Attachment disorder in children is a psychiatric condition characterized by difficulty in attaching to others emotionally. Typically, children with attachment disorder have been subjected to severe trauma or neglect in infancy or later. Many of them have been abused or have been a product of institutionalized living where they can’t form adequate loving relationships.
An incident early in my nurse training days brings back memories of a child who was certainly at risk of attachment disorder. As a young student nurse in my obstetrics rotation, I was thrilled to have the chance to care for newborn infants. Bottle-feeding and cuddling babies was the highlight of my day. One afternoon, I went to pick up a sweet newborn girl to feed. My nursing professor approached me and requested that I limit contact with this poor child because she was to be placed in foster care after discharge. The professor went on to say that the child shouldn’t get used to human contact as she may be without a nurturing adult for the rest of her life. So sad!
I’m happy to say that the current philosophy has changed in the newborn nursery and for children in general. We now know that children can develop an attachment disorder without early caring, constant, and positive relationships.
I still think of the lonely beginning that newborn child had to endure and wonder if she developed attachment disorder. Although attachment disorder has been a formal diagnosis for many years, it was essentially unstudied and forgotten until the last decade, when the traumatic life-long ramifications of the problem were highlighted. Research has proven that early human touch and connection are vital for all children, whatever their circumstances.
There is now broad consensus that in early childhood, attachment disorders result from inadequate caregiving environments. — Journal of Child Psychology and Psychiatry.
Thankfully, psychologists, physicians, and nurses are now knowledgeable about attachment disorder syndromes, the result being improved recognition, diagnosis, and treatment.
Why are attachment bonds so important?
A strong bond to a primary caregiver as an infant is necessary to form solid and meaningful attachments to others as an adult. Weak or no relationships in infancy or early childhood can result in emotional and social development delays and attachment issues throughout life. This missing piece of a child’s emotional development can later lead to a lack of conscience, empathy, and trust.
The 4 types of attachment bonds are:
- Secure: A child will interact with others while the mother or loved caregiver is present and will exhibit distress when she leaves and then become shy with a stranger. When the mother returns, the child is once again happy and social.
- Anxious-Resistant Insecure: A child will exhibit anxiety in the presence of strangers, even with the mother present. When the mother leaves, the child is even more distressed and remains inconsolable when the mother returns.
- Anxious-Avoidant Insecure: A child shows neither happiness nor anxiety/distress around strangers and when the mother leaves or returns.
- Disorganized/Disoriented: A child may show inconsistent or ambivalent behavior when the mother is around or leaves. When the mother returns, the child may exhibit relief but may hit or move away from the mother and refuse to engage with her.
A secure attachment bond is seen in children with a healthy attachment. Children who have experienced abuse or neglect may exhibit one of the other 3 types of bonds.
Causes of attachment disorder
Categorized as a trauma-related diagnosis, attachment disorders are primarily due to lack of meaningful human contact and relationships, many times as a result of institutional living, abandonment, and/or severe abuse as an infant or toddler.
Children who have spent long periods hospitalized may also exhibit attachment disorder. Children under the age of 5 who experienced long-term impaired relationships with their caregivers are more likely to develop attachment disorder.
Unlike many psychological illnesses, attachment disorder is not caused by genetics.
Types of attachment disorders
There are 2 types of attachment disorders in children:
- Reactive attachment disorder (RAD)
- Disinhibited social engagement disorder (DSED)
RAD in kids is a more common diagnosis than DSED. The 2 disorders are caused by past trauma and abandonment.
Although reactive attachment disorder in adults is possible, attachment disorders are typically first diagnosed in childhood due to the condition developing in infancy or the toddler years. Given the complexity of attachment disorder in kids and the poor outcomes even with treatment, adults with attachment disorder may continue to struggle throughout their life with forming meaningful relationships and appropriate social behavior.
What is disinhibited social engagement disorder?
Disinhibited social engagement disorder is an attachment disorder that makes lasting emotional attachment with others difficult. Children with DSED have particular difficulty forming meaningful relationships with their caregivers and siblings.
However, they are not shy and may inappropriately befriend strangers. These children may be harder to diagnose as they exhibit superficial attachment and charm towards those treating them.
What is reactive attachment disorder in children?
Children with reactive attachment disorder tend to be more skittish and fearful than those with DSED. Similarly to those with DSED, they still can’t form meaningful relationships with parents and other people close to them. They tend to be loners and don’t seek comfort from others.
Reactive attachment disorder in foster or adoptive kids is particularly prevalent due to their unstable backgrounds. One example is my friend Cindy. She’s a social worker adept at dealing with children from problem backgrounds, which includes all of the emotional baggage attached. With a big heart and vast experience in parenting and troubled children, Cindy fostered and then adopted an active, adorable blond-headed toddler. Although the child was bright and sometimes social, she had frequent outbursts and destructive behaviors. This little towhead was later diagnosed with RAD after being “discharged” from all of the area preschools due to her defiant and aggressive behavior.
Cindy continued to struggle with her daughter as home problems from out-of-control behavior escalated. Finally, fearing for the safety of their own 2 boys, the family had to move their troubled daughter to an environment where she could receive around-the-clock psychiatric care. Fortunately, due to the detachment aspects of RAD, this little girl is perfectly happy being apart from her family and living with strangers.
