Every November, a Presidential Proclamation launches activities and celebrations to help build awareness of adoption throughout the nation. Thousands of community organizations arrange and host programs, events, and activities to share positive adoption stories, challenge the myths, and draw attention to the thousands of children in foster care who are waiting for permanent families. For the whole month of November I will be sharing some of my most popular articles along with various specials. Giving parents the resources they need to become a successful parent is something we are passionate about at Beyond Consequences Institute.
Reactive Attachment Disorder: A New Understanding
Reactive attachment disorder (RAD) is a mental health
diagnosis listed in the Diagnostic and Statistical Manual of Mental
Disorders (DSM-IVTR) under disorders usually first diagnosed in infancy,
childhood, or adolescence. RAD was initially introduced to the mental health
community some 20 years ago. Since that time, much of the information regarding
this disorder has painted a dismal and often dangerous picture of these
children. Books and articles have compared children with RAD to serial killers,
rapists, and hard-core criminals. Intensive and often physically aggressive
therapies have been developed to treat these children. Additionally,
unconventional parenting techniques have been taught to parents in order to
control these children—children referred to as “disturbed” or “unattached.”
The main premise of RAD is that the child cannot socially
connect or attach to others in interpersonal relationships. Behaviors
inhibiting attachment to caretakers are often demonstrated by children
diagnosed with RAD. Some of the behavioral symptoms published in literature
include the following: oppositional; frequent and intense anger outbursts,
manipulative or controlling; little or no conscience; destructive to self,
others, and property; cruelty to animals or killing animals; gorging or
hoarding food; and preoccupation with fire, blood, or violence.
Wow! Read that list again. Many of these behaviors sound
downright frightening. It is hard to imagine that a child can do these things.
Yet, while these behaviors certainly appear abnormal for anyone, especially a
child, they are actually quite reasonable reactions to the experiences these
children have endured. Read on….
There are many life events that can cause attachment trauma
between the primary caretaker (usually the mother) and the child. These include
an unwanted pregnancy, separation from the birthmother due to adoption, death
of a parent, premature birth, inconsistent caretakers, abuse, neglect, chronic
pain, long-term hospitalizations with separations from the mother, and parental
depression. Such life events interrupt a child’s ability to learn to
self-regulate through the relationship with the parent.
Typically, when a baby or small child is in a
state of stress, he cries and the parent attends to the child’s needs, whether
by feeding, rocking, or simply holding him. Each and every one of these
interactions with the parent plays a critical part in assisting the development
of the child’s neuro-physiological control system—the system that allows the
child to return back to a calm state. It is truly through this parent-child
relationship that we as humans learn how to self-regulate in order to stay
balanced and easily shift from a state of stress back to a state of calm. This
regulatory mechanism within us is not “online” at birth, and brain research has
shown that it takes up to thirty months before this part of the brain is fully
developed. Within this thirty-month timeframe, a well-attuned parent has connected
with this child to calm his stress response system thousands, if not millions, of
--> times. How critical these first thirty months are to a baby!
It is through the parent-child relationship that a child’s self-regulatory
ability becomes engaged. This internal regulatory system then sets the
foundation for the child’s neurological, physical, emotional, behavioral,
cognitive, and social development.
When a child does not receive loving, nurturing care, the
child’s ability to develop a sufficient regulatory system is severely
compromised. In cases of severe neglect and abuse, the child’s life is
literally at risk. For these children, their internal survival mechanisms
become activated, dedicating all the body’s resources to remain alert in
“survival mode.” These children perceive the world as threatening from a
neurological, physical, emotional, cognitive, and social perspective. These
children operate from a paradigm of fear to ensure their safety and security.
Hence, we see an overly stressed-out child who has difficulty interacting in
relationships, who struggles to behave in a loving way, who quite often cannot
think clearly, and who swings back and forth in his emotional states due to an
underdeveloped regulatory system. While perceived by most professionals as
dangerous, a child with RAD is essentially a scared and stressed child living
out of a primal survival mode in order to maintain his existence.
