What
is Attachment Disorder?
Attachment is defined as the affectional tie
between two people. It begins with the bond between the infant and mother.
This bond becomes internally representative of how the child will form
relationships with the world. Bowlby stated “the initial relationship between
self and others serves as blueprints for all future relationships.” (Bowlby,
1975)
Attachment Disorder is defined as the condition in which
individuals have difficulty forming lasting relationships. They often show
nearly a complete lack of ability to be genuinely affectionate with others.
They typically fail to develop a conscience and do not learn to trust. They do
not allow people to be in control of them due to this trust issue. This damage
is done by being abused or physically or emotionally separated from one primary
caregiver during the first 3 years of life. “If a child is not attached–does
not form a loving bond with the mother–he does not develop an attachment to the
rest of mankind. The unattached child literally does not have a stake in
humanity” (Magid & McKelvey 1988). They do not think and feel like a normal
person. “At the core of the unattached is a deep-seated rage, far beyond normal
anger. This rage is suppressed in their psyche. Now we all have some degree of
rage, but the rage of psychopaths is that born of unfulfilled needs as infants.
Incomprehensible pain is forever locked in their souls, because of the
abandonment they felt as infants.” (Magid & McKelvey 1988) “There is an
inability to love or feel guilty. There is no conscience. Their inability to
enter into any relationship makes treatment or even education impossible.”
(Bowlby 1955). Some infamous people with Attachment Disorder that did not get
help in time: Saddam Hussein, Edgar Allen Poe, Jeffrey Dahmer, and Ted
Bundy. One famous person with Attachment Disorder who did get help in time (in
1887!) and became one of the greatest humanitarians the US has ever produced is
Helen Keller.
Attachment
Disorder Symptoms
Superficially
engaging & charming
Lack
of eye contact on parents’ terms
Indiscriminately
affectionate with strangers
Not
affectionate on parents’ terms (not ‘cuddly’)
Destructive
to self, others and material things (‘accident prone’)
Cruelty
to animals
Lying
about the obvious (‘crazy’ lying)
Stealing
No
impulse controls (frequently acts hyperactive)
Learning
Lags
Lack
of cause-and-effect thinking
Lack
of conscience
Abnormal
eating patterns
Poor
peer relationships
Preoccupation
with fire
Preoccupation
with blood & gore
Persistent
nonsense questions & chatter
Inappropriately
demanding & clingy
Abnormal
speech patterns
Triangulation
of adults
False
allegations of abuse
Presumptive
entitlement issues
Parents
appear hostile and angry
Causes
Any of the following conditions occurring to a child during
the first 36 months of life puts them at risk:
Unwanted
pregnancy
Pre-birth
exposure to trauma, drugs or alcohol
Abuse
(physical, emotional, sexual)
Neglect
(not answering the baby’s cries for help)
Separation
from primary caregiver (i.e. illness or death of mother, or severe illness or
hospitalization of the baby, or adoption)
On-going
pain such as colic, hernia or many ear infections
Changing
day cares or using providers who don’t do bonding
Moms
with chronic depression
Several
moves or placements (foster care, failed adoptions)
Caring for baby
on a timed schedule or other self-centered parenting
Helpful Resources
Books
Adopting the Hurt Child: Hope for Families With
Special-Needs Kids : A Guide for Parents and Professionals – by Gregory C. Keck & Regina M.
Kupecky
Building the Bonds of Attachment: Awakening Love in Deeply
Troubled Children – by
Daniel A. Hughes
99 Ways To Drive Your Child Sane – by Brita St. Clair
The Primal Wound: Understanding the Adopted Child – by Nancy Verrier
So You Want to Be a Prince? – by Deborah Hage, MSW
So You Want to Be a Princess? – by Deborah Hage, MSW
Therapeutic Parenting It’s a Matter of Attitude! – by Deborah Hage, MSW
Understanding and Treating the Severely Disturbed Child – by Foster W. Cline
When Love Is Not Enough: A Guide to Parenting Children
with RAD – by Nancy L.
