Transcript The Institute for Attachment and Child Development

The Institute for Attachment and Child
Development
“Achieving Permanency For Children Diagnosed With Reactive Attachment
Disorder”
Presented by:
Forrest R. Lien, LCSW-Director
Email: [email protected]
P.O. Box 730 – Kittredge, CO 80457
(303) 674-1910-phone (303) 670-3983-Fax
www.InstituteForAttachment.org
Attachment Cycles
1st Year
Necessary ingredients of
development of basic trust
and attachment:
Need
Relaxation
of Tension
(trust)
Trust
Of
Caretaking
Satisfaction of
Need
(gratification)
State of
High
Arousal
(rage)
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Eye Contact
Food
Motion
Touch
Verbal Contact
Emotional Contact
Smiles
Attachment Cycles
2nd Year
Wants
Mutual good
Feelings
Trust
Of
Control
State of
High
Arousal
(rage)
Necessary ingredients of
development of autonomy,
good character foundation
and conscience.
Maintain parental control
while allowing child to
explore and begin to make
good choices for themselves.
Acceptance
Of
Limits
TRUST
ATTACHMENT
AUTONOMY
Sub-Types of Attachment Disorder
1.
AVOIDANT-isolation, avoid closeness, seldom seek comfort, avoid
2.
ANXIOUS-crazy liars, fake emotions, emotionally empty, “good actors”,
3.
DISORGANIZED-disorganized, odd, and bizarre behaviors. Other
4.
AMBIVALENT-openly angry, defiant, destructive, dangerous,
relationships, passive-aggressive, avoid feelings, intense sadness and
loneliness, believe their rejection by birth mom was justified
chameleons, often fool therapists that they’re normal and parents aren’t
psychiatric disorders, unpredictable moods, excessively excitable, frequent
sensory or neurological problems, difficult to manage
superficially charming, lack of empathy, delinquent acts, most prevalent
subtype in mental health systems
Brain Organization/Development
simple to complex
Brain is responsible for :
Survival/Biological responses, i.e.
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Heart rate
Temperature
Blood pressure
Arousal states
Limbic/Midbrain responsible for:
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Emotion
Attachment
Affect regulation
Cortex is responsible for:
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Abstract reasoning
Complex language
Brainstem
(arrives hard-wired and on-line)
Limbic/Midbrain
(carries blue-print only)
Cortex
(arrives blue-print only)
Abuse
Traumatic Event
(Physical, Sexual abuse)
Domestic violence
Release of
Stress-Based
Hormones
(catecholamine)
PROLONGED ALARM
REACTION
AROUSAL CONTINUUM
Normal stress
Response is
reversible
DISSOCIATIVE
CONTINUUM
Two distinct neuronal response patterns
“adaptive style”
ALTERED BRAIN
DEVELOPMENT
“STATES BECOME TRAITS”
Sensitized to external cues
Causes
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.
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Genetic predisposition
Maternal ambivalence toward pregnancy
Traumatic prenatal experience, in-utero exposure to alcohol/drugs
Birth trauma
Sudden separation from primary caretaker ( i.e. illness or death of mother or sudden illness or
hospitalization of child.)
Undiagnosed and/or painful illness, such as colic or ear infections
Inconsistent or inadequate day care
Unprepared mothers with poor parenting skills
Abuse ( physical, emotional, sexual)
Neglect
Frequent moves and/or placements ( foster care, failed adoptions)
ABUSIVE BIRTH PARENTS AND PSYCHIATRIC DIAGNOSIS
1.
ANTISOCIAL (SOCIOPATHIC) PERSONALITY DISORDER
Many of the diagnostic characteristics of children with Reactive Attachment Disorder also fit adult characteristics of Antisocial Personality
Disorder. These include substantial conduct disorders including cruelty to people or animals, lying, stealing, fire setting, failure to conform
to social norms, irritability, aggressively and impulsivity. These people have little regard for the truth, and lack empathy and remorse.
Many of these adults were themselves abused or neglected in early childhood.
2.
BORDERLINE PERSONALITY DISORDER
3.
PARANOID SCHIZOPHRENIA is a complex disorder, usually strongly genetically influenced and is characterized by though
The etiology of Borderline Personality Disorder is not well understood,
but there is evidence of both genetic and psychological influences, to some degree attributable to poor parenting (neglect or overprotective) between birth and three years of age. Borderline Personality Disorder manifests as long-term patterns of unstable mood,
interpersonal relationships and self image.
disturbances such as delusions and hallucinations. In a delusional or hallucinatory state they are capable of abuse or neglect, though
uncommonly.
4.
ALCOHOL/SUBSTANCE ABUSE
In my experience working with abused kids, this is the single most common characteristic of abusing parents,. However, in my experience,
it is also most commonly a coexistent factor of abuse. In other words, while alcohol and substance abusing parents may abuse their
children, it is usually of less severity and is usually not in an ongoing manner. Purely alcohol or substance abusing parents who overindulge and neglect or abuse their children are ordinarily regretful and remorseful of their actions.
