Attachment disorder in children .. a danger that no one pays attention to

Sean, a 6-year-old child who was taken by his adoptive parents to seek treatment for him, the doctor tells on the “goodtherapy” website that Sean was loving and kind at first, but he was also impulsive, and had tantrums during which he appeared More aggressive, but the parents tried to ignore it, assuming that his behaviors would improve as he got used to a stable life.

Instead of the improvement the parents had assumed, things quickly deteriorated.

Sean's parents told the therapist that he was aggressive with his older siblings, hard to discipline, had a lot of trouble at school, wet the bed at night, and exploded for no reason and wouldn't let anyone comfort him.

The therapist was able to find the signs of attachment problems, which caused all these crises in the life of a child who was not yet six years old. (1)

What is meant by attachment disorders?

When describing the concept of attachment, developmental psychologist John Bowlby focused on the mother-infant bond.

Attachment, according to Bowlby, is not a one-time event, but a process that begins at birth and extends throughout the first years of life. (2)

A child's relationship with the primary caregiver during the first years of life, often the mother, can affect the way a child relates and relationships throughout life.

Babies generally develop healthy and secure attachments to mothers who respond efficiently and regularly to a child's needs, feeding him food when he cries, and seeking to meet his various needs, including, of course, the needs of feeling warmth, affection, and cuddling.

Secure attachment is also related to a person's later ability to trust and empathize, and when a child does not obtain this secure attachment early in life, he may not learn to trust, and may not be able to develop his ability to empathize and interact with others.

Developmental psychologist Mary Ainsworth has attempted to determine what unsafe attachment is with a test she calls "stranger mode", in which a mother leaves her child with researchers who monitor the child's reactions.

Children with a secure attachment showed a strong attachment to the mother, while children with an insecure attachment showed a variety of unusual and unhealthy reactions, including anger at the mother when she returned. (3)

Collectively, these symptoms are called Reactive Attachment Disorder (RAD) is a rare but serious condition that occurs when an infant or young child does not form healthy and safe bonds with their primary caregivers. These children rarely seek comfort from caregivers, and struggle to form relationships With others, they have difficulty managing their emotions. (4)

Reactive attachment disorder is a relatively new diagnosis (5), first introduced in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. The diagnostic criteria indicate that children with RAD—which develops in childhood—usually between 9 5 months and 5 years old - Not comfortable with caregivers (mother/father) when experiencing distress or fatigue, causing the child to withdraw from being with the caregiver and withdraw from the caregiver

For a child to be diagnosed with this disorder, the child must display a consistent pattern of frustrating and emotionally withdrawn behavior toward adult caregivers, such as aversion to them when feeling upset. (6) Besides, the child is irritable, sad, or afraid for no apparent reason.

Children with this condition may dislike physical affection, and may react violently when held, cuddled or comforted.

Behaviourally, children affected by this disorder are unpredictable and difficult to control or discipline.

These children's moods fluctuate intermittently, and most have a strong desire to control their environment and make decisions for themselves, have anger and control problems, and have difficulty showing emotion.

Also, sometimes, children with reactive attachment disorder have comorbidities. Research shows that children with attachment disorders also have higher rates of ADHD (8), anxiety disorders, and conduct disorders. (9)

According to the Diagnostic and Statistical Manual of Mental Disorders, reactive attachment disorder occurs at a rate of about 10% in groups of children who have been abused. The only known risk factor for this condition is severe social neglect during early childhood, but in most cases of neglect, reactive attachment disorder does not develop. If the care that the child receives improves after neglect. (7)

As for the prevalence of this disorder, given that reactive attachment disorder is a relatively new diagnosis, and many children who suffer from it, their parents do not turn to mental health professionals and children are not treated for it, it is difficult to determine the number of children who may meet the diagnostic criteria for the disorder.

