Recognizing Attachment Concerns in Children
October 22nd, 2008 |
By Arthur Becker-Weidman, Ph.D.
Click here to contact Arthur and/or see his GoodTherapy.org Profile
Attachment is fundamental to healthy development, normal personality, and the capacity to form healthy and authentic emotional relationships. How can you determine whether your child has attachment issues that require attention? What is normal behavior, and what are the signs of attachment issues? If you’ve adopted an infant, when will you see attachment problems develop? These and other related questions are often at the forefront of adoptive parents’ minds. In this article I will help you understand what to look for and how to identify concerns.
Let’s begin with an explanation of attachment. Attachment is the base of emotional health, social relationships, and one’s world view. The ability to trust and form reciprocal relationships will affect the emotional health, security, and safety of the child, as well as the child’s development and future inter-personal relationships. The ability to regulate emotions, have a conscience, and experience empathy all require secure attachment. Healthy brain development is built on a secure attachment relationship.
Children who are adopted after the age of 6 months are at risk for attachment problems. Healthy and secure attachment develops during the child’s first few years of life. Problems with the mother-child relationship during that time, orphanage experience, or breaks in the consistent caregiver-child relationship interfere with the normal development of attachment. There are a wide range of attachment problems that result in varying degrees of emotional disturbance in the child. One thing is certain; if an infant’s needs are not met consistently, in a loving, nurturing way, the patterns of attachment that develop will be problematic.
When the first-year-of-life attachment-cycle is undermined and the child’s needs are not met, and normal socializing shame is not resolved, mistrust begins to define the perspective of the child and attachment problems result. The cycle can become undermined or broken for many reasons:
· Multiple disruptions in care giving
· Post-partum depression causing an emotionally unavailable mother
· Hospitalization of the child causing separation from the parent and/or unrelieved pain
· Parents who are attachment disordered, leading to neglect, abuse (physical/sexual/verbal), or inappropriate parental responses not leading to a secure/predictable relationship
· Genetic factors.
· Pervasive developmental disorders
· Caregivers whose attachment needs are not met, leading to overload and lack of awareness of the infants needs
The child may develop mistrust, impeding effective attachment behavior. The developmental stages following these first years continue to be distorted and/or retarded, and common symptoms emerge:
· Superficially engaging and charming behavior, phoniness
· Avoidance of eye contact.
· Indiscriminate affection with strangers.
· Lack of affection on parental terms.
· Destructiveness to self, others, and material things.
· Cruelty to animals.
· Primary process lying (lying in the face of the obvious*)
· Low impulse control.
· Learning lags.
· Lack of cause/effect thinking.
· Lack of conscience.
· Abnormal eating patterns.
· Poor peer relationships.
· Preoccupation with fire and/or gore.
· Persistent nonsense questions and chatter.
· Inappropriate clinginess and demandingness.
· Abnormal speech patterns.
· Inappropriate sexuality.
So how does one distinguish the difference between a child who “looks” attached and a child who really is making a healthy, secure attachment? This question becomes important for adoptive families because some adopted children will form an almost immediate dependency bond to their adoptive parents. To mistake this as secure and healthy attachment can lead to many problems down the road. Just because a child calls someone ”Mom” or “Dad,” snuggles, cuddles, and says, ”I love you,” does not mean that the child is attached or even attaching. Saying, “I love you”, and knowing what that really feels like, can be two different things. Attachment is a process. It takes time. The key to its formation is trust, and trust becomes secure only after repeated testing. Generally attachment develops during the first few years of life. The child learns that the child is loved and can love in return. The parents give love and learn that the child loves them. The child learns to trust that the child’s needs will be met in a consistent and nurturing manner. The child learns that the child “belongs” to his family and they to the child. It is through these elements that a child learns how to love, and how to accept love. This is how a child develops a secure sense of self.
