What is attachment, learning to attach, attachment disorder, RAD?
[font=Comic Sans MS]OK, the recent post about RAD got me digging out my basics of attachment and AD and RAD...I am going to go thru my links and find things I can post to help explain...it may take me a while so if you see this is updated, double check it...I may have added more. [/font]

[font=Comic Sans MS]At least since Freud we have recognized that the infant-mother relationship is pivotal to the child's emerging personality. Freud (1940) said that for the baby, his mother is "unique, without parallel, laid down unalterably for a whole lifetime, as the first and strongest love object and as the prototype of all later love relations for both sexes." More recently, Greenspan (1997), Schore (1994), and Siegel (1999) have written convincingly about the ways that the early care giving relationship influences the child's developing cognitive ability, shapes her capacity to modulate affect, teaches her to empathize withthe feelings of others, and even determines the shape and functioning of her brain. The attachment and care giving systems are at the heart of that crucial first relationship. John Bowlby (1969/1982; 1973; 1980) described the attachment and care giving systems in biological and evolutionary terms stating that, across species, the attachment system was as important to species survival as were feeding and reproduction. At the heart of the attachment and care giving systems is the protection of a younger, weaker member of the species by a stronger one. The infant's repertoire of attachment behaviors are matched by a reciprocal set of care giving behaviors in the mother. As the mother responds to the infant's bids for protection and security, a strong affectional bond develops between the two that forms the template for the baby's subsequent relationships. Attachment behaviors change as the child develops. A young baby who is tired, frightened, hungry, or lonely will show signaling and proximity seeking behaviors designed to bring his caregiver to him and keep her close. The baby may cry, reach out, or cling to his mother. Later when he is more mobile, he may actively approach her, follow her, or climb into her lap. A toddler may use his mother as a secure base, leaving her briefly to explore his world, and then reestablishing a sense of security by making contact with her by catching her eye, calling out to her and hearing her voice, or physically returning to her (Lieberman, 1993). By the time a child is four years old, she is typically less distressed by lack of proximity from her mother, particularly if they have negotiated or agreed upon a shared plan regarding the separation and reunion before the mother leaves (Marvin & Greenberg, 1982). These older children have less need for physical proximity with their mothers, and are better able to maintain a sense of felt security by relying upon their mentalimage of their mothers and upon the comforting presence of friends and other adults. [/font]

[font=Comic Sans MS]Bowlby (1969/1982) referred to attachment bonds as a specific type of a larger class of bonds that he and Ainsworth (1989) described as "affectional" bonds. Ainsworth (1989) established five criteria for affectional bonds between individuals, and a sixth criteria for attachment bonds. First, an affectional bond is persistent, not transitory. Second, it involves a particular person who is not interchangeable with anyone else. Third, it involves a relationship that is emotionally significant. Fourth, an individual wishes to maintain proximity or contact with the person with whom he or she has an affectional tie. Fifth, he feels sadness or distress at involuntary separation from the person. A true attachment bond, however, has an additional criteria: the person seeks security and comfort in the relationship. [/font]

[font=Comic Sans MS]It is important to note that an infant does not have only one attachment relationship. Bowlby (1969/1982) posited that babies routinely form multiple attachment relationships, arranged hierarchically, although they most likely have a single preferred attachment figure to whom they will turn in times of distress if she is available. As the baby develops, however, he will form multiple attachment bonds and an even greater number of affectional bonds. And the need for attachment bonds does not end with infancy. Across the lifespan, we all experience times when we feel weak, ill, or vulnerable and turn to a loved person for support and comfort. This turning, we will see, is the echo of our infant attachments, and our expectations of what will happen when we turn to another are also built in infancy. [/font]

[font=Comic Sans MS]Patterns of Attachment [/font]
[font=Comic Sans MS]The quality of the child's attachment to his mother is determined by the way the mother responds to her child's bids for attention, help, and protection. As Ainsworth (1989) pointed out, the defining characteristic of an attachment bond is that it is marked by one person seeking a sense of security from the other. If the seeker is successful, and a sense of security is attained, the attachment bond will be a secure one. If the seeker does not achieve a sense of security in the relationship, then the bond is insecure. [/font]