But in 2010, a study in Denmark found that less than 0.4% of children had reactive attachment disorder. (10) A 2013 study estimated that 1.4% of children living in a poor area of ​​the UK had an attachment disorder (11)

long lasting effects

“I know no more than that I do not trust anyone, no matter how much someone fills his mouth that he loves me or that he will not leave me, I shake my head silently, but I am certain within myself that he is a liar, and that he will leave one day, this is the only certainty that guides me in my relationships.” This is how Mona S. began her conversation with Maidan.

Mona is a girl in her twenties, who grew up in an orphanage and then moved to a care home for girls. Mona says about the reason for reaching this conclusion: “I do not know my father or my mother, but I know very well Mrs. Manal, that woman who showered me with her love and warmth. I spent my first years in I hugged her, I thought she was my mother, to wake up one day to a surprise that woke me up from the illusion of her motherhood, the surprise was that she was going to get married and leave the house, she was in pain that I can’t describe, and she closed my heart a thousand doors after her, despite Mrs. Manal’s visits to me after her marriage, my feelings towards her did not It is never the same as before, her marriage and her departure taught me never to trust, never to love, because even now I remember the pain in my heart on the day she left and she is happy with her marriage.

Mona often deals aggressively with those around her, according to the observations of the supervisors who interact with her.

But this is consistent with estimates that children in foster homes, and those staying in orphanages, show significantly higher rates of reactive attachment disorder. (12)

The negative impact is not limited to the early stages of life, it seems.

Ineffective or insecure attachment early in life can lead to attachment problems later on and difficulty forming relationships throughout life, and poor attachment attachment can lead to disruptions in social and emotional development.

This is what the platform "goodtherapy" monitors through the case of Mai, a 32-year-old married woman with intimate problems.

Almost immediately after the honeymoon, her sex life with her husband began to deteriorate, and she admits that the problem is hers;

She is averse to sexual invitations from her husband, and is afraid that he will touch her in bed in any way.

May asserts that she is angry with him for no reason she can identify, and feels that she would like to live a “separate life” from him, but the thought of divorce terrifies her and she does not want it.

Mai can't explain her feelings, but an examination of her childhood revealed cases of extreme neglect that Mai thought she had outgrown.

Therapy reveals Mai's fears of rejection and being controlled or dominated by others. (1)

Like May, Hiba's crisis was the one who spoke to "Maidan", saying: "I have spent my life in the arms of my mother, yet I miss her very much. I was constantly haunted by dreams in my childhood that were repeated, and I still remember her until now. I dreamed that I would like to embrace my mother, and with Every step I approached her during the dream was taking a step away, to feel pain in my heart and wake up in terror,” this is how Heba.M, a woman in her thirties, began her conversation with “Maidan”.

Heba adds: "My mother was devoted to raising me, I am her only daughter, she was immersed in my education and upbringing, and providing a stable home for me after my father left us, and my mother never told me more than that he was a traveler, I knew that she did not want to say more so as not to hurt me. I knew she was more responsible than she could handle, she wanted to do everything right, but in all her preoccupation with me I missed her warm embrace, I know she loves me, she does everything that proves it, but she wasn't cuddling me. .

Heba sees that this affected her in her life by making her lack the feeling of love, wanting to get it at any cost, making her accuse herself of not worthy of love and will never get it.

Her complete blindness to love subjected her to an unequal and cruel marriage experience that ended in the family courts.

Causes of reactive attachment disorder

Reactive attachment disorder occurs because a child receives inadequate care during his early childhood years, which may occur in various forms, such as: changes in primary caregivers that limit a child's opportunity to form a stable and warm attachment to a specific person, or a persistent lack of emotional warmth The affection that the child receives from adults, or the child being raised in an unusual environment severely limits the child's opportunity to form secure attachments such as orphanages (7).

Generally, the reason that can be considered a major cause of this disorder is that the caregiver does not respond to the crying of the infant, or the child is not given adequate care and love, and he does not develop a healthy attachment.

