Attachment issues in children are a result of infant and early childhood challenges in bonding between the child and their caregiver. Recent studies show that a child being exposed to trauma, neglect and abuse before the age of 5 disrupt the ability to create healthy attachments in the relationships of their family of origin and subsequent relationships later in life. The emotional and behavioral issues, in large part, root in the child’s lack of a sense of safety and stability because of the abuse and trauma they experienced at a young age. As a result of this lack of trust, there are emotional and behavioral outcomes that can hopefully be healed through treatment and a foster or adoptive family.
In a healthy family dynamic, the first years of a child’s life are spent bonding, connecting and attaching to their mother or caregiver. The mother may rock, sing or talk to the infant, use big smiles and other exaggerated facial expressions engaging in something called “attunement”. Attunement refers to the sharing of these interactions that occur between the child and mother and the child feels special. It is the sense of feeling one with someone else. There is skin to skin contact, eye contact, imitation of expressions and tracing the mother’s face with their hands and fingers. Much of this bonding takes place during breast or bottle feeding. Psalm 22:9 shares the security and sense of safety and trust developed during those moments. It reads, “Yet You are He who pulled me out of the womb; You made me trust when on my mother’s breasts.” The brain is being stimulated during these special moments and the child is learning all about intimacy, joy and even when corrected the child still feels special and safe. It is during this time the child begins to integrate the “good” and “bad” parts of themselves and develops a sense of self. This includes learning empathy, controlling behaviors and emotions and understanding the difference between right and wrong. In other words, morality.
Roots of Attachment Issues in Children
What happens when a mother is incapable of instilling safety, security and a sense of specialness to her child when she is depressed or struggling with addiction or illness? Attachment issues may be caused early on in a child’s life when they cry and no one responds with nurturing comfort and are not acknowledged, only ignored with no touch or eye contact. Perhaps their needs are not met in the lack of changing a diaper for an extended period of time. Also, when a child is hungry and left with the discomfort of an empty belly can impact a child’s ability to feel stable. These are all issues of neglect, but abuse can also be another cause of attachment issues.
An inability to have healthy attachments results is a lifetime of challenges and a number of empty relationships for that child as they navigate life through adulthood. This is particularly difficult if the child is removed from their abusive or neglectful parent and placed in foster care. The instability a child experiences in foster care may only further instill these behaviors and skills of manipulation and lying are honed in order to survive what they perceive as an unsafe situation. For a child with attachment issues it does not matter how safe and cared for they may be in their new home they react and behave out of the lack of trust that became the fabric of who they are today.
Reactive Attachment Disorder
Attachment issues in children is a broad term for behavioral and emotional challenges a child may experience due to trauma, neglect and abuse in their early years. Under the umbrella of attachment issues is Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED). The symptoms of attachment issues can be recognized as early as 1 year old.
Reactive Attachment Disorder symptoms can be recognized and diagnosed as early as 9 months old.
- They display an indifference to comfort and do not seek to be comforted when distressed or hurt or scared.
- They tend to show flat facial and emotional expressions.
- The child may have symptoms of colic and other eating challenges including not gaining age appropriate weight.
- The child with reactive attachment disorder may show a lack of interest in playing or interacting with others, withdrawn and lack of engagement socially.
- As the child gets older, they may be diagnosed with other disorders such as
- AttentionDeficit Hyperactivity Disorder (ADHD) or Post Traumatic Stress Disorder (PTSD) due to the trauma they endured with their family of origin. Oppositional Defiance Disorder (ODD) may be diagnosed as well as a variety of phobias that can develop or other psychiatric and personality disorders may develop too.
It is important that the child does not present with any criteria for the autism spectrum between 9 months and 5 years old in or to receive a proper Reactive Attachment Disorder diagnosis.
Disinhibited Social Engagement Disorder
The second attachment issue that may develop in a child who has experienced abuse, trauma or neglect is DSED. The child who experiences Disinhibited Social Engagement Disorder experiences:
- no fear of strangers and can overshare or be overly physically familiar with a new acquaintance.
- They are not shy nor is there hesitation in meeting people for the first time.
- They do not seek a parent or caregiver’s permission to approach a stranger.
- They have no inhibition leaving a safe place with a stranger not knowing about
- the safety of the next place.
- This disorder can present in children who have been institutionalized due to abandonment, death of their parents or foster care. Many times, they are shuffled from foster home to foster home with no hope of being adopted and this may exacerbate the existing disorder.
