Common concerns
If you are a family that has foster children or adopted children, chances are that child has experienced attachment issues in their past. Many children who have suffered early maltreatment have a faulty belief that they are not worthy and are bad or defective. In their minds, caregivers treated them poorly or their birth parents abandoned them because they are intrinsically faulty or deficient. Given that belief, children may consciously or subconsciously think, “Since I am basically defective, what’s the point in improving my behavior?” Individuals act in accord with their primary beliefs about themselves, their life, and others. Actions will give clues to a person’s beliefs. For example, a troubled child’s actions might indicate these beliefs about self-worth: “I’m only worthwhile when I have your undivided attention.” “I am only loved when I get my own way.” “When someone corrects me, it shows me that she does not love me.” If a parent does not address these faulty beliefs, few parenting strategies or methodologies will help. Most parenting guidance assumes that a child’s core belief is positive and, therefore, the child will choose good things for himself. A negative core belief inspires very different choices. A secure attachment to a primary caregiver can help a troubled child change faulty beliefs. 

What is Reactive Attachment Disorder?
Attachment problems fall on a spectrum, from mild problems that are easily addressed to the most serious form, known as reactive attachment disorder (RAD). RAD is relatively rare, but occurs when there has been gross neglect in infancy and childhood with a failure to form an attachment with a caregiver before the age of 5.  Common signs and symptoms of reactive attachment disorder include:

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• An aversion to touch and physical affection. Children with reactive attachment disorder often flinch, laugh, or even say “Ouch” when touched. Rather than producing positive feelings, touch and affection are perceived as a threat.

• Control issues. Most children with reactive attachment disorder go to great lengths to remain in control and avoid feeling helpless. They are often disobedient, defiant, and argumentative.

• Anger problems. Anger may be expressed directly, in tantrums or acting out, or through manipulative, passive-aggressive behavior. Children with reactive attachment disorder may hide their anger in socially acceptable actions, like giving a high five that hurts or hugging someone too hard.

• Difficulty showing genuine care and affection. For example, children with reactive attachment disorder may act inappropriately affectionate with strangers while displaying little or no affection towards their parents.

• An underdeveloped conscience. Children with reactive attachment disorder may act like they don’t have a conscience and fail to show guilt, regret, or remorse after behaving badly.

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Inhibited symptoms of reactive attachment disorder
This child is extremely withdrawn, emotionally detached, and resistant to comforting. The child is aware of what’s going on around him or her—hypervigilant even—but doesn’t react or respond. He or she may push others away, ignore them, or even act out in aggression when others try to get close.

Disinhibited symptoms of reactive attachment disorder
This child doesn’t seem to prefer his or her parents over other people, even strangers. The child seeks comfort and attention from virtually anyone, without distinction. He or she is extremely dependent, acts much younger than his or her age, and may appear chronically anxious.

What is your approach to treating attachment issues?
With a thorough assessment, we seek to understand the experiences your child had beginning if possible, intrauterine and throughout childhood.  Without this information due to foster or adoption, we gather as much information as we can in order to determine treatment.  This helps us understand how the brain developed and pathways we can work on in therapy to help re-build relationships and teach the child to regulate big emotions. Our focus is on creating a therapeutic environment of trust and connection in order to promote secure attachment.  The assessment includes:

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• Review of current symptoms, concerns, duration and intensity

• A thorough review of child development and past medical history

• Review of foster/adoption history 

• Additional important biological and adoptive family background history 

 

Then the best course of treatment is decided together with the caregivers. There are 4 dimensions of attachment that we will assess to determine where the imbalance is occurring within the dyad:  Nurture, Engagement, Structure and Challenge.  We consistently find that when parent-child attachment grows, many of the behavioral problems disappear because children begin to change their self view and understand that their parents honestly want good things for them. Treatment may include a combination of the following:

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• Theraplay® to learn strengthen parent-child attachment

• Play Therapy to assist child in expressing what is troubling them when they do not have the verbal language to express thoughts and feelings.

• Family therapy including play to explore and/or challenge existing family dynamics 

• Traditional talk therapy to create a therapeutic environment of safety and unconditional acceptance

• Sandtray and Expressive Arts to help with communication and healing

• Parenting support, coaching and training to implement therapeutic interventions at home to promote bonding