Q: Is there a definition of attachment disorder?
This is a very complex area and there continues to be a lot of debate on the subject here and in the US. The terms 'reactive attachment disorder' (RAD) or 'attachment disorder' are still sometimes used diagnostically, but some specialists are now recommending use of the term 'severe attachment difficulties' to describe children who present with extreme behaviours related to their early experiences. The world-renowned trauma expert Bessel van der Kolk argues that RAD should be renamed 'developmental trauma disorder', linking it with his work on post-traumatic stress disorder.
Q: How does this link with attachment theory?
It highlights the profound trauma experienced by a child who, for whatever reason, has not had the basic entitlement of continuous care and nurture in their first years and the impact of this on their brain development. Experts increasingly recognise that children in foster and adoptive families, who have experienced the trauma of early neglect, abuse, loss and multiple carers, are significantly at risk of developing attachment disorder.
Q: What behaviours are associated with attachment disorder?
A child who has been denied the security of knowing that their physical and emotional needs will be met with consistent love and nurturing care has no choice but to develop instinctive 'survival' behaviours. These might include:
- inappropriate attention seeking, for example, negative behaviours that can't be ignored; excessive clinginess; incessant chatter and nonsense questions; indiscriminately affectionate with strangers; controlling and manipulative behaviours
- poor reciprocal relationships, for example, lack of eye contact; superficial 'phoney' charm; difficulties sharing/collaborating/learning from others
- lack of conscience/ability to empathise, for example, pointless lying; poor impulse control; inability to see cause and effect, accept responsibility for own actions or show remorse; cruelty to animals or others smaller than themselves
- lack of self-awareness, for example, disregard for personal safety; high tolerance for discomfort and pain (yet extreme reactions to minor hurts)
- stealing (often of seemingly unimportant items) hoarding/gorging food and other abnormal eating patterns
- hypervigilance, for example, constantly aware of others, always on alert; difficulties in sleeping; hyperactive and fidgety or 'frozen' and vacant; aggressive over- reactions to slights and perceived threats; easily stressed and reactive to stress around them.
In addition, such a child may also display learning and developmental delays; abnormal speech patterns; preoccupation with fire, blood and gore; and behaviour that appears older or younger than their years.
Low self-esteem and lack of confidence in their abilities may lead them to be reluctant to learn or engage in new activities or to show persistence and learn from their mistakes (fear of failure).
Easily stressed, they find it hard to self-regulate and may resort to head-banging, rocking or self-harm. And, just to confuse matters, the behaviour seen in the setting may differ dramatically from that experienced in the home, or from one practitioner to another as the child explores what feels safe and what doesn't.
It is significant to note how many of these behaviours are often associated with other disorders, for example, ADHD (together with adult mental health issues and anti-social behaviours). It is possible that future research and further developments in neuroscience may highlight the role of attachment in the recognition and treatment of a wide range of behavioural difficulties and mental health issues.
Warning: Because of the complex nature of attachment disorder, it is vital that early years practitioners seek expert professional opinion whenever there is cause for concern about a child's behaviour
Q: How can settings and schools support adoptive and foster families caring for children who have attachment disorder?
It is not enough to assume that once a child has been removed from a neglectful or abusive home and placed with a family that will love and care for them, they will soon settle and learn to appreciate their good fortune.
Increasingly, adoptive and foster families recognise that their role will involve 'therapeutic re-parenting' if they are to make a difference to damaged lives. In the process, they themselves may become traumatised as they attune with their children and 'hold' the distress and fear as it is being acted out and projected on to them. Some families may be well prepared for this, but sadly, others may be less so, and support from health, social services and other agencies may be patchy for all.
- Be pro-active in showing your support. Families may be stressed, and uncertain about what help is available.
- Listen and show that you take seriously their concerns and suggestions as to how best to support the child. Unconventional approaches are more likely to be successful, and this may challenge your perspectives and professional judgements.
- Consider the best ways to safeguard the child's primary attachments in their new family while developing (and maintaining) secondary attachments within the setting.
- Think about how you provide emotional containment for the child. Is there a safe place they can go when fears and anxieties overwhelm them? Are you able to recognise their triggers and the signals that tell you they are struggling to stay emotionally regulated? Can you stay calm when they become dysregulated?
- Think about the effects of conventional behaviour strategies such as 'time out' and sanctions or rewards on a child who has only known rejection and doesn't believe themselves to deserve love and treats.
- Make sure your policies are flexible enough to allow you to respond to individual needs and to reassure the child that though you may reject the behaviour, you are not rejecting them.
- Be quick to seek re-attunement with them after an incident so they can begin to see themselves as having an entitlement to affection and nurture.
- Whatever a child's chronological age, their neurological development is likely to be stuck at a much earlier stage. Responding to behaviour in the way that you would with a much younger child is much more likely to have a positive impact.
- Help the child to hold their new family in mind while apart from them, and to learn that they too can be 'held in another's mind'.
- Be aware of the impact of attachment- disordered behaviour on your own well-being and that of your colleagues. Find ways of supporting each other so you can provide the best help for the child and their family.
Part Five, 'More strategies for supporting the development of secure secondary attachments', will appear on 14 February.
MORE INFORMATION
Where to find guidance on the needs of foster and adoptive families:
- Beyond Consequences, Logic and Control - A love-based approach to helping attachment-challenged children with severe behaviors by Heather Forbes and Bryan Post (Beyond Consequences Institute)
- Real Parents, Real Children - Parenting the adopted child by Holly van Gulden and Lisa M Bartels-Rabb (Crossroad Classic)
- First Steps in Parenting the Child Who Hurts - Tiddlers and toddlers by Caroline Archer (Jessica Kingsley Publishers)
- Guidance and training for educational professionals involved with foster/adoptive families are also available at www.postadoptioncentre.org, www.adoptionuk.org, www.afteradoption.org
LINKS TO EYFS GUIDANCE
- UC 1.1 Child Development
- UC 1.3 Keeping Safe
- PR 2.4 Key Person
- L&D 4.2 Active Learning
REFERENCES AND FURTHER READING
- Inside I'm Hurting - Practical strategies for supporting children with attachment difficulties in school by Louise Michelle Bomber (Worth Publishing)
- Why Love Matters - How affection shapes a baby's brain by Sue Gerhardt (Brunner-Routledge)
- Understanding Attachment and Attachment Disorders by Vivien Pryor and Danya Glaser (Jessica Kingsley Publishers)
- 'Attachment in Practice' - DVD and user notes by Siren Films (www.sirenfilms.co.uk)
- Key Persons in the Early Years Foundation Stage by Dorothy Selleck (Early Education)
- 'Being Held in Another's Mind' by Jeree Pawl, PhD, www.wested.org/online_pubs/ccfs-06-01-chapter1.pdf.
Photograph by Kate Beer.