Older adopted children need time to make adjustments to their new surroundings. They need to become familiar with their caregivers, friends, relatives, neighbors, teachers, and others with whom they will have repeated contact. They need to learn the ins and outs of new household routines and adapt to living in a new physical environment. Some children have cultural or language hurdles to overcome. Until most of these tasks have been accomplished, they may not be able to relax enough to allow the work of attachment to begin. In the meantime, behavioral problems related to insecurity and lack of attachment, as well as to other events in the child’s past, may start to surface. Some start to get labels, like “manipulative,” “superficial,” or “sneaky”. On the inside, this child is filled with anxiety, fear, grief, loss, and often a profound sense of being bad, defective, and unlovable. The child has not developed the self-esteem that comes with feeling like a valued, contributing, member of a family. The child cares little about pleasing others since his relationships with them are quite superficial.
When are problems first apparent?
Children who have experienced physical or sexual abuse, physical or psychological neglect, or orphanage life will begin to show difficulties as young as six-months of age. For example, the signs of difficulties for an infant include the following:
- Weak crying response or rageful and/or constant whining; inability to be comforted
- Tactile defensiveness
- Poor clinging and extreme resistance to cuddling: seems stiff as a board
- Poor sucking response
- Poor eye contact, lack of tracking
- No reciprocal smile response
- Indifference to others
- Failure to respond with recognition to parents.
- Delayed physical motor skill development milestones (creeping, crawling, sitting, etc.,)
- Flaccid
WHAT ARE THE SUBTLE SIGNS OF ATTACHMENT PROBLEMS?
Gail tells her seven-year-old daughter, Sally, to pick up the napkin Sally has dropped. As Sally crosses her arms a sad and angry pout darkens her face. Gail says, “Sally, I told you to pick up the napkin and throw it away.” Sally stomps over to the napkin, picks it up, and throws it away. Crying and whining, Sally stands with her back to Gail. Sally, angry and unhappy, is exhibiting one of the subtle signs of attachment sensitivity that nearly all children adopted after six-months demonstrate.
Attachment is an interpersonal, interactive process that results in a child feeling safe, secure, and able to develop healthy, emotionally meaningful relationships. The process requires a sensitive, responsive parent who is capable of emotional engagement and participation in contingent collaborative communication (responsive communication) at nonverbal and verbal levels. The parent’s ability to respond to the child’s emotional state is what will prevent attachment sensitivities from becoming problems of a more severe nature.
What are the subtle signs of attachment issues?
1. Sensitivity to rejection and to disruptions in the normally attuned connection between mother and child.
2. Avoiding comfort when the child’s feelings are hurt, although the child will turn to the parent for comfort when physically hurt.
3. Difficulty discussing angry feelings or hurt feelings.
4. Over valuing looks, appearances, and clothes.
5. Sleep disturbances. Not wanting to sleep alone.
6. Precocious independence. A level of independence that is more frequently seen in slightly older children.
7. Reticence and anxiety about changes.
8. Picking a scabs and sores.
Internationally adopted children experience at least two significant changes during the first few months of life that can have a profound impact on later development and security. Birth mother to orphanage or foster care and then orphanage to adoptive home are two transitions. We know from extensive research that prenatal, post-natal, and subsequent experiences create lasting impressions on a child. During the first few minutes, days, and weeks of life, the infant clearly recognizes the birth mother’s voice, smell, and taste. Changes in caregivers are disruptive. The new caregivers look different, smell different, sound different, taste different. In the orphanage there are often many care givers but no one special caregiver. Adoption brings with it a whole new, strange, and initially frightening world. These moves and disruptions have profound effects on a child’s emotional, interpersonal, cognitive, and behavioral development. The longer a child is in alternate care, the more these subtle signs become pervasive.
There are effective ways for a parent to help his or her child.
Parents and the right parenting are vital to preventing subtle signs from becoming anything more than sensitivities. Parenting consistently with clear and firm limits is essential. Discipline should be enforced with an attitude of sensitive and responsive empathy, acceptance, curiosity, love, and playfulness. This provides the most healing and protective way to correct a child.