Thomas
Websites
www.thelittleprince.org
Case
Management to the Rescue~Deborah Hage
For most
agencies the central duties for the case manager assigned to the family are
somewhat mechanical. The primary goal of case management with a child and
family affected by attachment disorders, mood disorders, thought disorders and
oppositional defiant disorder is more extensive. The very specific goal is to provide those services that will enable
the family to remain a unit. Determining what those elements are and
helping the family obtain them is critical.
Since it
is the parents who are living with the child and the parents who are the
experts on the child, they are the final
determiners of what services are needed. The parents decide if therapy is
effective. The parents help write the IEP so it is useful to them. The parents
decide if medications are effective or not. The parents are pivotal members of
the team and final arbiters of what is and what is not helpful to them in
parenting the child in their care. The task of the case manager is to create a
"circle of support" (Nancy Thomas coined the phrase) for the parents.
This circle of support includes the respite providers, schools, therapist and
psychiatrist.
When
asked, the case manager can provide crucial support and information when the
family must deal with others who work with the child. When not asked, it is
often because the family believes (often correctly) that the case manager does
not have the skills to help appropriately, does not have an understanding of
the special needs which the child presents and thus interferes with, rather
than contributes to, the provision of services.
In order
for the team model to work the parents must have every opportunity for training
in ways to gain control of the family environment and effectively discipline
(train) child in the reciprocal tasks necessary for a healthy life. They must
learn to do this while taking good care of themselves. The child must be able
to come when called, stay where he/she is put, do what is expected, follow
rules and regulations and go where he is told in order to be able to live
independently as an adult. (That is, go to school, maintain a job, drive a car
and stay out of jail.) Parent training must consist of appropriate and
effective, yet nurturing, interventions, to teach parents how to have backbones
of steel and marshmallow hearts. Training in Proactive, Reactive and Intrusive
techniques; getting a child to cooperate in chores and engage in reciprocal
activities; and when to engage in control battles and when and how to disengage
are all essential.
In order
to be able to offer appropriate support and advice, the case manager must know
as much as the parents about parenting interventions effective with severely
behaviorally disturbed children. Attending trainings with the parents, reading,
listening to audiocassettes, and being willing to be trained by the parents who,
as front line providers, often have more expertise than the worker, are all
important.
As
members of the circle of support the respite providers' goal is to support
parents by giving them a break while enforcing their discipline. They must
provide a safe, yet emotionally distant, environment. The goal is not to
compete with the child for the parent's affection. The case manager's task is
to identify people to provide respite, train them, help them identify and avoid
efforts of the child to triangulate and manipulate the adults against each
other and to listen to and address the parent's concerns regarding respite.
(See Respite Training outline.) The case manager must make sure there is appropriate
respite available for the parents as any time the child is in control of the
home he will not get well. When the child takes control then the child needs to
go to respite until he demonstrates he is willing to allow parents to give him
appropriate directives.
The
school staff enter the circle of support by teaching the child life skills
while not imposing that task on parents already overwhelmed with living with
and managing a child whose behavior is extremely challenging. The IEP must be
written in such a way that homework is assigned to the child with no
expectation of parental involvement. The child's behaviors must be dealt with
effectively at school with parental support and advice, but without expecting
parents to consequence for behaviors that occur at school. The case manager
provides critical support to the parents at staff meetings to ensure the staff
understands the pressures which the parents are facing at home and by not
allowing the school to assign them unrealistic and inappropriate education
related tasks.
