Attachment Issues
Overview of Attachment Issues: Attachment is our ability to form emotional bonds and empathic, enjoyable relationships with other people, especially close family members. Attachment issues are most obvious and prevalent during childhood, and are often the result of abuse or neglect. Attachment is related to trust, empathy, and self-esteem, and the inability to form attachments is sure to cause major disruption socially and emotionally.
Reactive Attachment Disorder (RAD) is a severe childhood disorder in which children display one of two kinds of inappropriate social behaviors. The first, the “inhibited form”, is characterized by withdrawal and introversion. The disinhibited form involves a lack of boundaries with strangers, and, in severe cases, sexual or aggressive tendencies. Often, children exhibit both forms at different times.
The Medical Model and Attachment: Reactive Attachment Disorder is rare, and its causes are well recognized. While in the general population it probably occurs in less than one percent of children, among maltreated children between fifty and eighty percent are likely to develop RAD, and as many as eighty percent of maltreated infants exhibit some signs of attachment disorder. It is a disorder primarily caused by chronic early maltreatment within a caregiving relationship. Prolonged institutional care (orphanage) and extended stays in a NICU can also cause such difficulties. In other words, this is an illness undoubtedly caused almost entirely by environmental factors. -- edited Arthur Becker-Weidman
Case Examples of Attachment Issues:
Shawn, 6, is brought in for therapy by his newly adoptive parents, who adopted him from the foster care system last year. He had been so loving and sweet with them when he’d first moved in, they were willing to overlook his impulsivity, sudden bursts of aggression, and sexualized behavior. They figured these behaviors would get better as he got accustomed to a more stable life with them, and with his new brother and sister, both older. Instead, things had deteriorated rapidly. He was aggressive with his siblings, impossible to discipline, and always in trouble at school. He seemed angry for no reason, and would not allow anyone to comfort him. He wet the bed almost nightly. Shawn’s parents were almost ready to give up and send him to a group home for children with behavior problems. The therapist recognized the signs of attachment issues, and instead of trying to change Shawn’s behavior with reinforcement and punishment, as had been tried by foster parents, teachers, and now Shawn’s adoptive mother and father, the therapist worked on creating positive attachment experiences in therapy between the parents and Shawn. In addition, the therapist helped the parents understand the cause of motivation of Shawn's behaviors and provide attachment-facilitating parenting experiences at home. After several months, results began to appear. Shawn accepted hugs, and was less easily triggered. Instead of hitting his siblings, he cried and asked for assistance from his parents. His poor behavior was but a symptom of intense emotional ambivalence, and when that was addressed through positive parenting, the symptoms began to fade.
Melissa, 32, is married and having problems with intimacy. Her sex life with her husband began to worsen almost immediately after their honeymoon, and she admits the problem is hers; she is repulsed by sexual invitation from her husband, and even afraid of touching him in bed at all. She feels angry at him for no reason she can identify, and feels she would like to live “separate lives”. However, the thought of divorce terrifies her and she does not want that. Melissa cannot explain her feelings, but an examination of her childhood reveals instances of severe neglect Melissa had thought she “was over”. Therapy reveals Melissa has intense fears of both rejection and of being enveloped or dominated by others. Through work on communication skills and by experiencing catharsis (emotional release) in the presence of, at first, the therapist and, later, her husband, Melissa is able to develop a bond that feels safe with her husband, and begin to repair her marriage.
Resources Related to Attachment:
Family Attachment
ATTACh.org
Therapy for Attachment Issues: There is a wide range of Psychotherapy Treatment Models or types of therapy used in the treatment of attachment issues. Most of these approaches fall into three historic camps of psychology: Psychoanalytic / Psychodynamic approaches; Behaviorism and; Humanism. Regardless of the type of therapy, there are some generally agreed upon elements of healthy therapy which are universal to all forms of psychotherapy. Before beginning therapy for attachment or any other issue, it is helpful to familiarize oneself with these elements.
