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The Institute for Attachment and Child Development

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Title: The Institute for Attachment and Child Development


1
The Institute for Attachment and Child
Development
Achieving Permanency For Children Diagnosed With
Reactive Attachment Disorder
  • Presented by
  • Forrest R. Lien, LCSW-Director
  • Email forrest_at_instituteforattachment.org

P.O. Box 730 Kittredge, CO 80457 (303)
674-1910-phone (303) 670-3983-Fax www.InstituteF
orAttachment.org
2
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3
Attachment Cycles1st Year
  • Necessary ingredients of development of basic
    trust and attachment
  • Eye Contact
  • Food
  • Motion
  • Touch
  • Verbal Contact
  • Emotional Contact
  • Smiles

Need
Trust Of Caretaking
4
Attachment Cycles 2nd Year
  • 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.

Wants
Trust Of Control
TRUST ATTACHMENT
AUTONOMY
5
Sub-Types of Attachment Disorder
  • AVOIDANT-isolation, avoid closeness, seldom seek
    comfort, avoid relationships, passive-aggressive,
    avoid feelings, intense sadness and loneliness,
    believe their rejection by birth mom was
    justified
  • 2. ANXIOUS-crazy liars, fake emotions,
    emotionally empty, good actors, chameleons,
    often fool therapists that theyre normal and
    parents arent
  • 3. DISORGANIZED-disorganized, odd, and bizarre
    behaviors. Other psychiatric disorders,
    unpredictable moods, excessively excitable,
    frequent sensory or neurological problems,
    difficult to manage
  • 4. AMBIVALENT-openly angry, defiant, destructive,
    dangerous, superficially charming, lack of
    empathy, delinquent acts, most prevalent subtype
    in mental health systems

6
Brain Organization/Developmentsimple to complex
  • Brain is responsible for
  • Survival/Biological responses, i.e.
  • Heart rate
  • Temperature
  • Blood pressure
  • Arousal states
  • Limbic/Midbrain responsible for
  • Emotion
  • Attachment
  • Affect regulation
  • Cortex is responsible for
  • Abstract reasoning
  • Complex language

Brainstem (arrives hard-wired and on-line)
Limbic/Midbrain (carries blue-print only)
Cortex (arrives blue-print only)
7
Abuse
Traumatic Event (Physical, Sexual abuse) Domestic
violence
Release of Stress-Based Hormones (catecholamine)
Normal stress Response is reversible
Two distinct neuronal response patterns adaptive
style
ALTERED BRAIN DEVELOPMENT
STATES BECOME TRAITS Sensitized to external cues
8
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.
  • 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)

9
ABUSIVE BIRTH PARENTS AND PSYCHIATRIC DIAGNOSIS
  • 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.
  • BORDERLINE PERSONALITY DISORDER 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
    over-protective) between birth and three years of
    age. Borderline Personality Disorder manifests as
    long-term patterns of unstable mood,
    interpersonal relationships and self image.
  • 3. PARANOID SCHIZOPHRENIA is a complex disorder,
    usually strongly genetically influenced and is
    characterized by though 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 over-indulge 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 ones 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.

10
Symptoms of Attachment Disorder
  • 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

11
Characteristics of Attention Deficit Disorder,
Bipolar Disorder, and Reactive Attachment
DisorderJohn F. Alston, M.D., P.C.Website
www.johnalstonmd.com
Symptoms Attention Deficit Disorder Bipolar Disorder Reactive Attachment Disorder
Age of Onset 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
Etiology 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
12
WORKING WITH PARENTS
  • Assess the developmental level and needs of
    parents.
  • Intact at-risk family child remains in abusive
    situation.
  • High incidence of parents with poor attachment
    histories of their own.
  • All of the qualities of unattached children still
    present in grown up form.
  • Not available for education (cortex).
  • Foster families.
  • Assess availability for work of attachment.
  • Impact of personal trauma history usually not
    explored.
  • Adoptive families.
  • Education re attachment and trauma
  • Family of origin history will become important
    and needs to be explored over time.
  • Respite !!!!

13
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14
Post Traumatic Stress in Parents
15
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16
TREATMENT FOSTER CAREDevelopmental Model
  • .
  • 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
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