The
therapist becomes part of the circle of support by providing appropriate and
effective therapy that is supportive of primary therapists - the parents. The
goal is not to have the child bond with the therapist and thus compete with the
parental bond. In order to avoid the child's attempts at triangulation and
manipulation it is imperative the
parents are present in the room at all therapy sessions. They must be
physically present in order to call the child on all lies and misrepresentations
of their behavior. Sessions are most useful to the parents when they begin by
asking the parents what positive and negative behaviors the child has been
exhibiting during the week. Another critical element of the session is
brainstorming parenting interventions that address a specific behavior and have
the potential to be more effective than what the parents are doing. The
paradoxical techniques, that is, telling the child to do what the child is
already doing, have great potential to be effective. After spending time with
the parents becoming familiar with the current situation, the therapist brings
the child in, praises the positive and confronts the negative. While useful, it
is not essential that the therapist be trained in holding techniques. Appropriate
interventions are experiential, rather than insight or talk based, such as
Theraplay, EMDR, Art therapy, Psychodrama, Brain gym, Sensory Integration and
other techniques where the therapist is in control. It is often helpful to have
the child redo the behaviors exhibited at home. For example, if the child is
calling the mom names, then the child comes to therapy and must say the same
thing in the same tone of voice at the same volume to the therapist that he/she
said to the mom at home. If the child had a tantrum at home then he/she must
re-create the tantrum in the therapist's office on the therapist's terms. The
point is that often the first step in stopping a behavior is to take control of
it away from the child. If the child refuses to cooperate in therapy then the
respite provider must step in and keep the child until the child is ready to do
what is required for the therapist.
Many of
the behaviors and emotions associated with attachment disorder are not
alleviated by medication. However, mood, thought, and oppositional defiant
disorders have a huge potential to be minimized by the appropriate use of
medication. Finding a knowledgeable psychiatrist with experience in the above
diagnoses is an important part of the case manager's job in creating a circle
of support. The psychiatrist must not be discounting of the parent's
experiences with the child's behavior and be able to ask probing questions
regarding the child's behavior while listening carefully to the parent's
responses. The goal is accurate diagnosis and provision of appropriate
medication in effective doses. (Generally, Ritalin is not only ineffective but
has the side effect of heightened physical outbursts! Stimulants in children
with ODD, RAD and Bipolar is generally counterproductive)
The case
manager is crucial in providing the circle of support the parents’ need in
order to be successful in maintaining the child's placement in the home. How
the case manager develops personal expertise and puts together and trains the
treatment team to be supportive of the parents and effective in dealing with
the child is key to the child's success and maintenance in the family.
From
those who are already entrenched in the RADical World
I asked my
fellow Trauma Mama’s what they wish that the people who work with their
families knew, here are their responses:
*When you have a
child with RAD and someone hands you a sticker chart, it makes you want to
shoot yourself in the face. A child who is unconcerned about anyone or anything
does not care about your chart. My child would do one of two things, earn all
the stickers, get the prize and break it immediately and go right back to the
behavior, or pee on the chart, yes I said pee. Secondly, it makes me absolutely
furious when a professional shows up to my home and has no idea who my child is
or what we are dealing with and pretends. If you don't know, ask, don't act
like you know.
*What I have
loved most is working with people who understand the chaos that comes with
parenting a child like mine and who adjust accordingly, who I can text late or
early and they will get to me when they can, who will say, "wow, I don't
know, let me work on it" The best professionals are not the ones who know
everything, but the ones who know to ask when they don't.
* I have also
loved working with people who listened empathetically, asked what she could do
to help, and even took all the kids back and sent me out for coffee on a couple
of occasions when she saw how tired I was. She didn't treat me or my children
like a case number, she treated us like humans and I love her for it.
* Don't be
judgmental upon arrival. Assess the situation with an open mind (especially if
they read a chart stating the child's special needs). Be aware that not all
children are truthful. Notice to new or newer therapist: when a parent is
disclosing child's history, please be aware they are sharing this for HELP. I
had a therapist come in and started working with our family a couple years ago.
She had never met our children. I gave her a history on J and she seemed very
eager to help. Next thing I know I received a call from CPS over an event that
happened while they were still in DCS custody. Needless to say that has made
our family very skeptical of any new therapist coming in now. Another thought,
don't be sympathetic all the time to my child all the time. She thrives on that
attention and causes her to regress. For instance if we go to the park and Ms J
didn't get to go for cussing our entire family out, don't show her you are
sympathetic and acting as if their was a better consequence. Be supportive of
the parent at all times and never show the child you disagree with parent. If
you do disagree with parent in something they have did take it up with them
personally in a confidential setting not in front of child.