Books Related to Attachment Issues:
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I have a friend who first became a foster parent and then ended up adopting one of the babies that was in her custody. And even though that child has been with them from a very early age she still just seems to need more love and care than her own biological children do. There is certainly something that happens even in infancy where a child learns how to love and to be loved in return and I watch as this mom and family struggle on a daily basis to help the adopted child find the right balance and for them all to learn what it means to be a loving and reciprocal family.
Can anyone provide any empirical evidence for that list of "attachment disorder" symptoms? Also, i've always wanted to know the actual source of the "first-year cycle" and "second-year cycle". They resemble some combination of Freud, the ego psychologists, and Wilhelm Reich, but no citation is ever given in the various holding therapy-related publications that refer to them. They have nothing to do with any empirical work in developmental psychology. Can anyone help me on these points?
Hi Jean, I’m not an expert on childhood attachment problems, but I can tell you that if you ask nearly any experienced clinician about the symptoms which Art lists above, he or she will tell you that these are generally agreed upon, blatantly evident behavioral / emotional reactions to attachment disturbance. Of course, due to differences in many factors, such as genetics, temperament, and experience, not all children are going to present similarly, given similar attachment disturbance. I'm guessing that there is probably loads and loads of empirical evidence for these symptoms. Would anyone with more information than I want to chime in and answer Jean's question? Noah
No, they aren't generally agreed upon, Noah. Read Everett Waters, read Zeanah, read whom you like (outside of holding therapists), you will not see those characteristics described. Of course there are severely disturbed kids who have such symptoms, but attachment is not the issue that causes them.
Jasmine, You are very observant and correct. Your comments are excellent, cogent, and valuable here. Those first few years are crucial in the development of a pattern of attachment. This is the basis for the capacity to engage in authentic emotionally meaningful relationships without undue distortions, anger, or disturbance. It requires parents who are able to engage in the concordant intersubjective sharing of experience (shared emotion (or attunement), shared attention, and shared attention). It requires sensitive and responsive and reflective parenting. Your friends may find the following texts quite helpful: Creating Capacity for Attachment by Arthur Becker-Weidman, Ph.D., & Deborah Shell, (2005) Wood N Barnes, Oklahoma City, OK. Building the Bonds of Attachment, 2nd Ed., by Daniel Hughes, Ph.D., 2007. If your friends are having difficulty, it is very important that they get appropriate support and treatment, if indicated. Dyadic Developmental Psychotherapy is an evidence-based and effective treatment for families with children who have trauma-attachment disorders, developed by a group of licensed mental health professionals and researchers with substantial experience in this area. Before beginning any treatment, it is very important to get a thorough and comprehensive evaluation so that the underlying issues are identified and not merely surface symptoms, which can have various causes and require different treatments. Regards...I hope you will continue to contribute here. Your comments are most valuable.
With all due respect Jean I can tell you that, yes in fact, the symptoms that Art describes are often a part of attachment disturbance. I am somewhat familiar with Zeanah's work and it would seem to support Art's list of attachment disturbance symptoms. But, as I’ve said previously, let’s invite the experts on the subject of attachment to comment about attachment and to answer your questions. You and I are clearly not experts on the subject of attachment. You write in your comment, "Of course there are severely disturbed kids who have such symptoms, but attachment is not the issue that causes them." I am frankly and completely dumbfounded by such a misinformed and false generalization. Furthermore, for you to associate Art's work with “Voodoo Science” (I later removed this statement and a number of others made by Jean) is truly an act of misinformation and potential slander that is not tolerated on this blog. Please state your facts accurately or I will have no choice but to moderate your comments in defense of truth and in protection of consumers who might be influenced by such nonsensical statements. You have been given fair warning. For more information on our Comment Policy, please see http://www.goodtherapy.org/custom/blog/terms-and-conditions-of-use/ Noah Rubinstein, LMFT Executive Director
Actually Jean, on second thought the most appropriate action (based on our Terms and Conditions) at this point would warrant me to either delete your comment in full or edit out the slander. I will first attempt to remove the slander and see if it is possible to keep the rest of your comment intact. If you don’t like the results of my edit, feel free to send me an updated comment without slander or request that I delete the comment in full and I will do so. Regards, Noah
Wow! I had no idea there was such debate over this particular issue. I have been a classroom teacher and guidance counselor for many years and while this may not qualify me to make a diagnosis, I have certainly met students and families over the years where this is clearly a problem. This is especially true in cases of not being able to identify cause /effect relationaships even on a most simplistic level as well as learning difficulties and behavior problems. While I know that there are those who will say that this may not have anything to do with attachement issues, I think that for many students this is actually the case. When you meet with families you get a sense of the familial relationships and know when there is more going on beneath the surface than meets the eye. I know this may be reaching for some people but I think that clearly there can be a realtionship between these issues and I am glad that this forum has given smeone the voice to bring this up. Thanks!
