context, with few exceptions. Attachment Disorder manifests before the age of 5 and is associated with an incompetent or ineffective standard or pathological parenting that disregards the child’s basic emotional and physical needs. In many cases, it is associated inappropriate, violent or ever changing care givers.
The word ‘attachment’ is used to describe the process of bonding that occurs between infants and carers in the first 3 years of life, and most importantly, between 7 – 9 months of the baby’s vulnerable stage, when a vast amount of brain development is occurring. When a carer does not respond to a baby’s emotional and physical needs, or does not respond consistently, or is abusive, the child starts to lose the capacity to form meaningful trusting relationships and a feeling of anxiety starts to grow.
Children with Attachment Disorders will present wide ranging emotional problems such as depression and anxiety symptoms or anxiety/ risk-taking behaviours. To feel safe, children may seek any person to attach to – they may cuddle strangers, and tell anyone ‘I love you.’ At the same time, they have reduced capacity to show authentic affection to others or develop meaningful emotional bonds. Children may show ‘soothing behaviours’ such as rocking and head banging, or biting, or self-harm. These behaviours will increase at times of stress or threat.
Child Example Of Attachment Disorder
At 7 years of age, John was referred for a psychiatric assessment by his specialist mental health worker of the last year. Jim had lived with his adopters for 3 years; before that he had been with those different carers in a foster placement for 1 years. He had been removed from his birth mother at 2 years of age because of chronic neglect and virtually abandoned by her.
John’s symptoms began before he was 2 years old and included acting out; he was easily agitated, disruptive, and intrusive. He was verbally and physically aggressive, exhibited temper outbursts and rage reactions, and was violent toward his friends and mother. His adopters described him as having up-and-down cycles: when up, John was easy to please and wanted to please others; when down, he was disruptive and intrusive. Regardless of the up-down nature, he had consistent difficulty in falling asleep.
John’s birth mother had a personal history of physical and sexual abuse. His father had a history of juvenile crime and his family history included substance misuse, sexual abuse, and domestic violence.
John came across as as a thin, fidgety, hyperactive boy who had trouble staying in his seat. He appeared immature, anxious, and had a difficult time understanding the reasons his adoptive parents had brought him for help. He was easily distracted and evidenced some mood swings and agitation. His mood often swung from anxious to agitated to giggly to irritated to being distant to calm.
There was no evidence of delusions, hallucinations, or violent intent to self-harm.. He was orientated to person, place, time, and situation. His intelligence appeared to be within a low average range. His short- and long-term memory was intact. His judgment and insight were fair to poor.
John’s history, symptoms, and emotional presentation were indicative of disorder, most likely being attachment disorder. While some of his behaviours improved because his adopters learned different ways of responding to him, John still had significant difficulties with motivation, attention, and task completion.
It was decided to work more closely with school, and involve them directly in the sessions that the carers were having. This had tremendous effects, as school were a lot more confident in responding to John’s behavioural needs and challenges.
John has been more settled from age 8 to his current age of 12 years. He has had no temper outbursts or oppositional tendencies and is dealing with his issues in a verbally appropriate manner.
This case study demonstrates how an accurate diagnosis of childhood disorders can provide the information needed for effective interventions for children with attachment disorders with histories of significant abuse, neglect, or maltreatment. Diagnosing the correct disorder is incredibly important, and attachment disorder is often mis-diagnosed, or labelled as ADHD, etc. It is incredibly important that the diagnostic process is comprehensive and at the right pace.
Ideas To Improve The Way Adopters Look After Children With Attachment Disorder
- Work closely with specialists – no child’s Attachment Disorder could have been diagnosed without specialist intervention in the first place. Understanding the purpose or functionality of the child’s disordered behaviours will help you respond more effectively. For example, a punishment approach or sanctioning may increase the child’s feelings of insecurity and distress and subsequently increase the problematic behaviour.
- Be predictable, consistent, and repetitive. Children with attachment disorders are very sensitive to changes in routines, transitions, unpredictable changes, and loud/ noisy social situations. Being predictable and consistent (in as much as you can be as a foster carer) will enable the child to feel safe and secure, and that can reduce the child’s anxiety and fear.
