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

2. What Is Attachment Disorder? n 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. n They typically fail to develop a conscience and do not learn how to trust.

3. What Causes AD? n 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? n 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! n Most (50%) of what we need to know for life is learned in the first year of life! n Another 25% is learned in the second year of life! n From the age of three on, only 25% of lifes survival skills are added.

7. Conscience Development n 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. Parent Present and Controlling 0 - 2 yo Parent Present and Initiates 3 yo 4 yo Parent Present and Able to Act 5 yo With Verbal Instruction Self Control 6 yo

8. How Does Attachment Develop? 1. Need2. Rage Reaction 3. Gratification or Relief 4. Trust Freud: Oral Erikson: Trust Vs. Mistrust Necessary Input: (a) Eye Contact (a) Eye Contact (b) Touch (b) Touch (c) Movement (c) Movement (d) Smiles (d) Smiles LOVE First Year of Life Cycle

9. Example: First Year Abuse Cycle 1. Need 2. Rage Reaction 3. Child is Silenced 4. Self-Gratification Model Provided: (a) Ignoring (a) Ignoring (b) Neglect (b) Neglect (c) Physical Abuse (c) Physical Abuse (d) Reciprocal Rage (d) Reciprocal Rage First Year Abuse Cycle Childs Adaptation: (a) Ignores Others (a) Ignores Others (b) Self Abuse (b) Self Abuse (c) lack of Trust (c) lack of Trust

10. How Does Attachment Develop? 1. Child Wants 2. Parents Give Appropriate Limits 3. Child Gives: Acceptance of Parental Requests Freud: Anal Erikson: Anatomy Vs. Shame & Doubt Normal Two Year Old Negativism Second Year of Life Cycle 4. Parents Allow: Increasing Independence

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 n Weak crying response or rageful and/or constant whining n Tactile defensiveness n Poor clinging and extreme resistance to cuddling: seems stiff as a board n poor sucking response n poor eye contact, lack of tracking n no reciprocal smile response n indifference to others n Failure to respond with recognition to Mother or Father. n Delayed physical motor skill development milestones (creeping, crawling, sitting, etc.,) n Flaccid

13. Symptoms of Attachment Disorder n Superficially engaging, and charming child n Indiscriminately affectionate with strangers n Destruction of self, others, things n Experiences developmental lags n Will not make eye contact (on parent terms) n Not cuddly with parents n Cruel to animals, siblings n Lacks cause and effect thinking n Has poor peer relationships n Inappropriately demanding or clinging n Engages in stealing or lying n Lacks a conscience n Engages in persistent nonsense questions or incessant chatter n Has poor impulse control n Has abnormal speech patterns n Fights for control over everything n Engages in hoarding or gorging on food n 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? n Parental dreams of love and understanding solving all problems are quickly dashed n Frustration of the parents to receive reciprocal loving and bonding n Venting of hatred towards the Mother - suffering through: –Emotional breakdowns –Post Traumatic Stress Disorder n Apparent close bond to the Father n Schools, churches, friends and relatives become critical of parents n The family becomes controlled by the antics of the child, withdrawing the family from normal social functions n Siblings are targeted, and threatened n Family pets are targeted, and endangered n Normal times of closeness such as Christmas become outbursts of reactive anger n Automatic parenting does not work, there is no logical point of reference n Parents appear to be hostile and/or angry

15. The Randolph Attachment Disorder Questionnaire (RADQ) n Unlike the DSM IV which labels symptoms rather than the causes n 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 n 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 n Eye Contact: warm, loving, soft n Touch: unrehearsed caresses n Movement:: rocking, bouncing n Smiles: the smile in the eyes is the childs focus n Basic carbohydrates: lactose, sugar n 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 n 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 n Re-do early developmental stages child may have missed n Demonstrate affection regardless of response n 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 n Be a tough parent n Build confliction - ask questions like, Are you happy with your life now? n Pizzazz!! n Listening actively to childs behavior –encourage verbal expression of feelings –acceptance of childs feelings –exploring choices for handling feelings –understanding consequences of choices n Promote continuity with childs past n 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 n Compliance is the beginning of reciprocity

18. Effective Treatment n 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 n 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 n 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 n 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 n 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 n 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 n 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