As Sally walks away to pout, Gail comes up behind her, scoops her up, and begins rocking her gently while crooning in Sally’s ear. Gail sings songs and tells Sally she loves her and understands Sally is angry at being told what to do. Gail expresses sadness that Sally is so unhappy. At first Sally resists a bit, but she soon calms down and listens as Gail tells her how much she loves Sally. Sally is sensitive to feelings of rejection and abandonment that are evoked by her mother’s displeasure, so Gail brings Sally closer to reassure Sally nonverbally. It is by experience that the subtle signs are addressed and managed. Nonverbal experience is much more powerful than verbal experience since most of the subtle signs have their origin in nonverbal experience and nonverbal memory. Finally, Sally eventually did what she was asked to do and praised for doing what was expected. In this manner, Sally experiences acceptance of who she is while becoming socialized.
These sensitivities do not constitute a mental illness or Reactive Attachment Disorder. They are subtle signs of attachment sensitivities. So, what can you do?
First, bringing the child in close is better than allowing the child to be alone or isolate him or her self.
Second, talk for the child. Put words to what the child is feeling. This allows the child to feel understood by you, maintains a connection, and helps assuage the fear of rejection and abandonment. It also helps the child become self-aware, models verbal behavior, and facilitates a sense of emotional attunement between parent and child.
Third, don’t make food a battle. A child who steals food or hoards food usually has sound emotional reasons for this. Providing the child with food so that your child experiences you as provider is often the solution. Put a bowl of fruit in the child’s room. (Be sure to keep if filled. It does not good if you provide and then leave an empty bowl!) In some instances, I’ve recommended that the parents provide the child with a fanny pack and keep it stocked with snacks. This usually quickly ends hoarding and stealing of food.
Fourth, for the child who is overly independent, doing for the child and not encouraging precocious independence is helpful. So, making a game of brushing your six-year old’s teeth, dressing your seven-year-old, or playing at feeding a nine-year-old, are all ways to demonstrate that you will care for the child. Keeping it playful and light, allows the child to experience what the child needs and helps eliminate hurtful battles.
In conclusion, these subtle signs are important reminders that our children have ongoing sensitivities that as parents we must address. Responsive and sensitive communication is essential. Attachment is a function of reciprocal communication; attachment does not reside in the child alone. It is very important for the parent to manage and facilitate this attuned connection within a framework of clear limits and boundaries, natural consequences, and firm loving discipline.
REFERENCES
- Becker-Weidman, A., & Shell, D., (Eds.) (2006) Creating Capacity for Attachment, Wood N Barnes, Oklahoma City , OK .
- Becker-Weidman, A., (2006) “Activities to Facilitate Attachment,” Attachment and the Adopted Child. #48, p. 7.
- Becker-Weidman, A., (2006) “What is Attachment?” In Adoption Now, Adoption UK (Ed.), Adoption UK , Banbury, Oxen, UK , pp. 14-17.
- Becker-Weidman, A., (2006) “Who is at risk?” In Adoption Now, Adoption UK (Ed.), Adoption UK, Banbury, Oxen, UK, pp. 17-19,.
- Becker-Weidman, A., (2007) “Treatment For Children with Reactive Attachment Disorder: Dyadic Developmental Psychotherapy,” http://www.center4familydevelop.com/research.pdf
- Becker-Weidman, A., (2007) “Complex Trauma and Attachment: Links and Differences,” Connections, November 2007.
- Becker-Weidman, A., & Hughes, D., (2008 In Press) “Dyadic Developmental Psychotherapy: An evidence-based treatment for children with complex trauma and disorders of attachment.”
- Hughes, D.,(2007) Building the Bonds of Attachment, 2nd Edition, Guilford , NY .
