Attachment Disorder in Children

Healthy, secure attachment to a caregiver, usually the mother, is crucial to an infant and child's development. Secure attachment is developed as the primary caregiver responds to the baby's needs consistently, thereby creating a bond of trust between the caregiver and the baby. This attachment continues to grow and become stronger if this cycle continues and is not interrupted. Unfortunately, all children do not have the benefit of secure attachment. There are many conditions which can put a child at risk for developing an attachment disorder. Some of these are: sudden separation from primary caregiver, abuse or neglect, frequent moves or placements (foster care or failed adoptions), multiple caretakers, painful or invasive medical procedures, postpartum depression in mother and insensitive parenting. 'The most striking cases of attachment disorder are demonstrated by children who spent a large portion of their infancy in large institutions and orphanages. These children did not receive the basic nurturing human infants need to develop a positive internal working model' (Breazeale, 2001).

The Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) gives the diagnostic criteria for diagnosing Reactive Attachment Disorder (RAD) in children as follows:

Diagnostic Criteria for 313.89 Reative Attachment Disorder of Infancy or Early Childhood

A. Markedly disturbed and developmentally inappropriate social relatedness in most contexts, beginning before age 5 years, as evidenced by either (1) or (2):

(1) persistant failure to initiate or respond in a developmentally appropriate fashion to most social interactions, as manifest by excessively inhibited, hypervigilant, or highly ambivalant and contradictory responses (e.g., the child may respond to caregivers with a mixture of approach, avoidance, and resistance to comforting, or may exhibit frozen watchfulness)

(2) diffuse attachments as manifest by indiscriminate sociability with marked inability to exhibit appropriate selective attachments (e.g., excessive familiarity with relative strangers or lack of selectivity in choice of attachment figures)

B. The disturbance in Criterion A is not accounted for solely by developmental delay (as in mental retardation) and does not meet criteria for a Pervasive Developmental Disorder.

C. Pathogenic care is evidenced by at least one of the following:

(1) persistent disregard of the child's basic physical needs

(3) repeated changes of primary caregiver that prevent formation of stable attachments (e.g., frequent changes in foster care)

D. There is a presumption that the care in Criterion C is responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criverion A began folowing the pathogenic care in Criterion C).

Specify type:

Inhibited Type: if Criterion A1 predominates in the clinical presentation
Disinhibited Type: if Criterion A2 predominates in the clinical presentation

The symptoms usually found in infants at high risk for the disorder are weak crying response or rageful and/or constant whining, tactile defensiveness, poor clinging, extreme resistance to cuddling, 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, and delayed motor skill development such as creeping, crawling, sitting, ect. Some sypmtoms exhibited by children with RAD are: artificially charming personality, indiscrimanately affectionate with strangers, destructive twoards property, aggressive toward self or others, poor eye contact, resists genuine affection with primary caregivers-especially mother, cruel to animals and siblings, lacks cause and effect thinking, has poor relationships with peers, engages in stealing and/or lying, lacks a conscience, engages in persistent nonsense questions or incessant chatter, lacks self control and is impulsive, fights for control over everything, has food issues such as hoarding, gorging, and sneaking food, and is fascinated with fire, death, blood, weapons, evil or gore.

There are various treatments for attachment disorders, though traditional therapy is said to be ineffective for this disorder. The most controversial of treatments is Holding Therapy, which is commonly referred to as Attachment Therapy. In this treatment, the child is held down, regardless of his current behavior and while he is down the therapist yells at the child, pokes at him, and pulls at his limbs while the child resists by crying, screaming, and yelling until the child finally breaks down. At that time the child is immediately given to his caregiver to whom he is to attach. Another treatment is a residential treatment where the child lives with therapeutic foster parents for a period of time while the therapy centers around four key areas- cognitive restructuring, re-parenting, psychodramas, and trauma resolution. A treatment called Theraplay is a treatment where the therapist works with the child in a form of controlled play therapy and another therapist works with the caregiver. In the process of Theraplay the caregiver learns to do Theraplay with the child, increasing attachment and bonding through the activities. There are also several other treatments that therapists are trying with attachment disordered children. From my research, it appears that these treatments are all trial and error, as nothing has been proven effective overall. Also, the studies done on different treatments have been poorly done . It seems to me that much more research needs to be done in this area.