Dear Christine, As a professional, you have a lot of real and direct experience with this topic. I don't think there is any real debate over this particular issue among actual professionals who have training and experience in this area. In any event, your comments are right on target here. Most of the current writing and research in infant mental health and related topics of treatment, trauma, and behavioral problems focus on attachment, attachment theory, and parent-child relationships. A wonderful book you may find helpful is Attachment in the Classroom by Heather Geddes. It is written by an educator. There is another great reference too, but I don't have that right at my finger tips now, but will post it later for you. regards. Art
But, Christine, don't you suppose that the inability to relate cause and effect might influence a child's ability to form an attachment, just as well as the events being the other way around? Or that there may be one or more other factors that influence both? In any case, how could you tell from behavior that a person can't relate cause and effect? Would this mean that someone couldn't learn to open a door by turning a knob? Or do you really mean that the child gets punished a lot, but still misbehaves? If it's the latter, that could have a lot of explanations other than a cause-and-effect problem. I think one of the difficultiess here is that people who have made this claim about cause-and-effect problems have based their thinking on Piaget's outmoded description of the development of that kind of thinking, whereas modern infant development research shows that the capacity to make some cause-and-effect connections is already present at a few months of age. The result of thinking that children can really lack that kind of ability is an unfortunate focus on what the child can or cannot do, rather than on the adult behaviors (e.g. punishment) that may be influential. Attachment is only one of the many variables that combine to determine the child's developing characteristics, and we shouldn't try to make it carry more weight than it's capable of. It's important to avoid "criterion creep"-- the extension of a concept or a diagnosis to include a lot more than it was ever meant to handle. I believe criterion creep is happening when we begin to hear about "attachment disorders" outside the usual evaluative or diagnostic schemes.
Dear Christine, I have those references now and hope that they will be helpful to you. In reading your comments I see that you made a rather astute observation about problems with cause-effect thinking that stem from very early difficulties in the parent-child relationship. As a professional you know from your experience, and as any licensed mental health professional with expertise in this area knows, it is through the early parent-child relationship and attachment that the beginnings of cause-effect thinking develop, as my article describes (you can also look at Infant Mental Health… for more technical details). Bowlby describes this process quite well, as do some other professional researchers with expertise in actually conducting such research in these matters such as Mary Ainsworth, Mary Main, Mary Dozier, etc., and as is amply described in the texts below. 1. Geedes, Healther, (2006), Attachment in the Classroom, Worth Publishing, London. 2. Carnes, Kate, & Stanway, Chris, (2007), Learn the child: helping looked after children to learn. A good practice guide for social workers, careers and teachers. British Association for Adoption & Fostering (BAAF), London. I think that you will find that these references will be quite helpful in your work. They describe the importance of attachment as a central organizing principle in child development and as a major factor in determining a child’s development and functioning in the classroom. As I mentioned in a previous post, these books are written by educators and professionals and so the authors understands the nature of your work, are professionals like you are, and have real training, licensure, and experience relevant to your work. I hope you find the texts of use to you and that you will continue to contribute to this site; your comments have been quite informative, knowledgeable, based in real experience and understanding, and valuable. Thanks. Art
Thanks so much for the guidance and resources. It is sometimes so frustrating to not know where to turn to help a student when there is obviously trouble at home and you feel like you are a real lifeline for a student, and sometimes the only lifeline you feel they might have at this point in time. I will certainly look at all of this and hopefully this can help me grow not only as a teacher but one who also struggles and desires to know and understand the lives and emotions of her students beyond that which is sometimes just a small piece reflected in the classroom and at school. Thanks.
