Transcript Reactive Attachment Disorder (RAD) or Attachment Disorder (AD)

Reactive Attachment Disorder (RAD)
aka
Attachment Disorder
(AD)
It’s Time To Understand . . .
What Is Attachment Disorder?
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Attachment Disorder is a condition in which
individuals have difficulty forming loving, lasting,
intimate relationships. The words “attachment”
and “bonding” are generally used
interchangeably. 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.
They typically fail to develop a conscience and
do not learn how to trust.
What Causes AD?
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Any of the following conditions put a child at
high risk of developing an attachment
disorder. The critical period is from
conception to about twenty-six months of age.
– maternal ambivalence toward pregnancy
– sudden separation from primary caretaker (i.e.., illness or
death of mother or sudden illness or hospitalization of child)
– abuse (physical, emotional, sexual)
– frequent moves and or placements (foster care, failed
adoptions)
– There are more . . .
What Causes AD?
– (Continued . . .)
– traumatic prenatal experience, in-utero exposure to
alcohol/drugs
– neglect
– genetic disposition
– birth trauma
– undiagnosed and/or painful illness, such as colic or ear
infections
– inconsistent or inadequate day care
– unprepared mothers with poor parenting skills
Why Is Attachment So Important?
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Attachment is essential for the foundation of a
healthy personality and is necessary for:
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the attainment of full intellectual potential
the ability to think logically
the development of a conscience
the ability to cope with stress & frustration
becoming self-reliant
the development of relationships
the ability to handle fear & worry
the ability to handle any perceived threat to self
Early Development Is Critical!
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50
P
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N
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A
G
E
40
30
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20
10
0
1st Yr
2nd
Yr
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Life's
End
Life Long Learning
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Most (50%) of what we
need to know for life is
learned in the first year
of life!
Another 25% is learned
in the second year of
life!
From the age of three
on, only 25% of life’s
survival skills are
added.
Conscience Development
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6 yo
5 yo
4 yo
3 yo
0 - 2 yo
Self Control
With Verbal Instruction
Parent Present and Able to Act
Parent Present and Initiates
Parent Present and Controlling
Interruption in the
conscience
development of the AD
child will evidence itself
in the cessation of
maturing in conscience
and responsibility at
that stage of
development.
How Does Attachment Develop?
1. Need
First Year
of Life Cycle
Freud:
Oral
4. Trust
Erikson: Trust
Vs.
Mistrust
Necessary Input:
(a) Eye Contact
(b) Touch
(c) Movement
(d) Smiles
“LOVE”
3. Gratification
or Relief
2. Rage Reaction
How Does Attachment Develop?
1. Child Wants
Second Year
of Life Cycle
4. Parents Allow:
Freud:
Anal
Increasing Independence
Erikson: Anatomy
Vs.
Shame &
Doubt
3. Child Gives:
Acceptance of Parental
Requests
2. Parents Give
Appropriate Limits
Normal
Two Year Old
Negativism
What Happens When a Child is Placed in
Protective Custody?
2/10/90
2/12/90
2/16/90
3/26/90
4/10/90
4/11/90
4/12/90
6/10/90
Patrick is rem oved to
em ergency foster hom e
as a result of a
substantiated abuse.
Patrick is placed in
Sm ith foster hom e.
Patrick is m oved to
Jones hom e.
Patrick has supervised
visit with his m other.
Patrick has
unsupervised visit with
his m other.
Patrick reports abuse
that occurred during
previous day’s visit.
Visits with m other are
term inated.
5/01/91
Reunification plan is
initiated.
5/10/91
5/20/91
6/10/91
6/25/91
6/26/91
Patrick has supervised visit
with both parents.
Patrick has unsupervised
visit with both parents.
Visits are going well and
parents are cooperating.
Patrick is returned to his
parents.
8/15/91
9/18/91
School reports that Patrick
has bruises on his face.
9/18/91
Patrick is placed in Rogani
foster hom e on an
em ergency basis.
Patrick is placed in
Kosloff hom e for longterm foster care.
Table from the book, “Adopting The Hurt Child” by Gregory C. Keck PhD. and Regina M. Kupecky, LSW
High Risk Signs In Infants
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Weak crying response or rageful and/or constant whining
Tactile defensiveness
Poor clinging and extreme resistance to cuddling: seems
“stiff as a board”
poor sucking response
poor eye contact, lack of tracking
no reciprocal smile response
indifference to others
Failure to respond with recognition to Mother or Father.
Delayed physical motor skill development milestones
(creeping, crawling, sitting, etc.,)
Flaccid
Symptoms of Attachment Disorder
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Superficially engaging, and
charming child
Indiscriminately affectionate
with strangers
Destruction of self, others,
things
Experiences developmental
lags
Will not make eye contact (on
parent terms)
Not cuddly with parents
Cruel to animals, siblings
Lacks cause and effect thinking
Has poor peer relationships
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Inappropriately demanding or
clinging
Engages in stealing or lying
Lacks a conscience
Engages in persistent nonsense
questions or incessant chatter
Has poor impulse control
Has abnormal speech patterns
Fights for control over
everything
Engages in hoarding or gorging
on food
Has a preoccupation with fire,
blood or gore
Ref. Reber, Keith. “Children at risk for reactive attachment disorder: assessment diagnosis and treatment.” Phillips
Graduate Institute.
