Understanding Attachment and Reactive Attachment Disorder DAWN - - PDF document
10/15/17 Understanding Attachment and Reactive Attachment Disorder DAWN LIVORSI, DSW, LCSW Goals for today u Participants will gain awareness of the importance of attachment in child development. u Participants will be able to identify
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DAWN LIVORSI, DSW, LCSW
u Participants will gain awareness of the
u Participants will be able to identify various
u Participants will be able to recognize symptoms
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u Attachment is the enduring emotional bond to another
person.
u In the case of children, attachment typically refers to
their connection to primary caregiver(s).
u Evolutionary process u Children are born with an innate desire to connect to
a caregiver.
u Developing a relationship with a caregiver increases a
child’s chance of survival.
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u Child psychiatrist (1907-1990) u Believed that infants were born with a number of
behaviors to which their caregivers were “programmed” to respond.
u The more available and responsive the caregiver is, the
more securely attached the infant will feel.
u Attachment is more than feeding and basic care; it also
involves an emotional bonding component.
u An infant’s experience with attachment can have
implications throughout the lifespan.
u“…the infant and young child should
Bowlby, “Maternal Care and Mental Health” (1951)
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uBe consistent uBe dependable and predictable uBe attuned to the child’s needs uBe willing to reflect the child’s emotional
uBe engaged uBecome the “Secure base”
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u Psychologist u Conducted a groundbreaking study in the 1970’s with children ages
12 -18 months.
u Used her data from this study to categorize attachment into 3 major
patterns – a forth pattern was added later by Main & Soloman (1986).
u Believed that attachment patterns developed early in life persisted
into adulthood.
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u https://www.youtube.com/watch?v=QTsewNrHUHU&t=16s
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u Children who are securely attached to the caregiver feel distressed
when the caregiver leaves, happy when a caregiver returns, and are able to be comforted by the caregiver when scared or sad.
u In general, secure children trust that their needs will be met.
Accordingly, they feel capable of going into the world and exploring, knowing that their caregiver will be available to them if they need help.
u Securely attached children tend to mature into securely attached
adults who are able to maintain positive self esteem and healthy relationships with others.
u The ambivalently attached child is distressed when the caregiver
leaves but is unable to be comforted upon the caregivers’ return. The ambivalently attached child will continue to cry despite caregivers’ attempts to soothe.
u The ambivalently attached child’s needs have been met
not- the caregiver behavior is unpredictable and confusing. This creates tremendous anxiety for the child.
u Ambivalently attached children tend to mature into adults who are
“Preoccupied”. They can demonstrate clingy, anxious behaviors as they worry about their needs going unmet.
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u The avoidantly attached child does not appear distressed when
caregiver leaves and does not seek comfort from caregiver when the caregiver returns. In general, the avoidant child does not engage much with the caregiver.
u The avoidant child tends to be disengaged and distant. Their needs
have not been met by caregivers and they do not trust that others would be willing/able to meet needs either.
u The avoidant child tends to mature into a “Dismissive” adult.
Dismissive adults prefer to be alone and have difficulty building intimate relationships with others.
u The child who is disorganized in their attachment demonstrates no
attachment behaviors. They are frequently dysregulated and have few strategies about how to receive comfort or aid from others.
u Caregivers’ behaviors toward the disorganized child were likely
erratic, abusive, and/or frightening. The caregiver may have responded to the child’s needs with anger, helplessness, and hostility.
u The disorganized child may grow into an adult who experiences
chaotic relationships with others.
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u Reactive Attachment Disorder (RAD) is a condition in which a child
is unable to develop healthy attachment and connection to parents or caregivers.
u Onset for RAD typically begins in early childhood. u Risk factors for developing RAD include:
u Prolonged separation from parents or caregivers u Living in an institution u Parents/Caregivers with mental health or substance abuse issues that
impede responsive and attuned parenting
u Frequent change of caregivers or foster homes
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u Unexplained withdrawal, fear, sadness or irritability u Sad and listless appearance u Not seeking comfort or showing no response when comfort is
given
u Failure to smile u Watching others closely but not engaging in social interaction u Failing to ask for support or assistance u Failure to reach out when picked up u No interest in playing peekaboo or other interactive games
u A consistent pattern of emotionally withdrawn behavior toward
caregivers, shown by rarely seeking or not responding to comfort when distressed
u Persistent social and emotional problems that include minimal
responsiveness to others, no positive response to interactions, or unexplained irritability, sadness or fearfulness during interactions with caregivers
u Persistent lack of having emotional needs for comfort, stimulation and
affection met by caregivers, or repeated changes of primary caregivers that limit opportunities to form stable attachments, or care in a setting that severely limits opportunities to form attachments (such as an institution)
u No diagnosis of autism spectrum disorder
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u Developing and maintaining a safe, consistent, and nurturing home
for the child.
u Individual counseling for child u Family counseling (if appropriate) u Education classes and training for parents and caregivers u Parenting skills classes (if appropriate)… It is important to remember
that disrupted attachment is often generational. Parents often need to learn how to bond because they did not experience that in their families of origin.
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You as a helper can help improve the child’s attachment experience by developing a healthy working relationship. Remember, the child will benefit from the following:
u Consistency u Patience u Predictability u Dependability u Positive regard and support
u Establish safe boundaries with child u Create a routine u Let the child move at their own pace u Warm, friendly, and approachable demeanor u Be sensitive to developmental issues and needs u Identify interests and build upon them u Respond to challenges in a calm and predictable manner u Know that small steps are actually big steps u Give the relationship time u Be aware of your limits and biases
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u Ainsworth, M. D. S. (1989). Attachments beyond infancy. American
Psychologist, 44, 709-716.
u American Psychiatric Association. (2013). Diagnostic and statistical
manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
u Bowlby, J. (1951) Maternal care and mental health. World Health
Organization.
u Bowlby, J. (1959). Separation anxiety. International Journal of
Psychoanalysts, XL1, 1-25.