Attachment Disorder and the Adoptive Family By
Brenda McCreight, Ph.D.
Chapter 1: Understanding Attachment Disorder
- Ø What is attachment disorder?
- Ø What causes attachment disorder
- Ø Characteristics of attachment disorder
- Ø Diagnosing attachment disorder
- Ø Suggested readings and web sites
What is attachment disorder?
Attachment disorder is a long term psychiatric condition, displayed through a number of negative behaviours that result when an infant or young child does not have an opportunity to bond with a significant, stable caregiver. The DMS IV (Diagnostic and Statistical Manual by the American Psychiatric Association) cites the correct wording for the diagnosis as Reactive Attachment Disorder, and defines several sub-categories of the disorder including ambivalent, anxious, and avoidant types. In the adoption and foster care fields, the condition is generally referred to by the term “attachment disorder” which has become a catch phrase to cover many of the emotional and psychological problems often presented by children adopted at an older age.
Some people consider attachment disorder to be a behavioural problem, which means that they expect the child to be able to change her behaviour by choice, or, simply by learning more acceptable ways of behaving. Some adoptive parents believe that once their newly placed child has a stable and safe family life, she will be able to love them and to behave for them as if she had always been a part of their family. But that is not the case. Attachment problems are the result of inappropriate, or insufficient, brain development, and so this is not a behavioural condition at all. It is a psychiatric disorder that can only change as the brain changes, and that takes time, as well as an enhanced and stable family environment.
The best way to think of attachment disorder is as a brain injury that occurred in the early months or years of life. With the right support combined with affection and nurturing, the brain can heal, or, develop more fully, but while that process is underway, the new adoptive parents should realize that they are raising a brain injured child and treat the problem with the same respect and patience that they would if the child had suffered a brain injury from being hit by a car.
Lately, the media has reported stories about older adopted children who have harmed, or even killed, their adoptive parents and attachment disorder is often presented as the underlying motive for the murder. That can be very frightening and discouraging to prospective adoptive parents who realize that most children adopted from foster care have some degree of attachment problems. It is important to understand that while attachment issues are part of these youths behaviour problems, they are not the sole cause. There may be other issues involved, such as a co-existing mental health problem like untreated schizophrenia, or drug abuse. Attachment disorder may be a factor in the murder, but it is not the sole cause.
Attachment disorder can also be thought of as exiting on a spectrum. Children may have the neuro structures in their brain to attach, but simply never had anyone to whom they could develop an attachment based relationship. Or, they may have the ability to attach to siblings, but again, have lacked a significant parent with whom they could extend this skill. It can be helpful to think of a newly placed child as being in a pre-attachment stage, which will be followed by an early attachment, when the child begins to develop some sense of stability, followed by a more fully developed attachment which includes loyalty, emotional reciprocity, and trust. Simply changing how an adoptive parent views the challenge of attachment can be helpful.
What causes attachment disorder?
The purpose of the attachment relationship is to help the infant develop the basic skills to develop healthy relationships throughout the rest of his life. It allows him to learn to trust others, to trust himself, and to live a life in which he is as capable of giving as he is of receiving. The emotional safety provided by the attached relationship also allows the infant or child’s developing brain to focus on growing the complicated and subtle infrastructures that lead to skills such as reasoning, mood monitoring, and general intellectual functioning. For most infants, this begins with the relationship between the mother and the baby, grows to include the father, then the siblings, other relatives, and so on.
The attachment process is an interactive one that is established by the care and nurturing of the baby. The baby cries, the mom responds with love and food, and the baby’s brain responds by growing and developing skills with which to respond back to mom. Most of the simple things that adults do with babies are in fact triggers for attachment. The cuddling, the cooing, the playing with toes, the warm baths, the gentle feeding of healthy food, gazing into the baby’s eyes, are all attachment tools.
Children develop attachment disorder when this process is interrupted by the experience of having multiple caregivers; or, when the process is denied to the infant because of poor quality, chronically inconsistent, or violent parenting, then the brain becomes focused on helping the infant to develop survival skills at the expense of relationship skills. The result is a child who only knows how to survive by manipulation, by control, by aggression, or by withdrawal. The infant grows into childhood with a keen sense of abandonment, but no understanding at all of how to belong to, or to trust, a parent figure.
Parents who have drug or alcohol problems, or have an untreated mental illness, or who are too young, or who themselves have an attachment disorder, are not likely to make the needs of an infant or young child a priority, leaving the child to suffer from neglect or abuse. Once the child protection authorities become involved, the baby is often moved to a foster home, back to the parents for several tries at rehabilitation, and to different foster homes in between. By the time the child is adopted, she may have had any number of caregivers, and any number of negative life experiences. This is fertile ground for an attachment challenge.
