The Institute for Attachment and Child Development

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The Institute for Attachment and Child
Development
Achieving Permanency For Children Diagnosed With
Reactive Attachment Disorder

• Presented by
• Forrest R. Lien, LCSW-Director
• Email forrest_at_instituteforattachment.org

P.O. Box 730 Kittredge, CO 80457 (303)
674-1910-phone [phone]-Fax www.InstituteF
orAttachment.org
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Attachment Cycles1st Year

• Necessary ingredients of development of basic
  trust and attachment
• Eye Contact
• Food
• Motion
• Touch
• Verbal Contact
• Emotional Contact
• Smiles

Need
Trust Of Caretaking
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Attachment Cycles 2nd Year

• Necessary ingredients of development of
  autonomy, good character foundation and
  conscience.
• Maintain parental control while allowing
  child to explore and begin to make good choices
  for themselves.

Wants
Trust Of Control
TRUST ATTACHMENT
AUTONOMY
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Sub-Types of Attachment Disorder

• AVOIDANT-isolation, avoid closeness, seldom seek
  comfort, avoid relationships, passive-aggressive,
  avoid feelings, intense sadness and loneliness,
  believe their rejection by birth mom was
  justified
• 2. ANXIOUS-crazy liars, fake emotions,
  emotionally empty, good actors, chameleons,
  often fool therapists that theyre normal and
  parents arent
• 3. DISORGANIZED-disorganized, odd, and bizarre
  behaviors. Other psychiatric disorders,
  unpredictable moods, excessively excitable,
  frequent sensory or neurological problems,
  difficult to manage
• 4. AMBIVALENT-openly angry, defiant, destructive,
  dangerous, superficially charming, lack of
  empathy, delinquent acts, most prevalent subtype
  in mental health systems

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Brain Organization/Developmentsimple to complex

• Brain is responsible for
• Survival/Biological responses, i.e.
• Heart rate
• Temperature
• Blood pressure
• Arousal states
• Limbic/Midbrain responsible for
• Emotion
• Attachment
• Affect regulation
• Cortex is responsible for
• Abstract reasoning
• Complex language

Brainstem (arrives hard-wired and on-line)
Limbic/Midbrain (carries blue-print only)
Cortex (arrives blue-print only)
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Abuse
Traumatic Event (Physical, Sexual abuse) Domestic
violence
Release of Stress-Based Hormones (catecholamine)
Normal stress Response is reversible
Two distinct neuronal response patterns adaptive
style
ALTERED BRAIN DEVELOPMENT
STATES BECOME TRAITS Sensitized to external cues
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Causes

• Any of the following conditions put a child at
  high risk of developing an attachment disorder.
  The critical period is from conception to about
  twenty-six months of age.
• Genetic predisposition
• Maternal ambivalence toward pregnancy
• Traumatic prenatal experience, in-utero exposure
  to alcohol/drugs
• Birth trauma
• Sudden separation from primary caretaker ( i.e.
  illness or death of mother or sudden illness or
  hospitalization of child.)
• Undiagnosed and/or painful illness, such as colic
  or ear infections
• Inconsistent or inadequate day care
• Unprepared mothers with poor parenting skills
• Abuse ( physical, emotional, sexual)
• Neglect
• Frequent moves and/or placements ( foster care,
  failed adoptions)