Do you think it is possible that a child can be born without the ability to form thes attachment bonds? Even if everything was done right during pregnancy and child rearing?
Dear Gayle, Thank you for that terrific question. My response highlights the importance of looking at causes and not symptoms since we treat causes not merely surface symptoms. The quick answer to your question is a "certainly, yes." For an extreme example of that one can look at children with severe Autism. In these children the capacity to form emotionally meaningful, cooperative, responsive, and collaborative interpersonal relationships is quite impaired and their "attachment bond," is quite impaired...but having nothing to do with chronic early maltreatment within a care-giving relationship. Another example might be the child who is born with significant brain-damage to the right orbital frontal cortex. regards, Art
Genetic factors and temperamental differences can make a difference to the ease with which a child forms a secure attachment to particular caregivers. Children with serious cognitive challenges may not display preferences for caregivers as early or noticeably as those with normal intelligence. However, because attachment is essentially a set of attitudes, feelings, expectations, and behaviors toward other people, and because it is a very robust aspect of development, the idea that there is "no attachment" in an otherwise normally-developing child is difficult to accept. Even children who approach strangers rather than staying with familiar people are displaying their attitudes about human beings, although in a disordered way. A child with "no attachment" would respond to all people (including other children) in about the same way. If by "no attachment" Gayle means no secure attachment or secure base behavior, as I said before, this might be more likely for some children than for others, because of temperamental factors (inborn, biologically-determined personality components). If she means a lack of obedience or affection to caregivers, these matters are related to many factors other than attachment. There are unconventional practitioners who claim that some babies are born with great resistance to attachment and refuse to respond to their caregivers. This claim is mistaken, and I would hope that other contributors to goodtherapy would speak against it.
Those interested in the connection of attachment with autism may like to look at Rutgers, A.H. etal. (2004). Autism and attachment: A meta-analytic review. Journal of Child Psychology and Psychiatry, Vol. 45(6), 1123-1134. This article reports evidence of attachment behavior in autistic children.
Gayle, One other point. As any clinician who has training, licensure, and experience (or who has conducted actual research) in this area and with, say Autism, would point out, that children can have "no attachment" for a variety of reasons and that this can be one factor in Austism Spectrum Disorders. In fact, this category of no attachment of nonattached attachment disorder is described in the text below. Most practitioners who have real knowledge and experience will point to several very important texts such as: Zeanah, C., (2005), The Handbook of Infant Mental Health, 2nd. Edition, Guilford Press, NY., among several others. I hope this is helpful for you...and, of course, if you have other questions, do feel free to post here or to contact me directly. Your post was quite helpful. Art
Yes, clinicians refer to handbooks and their own experience, and scholars refer to that difficult-to-read basic research literature-- which is why the best answers to important questions come from a combination of clinical and academic opinion. The use of this combination really defines evidence-based practice, doesn't it? And isn't it the intention of this blog to provide the best possible information?
Dear Gayle, One other point, if you'd like useful information. In addition to the seminal text I referred you to, which all those professionals familiar with this subject refer to, you might also want to look at The Diagnostic Classification of Mental Health and Developmental Disorders (2005) by the Zero to Three group. Of course the first text is really the primary text in the field, edited by Dr. Zeanah and including scholars (clinician/researchers) of international renown who have real professional experience, training, and who have conducted research into these questions. You will find this material most useful if you want to explore your very good question in more depth. regards, Art
DC:0-3R is a good source for people who have been trained in its use, and looking at the two versions (1994 and 2005) gives an interesting view of the changing definitions of attachment disorders. For example, the 1994 DC:0-3 speaks of Reactive attachment disorder, but this term was removed in 2005. Some researchers consider the possibility that children with symptoms of the inhibited form of RAD actually have anxiety disorders, and/or problems with regulation of emotion. These suggestions are especially notable when we consider that "attachment disorders" were originally-- and not so long ago-- equated with Failure to Thrive. Thinking continues to change on this topic, and it is no wonder that people feel confused about it. However, for the sake of children and families, we need to be able to tolerate ambiguity, and to avoid the assumption that disorders of attachment are well understood, easily diagnosed, or all treatable by a specific intervention.
