Attachment Disorders in Children
Attachment is defined in psychology as an emotional bond between an infant or toddler and primary caregiver,
a strong bond being vital for the child's normal behavioral and social development.
(www.dictionary.com; attachment theory; noun Psychology)
Is your child experiencing attachment difficulties?
Are they to the level of a psychiatric diagnosis?
Let's explore the definition so that you can more fully assess whether your child needs professional assistance
in the area of relationship attachment or not.
When attachment is labelled a "disorder," it is then considered a psychiatric illness
that can develop in young children who have problems with emotional attachments to others.
(https://www.aacap.org/aacap/Families_and.../Facts.../Attachment-Disorders-085.aspx)
Children with attachment disorders have had severe problems or difficulties in their early relationships.
They may have been physically or emotionally abused or neglected.
Some have experienced inadequate care in an institutional setting
or other out-of-home placement such as
a residential program or foster care or an orphanage .
Others have had multiple traumatic losses or changes in their primary caregiver.
Children who have serious attachment issues can develop two possible types of disorders:
Reactive Attachment Disorder and
Disinhibited Social Engagement Disorder.
According to the 'Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition' used by mental health professionals to diagnose patients, the following are the diagnostic criteria for BOTH disorders:
The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:
Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caring adults
Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care)
Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child to caregiver ratios)
The DISTINCTION between the two disorders:
Reactive Attachment Disorder (RAD)
I. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers,
manifested by both of the following:
The child rarely or minimally seeks comfort when distressed
The child rarely or minimally responds to comfort when distressed
II. A persistent social or emotional disturbance characterized by at least two of the following:
Minimal social and emotional responsiveness to others
Limited positive affect
Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adult caregivers
III. The criteria are not met for autism spectrum disorder.
IV. The disturbance is evident before age 5 years.
Disinhibited Social Engagement Disorder (DSED)
I. A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults
and exhibits at least two of the following:
Reduced or absent reticence in approaching and interacting with unfamiliar adults
Overly familiar verbal or physical behavior (that is not consistent with culturally sanctioned, and with age-appropriate, social boundaries)
Diminished or absent "checking back" with adult caregiver after venturing away, even in unfamiliar settings
Willingness to go off with an unfamiliar adult with little or no hesitation
To simplify: (https://www.helpguide.org/articles/parenting-family/attachment-issues-and-reactive-attachment-disorders.htm)
Children with Reactive Attachment Disorder are less likely to interact with other people
because of negative experiences with adults in their early years.
They have difficulty calming down when stressed and
do not look for comfort from their caregivers when they are upset.
These children may seem to have little to no emotions when interacting with others.
They may appear unhappy, irritable, sad, or scared while having normal activities with their caretaker.
The diagnosis of RAD is made if symptoms become chronic, being present for more than 12 months.
Children with Disinhibited Social Engagement Disorder
do not appear fearful when meeting someone for the first time.
They may be overly friendly, walk up to strangers to talk or even hug them.
Younger children may allow strangers to pick them up, feed them, or give them toys to play with.
When these children are put in a stranger situation, they do not check with their parents or caregivers,
and will often go with someone they do not know.
Most children with disturbed upbringings have attachment issues to some degree,
although perhaps not to a level of psychiatric illness.
The hopeful truth is that with time, patience, and coordinated effort,
attachment issues of all types can be lessened and, with some children,
even significantly repaired.
Some basic tips of parenting children with attachment issues:
(https://www.aacap.org/aacap/Families_and.../Facts.../Attachment-Disorders-085.aspx)
Safety is a core issue. Your child is distant and distrustful because they feel unsafe in the world.
They keep their guard up to protect themselves,
but it also prevents them, sadly, from accepting love and support.
So before anything else, it is essential to build up your child’s sense of security.
Set limits and boundaries.
You can accomplish this sense of security by establishing clear expectations and rules of behavior,
and by responding consistently so your child knows what to expect when they act a certain way
and—even more importantly—knows that no matter what happens, you can be counted on.
Take charge, yet remain calm when your child is upset or misbehaving.
Remember that “bad” behavior means that your child doesn’t know
how to handle what they’re feeling and needs your help.
By staying calm, you show your child that the feeling is manageable.
If they are being purposefully defiant, follow through with the pre-established consequences
in a cool, matter-of-fact manner.
And never discipline a child with an attachment disorder when you’re in an emotionally-charged state.
This makes the child feel more unsafe and may even reinforce the bad behavior,
since it’s clear it pushes your buttons.
Be immediately available to reconnect following a conflict.
Conflict can be especially disturbing for children with attachment disorders.
After a conflict or tantrum where you’ve had to discipline your child,
be ready to reconnect as soon as they’re ready (or even prior, so they know you are available to them).
This reinforces your consistency and love, and will help your child develop a trust
that you’ll be there through the ups and downs of their journey.
Own up to mistakes and initiate repair.
When you let frustration or anger get the best of you
or you do something you realize is insensitive,
quickly address the mistake.
Your willingness to take responsibility and make amends can strengthen the attachment bond.
Children with reactive attachment disorder or other attachment issues
need to learn that although you may not be perfect, they will be loved, no matter what.
Try to maintain predictable routines and schedules.
A child with an attachment disorder won’t instinctively rely on loved ones,
and may feel threatened by transition and inconsistency—
for example when traveling or during school vacations.
A familiar routine or schedule can provide comfort during times of change.
Help them feel loved.
...loving actions, hearing reassuring words, and feeling comforted over and over again.
(refer to another blog entry in the 'Parenting' category of blog posts: "Affirmation")
Find things that feel good to your child.
If possible, show your child love through rocking, cuddling, and holding
(attachment experiences they missed out on earlier in their lives).
But always be respectful of what feels comfortable and good to your child.
In cases of previous abuse, neglect, and trauma,
you may have to go very slowly because your child may be very resistant to physical touch.
Respond to your child’s emotional age.
Children with attachment disorders often act like younger children, both socially and emotionally.
You may need to treat them as though they were much younger,
using more non-verbal methods of soothing and comforting.
Help your child identify emotions and express their needs.
Children with attachment disorders may not know what they’re feeling or how to ask for what they need.
Reinforce the idea that all feelings are okay and show them healthy ways to express their emotions.
Listen, talk, and play with your child.
Carve out times when you’re able to give your child your full, focused attention
in ways that feel comfortable to them.
It may seem hard to drop everything, eliminate distractions, and just be in the moment,
but quantity time AND quality time together provides a great opportunity
for your child to open up to you and feel your focused attention and care.
Get healthy lifestyle habits in place.
A child’s eating, sleep, and exercise habits are always important,
but they’re even more so in children with attachment problems.
Healthy lifestyle habits help reduce stress levels, increase brain function, and level out mood swings.
(refer to another blog entry in the 'General' category of blog posts: "The Secrets to Aging and Longevity")
When children with attachment issues are relaxed, well-rested, and feeling good,
it will be much easier for them to handle life’s challenges.
The encouraging truth:
Attachment issues can be lessened and even significantly reduced.
Try implementing the above-mentioned parenting tips and begin to see a change in your child.
It is a long, so-often-times frustrating road, for sure,
especially if you adopted or began to be primary caretaker of a child at age 5 or older.
But, it can be accomplished!
Any progress toward healthier attachment within your child is worth every ounce of effort.