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ABUSIVE BIRTH PARENTS AND PSYCHIATRIC DIAGNOSIS

• ANTISOCIAL (SOCIOPATHIC) PERSONALITY DISORDER
• Many of the diagnostic characteristics of
  children with Reactive Attachment Disorder also
  fit adult characteristics of Antisocial
  Personality Disorder. These include substantial
  conduct disorders including cruelty to people or
  animals, lying, stealing, fire setting, failure
  to conform to social norms, irritability,
  aggressively and impulsivity. These people have
  little regard for the truth, and lack empathy and
  remorse. Many of these adults were themselves
  abused or neglected in early childhood.
• BORDERLINE PERSONALITY DISORDER The etiology of
  Borderline Personality Disorder is not well
  understood, but there is evidence of both genetic
  and psychological influences, to some degree
  attributable to poor parenting (neglect or
  over-protective) between birth and three years of
  age. Borderline Personality Disorder manifests as
  long-term patterns of unstable mood,
  interpersonal relationships and self image.
• 3. PARANOID SCHIZOPHRENIA is a complex disorder,
  usually strongly genetically influenced and is
  characterized by though disturbances such as
  delusions and hallucinations. In a delusional or
  hallucinatory state they are capable of abuse or
  neglect, though uncommonly.
• 4. ALCOHOL/SUBSTANCE ABUSE
• In my experience working with abused kids, this
  is the single most common characteristic of
  abusing parents,. However, in my experience, it
  is also most commonly a coexistent factor of
  abuse. In other words, while alcohol and
  substance abusing parents may abuse their
  children, it is usually of less severity and is
  usually not in an ongoing manner. Purely alcohol
  or substance abusing parents who over-indulge and
  neglect or abuse their children are ordinarily
  regretful and remorseful of their actions.
• 5. BIPOLAR DISORDER
• This is a common psychiatric mood disorder
  representing 2 to 3 percent of the general
  population. It is a genetic, inherited, familial
  disorder that ultimately results in biochemical
  imbalances within ones central nervous system.
  It manifests in manic (or hypomanic, a lesser
  form of manic) and/or depressive mood
  disturbances. In my professional experience, this
  is by far the disorder that has the greatest
  coincidence with abuse or neglect of children and
  as such is the genetic disorder that these
  children with coexistent Reactive Attachment
  Disorder also inherit. The degree of
  self-centeredness, irritability and intensity of
  rage reactions while in a manic state is
  frequently sufficient to create severe abusive
  conditions. Correspondingly, the degree of
  profound depression is likewise severe and
  prolonged enough to create long standing
  neglectful circumstances.

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Symptoms of Attachment Disorder

• Superficially engaging, charming (phoniness)
• Lack of eye contact
• Indiscriminately affectionate with strangers
• Lacking ability to give and receive affection
  (not cuddly on parents terms)
• Extreme control problems often manifest in
  covert or sneaky ways
• Destructive to self, others, things
• Cruelty to animals
• Chronic lying
• No impulse controls
• Learning lags and disorders
• Lacking cause and effect thinking
• Lack of conscience
• Abnormal eating patterns
• Poor peer relationship
• Preoccupied nonsense questions and incessant
  chatter
• Inappropriately demanding and clingy
• Abnormal speech patterns
• Parents appear unreasonably hostile and angry

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Characteristics of Attention Deficit Disorder,
Bipolar Disorder, and Reactive Attachment
DisorderJohn F. Alston, M.D., P.C.Website
www.johnalstonmd.com
Symptoms Attention Deficit Disorder Bipolar Disorder Reactive Attachment Disorder
Age of Onset Infancy to toddler, 6 years, 13 years 2 to 3 years, 6 years, 13 to 25 years Birth to 3 years
Family History ADHD, academic difficulties (based on task incompletion), alcohol and substance abuse Any mood disorder (depression or bipolar), academic difficulties (based on motivation problems or opposition or defiance), alcohol and substance abuse, adoption, ADHD Abuse and neglect, severe emotional and behavior disorders, alcohol, and substance abuse. Abuse neglect in parents own early life
Lifelong Prevalence 3 to 6 general population 3 to 5 of general population Uncommon to common
Etiology Genetic, Neurochemical, fetal development, brain traumas, nutritional deficiencies, exacerbated by stress Genetic, exacerbated by stress and hormones Psycho physiologic secondary to neglect, abuse, mistreatment, abandonment
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WORKING WITH PARENTS

• Assess the developmental level and needs of
  parents.
• Intact at-risk family child remains in abusive
  situation.
• High incidence of parents with poor attachment
  histories of their own.
• All of the qualities of unattached children still
  present in grown up form.
• Not available for education (cortex).
• Foster families.
• Assess availability for work of attachment.
• Impact of personal trauma history usually not
  explored.
• Adoptive families.
• Education re attachment and trauma
• Family of origin history will become important
  and needs to be explored over time.
• Respite !!!!

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Post Traumatic Stress in Parents
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TREATMENT FOSTER CAREDevelopmental Model

• .
• A) Creating a circle of security in a family
  setting
• -Line of site safety-developmental circle of
  security with environmental controls
• -Parents direct and redirect
• -Children learn life skills living in a family
  i.e. doing chores, learning respectful
  communication, cooperative play, build
  self-confidence
• -Learn to trust that adults will keep you
  safe-children give up control
• B) Skilled attachment therapist leads the
  team
• - Empathic confrontation therapist is
  coach/guide, providing balance of challenge and
  support
• C) Creating a circle of community support
• -school, police, caseworkers
• D) Psychiatric Care and Neurofeedback
• E) Working with Attachment Figure i.e.
  relative, adoptive parent, foster parent
• -creating safety with attachment figure by
  helping with emotional triggers, parent training,
  attachment therapy