- Determining Attachment Issues
- The severity of a child’s attachment issue varies. Some may experience neglect, abuse and trauma but may not be diagnosed with Reactive Attachment Disorder or Disinhibited Social Engagement Disorder. An article written by Daniel Hughes called “Adopting Children with Attachment Problems” (Vol. LXXVIII, #5 • September/October) describes the questions he asks in order to determine a diagnosis or to answer how severe the attachment problem is:
• How severe, chronic, and pervasive were the child’s experiences of neglect and abuse?
- How many caregivers did the child have? (Disrupted relationships with foster parents are each likely to be experienced as rejection and abandonment. With each subsequent disruption, a child’s readiness to form an attachment with the next caregiver is likely to be less.)
- Were there any positive, continuing relationships during the first two years of the child’s life?
- Has the child begun to show any significant improvements in his current family foster home?
- Is there any selectivity in the child’s attachments?
- Has the child ever shown grief over loss?
- Does the child accept help and comforting?
- Can the child enjoy, without disrupting them, close and playful interactions that
- are similar to the attunement interactions mothers have with their infants?
- Does the child ever directly show shame over his behaviors?
- Does the child ever show sadness over the consequences of his behaviors, rather
- than being enraged over their perceived unfairness?
- Can the child experience and give expression to sadness and to fears?
- Traits of Unresolved Attachment Issues in Adults
- A child who may have experienced the abuse, trauma and neglect that results in an attachment disorder and was not given an opportunity to process and heal may grow up into an adult who experiences insecure attachments. We see traits of these issues in about 45% of adults but go largely unrecognized. Perhaps they are blown off as flaky, insecure or jealous. Our attachment style learned as a child becomes the blueprint for relationships in life.
Attachment issues in adults usually fall into two categories. The avoidant or dismissive adult learned that their needs are not important and were largely dismissed. They do not express these needs and feel resentment towards those who do as if it is a weakness. They maintain distrust in their relationships and even feel as though they are superior to the person in the relationship with them as a means to maintain control.
We also see attachment issues present in adults as anxious or ambivalent. This adult will feel as though they give their all but are not fully appreciated. They can come across needy yet turn their affections on and off or hot to cold easily. They also experience distrust in their relationships obsessing and analyzing conversations and behaviors. They experience extreme emotions like jealousy and are sensitive to any kind of rejection or perceived rejection.
A secure baby will grow into a secure adult with the ability to give and receive care. An avoidant baby becomes a dismissive adult lacking attunement and preferring to be alone with material things rather than relationships. An ambivalent baby becomes an entangled adult and exhibits push-pull in relationships because they fear being too close or not close enough. A disorganized baby becomes an unresolved adult who have chaotic relationships are at risk for dissociative or emotional disorders.
When attachment issues are not resolved and healed as children, we see statistics such as:
- High divorce rates
- Alcohol and drug abuse or addiction
- Controlling relationships
- Repeating the cycle and abusing their own children
- Lacking respect for authority or rules
- Does not feel empathy
- Cannot process positive emotions or affection from othersParental Guiding and Skills
- While attachment issues in children cause a child’s brain to be hardwired due to experiencing deep trauma at such an early age it is possible to come along side these children with therapies to help reduce the damage these issues can cause into adulthood. In the home, however, parents can model and help reshape some of the child’s tendency to live and react out of fear.
- In the home it is important the parent or caregiver is aware that defiance and manipulation can be addressed for the betterment of the child’s mental health. Even at a much older age parents can place limits when their child with attachment issues does something that is inappropriate or wrong. This gives the child a moment of feeling shame and this becomes a positive teaching moment when handled by a parent who can regulate their own emotions if the child bursts into anger and resist resentment towards the child. The parent should not take it personal when a child rejects them. First, the parent must be able to express their own anger and disappointment dealing with the unacceptable behavior but then quickly bring comfort and reassure the child they are not rejected. Immediately reconnecting after conflict goes a long way in helping to rewire the child’s brain to a place of safety.
- It is also important that parents have realistic expectations in helping their child. Success is measured in small victories and this is a marathon not something that can be healed in a matter of weeks or months.
Finding joy and maintaining humor during these years helps to lift the burden for both the parent and the child. Keeping in perspective it is a safe place to make mistakes and fall down. Everything is a learning moment for the whole family. The child’s perspective can bring laughter and a freshness to an otherwise difficult circumstance.