- Hughes, D., (2008) Attachment-Focused Family Therapy, W. W. Norton, NY
©Copyright 2008 by Arthur Becker-Weidman, Ph.D. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Arthur and/or see his GoodTherapy.org Profile
21 comments so far
Hi,
Just an update. The article listed as “In Press” has now been published. The correct citation is:
Becker-Weidman, A., & Hughes, D., (2008) “Dyadic Developmental Psychotherapy: An evidence-based treatment for children with complex trauma and disorders of attachment,” Child & Adolescent Social Work, 13, pp.329-337
regards
art
I am often concerned about the welfare of some of these adopted children who are farmed out to celebrities who do not have a stable home environment anyway. Look at Madonna or even Angelina and Brad- they have children of their own. Why invite the scrutiny of the whole world to feed upon the innocent children you are adopting? Not only will these kids probably have attachment issues but they are destined to be brought up with the entire world scrutinizing their every move. That is not to say that some of them are not trying to do a good thing but who is it benefitting in the end? The children they bring into this or their own self image? I wonder sometimes.
I am a mom who adopted two children several years ago from a foreign country and I think that not only am I happier now with children but I saved them from a lifetime of poverty, poor health, orphanages, and who knows what else. I cannot imagine my family now without these two very healthy, physically and emotionally, children. We had such a wonderful transition and it makes me very sad to hear that other adoptive families routinely do not experience the same. For us and for the kids the adoption process was such a blessing and I would never want to discourage anyone from taking this journey which can enrich your lives in so many ways. I do think that there are sometimes mistakes made along the way but that is why you have to do your research into the issue ahead of time and make a committment that this is what is going to be the ideal arrangement for your whole family. You have to be willing to give one hundred percent of yourself and your time to make it work just like you do when any new child enters your family. There are things you can do to make the transition easier and many support groups who will stand by you every step of the way to help ensure a positive experience for everyone. Adoption can be such a blessing and I hope that anyone who longs for a child will take this option under serious consideration.
Ryan,
You raise an interesting point. I suppose we also have to consider the fact that permanency for a child is very important and a lack of permanency is one factor in a variety of mental health problems. Having a forever family makes a significant positive difference in a child’s life, especially when that child has a history of chronic maltreatment and is now in the child welfare system.
Thanks for the comment.
Art
Robyn,
What a beautiful and lovely story. Thank you so much for sharing this. Sometimes we get caught up on only thinking about the problems. There are many joys as well. As an adoptive parent I am in complete agreement with you on this point.
regards
Art
I am a grandparent who adopted 4 grandchildren 2 years ago after fostering them for 3 years. They are now 12, 10, 8, and 6. We have multiply problems including RAD which so far in AZ (PHX) no luck in getting help. The system finds us at fault instead of realizing that these children have been through so much in the first few years of life. People are so blind to see the problem and would rather place blame. We are having such a hard time finding a therapist for them as one possiblely two the oldest ones were sexually molested. The one they have now has gotten now where in the last year. Help just doesn’t seem to be there and it is tearing our family apart. RAD is real wish people would see and understand!!!
Dear Audry,
Yes, it can be a real struggle. That is why it is so important to be sure that you get an excellent and thorough evaluation and then appropriate treatment. Dyadic Developmental Psychotherapy is an evidence-based and effective treatment for complex trauma and disorders of attachment. You may be able to find someone in your area on the list of registered clinicians at attach. org. I hope this helps.
regards
art
I did check the attach.com site and there are no listings in AZ. Maybe you may know of someone or how I can find someone for this. I have tried several avenues but hit dead ends so any help would be helpful.
Dear Audry,
You may have to contact someone in a nearby state to find a closer resource. Try someone in any of the neighboring states and see if they have a recommendation for you. It can be very difficult to find the right person in your town. I sometimes have people traveling four hours each way each week for treatment and we have families coming from all across the US and internationally for our two-week intensive treatment program…so I do understand what you may be up against.
You can always feel free to call me to discuss any of this in more detail.
regards
Art
Since often autism does not manifest itself until sometime around the 18 month old stage have there been any studies relating to increased cases of autism in adopted children? I wonder if attachment are ever thought to be a part of this? Any input would be helpful and appreciated.
Dear Deidre,
Autism can manifest itself before 18 months of age. As far as I am aware, there is no increased incidence of Autism among adopted children. Actually, if we think about it, that should not be a surprise. Since Autism is largely a neurological disorder, it’s incidence may be expected to be similar across various methods of forming a family.