With this understanding, the term “attachment-challenged”
becomes more appropriate to use with children instead of the traditional label
of “RAD child.” In times of
stress, this child is challenged to connect and his ability to make connection
is restricted. In fact, we all
become attachment-challenged to some degree when we’re stressed. Reflect
for a moment on the last time you were overly stressed: How did you react when
someone tried to interact with you? Be honest! Perhaps you had difficulty
interacting appropriately. Stress causes confused and distorted thinking, and
it constricts us emotionally, leaving little room for relationships. Thus, a
child with a traumatic history who is living in a stressful, fear-based state,
simply is not capable of nor equipped to be in a relationship. From a
behavioral standpoint, a child living in a state of fear simply cannot act in a
loving way. The frightening behaviors listed above are only external
reflections of the internal fear and chaos within these children. They are
simply behaviors that are intended for survival.
Treatment for the attachment-challenged child needs
to address this internal fear. When the child’s stress state can be soothed,
and the deep wounds driving the fearful behaviors can be acknowledged, the
child has an opportunity for healing. Yes, healing is possible, but it takes
intense work and many, many repetitions of positive experiences to recondition
the body’s reactions. It is also essential that the therapeutic attachment
techniques and parenting paradigms enlisted for these children be grounded in
neurological research and based in love and compassion. Such techniques can
offer ways to create peaceful environments within the home that work to
recreate safety and security in the insecure foundations set within these
children.
A word of caution from the author: Some
therapists specializing in attachment therapy work from a fear-based platform
and recommend techniques that are confrontational, aggressive, child-centered
instead of family-centered, and fear-based. While these techniques sometimes offer short-term results, families
using them are often faced with more severe long-term pain and challenges. Many
of these therapies and therapists have separated themselves from dangerous
techniques that have resulted in the tragic death of children in the past;
however, they continue to lack compassion and are grounded in fear. Some
examples of these techniques include instructing parents to force eye contact
with their children; have children do excessive chores to feel a part of the
family system; send children to respite care out of the home for making poor
choices; give up their need to communicate love to their children; and put
locks on the outside of children’s doors to keep them “safe.” When looking for
appropriate interventions for families, be alert to these specific techniques.
Be aware, as well, of techniques that talk in general about
gaining control of a child and viewing the child as manipulative. These
techniques are child-blaming, parent-controlling, and devoid of scientific
research. It is counterproductive to feed more fear into an already scared
child. When seeking help, it is highly recommended that you have a thorough
understanding of the basis for each therapy being considered.
When parents first begin realizing that they are dealing
with an attachment-challenged child, they have likely already experienced many
severe and disruptive behaviors in their homes. In these experiences, they
themselves often begin to slip into their own fear and see the child as a
threat (at times so threatening that they simply want the child out of their
home, forever). Because the behaviors can be so intense, it is easy to lose
sight of the child’s reality—that of a young person living in a world of pain,
fear, and isolation.
As a therapist specializing in working with
attachment-challenged children, I am overwhelmed by great sadness every time I
initially speak with a parent seeking help for their family. This sadness stems
from the realization that all of these wounds and pain could have been avoided.
Babies are born in a spirit of love, but it is life’s circumstances that shift
them into a spirit of fear. All it takes to maintain this spirit of love is
high quality care giving; it takes an emotionally available parent to create a
secure and loving base for a child. Attachment Parenting in the formative years,
from conception to three years old, sets the foundation for all future
relationships, and it gives the child’s body’s own internal regulatory system
the opportunity to develop to its fullest. The old adage, “an ounce of
prevention is worth a pound of cure” says everything in the context of
Attachment Parenting.
Several years ago, I
found myself in the same situation, waking up every morning wondering how I was
going to make it through the day.
In learning more about my children and understanding that their
behaviors were driven from a deeply wounded place, I was able to parent them in
a way that allowed healing to begin.
Yes, it is hard work and it takes endurance and faith, but creating a
peaceful home is possible!
Heather T. Forbes, LCSW
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