[font=Comic Sans MS]Ainsworth and her colleagues (1978) established the most widely used research method for assessing quality of attachment: a laboratory procedure known as the Strange Situation which involves two brief separations from mother in which the baby is left with a stranger. The baby's behavior on reunion following these separations forms the basis for classifying her quality of attachment. Ainsworth (1978) described three basic patterns of attachment: securely attached, avoidant, and resistant. [/font]

[font=Comic Sans MS]Babies described as securely attached actively seek out contact with their mothers. They may or may not protest when she leaves the laboratory, but when she returns they approach her and maintain contact. If distressed, they are more easily comforted by their mothers than by the stranger, demonstrating a clear preference for their mothers. They show very little tendency to resist contact with their mothers and may, on reunion, resist being released by her. [/font]

[font=Comic Sans MS]Babies who are classified as avoidant in the Strange Situation demonstrate a clear avoidance of contact with the mother. They may turn away from her or refuse eye contact with her. They may ignore her when she returns after the separation. Some avoidant babies seem to prefer the stranger and appear to be more readily comforted by the stranger when they are distressed. [/font]

[font=Comic Sans MS]The third group, resistant babies, may initially seek contact with their mothers on reunion, but then push her away or turn away from her. They demonstrate no particular preference for the stranger, but on the contrary appear angry toward both their mother and the stranger. [/font]

[font=Comic Sans MS]Later, Main and Solomon (1990) described a fourth pattern of attachment behavior: disorganized/disoriented behavior. These babies seem to have no clear strategy for responding to their caregivers. They may at times avoid or resist her approaches to them. They may also seem confused or frightened by her, or freeze or still their movements when she approaches them. Main and Hesse (1990) have hypothesized that disorganized infant attachment behavior arises when the baby regards the attachment figure herself as frightening. Studies have demonstrated a higher incidence of disorganized/disoriented attachment patterns in infants whose mothers report high levels of intimate partner violence (Steiner, Zeanah, Stuber, Ash, & Angell, 1994) and in infants who were maltreated (LyonsRuth, Connell, Zoll, & Stahl, J., 1987). The babies of mothers who abuse alcohol have been shown to have higher incidence of disorganized/disoriented attachment behavior (Lyons-Ruth & Jacobivitz, 1999).[/font]

[font=Comic Sans MS]Even though some studies indicate that insecure attachment styles can lead to emotional and behavioral difficulties, it is important to keep in mind that insecure attachment styles are not mental disorders. They are strategies for protection seeking that occur in the normative population. Lieberman and Zeanah (1995) propose three separate categories of attachment disorders: (1) disorders of non‑attachment, (2) disordered attachments, and (3) disrupted attachment disorder: bereavement/ grief reaction. This article will discuss only the first two categories. [/font]

[font=Comic Sans MS]Disorders of Non-Attachment [/font]
[font=Comic Sans MS]The disorders of non-attachment closely parallel the description of reactive attachment disorder that appears in the DSM-IV (APA, 1994). These disorders most frequently appear in children who have not had the opportunity to attach to a single caregiver, and they are of two major types, the first involving emotional withdrawal and the second, emotional promiscuity or indiscriminate behavior.[/font]

[font=Comic Sans MS]Example of non-attachment with emotional withdrawal [/font]

[font=Comic Sans MS]Ivan was born to a young mother overwhelmed by the demands of poverty. Ivan's active 19‑month‑old brother, and her violent relationship with her children's father, who lived with her sporadically when he was not in jail. Ivan's mother, who reported a lonely childhood in which she sat alone in her apartment many hours each day waiting for her mother to return from work, coped with her negative feelings by drinking heavily. She was ambivalent about her pregnancy with Ivan and abused alcohol throughout. Ivan was born several weeks premature and small for his gestational age. [/font]

[font=Comic Sans MS]Example of disorganized/disoriented attachment behavior [/font]
[font=Comic Sans MS]Jill was 30 months old when she was removed from her parents' home because of their pervasive neglect of her. Both of her parents were heavy drinkers. They fought with each other, sometimes with knives as weapons, and they had been observed to punish Jill for small infractions by biting her. Jill did not see her parents for the first ten days that she was in foster care, and then was reunited with them for a visit in our clinic playroom. When they came into the room, Jill did not respond to them and seemed not to see them or anyone. She sat frozen in her chair. She did not explore the room or [/font][font=Comic Sans MS]play [/font][font=Comic Sans MS]with any of the toys. When her mother offered her a toy or food, Jill sometimes seemed to be looking at her without seeing her, and sometimes turned away. When either of her parents spoke, Jill startled visibly, pulled at her hair, and shouted, "What?" in an alarmed tone. Other than that she spoke no words during the two hour visit. When the therapist said that it was time to leave, however, she fell screaming to the floor, refused to put on her coat, grabbed for her mother and clung to her as she tried to walk away. She remained inconsolable for nearly 20 minutes after her parents left the visiting room. [/font]

