working-with-children-with-attachment-disorder

Working With Children With Attachment Disorder

So, you have or know a child with attachment disorder!  At the root of every child with attachment disorder is interpersonal or relational trauma in early childhood.

If you are the parent, my heart goes out to you as I know how difficult it can be to live with the reactive emotions and the behavioral outbursts of a child with attachment disorder.  The most difficult thing for me as a parent of a child with attachment disorder was the continual rejection of me and my love in our every day interactions.

For teachers and care-givers, the defiance and opposition might be the most difficult aspect.  No matter the lens through which we look, underneath the behaviors, rejection, and defiance, we see a heart that has been broken and cannot trust.

The Root Of Attachment Disorder

While we talk metaphorically about a broken heart, at the root of attachment disorder is interpersonal or relational trauma in early childhood that resulted in the brain developing in stress and survival mode.  This trauma can occur because of either a complete loss of a major life figure (adoption, foster care, death of parent) or because of a disruption in the relationship and bonding process. The result of early childhood interpersonal trauma is insecure attachment, or attachment disorder.

To establish a secure attachment style, a child needs a maternal primary caregiver who is emotionally present, engaged, calm, and consistent.  Anything that disrupts this results in a degree of insecure attachment.

During the bonding process of the 1st year of life, the right brain is forming the core of all our future emotional and social interactions.  By no means does a child need a perfect parent to develop a secure attachment.  They need enough healthy social interactions with an emotionally present and stable maternal care-giver. This allows the right brain to develop a subconscious state of knowing and feeling worthy of love, protected, heard and understood. In short, they know there are people in life they can trust with their life.

Foster care children and adopted children have undergone a disruption of a significant relationship and most, if not all, have some degree of insecure attachment and attachment disorder.  Biological children can have attachment disorder if they experienced hospitalizations or recurrent infections, or if the parents were under stress.

Effects Of Attachment Disorder

What exactly are the effects of relational trauma and attachment disorder on the brain and the body?  Bessel van der Kolk and Allan Schore are great resources for in-depth information.  In short, it wires the brain and body for chronic overwhelming stress, with a very reactive survival system.  All of this together has been termed Neurodevelopment Trauma Disorder.

The effects on the brain include the Dopamine Reward System becoming imbalanced, the same system that is involved in addictions. In a secure attachment, the Dopamine Reward System is wired during infancy to get pleasure from healthy emotional connections with other people.  In an insecure attachment, this does not occur, and anxiety replaces pleasure in emotional interactions with others.

What are the effects of attachment disorder on the body? Throughout the body, the nervous system is very sensitive and reactive, and has been associated with adult diseases like high blood pressure, inflammation, asthma, fibromyalgia, breast cancer, and obesity.

Can children heal from attachment disorder when it has such a long-term effect on brain development and the body’s biology systems?  Yes, children and adults can achieve an earned secure attachment, with a great reduction in associated physical and mental health symptoms especially when combined with mindfulness activities.

However, many adults think that these children will grow out of their behaviors.  However, when they have attachment disorder, they will not grow out of these behaviors.  As they reach adolescence and beyond, their behaviors may change to substance use, delinquency, early pregnancy, eating disorders, mood disorders, unhealthy relationships, self-sabotaging behaviors, and overall an emotional instability that permeates every area of their life.

The earlier these children can heal, the better for them and their families.  Education and planning on part of the parents and teachers are required to intentionally create the environment in which they can heal.  It is possible for them to trust, enjoy healthy intimacy and be able to feel and communicate feelings!

A Healing Environment

What type of environment is needed for them to heal?  A very specific therapeutic environment is required.  This is a hard process for anybody to become willing to trust the very people they have believed to be threatening their survival.  Without the right pressure in the right way, they will naturally default to what is more comfortable, staying in their insecurities even if they are not happy.

The necessary therapeutic environment has two components: (1) safe structure and (2) powerful nurture.  Safe structure because this is how they feel safe, and nurture because this is what facilitates the attachment.  In short, the structure allows them to feel safe enough to take their medicine which is the nurture.

What does a safe structure mean?  A structured environment simply means one that has high, clear and consistent expectations.  This creates a feeling of safety.

Creating such an environment at home helps the child feel contained and safe, a necessary feeling for them to heal. When their emotions and behaviors are out of control, their is safety in feeling contained by strong adults who are helping them understand themselves better and get better control of their emotions and behaviors.

Now, children with attachment disorder will not immediately thank you for this now safe emotional and physical containment!  Initially, they usually push back on the boundaries to see if they will hold. Remember, they do not automatically trust you!  You will need to earn their trust as you hold the boundaries, remaining calm, consistent and yet understanding of their emotions.

Many parents in today’s society feel that their child will trust them if as a parent they get on their level, try to connect and show them love.  This may be true for a child with secure attachment, but for a child with attachment disorder, trust has to be earned through respect, respecting you as they see you are strong in holding the boundaries and not reacting to the emotions and drama.

Connected, calm, and consistent is what earns respect!  Only when an attachment disorder child sees you as strong will they trust and attach.

Thinking of the bonding process that happens in the first 12 months of life, trust develops as the infants needs are met, as the infant feels their parent’s strength as they are picked up and carried around in strong arms and connect to their calm voice and steady heartbeat.  They attach because they recognize the benefit for them if they attach to something strong, secure, and stable – they will survive infancy, the utmost vulnerability!

However, if we are healing a child from attachment disorder, they are no longer an infant and cannot be as easily picked up and contained!  Parents can become scared of their children’s behaviors, especially if they are violent, and may think it best to give in to avoid the fit.  This works against the parent as the child internalizes the message that they are more powerful than adults and that their feelings are uncontrollable and to be feared.

Just like a mother who will hold a baby’s arm if they try to scratch her in the face, establishing the expectation of respectful words and actions to others now.  Establishing high expectations and communicating those very clearly is one of the key features to success in an attachment intervention with a child.

Many children who grow up with an insecure attachment find a security in the military and feel at their best in such a structure environment where the expectations are very high and very clear.  Even if the expectations are something they don’t want to do, if they know exactly what is expected, it is not anxiety producing.  It is the unknown that creates anxiety.

In addition to the safe structure of high and clear expectations, powerful nurture is the real heart medicine.  It should be given frequently and intentionally!  The powerful nurture that an infant experiences in the first 12 months of life needs to be re-done.  Close physical contact, soothing words of understanding when upset, and even bottle time, rocking, and frequent eye contact can aid in the attachment process.

Remember, words are not as important as actions, touch, facial expressions, and the tone of voice.  In fact, at first, the words “I love you” have little meaning and can trigger reactive behaviors because it strongly contradicts their core beliefs.  Until those core beliefs change, “I love you” needs to be expressed, but has to be communicated non-verbally through indirect means until they can receive it directly.

It’s Worth It

Healing a child with attachment disorder is a lot!  It can be exhausting, but with the right support and knowledge, anybody can do it!  To see their hearts heal is worth every sweat and tear, as this is for the rest of their life that they will be able to feel and express love.  You will have set them on a very different life course!

What has been your experience with living or working with a child with attachment disorder?  What are ways in which you have do powerful nurturing during the healing process?  Please share your thoughts!

And from me, a very warm hug,

Dr. Aimie

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