This reason manifests in various forms that lead to an attachment disorder, such as: the child's mother is intermittently incarcerated, the child stays with different relatives while she is in prison, and the child does not stay in the same home long enough to form a strong relationship with any adult.

It also happens when the mother is depressed, so she struggles to take care of her baby, she can't respond to the baby when he cries, and she can't show him much affection.

This is also the case when the child is separated from his parents and entered into a nursing home, where he is taken in turns by multiple people who may look after him superficially and without affection, and he does not form secure relationships with any of the caregivers.

During the previous cases, and dozens of other cases and other examples, the main common factor is the constant disregard for the child's emotional or physical needs, and this lack of emotion plays a key role in the child's development of attachment disorder.

How to deal with attachment disorder?

Treating reactive attachment disorder is extremely important according to some research.

Without treatment, a child with reactive attachment disorder may have persistent social, emotional and behavioral problems.

Researchers estimate that 52% of juveniles in conflict with the law have an attachment disorder, and the vast majority of these adolescents have experienced abuse or neglect early in life. (13)

The sooner the child receives treatment, the fewer problems the child may have over time.

Usually the first step in treating a child with reactive attachment disorder is to ensure that the child is given a stable environment in which he or she can receive love and care. Treatment may include the child as well as the parent or primary caregiver. The caregiver is educated and aware of reactive attachment disorder, and given information On how to build trust and develop a healthy relationship with a child.

There are several ways, some very simple, in which primary caregivers can reduce a child's risk of reactive attachment disorder, including providing positive attention to the child, by playing with your child, reading to him, and cuddling, which helps in forming a loving relationship and building trust between you.

Simple daily activities, such as changing your baby's diaper and feeding him, are also good opportunities for bonding.

Besides, it's even more important to educate yourself about attachment disorder, especially if you're raising a child with a history of neglect or abuse or changing caregivers.

Because children with attachment disorder often experience multiple difficulties, medical treatment may be recommended for some co-existing conditions.

It often takes some time to notice improvement.

A parent to deal with an affected child needs to set clear boundaries, lots of patience, and set realistic expectations.

A child with reactive attachment disorder wants to control his environment, make his own decisions and rely on himself, so the caregiver must also be in control, by clarifying the limits of what is allowed and what is not allowed.

It should also be noted that warning this child in front of others is not a good strategy, as individual discussion will be more beneficial. (14)

Caring for a child with reactive attachment disorder is stressful.

If your child has this problem, you will start to feel very tired if you do not get regular breaks. Also, try to practice stress management skills, such as yoga or meditation, that may help you relax.

Gaps in attachment theory

Aside from reactive attachment disorder as an observed condition, there are some criticisms of John Bowlby's attachment theory.

The theory postulated that if an infant successfully bonded effectively with primary caregivers, they would be able to have secure, emotionally stable relationships largely throughout their life.

On the other hand, if he is not able to communicate or bond well, he is doomed to an unstable life and he is in dire need of treatment to avoid the negative effects of the disorder.

Bowlby's evidence for this theory is seen by some as weak and included a mixture of emphatic personal and cultural prejudices, including his own childhood, during which he was separated from his mother and taken in by a nanny, who resigned when he was only four years old. (15)

“Social class, temperament, and culture are more accurate predictors of future outcomes,” says psychologist Dr. Jerome Kagan, professor emeritus at Harvard University, and a leading critic of attachment theory. And crime, the environment has a more important role to play than any combination of genes or a child’s experience.” (16) Research has shown that social and economic factors have a strong influence on development, and that the strongest predictor of depression or adult anxiety in many cultures is growing up in a class socially disadvantaged.

(17)

Classified by the American Psychological Association as the 22nd preeminent psychologist of the twentieth century, Kagan argues that in 10-15 years, attachment theory will be just an out-of-date history. It will take this time to get rid of the theory because correction happens very slowly.

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