[font=Comic Sans MS]Internal Working Models and the Role of Attachment in Normative Development [/font]
[font=Comic Sans MS]Bowlby [/font][font=Comic Sans MS](1969/1982) believed that as the baby or child experienced his caregiver's responses to his bids for help and protection, he developed mental/emotional templates called internal working models of himself and what he could expect in his relationships with other people. A baby whose mother responds quickly and sensitively to his cries comes to see himself as worthy of attention and help. He comes to anticipate that other people in his life will respond to him positively when he needs something. He gains a sense of efficacy and agency: a belief that he can make things happen. On the other hand, a baby whose mother does not respond to his bids constructs an internal working model of himself as unworthy and other people as unresponsive or, perhaps, as dangerous. The avoidant, resistant, and disorganized styles of attachment described above are in response to inconsistent or insensitive caregiver responses to the baby's bids. [/font]

[font=Comic Sans MS]The literature suggests that the internal working models of attachment that are formed in infancy and early childhood form the templates for a variety of relationships, not only attachment relationships. Preschool children with secure attachment histories have been shown to be more self‑confident and less dependent with their teachers than insecurely attached children (Sroufe, 1983). The same children, at age ten, were less dependent on summer‑camp counselors than were children with insecure attachment histories (Urban, Carlson, Egeland, & Sroufe, 1991). Warmer and his colleagues (1994) also found that securely attached six year olds were more competent in play and conflict resolution with peers than were insecurely attached children. Other researchers have found that these increased competencies extended into later childhood (Grossmann & Grossmann, 1991) and adolescence (Weinfield, Sroufe, Egeland, & Carlson, 1999). [/font]

[font=Comic Sans MS]Further, insecurely attached babies have grown into children with problems in some areas of functioning. Cohn (1990) and Turner (1991) found that insecurelyattached boys were more aggressive than securely attached ones at four and six years of age, respectively; and Turner (1991) found that insecurely attached girls were more dependent and less assertive than securely attached girls. Although other findings of increased aggression, particularly among avoidantly attached children, have been reported, many studies have failed to replicate them. and one must be cautious in suggesting that insecure infant attachment leads to any particular psychopathology. Recent studies have also noted that other factors besides inconsistent or insensitive maternal care giving contribute to attachment insecurity. Some authors now suggest‑that an interaction of child characteristics.. (such as a difficult or "slow to warm" temperament), insensitive care giving (including factors such as child maltreatment, maternal depression and maternal substance abuse), and high levels of family adversity and stress interact to result in insecure attachment (Greenberg, 1999).[/font]

[font=Comic Sans MS]Disorders of Attachment [/font]
[font=Comic Sans MS]He lagged behind in his development and from time to time during his first year of life slipped from his growth curve. He spent the year moving between the homes of his mother, his maternal grandmother, and a maternal aunt. When he was first seen in the clinic he was 17 months old. He could sit and crawl but could not walk and he had no language. He did not respond when his mother spoke or approached him; nor did he respond when the therapist approached him. He would sit quietly for up to an hour on a sofa without toys or anything else to entertain him. [/font]

[font=Comic Sans MS]Ivan appeared withdrawn from contact not only with his mother but also from the world. He did not seek stimulation from people or objects in his environment, and he seemed to have given up on asking for anything. It took extraordinary effort, over several weeks, for the therapist to begin to engage him so that he would make consistent eye contact, accept a toy from her or respond by vocalizing and smiling to her emotional expressiveness. Even then, his mother remained ambivalent about Ivan's development. She wanted him to walk so that she would not have to carry him everywhere, but she dreaded the loss of her "easy" baby, who placed so few demands on her. It was difficult for her to understand the importance of talking to Ivan or playing with him, and she seemed unable to follow the therapist's lead in trying to engage her son. [/font]

