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Reactive Attachment Disorder RAD aka Attachment Disorder AD Its Time To Understand . . .

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Anxious - The 'in your face' child with very destructive behavior. Differential -The child who has hidden their anger deep inside, easier to live ... – PowerPoint PPT presentation

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Title: Reactive Attachment Disorder RAD aka Attachment Disorder AD Its Time To Understand . . .


1
Reactive Attachment Disorder (RAD) aka Attachment
Disorder (AD) Its Time To Understand . . .
2
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.

3
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 . . .

4
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

5
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

6
Early 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.

7
Conscience 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.

8
How Does Attachment Develop?
First Year of Life Cycle
Freud Oral Erikson Trust
Vs. Mistrust
9
Example First Year Abuse Cycle
10
How Does Attachment Develop?
Second Year of Life Cycle
Freud Anal Erikson Anatomy
Vs. Shame
Doubt
Normal Two Year Old Negativism
11
What 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
12
High 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

13
Symptoms 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.
14
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

15
The 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/

16
Keys 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

17
Keys 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

18
Effective 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 . . . )

19
Effective 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.

20
Effective 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

21
The 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.

22
Effective Parenting Can Lead To the Child Being
RESPECTFUL
RESOURCEFUL (In a good way)
Responsible
Fun To Be Around!
23
New 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
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