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.