[font=Comic Sans MS]Example of non-attachment with indiscriminate behavior [/font]
[font=Comic Sans MS]Susan was 15 months old when she came to live with her paternal aunt and grandmother. Until then, she had been in the care of her crack‑cocaine addicted mother and had lived with her in a variety of crack houses and, sometimes, on the y street. Her mother also had left Susan sporadically with relatives, sometimes telling them that she would be back in several hours and then not returning to retrieve her daughter for days or weeks. When Susan's mother learned of her own HIV status, she left Susan with her aunt and grandmother, saying that she could no longer care for her. Susan was weak, dirty and malnourished, unable even to sit up. A physical exam disclosed that she had been raped. When she was first seen in the clinic, Susan had been with her grandmother and aunt for three months. She had regained her physical strength and was able to stand and walk. but emotionally she remained devastated. She clung to both her aunt and her grandmother, screaming if they left the room and waking up in terror several times each night to make sure that they were still there. She hugged strangers in line at the bank, and when her uncles came to visit, she crawled into their laps, embraced them, and tried to remove her clothing. She approached the therapist in the very first session, clung to her knees, and sat on her lap. At the end of the hour, she sobbed when the therapist got up to leave, and could not be comforted even by her grandmother. It took many months of sensitive care for Susan to begin to develop a preference for her grandmother and to reliably turn to her for comfort. [/font]

[font=Comic Sans MS]Disordered Attachment [/font]
[font=Comic Sans MS]Lieberman and Zeanah (1995) make the important point that a child does not have to be non‑attached to have disorders of attachment. This is a major step forward that they have made in diagnosing relational problems in infancy that put a baby at developmental risk. As they point out, the principal difference between a disorder of non‑attachment and a disordered attachment is that in the latter, the child does express a preference for a particular attachment figure. The preference, however, is unlike normative attachment patterns (even insecure ones) in that it is characterized by intense conflict that pervades the relationship because of intense negative feelings such as anger, fear or anxiety. The child does not express these emotions directly, but masks them with defenses that interfere with the heart of his attachment relationship. Such a child may appear to be extremely inhibited, may engage in self‑endangering behavior, or may reverse roles and offer emotional relief to the attachment figure to whom she would more appropriately turn for comfort and safety herself.
[font=Comic Sans MS]The rest of that article..[/font]

[font=Comic Sans MS]Treatment of Attachment Disorders [/font]

[font=Comic Sans MS]There are several models for treating attachment disorders. Some of them have sprung up in response to an increase in numbers of children in foster care and children adopted from institutions in the Eastern European block countries. Children from these backgrounds often present as non-attached to any particular caregiver. Keck and Kupecky (1995) use cradling in their work with poorly attached children and adolescents. Cradling is a technique in which the child is physically held on the lap of parent(s). The cradling is intended to provide physical containment, which can be reassuring if frightening feelings are aroused. Hughes (1997) describes a treatment method for working with nonattached children that encourages the caregiver to treat the child in a manner consistent with the child's developmental age, keeping the child under the constant close supervision of the caregiver. [/font]

[font=Comic Sans MS]Dyadic Developmental Psychotherapy has been shown to be an effective treatment method for the treatment of children and teenagers with trauma-attachment disorders. [/font][font=Comic Sans MS]Another treatment method that has been tested and empirically demonstrated to facilitate secure attachment is infant-parent psychotherapy, originally described by Selma Fraiberg and her colleagues (1975). In infant-parent psychotherapy, as it was first conceived, the focus of the treatment was on the parent's emotional conflicts as they affect the infant. Fraiberg believed that a parent's emotional difficulties, originating in conflicted relationship histories, mental illness, family disruption, socio‑economic hardship, or a combination of these factors, could interfere with adequate physical and emotional care giving and lead to a disturbed relationship between mother and baby. More recently, infant‑parent psychotherapy has incorporated the understanding that infant constitutional vulnerabilities, and poorness of fit between the infants' characteristics and needs and the parents' care giving style, may also disrupt the parent‑child relationship. Infant‑parent psychotherapy now focuses on these factors as well as on the parents' emotional liabilities (Lieberman & Pawl, 1988). [/font]