* I hate it when
a professional tries to "put themselves in our situation" or acts as
if something they have gone through is similar. I'm sorry unless you have
experienced a child IN YOUR HOME with this condition at this severity, I don't
need your stories because our family needs HELP.
* Honestly, I've
become so jaded that I automatically assume that they won't understand or be
educated or be helpful. I just assume that there will be no help. I assume that
they are people who mean well, but are incapable of helping. I'm not sure if
that helps you at all, but that is where I am. People don't understand the
stress, the pain, the frustration, and the damage being done.
* I have been
fortunate in this area. When Tori was in kindergarten I had a brand new (her
first case) TSS. I trained her on RAD with Nancy T. stuff. I was thankful that
she was willing to learn and not set in her ways. I have tried to get
professionals who understand the diagnosis. It goes much easier when they do.
When sticker charts have been suggested to me, I usually say "They are
ineffective with RAD kids, but go ahead and try if you want." Some have
taken my advice, and some have learned through experience. A few weeks ago, my daughter's new behavioral
specialist gave her a journal. I just smiled, knowing that she would use it for
anything but journaling. She did. Lesson learned for the BSC. Most of the
professional wrap around support people have loved working with us. Our home is
clean enough to be healthy, not infected with fleas and lice , and they are not
afraid to sit down or take me up on an offered drink. They notice that I have
parenting skills and am doing the right things. They appreciate that they do
not have to spend time trying to teach me basic parenting skills. Most of what
they try doesn't work any better than what I am already doing. What I love
about them working with Tori is that I get a break when they are with her.
Hubby and I often have a lunch date when Tori's TSS takes her to the library
for a few hours. It is like a mini respite for me, and Tori gets another adult
reinforcing what Mom and Dad are doing at home.
* Education of
law enforcement for when they need to be called out. Do NOT separate parent
& child. Do NOT assume the child is being abused. Do NOT tell the parent
they need to spank (discipline) the child more. Assume the child COULD be
playing the victim role VERY well if the parent TELLS you they are RAD and
tries to explain the problem. If a child is hiding with a knife in hand when
the police arrive, don't assume that knife wasn't a threat. Don't come down on
the parent for calling 911. These things only empower a RAD child. Our RAD
therapist told us we had no choice but to put our child in a home because of
the inadequacy of our emergency services (including the mental health in our
area).
*I must say I'm
I'm agreement with the sticker charts because with mine it just doesn't matter
how many charts or rewards...I also agree with the pitiful act when all they
really need is to be held accountable for the hell they've been subjecting
everyone around them to....I think journals are pointless as you have to want
to make them worthwhile.....writing down coping skills to use next time....yea
never happens....I am not sure how to make things work more effectively, but I
wish we could figure something out. The things that don't work time and time
again are just frustrating.
*NEVER say
things like, "That's typical teenage boy behavior," or "my
niece/ child/ neighbor's second cousin did that once" - you have NO IDEA
of the difference in intensity and frequency unless you've lived it. Please
don't assume that just because you've worked with my child for 50 minutes that
you "get it," especially if I'm saying you aren't seeing something -
my child can honeymoon for 6 weeks or more, and one would LITERALLY rather die
than let anyone see her issues. Believe me, support me and validate me. Do NOT
refuse to read the documents and questions the parent provides because you want
to "form your own opinions and develop a relationship" with my child
- my child has RAD - and I have learned a LOT about my child's needs that needs
to be respected so we're not wasting time - especially attempting to develop a
relationship with MY child - that's MY job. Just because my child is your
client, please respect that I have to take care of my WHOLE family, including
myself - that doesn't make me a bad parent to this ONE child. Here's some more
things I wish I knew - http://marythemom-mayhem.blogspot.com/2009/07/things-i-wish-i-knew-when-adopting.html
Feel free to
contact me anytime, if I don’t know, I will help find it.
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