Title: Reactive Attachment Disorder (RAD) aka Attachment Disorder (AD) It
1Reactive Attachment Disorder (RAD)akaAttachment
Disorder(AD)Its Time To Understand . . .
2What 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.
3What 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 . . .
4What 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
5Why 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
6Early Development Is Critical!
- 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 lifes
survival skills are added.
7Conscience 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.
8How Does Attachment Develop?
First Year of Life Cycle
Freud Oral Erikson Trust
Vs. Mistrust
9Example First Year Abuse Cycle
10How Does Attachment Develop?
Second Year of Life Cycle
Freud Anal Erikson Anatomy
Vs. Shame
Doubt
Normal Two Year OldNegativism
11What Happens When a Child is Placed in Protective
Custody?
Table from the book, Adopting The Hurt Child by
Gregory C. Keck PhD. and Regina M. Kupecky, LSW
12High 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
13Symptoms 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.
14What 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
15The Randolph Attachment Disorder 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/
16Keys To Bonding
- Eye Contact warm, loving, soft
- Touch unrehearsed caresses
- Movement rocking, bouncing
- Smiles the smile in the eyes is the childs
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 parents 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 Ill do that
17Keys To Bonding
- Be a tough parent
- Build confliction - ask questions like, Are you
happy with your life now? - Pizzazz!!
- Listening actively to childs behavior
- encourage verbal expression of feelings
- acceptance of childs feelings
- exploring choices for handling feelings
- understanding consequences of choices
- Promote continuity with childs 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
18Effective Treatment
- Successful therapy with these children will
depend upon the therapists 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 . . . )
19Effective Treatment
- Therapists need to be prepared to face the
horrors 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.
20Effective 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
21The 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 dont have to cope
with a child that has won.
22Effective Parenting Can Lead To the Child Being
RESPECTFUL
RESOURCEFUL (In a good way)
Responsible
Fun To Be Around!
23New 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
childs 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