Dear Christine, Another good text for you as a teacher is: Bomber, L., (2007) Inside I am Hurting: Practical strategies for supporting children with attachment difficulties in schools. Worth Publishing, London. It is a terrific book, written by an professional who is both a teacher and licensed therapist and researcher. You might also want to look at: Becker-Weidman, A., & Shell, D., (2005) Creating Capacity for Attachment, Wood N Barnes, Oklahoma City, OK, which describes Dyadic Developmental Psychotherapy, an evidence-based treatment with empirical support that is grounded in current thinking and research on the etiology and treatment of Complex Trauma or Developmental Trauma Disorder. If you have other questions, let me know. I also have other information that may be useful to you. For several years now I have consulted monthly during the school term with a group of counselors from a regional BOCES program (BOCES stands for Board of Cooperative Educational Services). BOCES is an entity created to provide special education services for a regional group of school districts. The idea being that a school district may not be able to meet the specific needs of a limited number of children, but by pooling resources, the BOCES programs have sufficient numbers to provide pretty decent specialized services for children with severe emotional problems, Autism Spectrum Disorders, etc. regards Art
I have been in clinical practice for over twenty years and my specialty is depression, anxiety, and trauma. In this period I have experienced many, many different perspectives, different theories, different evidence-based practices and always I prefer respectful dialogue and appreciation for another's point of view, whether or not it agrees with mine. Evidence-based practice is as important to consider as the cogent, well-thought out analysis a clinician presents to explain effective treatment that is not supported by empirical studies. We are complex beings and our understanding of ourselves changes over the years. Criticism shuts down communication and sharing our respectives beliefs without it brings rich learning and equally important, warm connection to the process. I don't often participate in online dialogue because my life is very busy off line. But I read these comments and was prompted to offer these thoughts and thank the Admin Staff for managing this site so that we all have a place to respectfully give to and receive of each other. Patti
Hi, I am a parent of a 4 year old boy. I am worried that my reprimanding my son constantly might make him hate me.
I have an MA and an EdS in counseling. I have been going through holding therapy for the last year with my therapist who has the proper credentialing and supervision. At 40 years of age, this is an extremely difficult task, yet from my own experience as a therapist, I know that this is something I must endure to be able to "feel" love, which I currrently don't feel - at least not the way most people do. Can you please recommend a site for Adults who are going through holding therapy? I need to be able to connect with others who feel the same way as I do. Thank you.
Dear Karen, You might want to look at the White Paper on Coercion at the Association for the Treatment and Training in the Attachment of Children (www.attach.org). Cradeling or being held by a caregiver/significant other in a collaborative and non-coercive manner can be a very therapuetic and engaging experience. Coercion and intrusive methods are not appropriate in any treatment. The only time forced holding or restraint is appropriate is in those very rare situations where a person is dysregulated, out of control, and about to hurt self or others. I have some material about attachment that is relevant for adults on my website, www.center4familydevelop.com regards Art
Children just seem to be getting the raw end of the deal in so many ways these days. Just another manifestation that poor parenting and abuse can bring about, as if they needed something else on their plate already. Jeez I am really kind of tired of hearing all of the bad things yet that is constantly what makes the news! I am glad to hear though that there can be hope for these kids when they are given the right treatment.
Hi, I was attracted to this article through a management blog and as a beleiver in behavioral leadership theories I am interested to read articles on effective use of prositive reinforcement (Reward) and the effect it can have on people. It is great to see that someone is interested in these poorly treated children, it is a great article for all levels of managers and leader to read an understand the power of reward I hope more children can benefit from this research.
Have they seen that behavior modification such as this really has positive long term results in these cases?
