Attachment Disorder

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  1. According to villagebh, "Attachment disorder is a complex, severe, and relatively uncommon condition in which infants and young children do not establish lasting, healthy bonds with parents or caregivers. While this condition is rare, it is serious. In many cases a child with has been the victim of abuse, neglect, or abandonment or is orphaned. These children have never established a loving, caring attachment with anyone. Undeveloped attachments may permanently damage a child’s growing brain and hurt their ability to establish future relationships. Additionally, it can lead to controlling, aggressive, or delinquent behaviors, trouble relating to peers, and other problems."
  2. state that those at-risk include:
    1. children who have suffered abuse
    2. children who have been neglected
    3. children in the care system
    4. children who have been separated from caregivers

Anxious Attachment (AxAD)

  • These children feel extreme anxiety connected to abandonment (e.g Parents may have left the child or ignored the child in favor of a sibling). They have a terrifying inner emptiness. These children appear at first to relate emotionally to others. Attention from others helps to confirm their existence. They seek physical closeness as a treatment for the terror, rather than an actual desire to be close to other people in a meaningful way.
  • "They have a terrifying inner emptiness and a sense of no existence of their own. They are working very hard, all the time, to protect themselves from abandonment and from experiencing their internal sense of non-existence. One way AxAD children do this is to appear to emotionally relate to others, and thus, they can exhibit what looks like attachment behaviors. In the absence of needing relief from their anxiety, AxAD children can be indifferent to, or rejecting of, interaction. When not motivated to be charming, AxAD children are likely to revert to whining or complaining about a variety of things, or engaging in baby talk for the attention drawing effects. In quieter or calmer moments, AxAD children are likely to raise their activity level so that they behaviorally avoid their terror within. This often takes the form of non-stop talking or asking of meaningless questions. This has much of the appearance of AD/HD and can lead to such a partial misdiagnosis." (Attachment Disorder Maryland)
  • "The primary behavioral strategy AxAD children rely on could be termed “impression management”. AxAD children are generally skilled at presenting a charming façade. These children work diligently to “manage” the adults’ liking of them. In addition to their charm, AxAD children lie a high percentage of the time. They almost always lie about their feelings, and AxAD children never acknowledge having lied- they are proficient at lying about lying. Usually, anything AxAD children are genuinely worried about will be dismissed with indifference. They can invent compelling tales of abuse at the hands of parents or other adults. AxAD children rarely express thoughts that are truly “their own”. The demand to be “real” frightens them. They devote their hypervigilance skills to determining what others want from them. They are very skilled at eliciting clues from the environment; and often ask, “What do you want me to say?” or may just wait in silence for the adult to offer a prompt. Answers are then crafted around these clues. Such answers can sound insightful, but are typically meaningless. Most appearances of emotional expression are “constructed”. They like the adults being confused about them. It is very easy to underestimate AxAD children’s ability to evade real feeling. They almost always deceive adults outside the home. Their behavior can vary dramatically depending upon with whom they’re interacting. AxAD children often do well in school because they see that as a way to get the teacher to like them." (Attachment Disorder Maryland)
  • "Therapy: Because AxAD children are rarely openly defiant or irritatingly passive-aggressive, they can appear to be making progress when, in fact, little of significance is occurring. They can convincingly lapse into tears or “constructed anxiety”, in an effort to influence the therapist and parents to not challenge them so much. The key to making therapeutic progress with AxAD children is getting access to something, anything, that is real and following that thread to open up their terror that they do not really exist. This can require the therapist to be vigilant, even skeptical, to a degree that might be uncomfortable. It can also require being repeatedly, though gently challenging, and expecting more from the child. Empathy / support offered too soon will likely be empathy for a “constructed presentation” and this will put the therapeutic journey in reverse. (Attachment Disorder Maryland)

Reactive Attachment Disorder (RAD)

  1. Reactive attachment disorder is considered one of the more severe attachment problems. It tends to occur when the child has been abused or neglected.
  2. According to the AACAP, "Children with RAD are less likely to interact with other people because of negative experiences with adults in their early years. They have difficulty calming down when stressed and do not look for comfort from their caregivers when they are upset. These children may seem to have little to no emotions when interacting with others. They may appear unhappy, irritable, sad, or scared while having normal activities with their caretaker. The diagnosis of RAD is made if symptoms become chronic."
  3. There are two sub-types of attachment within RAD.

Disinhibited Social engagement Attachment

  1. Overly familiar with strangers but unresponsive to parental affection.
  2. Seeks constant attention.
  3. Inappropriately childish.

Inhibited Attachment

  1. Emotionally detached. Unlikely to respond emotionally to events around them, despite them being hyper-aware of what is happening.
  2. May push people away, ignoring them or even acting aggressively; child exhibits non-engagement in normal social interactions.
  3. Difficulty forming and maintaining relationships with adults and peers.
  4. Does not want to be shown physical affection and seems to be almost in pain when they are touched. May become physically aggressive
  5. Seems ‘moody’ and emotionally detached regularly; withdrawn socially.

Universal Characteristics

  1. Extremely manipulative.
  2. Controlling in relationships.
  3. Refusal to accept responsibility.
  4. Destructive and self-harming behaviours such as drug and alcohol abuse.
  5. Impulsive tendencies.
  6. Defiance of instructions.
  7. Lack of remorse and conscience.
  8. Inappropriate and over-sexualised behaviours.
  9. Anger and aggression.
  10. Hurting peers, siblings and animals physically.

Classroom Strategies

  1. Students with attachment disorders require specialist therapy from a mental health professional to help them.
  2. Clear rules and expectations which are frequently re-iterated (both for rewards and sanctions). The student with RAD will have difficulty understanding the concept of 'cause and effect'.
  3. Be unambiguous with positive/negative reinforcers. Rather than, “nice work”, use “You correctly designed your circuit”, or “did very little of the work set - you will be in at the start of lunch to complete it".
  4. Don't lose your temper.
  5. Avoid being alone with the student (e.g. in a detention setting) - this could lead to safeguarding allegations by way of the child seeking attention and control.
  6. Don't engage in an escalating argument that expands in demands. Maintain control of the situation, even if a temporary pause is needed for cooling off and then returning to calmly finish the conversation.
  7. Make your lesson objective and plan clear from the outset, breaking down structured activities into small steps that can be completed without too much, if any, help from adults in the room. By doing this, we are fostering independence in a way that is safe for the child.

Further Reading / Sources