There are several
different sub-types of Reactive Attachment Disorders. The ambivalent
sub-type can be described as an "in-your-face" child. This
is the child who is angry, oppositional, and who can be violent. The
anxious sub-type is clingy, anxious, shows separation anxieties, among
other symptoms. The avoidant sub-type is often overlooked. This child
is very compliant, agreeable, and superficially engaging. This child
often has a lack of depth to his emotions and functions as an "as-if"
child; meaning that he tries to do and say what you want, but is not
genuine, authentic, or real in emotional engagement. Finally, there
is the disorganized subtype, this child often presents with bizarre
symptoms.
The words 'attachment'
and 'bonding' are now used interchangeably. Children with Reactive
Attachment Disorder exhibit many of the following symptoms:
IN INFANTS:
Weak Crying
Response.
Rage.
Constant Whining.
Sensitivity to Touch/Cuddling.
Poor Sucking Response.
Poor Eye Contact.
No Reciprocal Smile Response.
Indifference to Others.
IN CHILDREN:
Lack of Conscience
Development.
Superficially Charming.
Lack of Eye Contact (except when lying).
Inability to give and Receive Affection.
Extreme Control Issues.
Destructive to Self, Others, Animals and Property.
No Impulse Control.
Unusual Eating Patterns (hoarding, gorging, or refusal to eat).
Unsuccessful Peer Relationships.
Incessant Chatter in Order to Control.
Very Demanding.
Unusual speech patterns, mumbling, robotic speech, talking very
softly except when raging.
Associated
Features
Learning Delays
and Disorders.
Depressed I.Q. scores.
Differential
Diagnosis:
Some disorders have similar symptoms. The clinician, therefore, in
his diagnostic attempt, has to differentiate against the following
disorders which need to be ruled out to establish a precise diagnosis.
ADD.
Anti-Social
Personality Disorder.
Conduct Disorder.
Oppositional Defiant
Disorder.
Fetal
Alcohol Syndrome.
Developmental Disorder of Receptive Language.
Socio-Emotional Problems.
Mental Retardation.
Schizophrenia.
Rett's syndrome.
Cause:
From conception
through approximately the third year of life the child needs to bond
in order to develop physical, psychological and emotional health.
This early attachment is the foundation for the child's ability to
feel empathy, compassion, trust and love.
Children with
attachment issues and those with Reactive Attachment Disorder have
experienced a break in this bonding cycle. This break can be the result
of:
Genetic Predisposition.
Maternal Ambivalence Toward the Pregnancy.
Traumatic Prenatal Experience.
In-Utero Exposure to Alcohol and/or Drugs.
Birth Trauma.
Neglect.
Abuse.
Abandonment.
Separation from Birth Parents.
Inconsistent or Inadequate Day Care.
Divorce.
Multiple Moves and/or Placements.
Institutionalization (e.g. children adopted from orphanages).
Undiagnosed or Untreated painful illness (e.g. untreated ear infections).
Medical Conditions which Prohibit Adequate Touch (e.g. child who
is in an incubator or body cast).
Treatment:
Traditional 'talk' or 'play'
therapies do not work with these children because such therapies depend
upon the child's ability to develop a trusting relationship with the
therapist. Children with Reactive Attachment Disorder are unable to
form any genuine relationships.
Therefore parenting
must be very structured and very nurturing. Natural consequences,
not lectures work best. If the child does not want to eat and you've
put a meal in front of them which they will not eat, If the child
complains and begins to ruin the mealtime, remove them from the table.
The key is to not let such a child make everyone feel like she does.
Such children are very good at externalizing their feelings and getting
everyone else to feel as miserable as the child does.
Counseling
and Psychotherapy [ See
Therapy Section ]:
Many therapeutic
methods are employed: re-parenting, role-playing, therapist-supervised
parent holdings, modeling of behaviors, behavioral shaping, cognitive
restructuring, Gestalt Therapy, family therapy and general psychotherapy.
Effective therapy
requires a team approach which must always include the child's parents.