Parental bonding shouldnt end with the cradle. I believe most people dont know what happens in their children's lives. Out of sight is definitely out of mind. We dont know how they are treated at daycare or at school. We dont know who bullies them in the john. We also dont know what keeps them awake when they are pretending to sleep. The core of most psychological problems with children is we dont try putting ourselves in their small feet.
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.
I was adopted into a very loving family at a young age so I never really experienced any of these problems but as an adopted child I have met others who did and I just think that would be a painful situation for the entire family to endure. These families only want to give these kids care and love but because of the emotional baggage that many of them bring with them it makes giving that love very difficult sometimes. I hope that all of the families of adopted children can somehow find more peace and understanding with one another. I know that reading articles like this can really help.
Dear Sonia, Thanks for your comment. There are so many helpful things parents can to do help their children overcome trauma and the lingering effects of chronic early maltreatment. I hope this article can help spread some of that knowledge. regards Art
Interesting post and very insightful. There are so many things parents can do to help support and guide a child so that they feel loved and cared for.
I have a child of my own and am considering adopting my second one. Its been a very useful article and it throws light on the issues of parenting an adopted child in some very dark areas.
I agree... it is very important to give adoptive the children the love they need and deserve. Just being there for the child and understanding would mean a lot to them.
I have a daughter n law who adoptive and in my opinion is one of the best parents to this child she has adoptive. The child knew she had been adoptive at a young age and my daughter n law made sure to let her know that she is very loved and can come to her for any questions she may have.
I can't believe the percentage of attachment disorder symptom... What an overwhelming statistic. This goes to show that these adoptive kids need all the love they can get. I know there are many families out there who are very caring, but I have also heard of some adoptive families who were no better than the people who gave them up.
Great point and hopefully we will all remember that this goes for biological children as well and not just those who are adopted.
You are very right, John. It is very important that parents have the right information so that they can understand what is "driving" the child's behavior and so be able to respond in a helpful manner.
Wow, lots of comments here now. Thank you all for reading the article and taking the time to post these lovely comments and thoughts. Several of you have mentioned love and that is vital to a sucessful relationship and a successful placement. In some ways love provides the necessary committment that these children need. Love is often not sufficient by itself (necessary but not the only experience necessary) to help heal the underlying trauma has can cause problems for these children. In addition to unconditional love, therapeutic parenting to address the feelings driving the behavior is another very important element. Again, thank you all for your comments and thoughts. regards art
Do you think that it is good idea to talk to adopted children from a very early age about adoption and that this is how they may have come into your family? Or do you think those kinds of talks would be better left until they are older? I tend to lead toward the younger the better but I would love to hear your opinion.
Dear Julia, The research and material I've read really supports telling children from the beginning. I often respond to the question by saying, "about the same time you begin telling you child he is a boy/she is a girl. In other words, from day one. If this is just part of the "stuff" everyone knows, then it will not come as a surprise or shock to the child later. More to the point, if the parent(s) are comfortable with the manner in which the child joined the family, so will the child. It is very sad to hear adults talk about not finding out about having been adopted as an infant until they were older. The sense of betrayal and feelings of having been deceived are quite strong and corrosive. So, Julia, I concur with your opinion. regards
I agree with Dr. Arthur... It is a very good idea to tell the child at an early age about being adopted....I believe if you tell them when they are older, they would resent the fact you didn't tell them and kept it as a secret. The younger the better... After that, just be there for them, love them and let them know they can come to you for any questions they may have.
Your right Helen... adoptive or biological, they all need the same love.
Yes, all children need love. Children who have experienced chronic maltreatment within a caregiving relationship, as have nearly all the children in the child-welfare system, need that and more. These children also need attachment-facilitating therapeutic parenting in order to undo the damaging effects of this early maltreatment. regards
I enjoyed reading this. Very informative. Have you read Heather Forbes' books? Her method, which is similar to what you recommend, saved our lives. I adopted my daughter 4 years ago when she was 12, not knowing she has RAD, among other diagnosis. It has been a long hard road working on her healing, but so worth it. I wish more of the info you present went mainstream. I know so many other adoptive parents who subscribe to the Nancy Thomas' camp and just hurt their already-traumatized children even more. I look forward to reading more of your site...