- Model and educate the child in appropriate behaviors for specific social settings or contexts. One of the best ways to teach children these skills is to demonstrate the behavior and then tell through narration the child what you are doing and why you are doing it. For this to work it needs to be on a committed and grand scale – and culturally in the UK we are not used to overly demonstrating such behaviour strategies.
- Avoid power battles. When intervening, approach the situation in a light-hearted, stress-free and matter of fact manner.
- Make sure the situation is not about a child’s basic inability to understand (Attachment Disorder can mask a child’s true social functioning ability by enabling a child to apparently show a high ability to function in sophisticated situations) by breaking situations down into manageable chunks.
- As you would with a child with autism or ADHD, break down social situations and their meanings into manageable steps/ chunks to help simplify and make understandable complex social functions.
- Identify a place for the child or young person to go to take time out to at times of stress and anxiety.
Children with attachment disorder need clear structure more than the average child if they are to develop any trust in the adult professionals. Multiple warnings, negotiated bargains, or motivational pep talks all tend to undermine the development of trust. However, children with AD are also prone to perceiving discipline and authority as intentional humiliation by the adults, particularly given institutional contexts, and the context of looked-after children’s lives. This can generate shame and anger which may sabotage performance and compliance.
After an young person with attachment disorder makes a choice to co-operate, appreciation is often a better response than praise. Praise is a hierarchical interaction, with the more powerful one (adult) able to pass judgement (albeit positive) on the less powerful one child). Praise runs the risk of triggering payback behaviour as a result of the AD young person perceiving that the carer is rubbing his face in “having won”. Appreciation is an non-hierarchical reaction that avoids triggering oppositional behaviour and can strengthen the carer-child relationship. Linking the appreciation to the specific behavior that is its focus is preferable to a bland expression of appreciation. The positive attention should also be delivered in an attention-focussed fashion, as positive attention can trigger internalized shame. This is painful and a carer/ professional offering positive attention that triggers shame – and shows how complex attachment disorders are.
Attachment disordered young people often have little real sense of personal responsibility or choice. Instead, a sense of victimisation often dominates young people. However, even “victims” still make choices. Personal responsibility and choice are literal central lessons that children need to learn. Most basically, children should be held accountable for their choices and the behaviors that then flow from them. Thus learning needs to be experiential, and not simply verbal. This experiential learning requires establishing specifically, what the child did.
Once this has been done, whatever the behaviour was, it is simply defined as a “choice” that the young person made. The next step is to make a best effort to establish the reason for making the choice (this is taking responsibility for motivation). If the choice was a positive one (adult view) this should be acknowledged. If the choice was a negative one (adult view), carers should avoid the temptation to encourage better choices in the future. This is sinking mud for the carer, as the carer cannot extract improved choices the child does not wish to make, and children are acutely aware of this. Simply hold the young person accountable for the choice and determine whether to impose a consequence of some form. In general, a consequence should be imposed no later than the second time a behaviour appears. The first appearance can be used to identify the behaviour as problematic and establish the expectation that the child should replace the behaviour with a more constructive alternative in the future. Though children will likely test this, it is still a process worth doing for it lays the groundwork for the carer to clearly establish the child’s responsibility, experientially, should s/he choose the same behaviour a second time.
One Of The Traps To Be Aware Of:
Holding young people accountable for themselves will be met with blaming the adult in some fashion. The last thing for carers to do here is to defend themselves. A defense will be seen by children as proof the child is right in his blaming and the carer is trying to “get away with something”. Instead, give the child the freedom to view the adult/ carer/ professional however they wishes and go right back to the accountability topic.
Caring for children with attachment disorders is a huge challenge, but also will bring huge rewards. Outlined above are some of the key challenges that foster carers and adopters will face. Being the adult carer or adopters of a child with attachment problems is challenging enough, but when a diagnosis of disorder is involved the challenges are immense. That is where support, networking and resourcefullness come in, and adopters are champions at networking and being resourceful.
Overall the rewards far outweigh the challenges in looking after a child. One only needs to ehar from carers and children who have been through this difficult and emotional process to see that.