Wednesday, April 07, 2010

Attachment Disorder

One of the things that they are going to be evaluating Josiah for is Reactive Attachment Disorder. I was always told that all foster children have attachment disorder to some degree. The way that Emily has always gravitated to Andy and if she has a question and I answer her, she will immediately ignore me and ask Andy the same question over doesn't mean anything to her unless the answer comes out of his mouth. She is slowly coming around to me...I don't force her to say I love you or to give hugs/kisses...but she finally started to come around and do those things back to me about 6 months ago. She still doesn't hold a lot of value to what I say when answering her questions and she will still ignore me and go to Andy. But, I've accepted that is part of her attachment issues and since she couldn't trust her birthmom, she brings those same trust issues towards me. The way Tracie would cry and scream anytime I left the room and can still be whiny at times when she has to wait a little bit for her needs to be met and she would rather scream and cry over things...I think that's her attachment issues. She still prefers me to do things for her over Andy, but she is slowly coming around. But, she whines and screams far more for me than she does for anyone else. I have to keep reminding her to use her's a battle around here to get her to stop her whining, crying, and screaming anytime something doesn't go immediately her way...she's come a long way and I'm very proud of her with her progress, but she still has a lot farther to go. Josiah...I always thought it was ADHD or bi-polar that we were dealing with...I thought we got to him early enough (he came to us at 13 months old) I've had a couple people bring up the possibility of him having RAD to me and I've been looking more into it. I really think this may be what we're dealing with in addition to some other things....I guess what I'm scared about right now is the fact that if we are truly dealing with and need to get into attachment therapy, from things that I have read is that Mom should be the primary caregiver and nobody else should be allowed to feed, bathe, clothe, play with the child until they start to learn to trust. I keep wondering how this is all going to be possible given the fact that we have Baby Melina arriving very soon. I guess I need to quit worrying about it and keep handing my worries over to God. I get overwhelmed just thinking about it all...but I have to keep telling msyelf that we don't know any definites right now and that I just need to patiently wait until the testing happens next week and then wait until the following week to go see what they have found to be going on.

Reactive Attachment Disorder (RAD)
There are several different sub-types of Reactive Attachment Disorders. The ambivalent sub-type can be described as an "in-your-face" child. This is the child who is angry, oppositional, and who can be violent. The anxious sub-type is clingy, anxious, shows separation anxieties, among other symptoms. The avoidant sub-type is often overlooked. This child is very compliant, agreeable, and superficially engaging. This child often has a lack of depth to his emotions and functions as an "as-if" child; meaning that he tries to do and say what you want, but is not genuine, authentic, or real in emotional engagement. Finally, there is the disorganized subtype, this child often presents with bizarre symptoms.

The words 'attachment' and 'bonding' are now used interchangeably. Children with Reactive Attachment Disorder exhibit many of the following symptoms:


Weak Crying Response.
Constant Whining.
Sensitivity to Touch/Cuddling.
Poor Sucking Response.
Poor Eye Contact.
No Reciprocal Smile Response.
Indifference to Others.


Lack of Conscience Development.
Superficially Charming.
Lack of Eye Contact (except when lying).
Inability to give and Receive Affection.
Extreme Control Issues.
Destructive to Self, Others, Animals and Property.
No Impulse Control.
Unusual Eating Patterns (hoarding, gorging, or refusal to eat).
Unsuccessful Peer Relationships.
Incessant Chatter in Order to Control.
Very Demanding.
Unusual speech patterns, mumbling, robotic speech, talking very softly except when raging.

Associated Features

Learning Delays and Disorders.
Depressed I.Q. scores.

Differential Diagnosis:

Some disorders have similar symptoms. The clinician, therefore, in his diagnostic attempt, has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

Anti-Social Personality Disorder.
Conduct Disorder.
Oppositional Defiant Disorder.
Fetal Alcohol Syndrome.
Developmental Disorder of Receptive Language.
Socio-Emotional Problems.
Mental Retardation.
Rett's syndrome.


From conception through approximately the third year of life the child needs to bond in order to develop physical, psychological and emotional health. This early attachment is the foundation for the child's ability to feel empathy, compassion, trust and love.

Children with attachment issues and those with Reactive Attachment Disorder have experienced a break in this bonding cycle. This break can be the result of:

Genetic Predisposition.
Maternal Ambivalence Toward the Pregnancy.
Traumatic Prenatal Experience.
In-Utero Exposure to Alcohol and/or Drugs.
Birth Trauma.
Separation from Birth Parents.
Inconsistent or Inadequate Day Care.
Multiple Moves and/or Placements.
Institutionalization (e.g. children adopted from orphanages).
Undiagnosed or Untreated painful illness (e.g. untreated ear infections).
Medical Conditions which Prohibit Adequate Touch (e.g. child who is in an incubator or body cast).


Traditional 'talk' or 'play' therapies do not work with these children because such therapies depend upon the child's ability to develop a trusting relationship with the therapist. Children with Reactive Attachment Disorder are unable to form any genuine relationships.

Therefore parenting must be very structured and very nurturing. Natural consequences, not lectures work best. If the child does not want to eat and you've put a meal in front of them which they will not eat, If the child complains and begins to ruin the mealtime, remove them from the table. The key is to not let such a child make everyone feel like she does. Such children are very good at externalizing their feelings and getting everyone else to feel as miserable as the child does.

Counseling and Psychotherapy [ See Therapy Section ]:

Many therapeutic methods are employed: re-parenting, role-playing, therapist-supervised parent holdings, modeling of behaviors, behavioral shaping, cognitive restructuring, Gestalt Therapy, family therapy and general psychotherapy.

Effective therapy requires a team approach which must always include the child's parents.

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