Good question.
regards
Art
Adoption can be such a wonderful thing for so many families. I worry more about these older kids who are being dropped off in Nebraska all over the place because their parents have decided they cannot take care of them. I wonder what kinds of attachment issues and emotional concerns this is going to cause into adulthood for these kids. These are the kids who need loving familes the most and they are simply being thrown away like yesterday’s garbage. Shame on those who are doing this. You can say it is to give them a better life but there has to be a better way than this. Think long and hard before having children- look at all of the people out there who actually want them and cannot have kids of their own.
Dear Jerry,
Abandoning a child is a difficult and painful event (for all involved). Being able to safely abandon a new born is actually a good thing as it allows for just what you are suggesting: allowing the child to be taken in and adopted by a family that care adequately care for the infant.
thanks for your comments, I appreciate it.
Art
I think it’s wonderful for people who can adopt. These children need the love and understanding of a caring parent. I really enjoyed this article and it brings some light on adopting and what one goes thru
Robyn, I don’t think I could have said it better. I applaud you for your commitment! Whether the children are adoptive or your own, every parent is going to make mistakes, but we learn from them. We are human. I am happy to hear that the adoptive process was a success.
Adoption is a complex process and it is so important to be ready. This is especially true if the child is an older child. In those instances, a more therapeutic parenting approach is often necessary. A good resource if the Therapeutic Parenting Manuel that is published by the Association for the Treatment and Training in the Attachment of Children (www.attach.org).
regards, and thanks so much for your comments.
art
I love the example above with Gail and Sally. This just reminds us that we need to show love and understanding to not only adoptive children but our own as well.
after reading this article, I sometimes wonder if my son had attachment issues. When he started pre-school, I worried that he would not want to leave home due to he was always with me. When he hesitated about getting on the bus and looked back at me, and later that day acted like he didn’t want to go back to school, I wanted to cry, but I explained afterwards that is was something he had to do (school) and that he would make new friends. Although he was not adopted, I believe that a lot of children are afraid of being away from their parents and sometimes act out if they don’t want to do something. We just need to be a little understanding and explain the best way we can why we do the things we do.
Dear Holli,
It is not unusual for a child to be initially hesisitant about being away from the child’s parent on first going to school. That apprehension is quite normal. If it persists, then there may be a problem. Sometimes children reflect their parent’s anxieties and fears and the child’s apprehension about separation may reflect the parent’s anxieties about separation. Of course, separation anxiety can also have other causes as well.
regards
Art
If you find that you want to explore treatment, it is very important to secure treatment that is effective. There are specific treatments for different conditions. Dyadic Developmental Psychotherapy is an evidence-based and effective treatment for attachment disorders and Complex Trauma.
regards
Therapists may be interested in the new Dyadic Developmental Psychotherapy Institute that has been formed to certify practitioners of Dyadic Developmental Psychotherapy. The following letter by Dr. Daniel Hughes about the Institute may of interest to you:
Dyadic Developmental Psychotherapy Institute® (DDPI®)
Dyadic Developmental Psychotherapy™ (DDP™) is a method of psychotherapy that was developed in the 1990s for the treatment of children and youth who manifested serious psychological problems secondary to intrafamilial trauma and serious failure to establish stable attachment patterns. Most of the clients receiving this treatment were residing in foster homes, adoptive homes, or—at times—residential treatment centers. DDP was—and is—highly influenced by the theory and research findings related to attachment and intersubjectivity (Bowlby 1988, Holmes, 1993, Hughes 1997, 1998).