Dear Keri, Yes, I am familiar with her book and approach. I'd say that one distinction is that Dyadic Developmental Psychotherapy focuses on helping parents understand what is driving or causing the behavior, the development of sensitive and responsive parenting, the concordant intersubjective experience (shared emotion, shared attention, and share intention), insightfulness, state of mind with respect to attachment, and committment while Forbes and Post's approach does not do so...or at least is more more focused on behaviors and symptoms than DDP and is not really grounded in attachment theory. I do appreciate that their book (written with Bryan Post), is not a severely coercive approach focusing only on compliance. I much prefer and strongly recommend to the parents I work with: Nurturing Attachments by Kim Golding, 2008, Jessica Kingsley Publishers. I have all the parents I work with read this as it is a terrific book that is grounded in attachment theory. It is written for parents. It clearly explains various attachment styles, what it is that may be behind various behaviors, how to help children in a sensitive and responsive manner, addressed parents own "buttons," and is gentle and well grounded in accepted theory. I also strongly recommend: Parent Manual by Association for the Treatment and Training in the Attachment of Children 2008, at www.attach. org Very practical and helpful for parents. I am very glad that you have been able to help your child and that you found this article helpful. That is quite encouraging.
Thank you for enlightening me by providing various methods of therapy. I am from Nepal. I am involving in trauma and psychosocial counseling and had some lessons on art therapy. The articles as well as the suggestion various professionals gave will definitely help me in my counselling.
I am sorry that by mistake I did not tick the notify me followup comment box. I would like to have one
Dear Chetana, I'm glad you found the article helpful. If you want more details, you may want to pick up a copy of the book I edited: Creating Capacity for Attachment, edited by Arthur Becker-Weidman & Deborah Shell, 2005/2008. This text is as close as you can get to a manual for Dyadic Developmental Psychotherapy, which is the evidence-based and effective treatment on which the parenting approach described in the article is grounded in. regards Art
attachment is a weird thing,don't you think? i say this because although there is enough reason and logic for a child to be attached to its parents, sometimes as kids or even adults, we find ourselves being attached to a particular person for no apparent reason whatsoever... you may not know why, but you feel like you are being pulled toward that person, maybe its their aura or their good nature, but you don't quite know why you are so pulled towards them...
Hmm...interesting to know that seemingly simple things have so much depth and detail to them... I for one didn't think there are different patters to attachment ...
Dear Germie, The research literature describes several patterns of attachment: Secure Two Anxious patterns: Avoidant or Dismissing Ambivalent or Preoccupied Disorganized Cannot Classify regards
Joshua, Attraction and Attachment are related and overlapping terms. The Attachment system is a biologically based system that evolved to ensure the survival of the human infant. It is primarily a proximity seeking system. When the child experiences some threat, the child seeks proximity to some preferred caregiver. Attractions are different and can have many bases.
Funny how it always seems to come back to what we experinced as children. I guess that this is how we learn what is right and what is wrong and also becomes the model for how we think that relationships need to be. So parents if reading something like this does not open your eyes then there is nothing that will. Remember that everything that you say and do is held onto by your children and the mistakes that you make are probably the ones that they are going to be destined to make in the future. That should encourage all of us to be better role models for them.
Wow. first time I realized the consequences of every interaction a child has in childhood. So much we dont understand about other people and ourselves as adults. Especially when things fall into a pattern in relationships
Thanks for this helpful information. I'm looking for "measurable treatment goals" for my Utilization Review paperwork. Can you suggest any resources? Thank you. Peter
Great article Lisa! I practice Emotionally Focused Therapy with couples and do just this work, help couples re-connect and form a secure attachment with one another. I tell clients often "Many of us have no reason to know what a good adult love relationship looks like." Asking people to take these risks and try relating in a different manner feels so scary in the room, but the risk is worth the gain. What I love about the work I do is hearing couples say to each other at the end of therapy "She loves me. I know that now, I feel that now all the time." What a wonderful thing to feel, say, believe, and hear!