[font=Comic Sans MS]In two empirical studies, Lieberman and her colleagues (Fraiberg, Lieberman, Pekarsky & Pawl, 1981; Lieberman, Weston, & Pawl, 1991) have demonstrated that infant-parent psychotherapy can affect changes in the quality of infant-parent attachment, converting insecure attachments to secure ones. This therapy, which combines non‑didactic developmental guidance, help with problems in living, and the psychodynamic exploration of the infant-parent relationship and the parents' relationship history, can help repair anxious relationships and improve the baby's chances for the most favorable developmental outcomes. The case of Lily and her parents illustrates how infant‑parent psychotherapy can facilitate the development of secure attachments in families where there are multiple risk factors in the parents' histories and present lives. [/font]
[font=Comic Sans MS]Example of infant parent psychotherapy used with a drug-addicted mother [/font]
[font=Comic Sans MS]Karen was separated from her daughter, Lily, at birth because Karen had sought no prenatal care, she and Lily both tested positive for several substances (including heroin and methadone), and she had no stable home. Lily was placed in a group home where she was cared for by nurses and aides, including one nurse who was assigned to be her particular caregiver. Karen engaged in a day treatment program and visited Lily several times a week. Karen and her frequent comings and goings were confusing to Lily. The staff at the home noted that Lily cried frantically whenever Karen left her, but that when Karen was with her Lily was sometimes clingy and sometimes pushed her away or ignored her overtures. [/font]

[font=Comic Sans MS]When Lily was ten months old, Karen was admitted to a clean and sober house for mothers and young children, and Lily was transitioned to her care. The referral for infant‑parent psychotherapy was made to facilitate the transition and to support Karen in undertaking the fulltime care of her daughter. Karen was thrilled to have Lily with her every day, but told the therapist that she could not understand Lily. Lily cried, refused to sleep in her own bed at night, and turned away from Karen when Karen tried to comfort her. Karen was deeply hurt that Lily did not share her joy at their reunion and said, "Lily just doesn't love me. She wants to hurt me to get back at me for leaving her alone. " Over time, the therapist helped Karen to see how difficult the transition from the group home to her care might have been for Lily. Although the group home had been imperfect, it had been Lily's home and filled with familiar figures. The therapist asked Karen about her own responses when she lost people who had been close to her. When Karen began to understand that Lily's behavior might be motivated by grief rather than vengeance, she was able to find ways to comfort Lily. [/font]

[font=Comic Sans MS]The therapist observed that in her eagerness to care for Lily, Karen was often intrusive. Rather than responding to Lily's bids for attention, Karen pressed her affection on Lily in ways that made Lily angry. Karen would then feel rejected and pull away. The therapist helped Karen focus on times when Lily turned to . her, and supported her response to Lily at those times. The therapist could then point out the pleasure that Lily took in Karen's attention. The therapist also supported Karen by giving her a place to talk about her hurt and frustration that Lily did not always want her affection when she wanted to give it. With this support, Karen became less intrusive, more aware of Lily's bids, and more consistent in responding to them. As Lily grew more confident that her mother would respond when she expressed her need she turned to her mother more frequently and their interaction became more spontaneous and joyful. Within several months, Lily consistently turned to her mother when she needed help, and no longer pushed Karen away when Karen spontaneously offered her affection. her affection on Lily in ways that made Lily angry. Karen would then feel rejected and pull away. The therapist helped Karen focus on times when Lily turned to . her, and supported her response to Lily at those times. The therapist could then point out the pleasure that Lily took in Karen's attention. The therapist also supported Karen by giving her a place to talk about her hurt and frustration that Lily did not always want her affection when she wanted to give it. With this support, Karen became less intrusive, more aware of Lily's bids, and more consistent in responding to them. As Lily grew more confident that her mother would respond when she expressed her need she turned to her mother more frequently and their interaction became more spontaneous and joyful. Within several months, Lily consistently turned to her mother when she needed help, and no longer pushed Karen away when Karen spontaneously offered her affection. [/font]

[font=Comic Sans MS]SUMMARY [/font]
[font=Comic Sans MS]Attachment, an affectional relationship between mother and baby and, later, between other caregivers and baby, is central to the personality development of every infant. Secure attachment can be derailed in many ways. Economic and social stresses, mental illness, substance abuse, and the constitutional vulnerabilities of the child can all act to place difficulties in the path of the relationship between a baby and her mother. These relationships can, however, be healed and the baby returned to a hopeful developmental path.[/font]

[font=Monotype Corsiva]Notes on Attachment[/font][font=Arial]

[font=Arial]by Arthur Becker-Weidman, Ph.D. [/font][/font]