Over the past 10 years, DDP has continued to maintain its attachment-focused, family-centered stance while continuing to refine its theoretical foundations and treatment interventions (Becker-Weidman & Shell, 2005; Hughes, 2004, 2006) and to broaden its focus to include the treatment of all families (Hughes, 2007). At the same time there have been two empirical studies that have begun to demonstrate the clinical efficacy of this treatment model (Becker-Weidman, 2006a, 2006b, Becker-Weidman, 2007). The broader evidence-base for this effective treatment was recently described in an article (Becker-Weidman & Hughes, 2008) While DDP continues to develop its theoretical and practice base and although more research would be quite beneficial, its framework is now well enough established to warrant greater efforts to standardize its use, and to insure that those practicing DDP are remaining faithful to its core principles and practices. For these reasons DDPI is now being established.
DDPI will provide a certification process for those clinicians who are utilizing the DDP model of treatment and who wish to become certified in having demonstrated their knowledge of its core principles and their competence in its implementation in their practice. To be certified clinicians will have completed a minimum number of hours both in DDP course participation as well as in receiving consultation of their utilization of DDP in their treatment (through video review). Clinicians will also be certified to be DDP consultants, who are responsible for the providing consultation to those applying to become DDP certified therapists.
DDPI is currently in the process of establishing a board as well as finalizing the certification processes. Art Becker-Weidman has been securing legal advice so that DDPI can meet the regulatory requirements to become a nonprofit organization and to establish necessary trademarks for the organization. He also has agreed to manage the initial administrative responsibilities of DDPI. In 2009, DDPI will be developing training and treatment manuals that will further operationalize the core principles and interventions of DDP, while still remembering that any such efforts must always be inherently flexible since the central features of each dyadic relationship are unique and often emerge in a nonlinear fashion.
Information regarding DDPI, the certification requirements for clinicians and consultants, and other information can be found on my website: (www.danielhughes.org) as well as Art Becker-Weidman’s website: (www.Center4FamilyDevelop.com). In the near future DDPI will have its own website.
If you have any questions or comments about DDPI please contact me (dhughes202@comcast.net) or Art (aweidman@aweidman.cnc.net).
Dan Hughes, Ph.D.
Becker-Weidman, A. (2006a). Treatment for children with trauma-attachment disorders:
Dyadic Developmental Psychotherapy. Child and Adolescent Social Work Journal, March, 2006.
Becker-Weidman, A. (2006b). Dyadic Developmental Psychotherapy: a multi-year
follow-up. In New Developments in Child Abuse Research. S.M. Sturt, Ed.
Nova Science Publishers.
Becker-Weidman, A., (2007) “Treatment For Children with Reactive Attachment Disorder: Dyadic Developmental Psychotherapy,” http://www.center4familydevelop.com/research.pdf
Becker-Weidman, A., & Hughes, D., (2008) “Dyadic Developmental Psychotherapy: An evidence-based treatment for children with complex trauma and disorders of attachment,” Child & Adolescent Social Work, 13, pp.329-337.
Becker-Weidman, A. & Shell, D. Eds. (2005, 2nd Printing 2008). Creating Capacity for Attachment. Oklahoma City, OK: Wood ‘N’ Barnes, Williamsville, NY: Center For Family Development
Bowlby, J., (1988). A Secure Base: Parent-Child Attachment and Healthy Human Development. NY: Basic.
Holmes, J., (1993). John Bowlby & Attachment Theory. London: Routledge.
Hughes, D. (1997). Facilitating Developmental Attachment: The Road to Emotional
Recovery and Behavioral Change in Foster and Adopted Children (1997).
Northvale, NJ: Jason Aronson.
Hughes, D. (1998). Building the Bonds of Attachment: Awakening Love in Deeply
Troubled Children. Northvale, NJ: Jason Aronson.
Hughes, D. (2003). Psychological Interventions for the Spectrum of Attachment
Disorders and Intrafamilial Trauma. Attachment and Human Development, 5,
271-277.
Hughes, D. (2004). An Attachment-Based Treatment for Maltreated Children and Youth.
Attachment and Human Development, 6, 263-278.
Hughes, D. (2006). Building the Bonds of Attachment: Awakening Love in Deeply
Troubled Children.2nd Edition. Northvale, NJ: Jason Aronson.
Hughes, D. (2007). Attachment-focused family therapy. New York: WW Norton.