Working With Children with Attachment Disorder: Residential Treatment Center

By | 2017-01-09T17:48:12+00:00 January 9th, 2017|

When working with children who have an attachment disorder, the question that always comes up and must be thoroughly considered is, does this particular child need residential treatment care? 

There are a number of residential treatment centers that treat children with attachment disorders, other psychiatric disorders, and mood disorders. Let’s look at the benefits and limitations of residential treatment centers.

Benefits of Residential Treatment Centers

For some children with attachment disorders, residential treatment care will be necessary, which can also be a blessing for the parents. While it is never easy to place a child in residential care, if a child has severe enough behaviors, parents will not feel a sense of loss, but a sense of safety by having their child in a place that is equipped to keep everybody safe.

After all, a home is a home, not a residential treatment center. There are things that residential care centers can do to help that particular child; whereas the child’s family may have difficulty in doing similar treatments, and can be questioned or judged by neighbors and friends who misunderstand the situation. Such as, if a child requires physical restraining to the point that puts anybody’s physical safety in jeopardy, that child requires a higher level of care than what can be provided at home.

However, a good time to consider the option of residential treatment care is when the child’s behavior puts the parents’ jobs and roles in jeopardy. If a child’s behaviors limit anybody’s ability to function in life and maintain their health, out-of-home care should be considered for the child! Though by this time, the parent may want to leave for out-of-home care!

This also includes whether or not the child’s behaviors draw attention to the home often enough that the parents’ abilities to care for their child is brought into question by others.

For example, if people in a grocery store approach the parent or make comments about reporting the parent to Child Protective Services (CPS), and yet the parent has no other means of getting groceries other than going themselves and taking the child with them, this would be a time to consider out-of-home care.

If a parent’s livelihood or finances are compromised because of the child being in the home, these are all sufficient reasons to realistically consider the option of residential treatment care.

A residential treatment center can help stabilize them, manage behaviors, and can often times get them to a place of self-regulation. All residential treatment centers use various forms of therapy, counseling, biofeedback, and even neurofeedback. This helps stabilize them, although without the attachment work with the child’s parents, it will not heal them at their core from attachment disorder.

Limitations of Residential Treatment Centers

Let’s discuss the limitations of residential treatment centers, the issues they cannot solve, and bad reasons for sending a child.

A child knows that a residential treatment center is temporary. They arrive with the attitude of a survivor – “I will do what I need to do to get out of here.”  They comply because they feel they have to in order to ultimately get what they want, which is to leave and go home.

They never settle in, relax, and…well, attach. They never see it as home, thus why would they ever get attached to anything that isn’t permanent?  It reinforces their core belief that they shouldn’t get close to people and care for others, because these people will just leave or hurt them.

So, while they may get stabilized, learn some emotional and social skills, symptoms and surface behaviors may even go away with enough time at a residential treatment center, but they will not heal from attachment disorder. Thus, it is not a good reason to send a child to residential treatment care to heal them from attachment disorder.

In addition, it is standard for a residential treatment center to promote the use of mood medications to help manage symptoms and behaviors. Often kids arrive on a few medications already, and in general, residential treatment centers maintain current medications and dosages. Their goal is not to decrease the need for or completely get a child off of their medication.

Hence, the main benefit and primary use of a residential treatment center is to stabilize. The healing work is done at home with an experienced and knowledgeable parent/caregiver who can invest the time to optimize brain and body for attachment. When working with children who have attachment disorder then, to truly heal, a child must be with a knowledgeable and competent caregiver in attachment parenting.

This brings me to the next limitation of residential treatment center. Not only is their usefulness focused on short-term stabilization, but also they are not intended to optimize the brain and body for attachment.  Usually, this would start with looking at neurobiology including brain scans, genetics, and then the nutritional status of the children.

With specific nutritional deficiencies that are known to cause anxiety, depression, and a multitude of behavioral and emotional processing disorders, genetic and nutritional analyses are tests that should be done when looking at a comprehensive treatment plan for healing attachment disorder.

Conditions such as pyroluria, vitamin deficiencies, methylation disorders, and food sensitivities are all things that may contribute to attachment disorders. It is hard to know what behaviors are diseases of the body and core nutritional needs, versus what behaviors are strictly from attachment disorder neurobiology. It is possible to stabilize, heal, and have children get off all psychotropic medications. In fact, for every child, that should be the ideal destination, while knowing that not every child will reach that place.

Although there are some great benefits to residential care such as, keeping the parent, other children, and society safe, I have never seen a child truly healed from attachment disorder leave a residential care facility. And as hard of a decision as it is to make, I commend every parent who understands that they cannot do and be everything to their child, and thus seek help from others. However, the attachment work has not been done in a situation such as this. The stabilization and regulation piece has been improved on, and this may help the attachment work at home to go better, but a child needs to be at a home with a competent parent in order to heal.

Understand that needing to be at a home with a competent parent in attachment work, does not have to mean in the child’s own home, but can mean in a long-term in-home placement. A long-term in-home placement would, in general, be for a minimum of 3 months, though can be as long as a year or more depending on how the child is attaching.

Long-term in-home placements with a respite provider who will step in the role of a parent to do the attachment work has been very successful in the past with some children, especially when going home is not an option. In the case of long-term in-home placements, the respite provider serves as the parent and is the one to form a secure attachment with the child. Later, the attachment can then be transferred over to the parent and the child can transition home.

My (Almost) Experience With A Residential Treatment Center

From my experience, there was a time when I had decided on residential treatment center for my adopted son. His violence had become out of hand and he had started claiming false allegations of abuse to my own family, who believed him. This, plus taking an excess amount of time off from my career and work, and being a single Mom, caused my life to become unmanageable. In order to provide for my son, I had to return to work.

I had hoped that by staying home for a year and giving it my all would have helped put him in a state that would allow him to be able to go to a school, have a tutor or nanny, or even be able to come to work with me sometimes. But I had to face the music, see reality for what it was, and understand that he had not healed after trying my best and giving him all of my time. He needed additional help.

When I looked into residential care centers, I was first aghast at the cost. Finances aside, knowing what I knew at that time about the comprehensive care that was needed to heal a child with severe attachment disorder, I felt like no place offered and provided enough. I was in a very desperate place though, and beggars cannot be choosers. I was not able to afford residential treatment care at that time, and thus, ended up first going with a long-term in-home placement with a respite provider, then with a boarding school for troubled kids.

Thankfully our story does not end there, because now he has fully healed and is truly happy with himself and others at his core. The out-of-home placements provided enough to help him stabilize, and allowed me the time and space needed to step back, recover, and plan thoughtfully the best way to help him heal. Fortunately, after so many long, grueling years of fighting in the trenches for his life, it worked! And it has become the most meaningful thing in my life to see him healed!

I am grateful for the services that residential treatment centers can provide. They are not intended to, nor are they able to, heal a child with attachment disorder, but they can help the process by stabilizing a child when the child’s behavior and life becomes unmanageable!

What has been your experience with residential treatment centers?

What would be your reasons for sending a child to a residential treatment center? Or what would be your reasons for not sending your child?

Look forward to hearing from you,

Dr. Aimie

Related: Working With A Child With Attachment Disorder: Frequently Asked Questions

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