5.
BIPOLAR DISORDER
This is a common psychiatric mood disorder representing 2 to 3 percent of the general population. It is a genetic, inherited, familial
disorder that ultimately results in biochemical imbalances within one’s central nervous system. It manifests in manic (or hypomanic, a
lesser form of manic) and/or depressive mood disturbances. In my professional experience, this is by far the disorder that has the greatest
coincidence with abuse or neglect of children and as such is the genetic disorder that these children with coexistent Reactive Attachment
Disorder also inherit. The degree of self-centeredness, irritability and intensity of rage reactions while in a manic state is frequently
sufficient to create severe abusive conditions. Correspondingly, the degree of profound depression is likewise severe and prolonged
enough to create long standing neglectful circumstances.
Symptoms of Attachment Disorder
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Superficially engaging, charming (phoniness)
Lack of eye contact
Indiscriminately affectionate with strangers
Lacking ability to give and receive affection (not cuddly on parents terms)
Extreme control problems: often manifest in covert or “sneaky” ways
Destructive to self, others, things
Cruelty to animals
Chronic lying
No impulse controls
Learning lags and disorders
Lacking cause and effect thinking
Lack of conscience
Abnormal eating patterns
Poor peer relationship
Preoccupied nonsense questions and incessant chatter
Inappropriately demanding and clingy
Abnormal speech patterns
Parents appear unreasonably hostile and angry
Characteristics of Attention Deficit Disorder, Bipolar Disorder, and Reactive
Attachment Disorder
John F. Alston, M.D., P.C.
Website: www.johnalstonmd.com
Symptoms
Attention Deficit
Disorder
Bipolar Disorder
Reactive Attachment
Disorder
Infancy to toddler,
6 years, 13 years
2 to 3 years, 6 years, 13 to 25
years
Birth to 3 years
Family History
ADHD, academic difficulties
(based on task incompletion),
alcohol and substance abuse
Any mood disorder
(depression or bipolar),
academic difficulties (based
on motivation problems or
opposition or defiance),
alcohol and substance abuse,
adoption, ADHD
Abuse and neglect, severe
emotional and behavior
disorders, alcohol, and
substance abuse. Abuse
neglect in parents’ own early
life
Lifelong Prevalence
3 to 6 % general population
3 to 5 % of general
population
Uncommon to common
Genetic, Neurochemical, fetal
development, brain traumas,
nutritional deficiencies,
exacerbated by stress
Genetic, exacerbated by
stress and hormones
Psycho physiologic secondary
to neglect, abuse,
mistreatment, abandonment
Age of Onset
Etiology
WORKING WITH PARENTS
Assess the developmental level and needs of parents.
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Intact at-risk family – child remains in abusive situation.
a. High incidence of parents with poor attachment histories of their
own.
b. All of the qualities of unattached children still present in grown
up form.
c. Not available for education (cortex).
Foster families.
a) Assess availability for work of attachment.
b) Impact of personal trauma history – usually not explored.
Adoptive families.
a) Education re: attachment and trauma
b) Family of origin history will become important and needs to be
explored over time.
c) Respite !!!!
Post Traumatic Stress in Parents
Causes
Repeated rejections
by child – giving and
giving with little or no
lasting positive return
Relentless, unending
control battles – need
for incredible selfcontrol at all times
Changes within yourself &
family that seem out of your
control & are not apparent
choices
Primary Symptoms
Avoidance of thoughts &
feeling,, decreased interest
& participation in
significant events
Psychological/Physical
distress at exposure to
trigger events that
symbolize the trauma
Decreased affect & display
of feelings, sense of being
detached or estranged from
others
Secondary Symptoms & Effects
Feeling that you are unlike
Others, damaged sense
of self-worth,
feeling out of control of emotion
Selectivity in perceptions,
victim identity, fatigue and
depression, loss of security
Increase arousal sleep problems,
Irritable, angry,
hyper vigilance, higher startle
response
Helplessness
Hopelessness
Anger
RAGE
TREATMENT FOSTER CARE:
Developmental Model
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A) Creating a circle of security in a family setting
-Line of site safety-developmental circle of security with environmental controls
-Parents direct and redirect
-Children learn life skills living in a family i.e. doing chores, learning respectful communication, cooperative
play, build self-confidence
-Learn to trust that adults will keep you safe-children give up control
B)
Skilled attachment therapist leads the team
- Empathic confrontation – therapist is coach/guide, providing balance of challenge and support
C) Creating a circle of community support
-school, police, caseworkers
D) Psychiatric Care and Neurofeedback
E) Working with Attachment Figure i.e. relative, adoptive parent, foster parent
-creating safety with attachment figure by helping with emotional triggers, parent training, attachment therapy