[font=Arial][font=Comic Sans MS]A high percentage of the children that I see are foster or adopted children who have lived in one or more foster homes and have suffered from neglect and/or abuse. Often the children come with a diagnosis of Oppositional Defiant Disorder [ODD] or Conduct Disorder [CD]. Many have a secondary diagnosis of Attention-Deficit Hyperactivity Disorder (ADHD). The child's symptoms could also be understood as a Post Traumatic Stress Disorder or depression stemming from a delayed grief reaction in response to one or more significant losses early in childhood. Whatever the diagnosis is, it is important that the developmental history receives the consideration required to provide the appropriate treatment.[/font][/font][font=Comic Sans MS]

[/font][font=Arial][font=Comic Sans MS]Because attachment is developed in the first years of life, often times the trauma driving the child's pathology is preverbal. The child needs a solid educational component of treatment for the child to understand what force is driving the feelings and controlling the child's behavior. The parents also need the education and understanding that the child's behavior is not caused from their parenting, but from past traumas. From this base then, new parenting interventions can be designed from a cooperative relationship to fit a child with special needs.[/font][/font][font=Arial][font=Comic Sans MS]

[/font][/font][font=Arial][font=Comic Sans MS]Attachment is the base upon which emotional health, social relationships, and one's world view are built. The ability to trust and form reciprocal relationships will affect the emotional health, security and safety of the child, as well as the child's development and future interpersonal relationships. The attachment-disordered child does whatever she feels like, with no regard for others. She is unable to feel remorse for wrongdoing, mainly because she is unable to internalize right and wrong. This child may be savvy enough to speak knowledgeably about standards and values, but cannot truly understand or believe what she is saying. The child may tell you that something is wrong, but that will not stop her from doing it.[/font][/font][font=Arial][font=Comic Sans MS]

[/font][font=Arial][font=Comic Sans MS]Children who are adopted after the age of 6 months or so are at risk for attachment problems. Normal attachment develops during the child's first two years of life. Problems with the parent-child relationship during that time, or breaks in the consistent caregiver-child relationship, prevent attachment from developing normally. There is a wide range of attachment problems that result in varying degrees of emotional disturbance in the child. The severity of attachment disorder seems to result from the number of breaks in the bonding cycle and the extent of the child's emotional vulnerability.[/font][/font][font=Comic Sans MS]

[/font][font=Arial][font=Comic Sans MS]Emotional vulnerability can be affected by a variety of factors including: genetic factors; prenatal development including maternal drinking and drug abuse; pre-natal nutrition and stress; Fetal Alcohol Syndrome and Fetal Alcohol Effect; temperament; and birth parent history of mental illness (schizophrenia, manic depressive illness, etc.). One thing is certain: if an infant's needs are not met consistently in a loving, nurturing way, attachment will not occur normally.[/font][/font][font=Comic Sans MS]

[/font][font=Arial][font=Comic Sans MS]So how can we tell the difference between a child who "looks" attached, and a child who really is making a healthy, secure attachment? This question becomes important for adoptive families, because some adopted children will form an almost immediate dependency bond to their adoptive parents. To mistake this as secure and healthy attachment can lead to many problems down the road. Just because a child calls someone "Mom" or "Dad," snuggles, cuddles, and says "I love you," does not mean that the child is attached, or even attaching. Saying, "I love you," and knowing what that really feels like can be two different things. Attachment is a process. It takes time. The key to its formation is trust, and trust becomes secure only after repeated testing.[/font][/font][/font]

[font=Arial][font=Comic Sans MS]Normal attachment takes a couple of years of cycling through mutually positive interactions. The child learns that he is loved, and can love in return. The parents give love, and learn that the child loves them. The child learns to trust that his needs will be met in a consistent and nurturing manner, and that the he "belongs" to his family, and they to him. Positive interaction. Trust. Claiming. Reciprocity (the mutual meeting of needs, give and take). These must be consistently present for an extended period of time for healthy, secure attachment to take place. It is through these elements that a child learns how to love and how to accept love.[/font][/font][font=Comic Sans MS]