Since there are many similarities between RAD and DSED, for simplicity’s sake, the remainder of this article will focus primarily on reactive attachment disorders in toddlers and children.
Reactive attachment disorder symptoms in kids
Attachment issues in children cause them to display certain anti-social behaviors.
Reactive attachment disorder symptoms include:
- Inability to show love and attachment to others, especially parents and caregivers
- Inability to receive or give emotional support and affection
- Sad or listless appearance
- Failure to reach out to others when picked up
- Failure to show remorse, guilt, or regret
- Irritability with frequent angry outbursts and tantrums
- Display of inappropriate affection towards strangers
Behavior issues in kids with reactive attachment disorder
The behavior issues in children with reactive attachment disorder are complex and substantial. Problematic behaviors stem from attachment issues in children with RAD.
Due to the complexity of this condition, children with RAD may first be misdiagnosed with other disorders, such as ADHD, personality disorder, and oppositional defiant disorder. However, it’s possible for children with RAD to also have numerous other psychological conditions in addition to RAD, such as those listed previously.
Some behavior issues that children with reactive attachment disorder exhibit are:
- Angry outburst towards others and themselves
- Inability to calm down when upset
- Destructive and aggressive behavior towards self and others, including animals
- Distractibility and short attention span
- Eating disorders, such as raiding the refrigerator in the middle of the night and hoarding or gorging on food
- Nighttime wandering
- Impulsivity and defiant behavior
- Suicidal ideation and murderous thoughts
- Stealing, lying, fire-starting, and destroying property
- Failure to acquire hygiene and self-care skills
- Failure at times to meet age-appropriate milestones
This video about a couple who tried to adopt a child with RAD shows a typical example of the complex behavior issues associated with this disorder.
Although outcomes for a child with RAD are poor, early detection and appropriate treatment offer hope for an emotionally healthy life for some kids. Read on to find how specific therapies and techniques can help children with RAD.
How to deal with reactive attachment disorder in kids
Children with RAD need consistent love and nurturing to heal past wounds. Although there are no standard treatments for reactive attachment disorder, individual and family counseling is recommended. Early intervention is essential for a positive outcome.
Attachment therapy is one form of psychological counseling that incorporates the individual and family to build trust and express emotions. Dealing with the child’s early relationship gaps and experiences is necessary to guide them to healthy attachments. The goal of attachment therapy is to enable the child to form secure and appropriate relationships as an adult.
Unfortunately, even with consistent and appropriate counseling, children with RAD act out and display severe behavior problems. With one crisis after another, how should a parent support or discipline a child with reactive attachment disorder?
How to support a child with RAD
By providing a safe, nurturing home and establishing a caring relationship with your child, you show the utmost support that a parent can give. Consistency in your home and parenting approach is vital for a child with RAD. Expect some bumpy roads as a parent of a child with RAD. Therefore, lowering the expectations for your parenting skills and the child’s behavior may take the sting out of the minor issues that develop. You will fail as a parent, but remember that you are trying your best, and even the experts may have difficulty at times dealing with your child.
Most of all, you will need to develop a support system for yourself and your child. Psychological therapy and family counseling will be an anchor for your child and your family. In addition, establishing outside support for child caring relief, such as grandparents and respite care, is necessary for your self-preservation. Taking breaks and caring for your own physical and mental health is paramount for helping you deal with the challenges of raising a child with reactive attachment disorder.
Support groups for parents of children with RAD are beneficial. Look for them through adoption agencies, Facebook groups, and foster care agencies.
In addition, there are some excellent books to assist in raising children with attachment disorders, such as Parenting the Hurt Child and The Connected Child.
How to discipline a child with reactive attachment disorder
Here are some basic pointers for parents who need to provide consequences for their child’s behavior:
- Make sure that your child and others are safe. Once you’re certain everyone is safe, you have time to plan your next move.
- Give yourself and your child time to de-escalate. Don’t be pulled into a kneejerk reaction because of your child’s emotional outburst. Give them time to calm down and work through their frustration. However, forcing your child to be by themselves as punishment can be detrimental if they don’t want to be alone. Plan to reconnect with your child as soon as they are able and ready.
- Be patient. You are in this relationship for the long haul, and you’ll be pushed to your limits time and time again. Patience will be your ally in this battle.
- Plan the consequences ahead of time when possible. Children with RAD can be predictable. If certain situations tend to set them off or they resist specific requests, you can figure out a consequence before the next explosion. Make sure that your child is aware of the consequence and be consistent in enforcing them when necessary.
- Look for patterns of what might set your child off, which include fears and past hurts. Try to avoid these triggers.
- Give yourself plenty of grace when you lash out or lose your temper. Raising a child with RAD is extraordinarily difficult. There will be plenty of times when you mess up. Remember that you are human and can only take so much abuse, frustration, and disappointment.
Raising a child with attachment disorder is a challenge for even the most capable parent. Having your child diagnosed with reactive attachment disorder is devastating. Children with RAD have to deal with crippling issues resulting from past hurts that have fractured their trust and ability to form positive relationships. They have much trauma to work through. By accepting help for you and your family and applying basic principles of healing, you are helping your child to establish one of life’s most basic needs; forming a lasting, meaningful relationship with a loved one.