10/15/17 Understanding Attachment and Reactive Attachment Disorder DAWN LIVORSI, DSW, LCSW Goals for today… u Participants will gain awareness of the importance of attachment in child development. u Participants will be able to identify various patterns of attachment. u Participants will be able to recognize symptoms of Reactive Attachment in children. 1
10/15/17 Attachment What is attachment? u Attachment is the enduring emotional bond to another person. u In the case of children, attachment typically refers to their connection to primary caregiver(s). u Evolutionary process u Children are born with an innate desire to connect to a caregiver. u Developing a relationship with a caregiver increases a child’s chance of survival. 2
10/15/17 John Bowlby u Child psychiatrist (1907-1990) u Believed that infants were born with a number of behaviors to which their caregivers were “programmed” to respond. u The more available and responsive the caregiver is, the more securely attached the infant will feel. u Attachment is more than feeding and basic care; it also involves an emotional bonding component. u An infant’s experience with attachment can have implications throughout the lifespan. Healthy attachment u “…the infant and young child should experience a warm, intimate, and continuous relationship with his mother (or permanent mother substitute) in which both find satisfaction and enjoyment.” Bowlby, “Maternal Care and Mental Health” (1951) 3
10/15/17 In order to help children securely attach, a caregiver should… u Be consistent u Be dependable and predictable u Be attuned to the child’s needs u Be willing to reflect the child’s emotional state u Be engaged u Become the “Secure base” Caregivers as “a secure base” 4
10/15/17 Components of a Secure Base Patterns of Attachment 5
10/15/17 Mary Ainsworth u Psychologist u Conducted a groundbreaking study in the 1970’s with children ages 12 -18 months. u Used her data from this study to categorize attachment into 3 major patterns – a forth pattern was added later by Main & Soloman (1986). u Believed that attachment patterns developed early in life persisted into adulthood. The Strange Situation 6
10/15/17 The Strange Situation u https://www.youtube.com/watch?v=QTsewNrHUHU&t=16s Patterns of Attachment 7
10/15/17 Secure Attachment u Children who are securely attached to the caregiver feel distressed when the caregiver leaves, happy when a caregiver returns, and are able to be comforted by the caregiver when scared or sad. u In general, secure children trust that their needs will be met. Accordingly, they feel capable of going into the world and exploring, knowing that their caregiver will be available to them if they need help. u Securely attached children tend to mature into securely attached adults who are able to maintain positive self esteem and healthy relationships with others. Ambivalent Attachment u The ambivalently attached child is distressed when the caregiver leaves but is unable to be comforted upon the caregivers’ return. The ambivalently attached child will continue to cry despite caregivers’ attempts to soothe. u The ambivalently attached child’s needs have been met inconsistently. The child is unsure whether they will be cared for or not- the caregiver behavior is unpredictable and confusing. This creates tremendous anxiety for the child. u Ambivalently attached children tend to mature into adults who are “Preoccupied”. They can demonstrate clingy, anxious behaviors as they worry about their needs going unmet. 8
10/15/17 Avoidant Attachment u The avoidantly attached child does not appear distressed when caregiver leaves and does not seek comfort from caregiver when the caregiver returns. In general, the avoidant child does not engage much with the caregiver. u The avoidant child tends to be disengaged and distant. Their needs have not been met by caregivers and they do not trust that others would be willing/able to meet needs either. u The avoidant child tends to mature into a “Dismissive” adult. Dismissive adults prefer to be alone and have difficulty building intimate relationships with others. Disorganized Attachment u The child who is disorganized in their attachment demonstrates no attachment behaviors. They are frequently dysregulated and have few strategies about how to receive comfort or aid from others. u Caregivers’ behaviors toward the disorganized child were likely erratic, abusive, and/or frightening. The caregiver may have responded to the child’s needs with anger, helplessness, and hostility. u The disorganized child may grow into an adult who experiences chaotic relationships with others. 9
10/15/17 Reactive Attachment Disorder Reactive Attachment Disorder u Reactive Attachment Disorder (RAD) is a condition in which a child is unable to develop healthy attachment and connection to parents or caregivers. u Onset for RAD typically begins in early childhood. u Risk factors for developing RAD include: u Prolonged separation from parents or caregivers u Living in an institution u Parents/Caregivers with mental health or substance abuse issues that impede responsive and attuned parenting u Frequent change of caregivers or foster homes 10
10/15/17 Signs and Symptoms u Unexplained withdrawal, fear, sadness or irritability u Sad and listless appearance u Not seeking comfort or showing no response when comfort is given u Failure to smile u Watching others closely but not engaging in social interaction u Failing to ask for support or assistance u Failure to reach out when picked up u No interest in playing peekaboo or other interactive games Diagnostic Criteria u A consistent pattern of emotionally withdrawn behavior toward caregivers, shown by rarely seeking or not responding to comfort when distressed u Persistent social and emotional problems that include minimal responsiveness to others, no positive response to interactions, or unexplained irritability, sadness or fearfulness during interactions with caregivers u Persistent lack of having emotional needs for comfort, stimulation and affection met by caregivers, or repeated changes of primary caregivers that limit opportunities to form stable attachments, or care in a setting that severely limits opportunities to form attachments (such as an institution) u No diagnosis of autism spectrum disorder 11
10/15/17 Treatment for RAD u Developing and maintaining a safe, consistent, and nurturing home for the child. u Individual counseling for child u Family counseling (if appropriate) u Education classes and training for parents and caregivers u Parenting skills classes (if appropriate)… It is important to remember that disrupted attachment is often generational. Parents often need to learn how to bond because they did not experience that in their families of origin. The Role of CASA 12
10/15/17 The Role of CASA You as a helper can help improve the child’s attachment experience by developing a healthy working relationship. Remember, the child will benefit from the following: u Consistency u Patience u Predictability u Dependability u Positive regard and support Strategies for engagement u Establish safe boundaries with child u Create a routine u Let the child move at their own pace u Warm, friendly, and approachable demeanor u Be sensitive to developmental issues and needs u Identify interests and build upon them u Respond to challenges in a calm and predictable manner u Know that small steps are actually big steps u Give the relationship time u Be aware of your limits and biases 13
10/15/17 Questions? Comments? References u Ainsworth, M. D. S. (1989). Attachments beyond infancy. American Psychologist, 44, 709-716. u American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. u Bowlby, J. (1951) Maternal care and mental health. World Health Organization. u Bowlby, J. (1959). Separation anxiety. International Journal of Psychoanalysts, XL1, 1-25. 14
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