Attachment

“As a child develops, their mind creates a sense of continuity across time, linking past experiences with present perceptions and anticipations of the future.” (Daniel J Siegel)

For some children, their past experiences have created perceptions that leave them fearful of relationships, viewing the world as hostile and unsafe. They may have had multiple caregivers, experienced loss or trauma, been exposed to abuse or neglect, or did not receive an early experience of nurturance, support, and acceptance for a multitude of reasons (parent depression, substance use, parents own history of separation/loss, medical conditions, family stress). As these children grow, they develop patterns of coping with these concepts of themselves and of the world. They may believe that they deserve bad things to happen to them, that they aren’t lovable, and that adults are not to be trusted. They grow up feeling isolated, angry, sad, and scared. Behaviors which result may be violent, avoidant, abusive, self-harming, or withdrawn. Parents also struggle. They create a similar self-concept that has to do with them being a bad parent, inadequate, and unlovable as well.

Attachment difficulties occur on a spectrum with “securely attached” at one end and “attachment disordered” on the other. Reactive Attachment Disorder is a diagnosis described in the DSM IV as “Markedly disturbed and developmentally inappropriate social relatedness in most concepts, beginning before age five”. It goes on to describe that children either avoid or are indiscriminate regarding attachments and relationships. Children may, however, not have a diagnosis of Reactive Attachment Disorder (that supposes “pathogenic care”), but may be somewhere else on the continuum with a family expressing concerns about his/her ability to trust and accept care and closeness within a family.

There are many checklists that have been published of what behaviors or symptoms may be seen in children who either have a Reactive Attachment Disorder diagnosis or experience challenges and fears in their ability to attach. Although I will list these as well, their presence does not rule in or out problems. Any concerns that prevent a child from being successful at home, school, or with peers should be addressed, but they need to be assessed by a clinician.

Children who do not have healthy attachments:
• May not trust caregivers or adults in authority.
• May display behavior that can be seen as “manipulative” or hostile.
• May not have developed a moral foundation, leading with an absence of 
   empathy, remorse, and compassion.
• Have trouble identifying their own feelings or expressing feelings.
• Lack the ability to give and receive genuine affection or love.
• May resist and avoid nurturance or guidance.
• May not understand cause/effect.
• Have difficulty regulating their own emotions and energy levels
• Attempt to provoke anger in others.
• May act out feelings in a passive-aggressive manner through lying, stealing, 
   or destroying property.
• May be very impulsive.
• Continue to use behaviors developed early in life to cope and survive.
• Can be hyper vigilant, always keeping an eye out to assure their safety.
• Can be superficially charming and engaging, leading others outside the 
   home to question a parent’s challenges in caring for them.
• Will have problems connecting and trusting in all relationships.

To assess whether a child would benefit or need Attachment Therapy, an
evaluation may include:
-- Medical history
-- Parent’s report of behavior
-- Social history
-- Early care and development
-- The presence of trauma, abuse, or neglect
-- A psychiatric evaluation
-- A neuropsychological evaluation
-- Observation of family interaction 
-- Family assessment
-- Previous nonresponsiveness to other modes of treatment and interventions.