[/font][font=Arial][font=Comic Sans MS]Older adopted children need time to make adjustments to their new surroundings. They need to become familiar with their caregivers, friends, relatives, neighbors, teachers and others with whom they will have repeated contact. They need to learn the ins and outs of their new household routines and adapt to living in a new physical environment. Some children have cultural or language hurdles to overcome. Until most of these tasks have been accomplished, they may not be able to relax enough to allow the work of attachment to begin. In the meantime, behavioral problems related to insecurity and lack of attachment, as well as to other events in the child's past, may start to surface. Some start to get labels like, "manipulative," "superficial," or "sneaky." Sooner or later the family may decide that this kid is all "take" and no "give." The child "gives" only when it is to his own benefit. The child can seem to be very selfish and controlling. On the inside, she is filled with anxiety. She has not developed the self-esteem that comes with feeling she's a valued, contributing member of a family. The child cares little about pleasing others, since her relationship with them is quite superficial.[/font][/font]

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[/font][font=Arial][font=Comic Sans MS]FIRST YEAR OF LIFE CYCLE[/font][/font][font=Comic Sans MS]
[/font][font=Arial][font=Comic Sans MS]by Arthur Becker-Weidman, Ph.D. [/font][/font]

[font=Comic Sans MS]
[/font][font=Arial][font=Comic Sans MS]The first year is a year of needs. When the infant has a need, it initiates attachment behavior in order to summon a nurturing response from the attachment figure. The need-gratifying response usually includes touch, eye contact, movement, smiles and lactose. When gratification occurs, trust is built. This cycle occurs hundreds of times a week and thousands of times in the first year. From this relationship, a synchronicity develops between parent and child. The caregiver develops a greater awareness of the child and learns just how to respond. The child develops good cause-and-effect thinking, feels powerful, trusts others, shows exploratory behavior and develops empathy and a conscience.[/font][/font][font=Comic Sans MS]

[/font][font=Arial][font=Comic Sans MS]Parenting children with attachment difficulties is a job that requires a great deal of patience, understanding, courage, solid support systems and personal fortitude. Children with attachment difficulties rarely and only superficially return love. Therapists, teachers, child protective services and even spouses often do not understand the challenge and deception an attachment-disordered child displays toward an adoptive or foster parent in charge of primary care. Often times the child will project the greatest amount of pathology towards the mother figure in an attempt to make the world believe that if the mother was not so harsh and controlling, the child would be as lovable as he superficially displays.[/font][/font][font=Arial][font=Comic Sans MS]

[/font][/font][font=Arial][font=Comic Sans MS]Therapists often times are introduced to attachment disorder cases by witnessing a burned-out parent in their office who is angry, resentful and full of blame toward their child. The child, however, is engaging, full of energy, innocent and displaying confusion at the parent's anger. Unfortunately, the therapist reacts by thinking (and sometimes saying), "If this mom would just lighten up on this kid, she would not have so many problems." This can lead the therapist to scolding the parent much in the same way the parent scolds the child. Many well-intentioned but naive healthcare workers believe that, "All this kid needs is love," and end up creating an alliance with the child against the parents that further prevents the family getting the help they desperately need. [/font][/font][font=Arial][font=Comic Sans MS]

[/font][font=Arial][font=Comic Sans MS]TREATMENT[/font][/font][/font]

[font=Comic Sans MS]The basic purpose of attachment therapy is to help the child resolve a dysfunctional attachment. The goal is to help the child bond to the parents and to resolve the fear of loving and being loved.[/font][font=Comic Sans MS]

[/font][font=Arial][font=Comic Sans MS]A major dynamic in the treatment is the affective regressive work needed to heal the emotional wounds that drive these children's behavior. Therapeutic holding allows the child to access deep, genuine, and intense emotions needed to work through the feelings, not simply get over them. A corrective emotional experience is orchestrated when allowing the child to express these feelings, recognize and recall them, and identify the events and the people involved. In essence, the child going through this experience with their parents allows for resolution of old pathological emotions while simultaneously creating powerful new bonds.[/font][/font]

[font=Comic Sans MS]Here's some more....[/font]
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What is Attachment? What Causes Attachment Issues? First Year Bonding Cycle

During the first year of life, baby's focus is on one goal: getting his needs met. The bonding cycle begins in utero and continues during infancy when the child experiences unpleasant sensations such as hunger, pain, discomfort, or tiredness. He expresses this feeling by whimpering, crying or raging. When his diaper is changed or he is given a bottle, the need is met, leading him to feel satisfied, creating a sense of trust. During the first year of life, this cycle of discomfort-need-gratification-trust, is created over and over again in a dance between mother and baby. Through this process the child understands that he is safe and loved.

