Reactive Attachment Disorder

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Reactive Attachment Disorder

Postby Marina » Fri Mar 17, 2006 10:56 am

Reactive Attachment Disorder

(This is a file I compiled several years ago on attachment disorder as it relates to high staff turnover in day-care. There are many articles out there on attachment disorder as it relates to foster care and adoption. I haven't surveyed them to come up with a few good ones for foster care. But I had to go through a rather large quantity to come up with the few good ones for daycare/ school which I am posting here."

Attachment Theory
This is from Caring For Our Children, an online book of national day care standards, which states research when considering regulations. The book took 5 years to prepare and combines all state regulations, health, psychological, safety, etc.

STANDARD 2.010 personal caregiver relationships for infants and toddlers Opportunities shall be provided for each child to develop a personal and affectionate relationship with, and attachment to, that child's parents and one or a small number of caregivers whose care for and responsiveness to the child ensure relief of distress, experiences of comfort and stimulation, and satisfaction of the need for a personal relationship. The facility shall limit the number of caregivers who interact with any one infant to no more than three caregivers in a given day and no more than five caregivers across the period that the child is an infant in child care.
RATIONALE: Trustworthy adults who give of themselves as they provide care and learning experiences play a key role in a child's development as an active, self-knowing, self-respecting, thinking, feeling, and loving person (1. 9). Limiting the number of adults with whom an infant interacts fosters reciprocal understanding of communication cues that are unique to each child. This leads to a sense of trust of the adult by the infant that the infant's needs will be understood and met promptly (88, 89). Studies of infant behavior show that infants have difficulty forming trusting relationships in settings where many adults interact with a child, e.g., in hospitalization of infants when shifts of adults provide care. This difficulty occurs even if each of the many adults are very caring in their interaction with the child. Assigning a consistent caregiver to an eight-hour shift in such settings has been observed to help. This limits the number of different adults with whom the child interacts in a three to 24-hour period (90, 91).

88. Kassidy J, Shaver, P, eds. Handbook of Attachment: Theory, Research and Clinical Applications. New York, NY: Guilford Press, 1999: 671-687. 89. Provence, S, Lipton, R.
Infants in Institutions . New York, NY: International Universities Press, 1962: 55-128.

STANDARD 2.014 personal caregiver relationships for 3- to 5-year-olds Facilities shall provide opportunities for each child to build long-term, trusting relationships with a few caring caregivers by limiting the number of adults the facility permits to care for any one child in child care to a maximum of 8 adults in a given year and no more than 3 in a day.
RATIONALE: Children learn best from adults who know and respect them; who act as guides, facilitators, and supporters of a rich learning environment; and with whom they have established a trusting relationship (1. 20, 21). When the facility allows too many adults to be involved in the child's care, the child does not develop a reciprocal, sustained, responsive, trusting relationship with any of them. ... ml#1048801

Reactive Attachment Disorder
A history of gross neglect, lack of contingent responses, and little or no attention, interaction, and affection are required to establish a diagnosis of inhibited RAD. For a diagnosis of disinhibited RAD, a history of multiple caregivers, sequential changes in caregiver, disruptions in relationships, and placement with different people for considerable periods must exist. The child does not develop preferential attachments and secure base behavior toward a specific person but instead develops an undifferentiated closeness with anyone who approaches the child.

(I experienced this when placed in a room full of 4-yr-olds. From my experience at this daycare center, staff changes during the day, week and month were phenomenal. Three of the girls told me their names wrong. Two I caught because I couldn't spell them and couldn't find their names on the cubbies. I didn't catch the other one until we were on the playground and I had to count my group mixed in with 2 other groups. These children had evidently experienced multiple caregivers in the Center like you wouldn't believe.)

Article on message board on narcissism
...when there is no single, adequate, continually available person
to whom the child can relate, or [that in which] the child is passed
through a series of placements where he makes only brief
attachments. In either case, the end result is a child who is afraid
to put down roots, a child left unable to relate in depth or to form
stable, long-term attachments. ... ssage/2598

Book: Being There
Babies who receive responsive and consistent care develop the sense that their world is essentially satisfying; that people around them are responsive and caring. Those who learn they cannot trust may feel that adults are replaceable, love uncertain, and human attachment a dangerous investment. They may create internal working models forecasting an unpredictable, unreliable, and untrustworthy world, and be left with wounds that are difficult, perhaps impossible, to heal. As Fox notes, a therapeutic reparative experience is initially based on trust--and these children have not learned to trust. ... there.html

10. High staff turnover is harmful

Attachments in the workplace
How to spot a bully in your workplace
If you have a serial bully on the staff they will reveal themselves by their department showing excessive rates of staff turnover

