Attachment disorder

A few months ago, Artyom Savelyev, an 8 year old boy was sent back to Russia by his adopted grandmother, Torry Hansen. The bewildered boy was found wandering in Moscow airport, unaccompanied and alone. In his hand, was a note which stated, “This child is mentally unstable. He is violent and has severe psychopathic issues/behaviors.” The statement ended with, “I do not wish to care for this child.”

According to the adopted grandmother, Nancy Hansen, the boy exhibited destructive behavior such as threatening to kill other family members and setting fires in the house. Considering his earlier life with an alcoholic mother and later at a Russian orphanage, he could be exhibiting symptoms of attachment disorder and possibly fetal alcohol syndrome (FAS).

What is Attachment disorder?

Attachment disorder is characterized by disturbed and inappropriate ways of relating socially. Stemming from early childhood, these symptoms arise when a child is deprived of basic emotional needs such as comfort, stimulation and affection by a primary caregiver.

In normal circumstances, it is essential for an infant to form a bond with a parent during the first year of life. Research conducted by Mary Ainsworth concluded that the caregiver provides a feeling of comfort and security, a secure base which enables the child to explore the world around them. A secure attachment plays an important role in the child’s ability to thrive physically and emotionally, as well as providing a strong foundation in future relationships with others.

There are two diagnostic forms of attachment disorder: inhibited and disinhibited.

Inhibited Attachment disorder is when the child fails to respond or initiate social interactions. They may display avoidant and hyper vigilant behavior i.e. “frozen watchfulness.” These children will not outwardly seek affection or will be resistant to comforting.

Disinhibited attachment disorder (DAD) can be indicated by excess familiarity with strangers and lack of close attachments. Therefore, the child will resort to psychological defense mechanisms i.e. self reliant, unable to ask for affection or be outwardly aggressive. Children with this condition have often lost attachment figures or transient multiple caregivers.

Other individuals with attachment disorder may exhibit antisocial personality traits such as persistent lying or stealing, failure to develop a conscience and a tendency to violate social boundaries. Superficially, they may be engaging and charming to outsiders whilst revealing their damaged selves to the caregivers. In extreme cases, they may act violently towards other family members or animals.

How to diagnose attachment disorder

The most commonly used procedure to diagnose attachment disorder in infants less than 18 months is the ‘Strange Situation’ experiment. Developed by Mary Ainsworth, she first noticed through observation that most babies were responsive to their mothers but some were not. There were a few who showed little emotion regardless of their mother’s presence. Bearing this in mind, she devised a 30 minute procedure consisting of a series of separations among a caregiver, a child and a stranger.

Children in secure relationships tended to balance exploring their environment and keeping a proximity to their mothers. When these children were separated from their mothers, they would show distress i.e. crying. When reunited with their mothers, they greeted them with hugs and were easily soothed.

However, children in ‘insecure-ambivalent’ relationships were more apt to cling to their mothers when they were present. They were typically upset when separated, but showed signs of anger or ambivalence when the mother returned. ‘Insecure-avoidant’ children would ignore their mothers when present as they wandered their environment, appear unperturbed during separations, and equally undisturbed when reunited. Finally, ‘insecure-disorganized’ demonstrated by extreme distress over separations and confusion during reunions. These children were particularly noticeable as they displayed frozen postures, dazed facial expressions and repetitive movements when rejoined with their mothers.

Another diagnostic method is Disturbances of Attachment Interview (DAI), created by Smyke and Zeanah, (1999). This is an interview format designed for clinicians to be administered to the caregiver. Twelve indications are covered such as responsiveness to caregiver and behavior around strangers. Furthermore, the propensity for self-endangerment, risk-taking, inhibition, hyper-vigilance and other inappropriate behaviors are assessed.

Where does attachment disorder occur?

Attachment disorder occurs in environments of severe neglect, abuse or abrupt separation from the primary caregiver. Reported findings of Romanian orphans displayed a high rate of attachment disorder. Manifestations were indiscriminate friendliness, inattentiveness, and willingness to go off with relative strangers. In addition, unstable mother figures with a history of psychosocial problems are more inclined to have children with insecure attachment issues.

How to treat attachment disorder

There are different therapies depending on the situation, whether it is to increase the caregiver-child bond, ease foster children into permanent situations, and help institutionalized adoptees adjust to family life.

There is a variety of therapy techniques designed to connect the mother to the child. Often, the mother has unresolved psychological issues of her own which has negated the bonding experience with her child. Most commonly, a mother with a major depression such as post partum depression will frequently have insecurely attached children. In extreme cases, mothers who have been sexually abused in childhood tend to display emotional and physical withdrawal from their children, whereas the mothers who have had physically abusive childhoods will be more aggressive towards their infants. The therapist must first unearth the underlying reason for the mother’s behavior.

A typical case study is Rita, a 32 year old mother and her 18th month old child, Karen. Rita had a history of major depression and had been on antidepressants a year before and during her pregnancy. Rita’s childhood was marred by her stepfather’s abuse of her mother and sexual abuse by a neighbor when she was 5 years old. This created ambivalence in raising Karen, therefore her psychiatrist referred her to a Toddler-Parent Psychotherapy program. In the preliminary strange situation test, Karen ignored her mother’s departure but when alone, visible signs of disorientation where shown. During the first reunion, Karen did not make eye contact with Rita nor did she approach her. During the course of 2 years, Rita related more of her childhood and how it affected her relationship with Karen. She revealed that her mother had attempted suicide many times when she was a child, and in order to avoid upsetting her mother, Rita would be passive and unassertive. After Rita learned to resolve her internal conflicts, another strange situation was enacted. The results were markedly different. Karen gave more eye contact and a much more positive interaction was evident.

In cases of severely abused children, more interventionist approach may be required. Beth Thomas was 6 years old when she was featured in the HBO documentary, Child of Rage. Beth, 19 months old and her brother, John 7 months, were discovered by welfare services. Soon after, she was adopted by Tom, a minister and his wife, Julia. Soon after, it was discovered that Beth was raped by her birth father when she was 1 years old. She was exhibiting sexually inappropriate behavior, as well as was physically abusing and sexually molesting her younger brother. The couple soon decided to send Beth away to a specialist center, when she was found hitting her brother’s head on the cement floor. The therapy center, run by Nancy Thomas, concentrates on rehabilitating extremely abused children with attachment disorder including children who kill. A pioneer in the field, the therapy emphasizes obedience and parental control. With strict rules in place, the child is more likely to feel secure in their surroundings. Slowly in time, Beth began to develop her self esteem and form a conscience (a sense of right and wrong). Today, she is a pediatric nurse and a known speaker of attachment disorder.

Bibliography

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