What Are The Effects Upon The Family?
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Parental dreams of love and
understanding solving all
problems are quickly dashed
Frustration of the parents to
receive reciprocal loving and
bonding
Venting of hatred towards the
Mother - suffering through:
– Emotional breakdowns
– Post Traumatic Stress Disorder
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Apparent close bond to the
Father
Schools, churches, friends and
relatives become critical of
parents
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The family becomes controlled
by the antics of the child,
withdrawing the family from
normal social functions
Siblings are targeted, and
threatened
Family pets are targeted, and
endangered
Normal times of closeness such
as Christmas become outbursts
of reactive anger
Automatic parenting does not
work, there is no logical point of
reference
Parents appear to be hostile
and/or angry
The Randolph Attachment Disorder
Questionnaire (RADQ)
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Unlike the DSM IV which labels symptoms rather
than the causes
The RADQ attempted to determine the causes and
the levels of severity between the two types of AD;
– Anxious - The "in your face" child with very destructive
behavior
– Differential -The child who has hidden their anger deep
inside, easier to live with, but harder to treat
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The RADQ is considered the most effective tool in
the diagnosis of AD
– Available through the Attachment Center at Evergreen, CO
– RADQ and AD resource book order site
– http://www.attachmentcenter.org/
Keys To Bonding
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Eye Contact: warm, loving, soft
Touch: unrehearsed caresses
Movement:: rocking, bouncing
Smiles: the smile in the eyes is
the child’s focus
Basic carbohydrates: lactose,
sugar
Parenting interactions to
encourage reciprocity on
parents terms:
– Singing a favorite song together
– reciting nursery rhymes
together
– imitation games that require
child to respond to parent
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Child and parent working
together in a reciprocal way
– doing chores together in a fun
way
– activities that child completes
on parent’s terms that enable a
child to feel he or she is able to
give back
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Re-do early developmental
stages child may have missed
Demonstrate affection
regardless of response
Avoid control battles!!!
– Control battles are lose-lose
– Try win-win approaches like:
• “When you do this, then I’ll do
that”
Keys To Bonding
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Be a tough parent
Build confliction - ask questions
like, “Are you happy with your
life now?”
Pizzazz!!
Listening actively to child’s
behavior
– encourage verbal expression of
feelings
– acceptance of child’s feelings
– exploring choices for handling
feelings
– understanding consequences of
choices
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Promote continuity with child’s
past
How do you keep ahead of an
AD child? Remove their control:
– Ask the child to do 20 chores
and leave all of them undone
– Alter normal schedule patterns
– Keep them busy, or have them
do quiet sitting
– For discipline - physical
exercise
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Compliance is the beginning of
reciprocity
Effective Treatment
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Successful therapy with these children will
depend upon the therapist’s willingness to
use unconventional strategies, to find and to
face the depth of the feelings that these
children keep hidden, to revisit the trauma
with the child and to communicate that by
doing this together, the trauma is not bigger
than the child, and the child can overcome it.
(Continued . . . )
Effective Treatment
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Therapists need to be prepared to face the
horror’s that these children have experienced if
we ever hope to help them heal. Goals of
treatment include: resolution of early losses,
development of trust, modulation of affect,
development of internal control, development of
reciprocal relationships, learning appropriate
responses to external structure and societal
rules, correcting distorted thinking patterns,
developing self respect.
Effective Parenting
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Successful parenting involves high structure,
effective environmental control, helping child
develop appropriate responses to authority as
well as developing internal controls, use of
logical and natural consequences,
reinforcement of reciprocity and
nurturing/reparenting. Goals of parenting are:
to prepare child for real world and to help
child learn to be:
The Need for AD Respite Care
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Although many empathize with the need for
respite care for the families of AD kids, few
understand the requirements
– AD respite care providers must provide a
structured, secure, no fun care
• It cannot be a reward for driving their parent(s) to the
brink of a nervous breakdown
• Providing plenty of high energy chores
• Must provide the child with time to reflect
– The parents must be confident that when they
receive the child back, they don’t have to cope
with a child that has “won.”
Effective Parenting Can Lead To the Child
Being:
New Research on RAD Holds Hope
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Brain Development, Attachment and Impact on Psychic Vulnerability
– Infant caregiver interactions, seminal events in brain development and their
possible relationship to later psychic vulnerability - by Deborah A. Lott
– MHi Psychic Times
http://www.mhsource.com/edu/psytimes/p980547.html
Affect Regulation and the Origin of the Self - The Neurobiology of Emotional
Development
– This book brings together the latest findings of socioemotional studies
emerging from the developmental branches of various disciplines - by Allan
N. Schore Ph. D.
– http://www.erlbaum.com/1994.htm
The Biology of Soul Murder - Fear can harm a child’s brain. Is it reversible?
– A U.S. News article on the recent research on the development of the mind
and the connection between; parental care, the neurobiology of touch, and
the chemistry of stress. - Shannon Brownlee
– http://www.usnews.com/usnews/issue/11trau.htm