Institutional bullying is similar to corporate bullying and arises when bullying becomes entrenched and accepted as part of the culture. People are moved, long-existing contracts are replaced with new short-term contracts on less favourable terms with the accompanying threat of "agree to this or else", workloads are increased, work schedules are changed, roles are changed, career progression paths are blocked or terminated, etc - and all of this is without consultation.

set unrealistic goals and deadlines which are unachievable or which are changed without notice or reason or whenever they get near achieving them denied information or knowledge necessary for undertaking work and achieving objectives.
starved of resources, sometimes whilst others often receive more than they need.
denied support by their manager and thus find themselves working in a management vacuum.
do not have a clear job description, or have one that is exceedingly long or vague;
the bully often deliberately makes the person's role unclear

The Workplace Bullying & Trauma Institute's
Definition of the Phenomenon

"and omission (the withholding of resources--time, information, training, support, equipment--that guarantee failure)--which are all driven by the bully's need to control the Target."

Trauma is most severe when accompanied by unpredictability and a lack of control by the recipient. Since control by the bully is the core principle driving the phenomenon, bullying can be said to be traumatizing. Even witnessing the suffering of another person is sometimes sufficient to trigger trauma.

There are three classes of symptoms in PTSD.
1. Hyper-Vigilance. This is seen in targets who are often edgy, irritable, easily startled, and constantly on guard. They sleep poorly, become easily agitated, have trouble concentrating, are aggressive, and are easily startled.

2. Work Trauma, triggered by a cumulative series of events, deserves a special name to distinguish it from traditional PTSD. According to two English psychologists, Michael Scott and Stephen Strandling (British Journal of Clinical Psychology, 1994) call it PDSD, Prolonged Duress Stress Disorder to take into account its cumulative nature over time. Most bullies assault their targets over a long period with no single episode appearing to be outrageously harsh. This gives the bully a defense. Yet it is the accumulation of several acts that makes the bully's hurtful misconduct outrageous.

1. The three items in the health impairment checklist in the CAWB survey matching the PTSD symptom categories and their respective percentages were as follows:
1) Feeling edgy, easily startled, constantly on guard (80%) ... ma.html#wt

Article on management

The Attachment Disordered Child in School
by Lawrence B Smith L.C.S.W. - C., L.I.C.S.W.
1. Characteristics of school that are problematic for the Attachment Disordered child.

5. One of the primary defensive maneuvers that AD children rely on to maintain their psychological safety is that of projection. The many people present in the school context offers the AD child an abundance of targets for their projections. Because of their hypervigilance, AD children are generally quite perceptive of others' vulnerabilities and skillful at striking at those vulnerabilities with their projections. This can make the projections seem very believable to the receiver which can put that person on the defensive.

3. Nuisance behaviors: These are frequently occurring minor infractions {such as interrupting or asking excessive questions} that disrupt the simplest of everyday interactions. These nuisance kinds of behaviors serve a dual purpose. First, they serve as ongoing reminders that the AD student is not under the teacher's domain. Secondly, they are "probes" that the AD child sends out into the environment to acquire information about the situation. From others' reactions to these "behavioral probes", AD children begin to piece together who is punitive and who is supportive; who will respond and who will ignore; who has a short fuse and who has a longer fuse, etc. The AD child uses the responses to his probes to figure out how to "work" the adults. When the AD child feels confident that he knows how to maneuver the teacher, the "honeymoon" will be over.

Education and the Child of Trauma

Brain research leads us to believe that the amygdala forms while still in utero. The hippocampus, on the other hand, is developing throughout the critical early period of infancy. In this manner, if the environment has been overly stressful and lacks effective parental regulation at an early age, the hippocampus becomes stagnated in its growth. Hence, the term "arrested emotional development." Ultimately, this leads to an amygdala that pours out stress and a hippocampus that is so poorly developed that it is unable to determine to any successful degree, how stressful the event may truly be. As a result, the stress and relating fear escalate, and the rational processes become confused and distorted. Bruce Perry has referred to such a state in children as an "amygdala hijacking." The amygdala pumps out stress and fear in an uncontrollable manner, and the child is essentially held hostage to his own neurophysiology

As this child continues to grow, his emotional system remains under arrest. This continues until an environment conducive to constant regulation has been provided. Once such an environment has been provided, the slow, tedious process of reparative stress interaction begins to occur. In this manner, the developing system begins to learn some degree of emotional regulation throughout each day. Overly stressful interactions send this highly sensitive system rapidly back into old patterns of chronic, intensified fear, triggered from the stress reaction

Secure, Low-Stimulus Environment: A low-stimulus environment will maintain the child in an environment of minimal stressors. Due to the sensitive nature of this child’s Stress Response System, the lower the external stimulus the more opportunity the child has to maintain a state of regulation, hence, calm. This state of neurophysiologic functioning is pertinent to the success of this child in the formal educational environment.