Not all children will respond to their damaging early years with the same degree of attachment challenge. A number of factors must co-exist in order to create an attachment challenge, including the individual differences of experience and response; inherited genetic tendencies; pre- natal exposure to drugs and alcohol; and these will combine to create an attachment challenge that is unique to each child. No adoptive parent can know simply from reading the child’s history how serious the attachment challenge is, nor can they know ahead of time how easy or hard it will be to help them develop an attached relationship with their adopted child.
Characteristics of an attachment challenge
Each child is different, therefore, each child will show her level of attachment, or lack of, in slightly different ways. As well, each adoptive family is different, so the things that are a problem in one family might not be a problem in another. For example, a couple with no other children might find it almost intolerable if their new child withholds affection, while adoptive parents of a large family might just shrug off the behaviour since their own parenting needs are being met by their other children. Therefore, when considering attachment characteristics, it is important to look at the overall picture.
In considering the characteristics of attachment disorder, remember that a child with attachment issues will display most, but not all, of these behaviours most, but not all, of the time; and, the behaviours will have begun before the child reached the age of five.
Destructive – the child may damage or break toys or objects that belong to the adoptive parents, or to teachers, or to the neighbours. He may even damage items that belong to him, with no apparent sense of loss or remorse afterward. Some children will claim the damage was an accident (but just how many accidents can one child have in a day?), while others will be forthright and admit, without any sign of caring, that they have purposely broken the object.
Inability to link cause with effect - the child may not show any understanding of why you are mad at him five minutes after she shredded your favourite dress, or cut her younger sister’s hair off, or let the dog off the leash to run in the traffic. The underlying issue isn’t that they don’t understand what they have done; it is that they don’t understand why it bothers the adoptive parent.
Inability to participate in a healthy relationship – he simply does not seem to understand that hugs
are an emotional experience that is shared between two people, not something that is used for trade purposes ie I’ll hug mom now so that she will let me watch the television later. He may cruelly tease or taunt less powerful children, hurt animals, argue incessantly, and boss others without any apparent understanding of what this feels like for the other person.
Charming – the charm is displayed at will, generally only when the child is interacting with someone they rarely see, or will never see again. For example, they can be very charming and delightful to strangers or therapists or store keepers, and even visiting adoptive grandparents, but rarely to the adoptive parent.
Poor eye contact – they just can’t look in another person’s eyes for any length of time. The contact is over stimulating and uncomfortable for the child. Eye contact skills are supposed to develop in early infancy, and for most children who have attachment problems, there was no safe adult to look deeply into their eyes in those early days.
Controlling – sometimes by manipulation, sometimes by aggression, sometimes by withdrawal –
they try to get what they want by forcing it one way or another because they don’t trust others to come through, and because their brain was too busy focusing on survival to let them develop the parts that normally deal with positive interaction.
Demanding or clingy behaviour – the same thing as control, the child either demands your attention by yelling or throwing objects or hitting; or, she clings on like a barnacle, even trying to follow a parent into the bathroom.
Stealing and lying – the child will take things that don’t interest him, as well things he wants, and he lies even when there is no apparent need to do so. To him, the truth is vague and unrelated to anything that is going on in his day.
Low impulse control – the child’s level of spontaneity is high, almost like attention deficit disorder. She will take or do what she wants without thinking through her actions and without any understanding of how her action might impact others.
No apparent remorse or conscience – she will do horrible things, and slightly irritating things, but will not indicate that it has bothered her at all. The few times she will look you in the eye are generally indications that she is lying.
Issues with food and/or sleep – he may under sleep or over sleep, whichever works worst for your schedule. With food, he may steal it, hoard it, avoid it, or anything else that gives him some sense of control over a basic issue.
Affectionate and in-appropriate with strangers – the child will display all the loving gestures with
total strangers that she meets in the store that she will not display at home. She will hug the mailman, but not the adoptive mom.
Does not appear to learn from mistakes – consequences that work with other children do not work with a child with attachment problems. She will do the same negative, hurtful, behaviour over and over again, as if the only purpose is to make the adoptive parent angry, and, she does not appear to be deterred by any form of consequence.
Can never, or rarely, be comforted when frightened or hurt – the child knows how to ignore pain and fear, and knows how to take care of himself, but has no clue about how to let others take care of himself or even understand that this is what the adoptive parent is trying to do.
These characteristics can be summed up by saying that the child does not have a developed sense of other. That is, she does is not able to connect with the way she makes other people feel, nor is she able to feel remorse or take joy for how she has made others feel.