Keeping routine and predictability can help parents of a child with attachment issues feel secure. The predictability helps to free up their mind to think on tasks at hand, even be creative and dream, rather than anticipate what will happen next and “how do I stay safe”.
Parents should stay aware in difficult interactions with their child of their actual emotional age. Much of their emotional growth has been stunted by the constant trauma, abuse or neglect. It was also probably not modeled or encouraged by the adults in their life and therefore they are not even aware of the ability or need to grow. Helping them identity their needs and teaching them how to express those needs is a skill they’ll use for a lifetime and in all relationships.
When a child’s attachment issues run deep many parents, foster parents, adoptive parents or other caregivers are not equipped to coach a child through prolonged destructive behavioral and emotional patterns and do well to partner with those in the community who can work with the child and assist the family during these years.
Since children with the inability to bond or attach cannot readily do so with parents it cannot be expected in a conventional counseling setting either. It may be necessary for the parents or caregivers of a child with attachment issues to engage with their therapeutic community in order to see healing for their child.
Attachment therapy is known to be controversial because of their unusual techniques. Many times, a child cannot maintain in a home and will be immersed into the Evergreen Model as a means to heal the inability to bond at a residential care facility.
This therapy engages in a technique called “rebirthing”. A child is wrapped tightly, like swaddling, and is then covered in blankets. The “practice parent” then holds the child down or leans on them. The child struggles to emerge as if being rebirthed giving them the opportunity to bond in ways they missed out on as infants. (This has been outlawed in Colorado known as Candice’s Law.) This technique may be followed by “infant care”. At this stage the parent rocks the child like an infant and bottle feeds them for about an hour every day. The child may be as old as 10 or 11. Holding is also a technique in which the child is provoked to anger then held and forced to maintain eye contact. The Evergreen Model works with primary emotions like anxiety that bring on a secondary emotion like anger. The child eventually breaks into sobbing and the parent comforts the child. Attachment therapy describes their work with a child similar to breaking a horse.
With a nurturing team there is hope for a child with attachment issues to bond. It is a long process, taking years, but a child may eventually learn to make eye contact, express needs and emotions, hug and reciprocate warmth. Even though the child was broken through relationship they can be healed through nurturing relationships.
Allen, B., Timmer, S. G., & Urquiza, A. J. (2014). Parent-Child Interaction Therapy as an attachment-based intervention: Theoretical rationale and pilot data with adopted children. Children and Youth Services Review.
Using attachment-based interventions with children in foster care or in adoptive homes who experience attachment issues shows promising results beyond infancy or preschool age. Research shows that employing Parent-Child Interaction Therapy (PCIT) is effective when used with treatment directives. It teaches giving positive when the child displays appropriate behavior and non-violent consequences.
Orlans, M., & Levy, T. (2006). Healing parents: Helping wounded children to trust and love. Washington, DC: Child Welfare League of America.
If the parent or caregiver has experienced healing, then helping to child heal and grow through their attachment issues is possible. To focus on the whole family and their community is a core philosophy expressed in this book. The parent becoming self-aware gives them the opportunity to respond rather than react to their child’s behavior who have attachment issues.
Purvis, K. B., Cross, D. R., Dansereau, D. F., & Parris, S. R. (2013). Trust-Based Relational Intervention (TBRI): A Systemic Approach to Complex Developmental Trauma. Child & youth services.
Attachment Issues in Children 12
Adopted children who have experienced trauma, neglect and abuse can have long reaching issues as adults. The Trust Based Relational Intervention focuses on the attachment system as a development system thereby alleviating the cost to society later if untreated. Using the model of empowerment, connection and correction addresses the needs of the child. Attachment is the core of everything: beliefs, behaviors, relationships and more.
R. Millward, E. Kennedy, K. Towlson & H. Minnis (2006) Reactive attachment disorder in looked‐after children, Emotional and Behavioural Difficulties.
53% of children in foster homes or residential care experience mental health difficulties. Hyperactivity, depression, anxiety and reactive attachment disorder are among the issues rooted in children who have suffered abuse or neglect in their birth homes.
Stryker, R. (2010). The Road to Evergreen. Ithaca, NY: Cornell University Press.
Evergreen is a controversial attachment therapy model to including holding, bottle feeding and rocking as a method. It is described as “reparenting”. This therapy style also includes “rebirthing” which is a breathwork to help release emotions.
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