Reactive Attachment Reactive Attachment Disorder (RAD)Disorder (RAD)

akaakaAttachment DisorderAttachment Disorder

(AD)(AD)

It’s Time To Understand . . .It’s Time To Understand . . .

What Is Attachment Disorder?What Is Attachment Disorder?

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?What Causes AD?

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?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?Why Is Attachment So Important?

Attachment is essential for the foundation of a healthy personality and is necessary for:– 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!Early Development Is Critical!

1 s t Y r 2 n dY r

~ ~ L i f e ' sE n d

0

1 0

2 0

3 0

4 0

5 0PERCENTAGE

1 s t Y r 2 n dY r

~ ~ L i f e ' sE n d

L i f e L o n g L e a r n i n g

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 DevelopmentConscience Development

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.

Parent Present and Controlling 0 - 2 yo

Parent Present and Initiates3 yo

4 yo Parent Present and Able to Act

5 yo With Verbal Instruction

Self Control6 yo

How Does Attachment Develop?How Does Attachment Develop?1. Need

2. Rage Reaction

3. Gratificationor Relief

4. TrustFreud: OralFreud: Oral

Erikson: Trust Erikson: Trust Vs. Vs. Mistrust Mistrust

Necessary Input:Necessary Input: (a) Eye Contact(a) Eye Contact (b) Touch(b) Touch (c) Movement(c) Movement (d) Smiles(d) Smiles“

LO

VE”

First YearFirst Yearof Life Cycleof Life Cycle

How Does Attachment Develop?How Does Attachment Develop?1. Child Wants

2. Parents GiveAppropriate Limits

3. Child Gives:Acceptance of Parental

Requests

Freud: AnalFreud: Anal

Erikson: Anatomy Erikson: Anatomy Vs. Vs. Shame & Shame & Doubt Doubt

NormalNormalTwo Year OldTwo Year OldNegativismNegativism

Second YearSecond Yearof Life Cycleof Life Cycle

4. Parents Allow:Increasing Independence

What Happens When a Child is Placed in What Happens When a Child is Placed in Protective Custody?Protective Custody?

2/10/90 Patrick is removed toemergency foster homeas a result of asubstantiated abuse.

5/01/91 Reunification plan isinitiated.

2/12/90 Patrick is placed inSmith foster home.

5/10/915/20/91

Patrick has supervised visitwith both parents.

2/16/90 Patrick is moved toJones home.

6/10/916/25/91

Patrick has unsupervisedvisit with both parents.

3/26/90 Patrick has supervisedvisit with his mother.

6/26/91 Visits are going well andparents are cooperating.

4/10/90 Patrick hasunsupervised visit withhis mother.

8/15/91 Patrick is returned to hisparents.

4/11/90 Patrick reports abusethat occurred duringprevious day’s visit.

9/18/91 School reports that Patrickhas bruises on his face.

4/12/90 Visits with mother areterminated.

9/18/91 Patrick is placed in Roganifoster home on anemergency basis.

6/10/90 Patrick is placed inKosloff home for long-term foster care.

Table from the book, “Adopting The Hurt Child” by Gregory C. Keck PhD. and Regina M. Kupecky, LSW

High Risk Signs In InfantsHigh Risk Signs In Infants

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 DisorderSymptoms of Attachment Disorder 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

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?What Are The Effects Upon The Family?

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

Apparent close bond to the Father

Schools, churches, friends and relatives become critical of parents

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 The Randolph Attachment Disorder Questionnaire (RADQ)Questionnaire (RADQ)

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 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 BondingKeys To Bonding 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

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

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 BondingKeys To Bonding

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

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 Compliance is the beginning of

reciprocity

Effective TreatmentEffective Treatment

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 TreatmentEffective Treatment

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 ParentingEffective Parenting

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 CareThe Need for AD Respite Care

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 Effective Parenting Can Lead To the Child Being:Being:

RESPECTFUL

RESPECTFULRESOURCEFUL

RESOURCEFUL

(In a good way)

(In a good way)

ResponsibleResponsible

Fun To Be Around!Fun To Be Around!

New Research on RAD Holds HopeNew Research on RAD Holds Hope

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