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Joined: Sat Feb 25, 2006 3:06 pm

Reactive Attachment Disorder in Adoption

Postby Marina » Thu Dec 21, 2006 9:43 pm

Attachment Parenting Site
Julie Renee Callaway

Reactive Attachment Disorder in Adoption

I recently read the book, An Unlit Path by Deborah L. Hannah. I believe that her message needs to be shared, but first I want to share some background about my own experiences with adoption and abused children.

I hesitate to even write this article because I believe strongly in adoption. I don't want to scare away desperately needed potential adoptive parents. I also have the scars of living the first 15 years of my life with foster and adopted siblings who made life impossible. I need to share what I know so families know the risks inherent in adopting hurt children. I believe that Hannah's book can be a help to families in similar situations.

There are hundreds of thousands of children in foster care in this country. Many of them will need adoptive homes. There are many more children in orphanages in Russia and other countries who are just as desperate for homes. Many adoptions work well. I have 4 successfully adopted siblings and I love them all dearly. They are an integral part of my family and they are NOT the focus of this article. Facing infertility myself, I don't know if I have the courage to try to adopt an older child. My mother was orphaned young and I know that a caring adoptive family would have changed her life. I also know the unbelievable pain some attempted adoptions brought into my family. Some older kids thrive in adoptive homes. Some kids with Reactive Attachment Disorder heal and learn to be part of a family. Some do not.

Picture this:

* A teenage foster child threatens to strangle their foster mother with a telephone cord while her two young children lock themselves in a bedroom.

* A 10 year old sprinkles pesticide over the family dog's food.

* A young girl lights matches and drops them into a can of gasoline in the garage while her adoptive family goes about every day tasks - unaware of the danger.

* A 12 year old carefully places cherry pits, sliced raw carrots and hazelnuts on the floor where two crawling babies play. When confronted she says calmly, "I want them to choke to death. You love them more than you love me so I will kill them. You can't stop me. When they are dead you will love me."

These are things that actually happened in my family as my parents attempted to raise "difficult" children. We now know that these behaviors are typical of Reactive Attachment Disorder (RAD), the technical term for children who fail to attach. For children who have been severely neglected or abused learning to love or be loved is often difficult. Learning to trust and open your heart to another is nearly impossible for some children. Devoid of a conscience or the ability to have any empathy, these children can become master manipulators and a few are extremely dangerous. Abusing parents and siblings as Hannah's adopted children did is typical for these kids.

Like an invisible handicap, this inability to develop emotional attachments can cripple a child emotionally. The most basic human needs to be a part of a community, a family, a relationship, becomes impossible for some badly wounded children. While there are some children who respond to therapy, some of these kids can not be healed. To someone who has not lived with a RAD child it seems impossible to believe that a child can be so broken as an infant that they are unable to heal no matter how much they are loved as they grow older.

Hannah is also a Christian and her faith that love could conquer all is so familiar. Everything in me says that love should be able to heal all wounds - but the reality I have lived is simply that some kids don't get fixed. When these broken hearts knit together again it somehow happens all wrong. Instead of learning to enjoy being loved they fight it and will even go to extreme lengths to avoid caring about others or letting others love them. Attachment parenting along with knowledgeable therapy can help to make a huge difference for the kids who can be helped. Some kids just won't let anyone reach them.

Deborah Hannah and her family adopted 5 children and fostered 9 more. Her family went through very similar expereinces to those of my family and other families I know attachment disordered children. Families of RAD children and teens will recognize life with hideous false accusations, abuse of other family members, physical threats, lying social workers, an underfunded system that has no resources to help familes with RAD kids, and the aching desire to just know how to help this child you love and fear.

Hannah does an excellent job of pulling you into her world. If you are considering adoption of an older child you will want to read this book as well as the others recommended below to prepare yourself for possible problems. If you have a RAD child on your hands, this book will make you feel much less alone. Explaining life with a RAD to someone with normal kids feels much like explaining war to someone with no combat experience. You just don't know what it is like to cross a mine field until you have done it. Watching a few war movies does not prepare you for the sound of exploding bombs falling around you.

Hannah is careful to point out that she believes in adoption as long as everyone is well informed and families get the support and informtion they need. A painful but important read for anyone dealing with RAD.

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