The cycle is disrupted by separation from the birth mother. The situation can be compounded by additional disruptions including hospitalization, foster care, or institutionalization. When the child's needs are not met or the caregivers are inconsistent, the child learns that the world is not safe. He believes that in order to survive, he must take care of himself, controlling everyone and everything in his little world.

We One

This is not a typographical error, but a pun. When a child is born, his emotional perceptions are entirely based on the experience of being in the uterus. Consequently, he perceives that he and the mother are one and the same. (In this discussion 'mother' refers specifically to the biological mother who carried the child in utero.) Even thought the baby now exists physically independent from the mother, its experiences have not yet caught up. The relationship of mother and baby is one of identity. Newborn babies are dependent on their mothers for regulating both their physical and emotional stasis. Proximity to the mother regulates the baby's respiration and heart rates. The baby is dependent on the mother to regulate its emotions as well. At this time in the baby's development, he has not yet fully developed the perceptual, expressive, or autonomic functions that would allow him to begin to evaluate his surroundings, act on that information and regulate his own body accordingly. For now, the baby still experiences the world through the mother. Therefore, her emotions are his emotions.

This deeply intimate relationship, in which the baby is not yet aware that he and the mother do not share the same identity, forms the foundation for the child's future relationship to the world and others in it. If the mother is contended, the baby will experience the world as a receptive and welcoming place to be. If the mother is anxious, depressed, or fearful, the baby will conversely view the world as hostile and threatening. The neurochemical responses of the mother to her environment and experiences are echoed in the developing central nervous system of the baby.

Thee and I

As the baby grows, and his neurological functions become more well developed, so too do his emotional functions develop. At about two months of age, as the baby enters the pons stage of development, one of the first steps on the path of his emotional development is the "discovery" that he and the mother are not identical. It is important to note that this "discovery" is not conscious in the same sense that adults experience new realizations. Rather, as the baby's perceptual awareness increases, its personal awareness also increases, providing the knowledge that his experiences are not at all times the same as the mother's; therefore, he and the mother are not the same.

This discovery at first brings with it a great deal of anxiety for the baby. This anxiety is based on a rather basic experience that most of us can relate to in our current lives. That is, we all have an intuitive, if false, sense that we have personal control over what happens to us ("I am the master of my fate, I am the captain of my soul"). In the same way, a newborn baby has a sense of being in control of the baby/mother entity. Upon realizing that he and the mother are not identical, the baby must also realize (again, not consciously) that he does not have control over the mother. Yet he still depends on her for his survival; without her, he will die.

Fortunately, mothers are well equipped to deal with his crisis of anxiety. In responding to the baby's cries and providing food, nurturing, and tenderness, the mother reassures the baby. (The reader should note that this article addresses normal emotional development; the article that follows will introduce issues that arise when the baby is separated from the birth mother.) The mother and baby now form what is to be the baby's first "relationship" with another. This will be the basis or model for all of the baby's future relationships.

Recall that the pons is the part of our brain that is largely concerned with life preservation functions. While the pons is developing, the baby experiences a world of extremes and absolutes (hungry/not hungry, cold/not cold, hurt/not hurt.) The baby's relationship with the mother at this stage is also one of absolutes, and primarily for the purpose of life preservation. Mother is present or not present. If she is not present, in fact, the baby will die. Through fulfilling her "life and death contract" with the baby the mother allows the baby to develop the function of trust. If she does not fulfill this "contract" the baby will have no neurological or emotional basis on which to form any other trusting relationship. Fulfillment of this "contract" includes tender nurturing, as well as providing basics of food, clothing, and shelter.

We Are Family

Just like the song that says, "We are family," we do not live out our lives in a single relationship with our mother. When a baby reaches about six months of age, and begins to develop at the midbrain level, his emotional development reaches a new level of complexity. The child's perceptual functions become sophisticated enough to discern nuances in his environment; he becomes increasingly aware of siblings and other adults in the household. At this point the child begins to implement the give-and-take of this first relationship with others besides the mother.

The basic element of baby's first relationship, mutually supportive interaction, is the core of all the new relationships that the child forms. Now, however, instead of being based on life and death, relationships with siblings, the father, and other members of the household now can be based on subtler issues. At the midbrain stage of development, children are exploring details in their environment, such as sights, sounds, and tactile sensations. Awareness of these details allows us to interpret such non-verbal expressions of communication as facial expression, body language and tone of voice. These are important means of expressing and understanding emotion. With these new tools, the child now has the ability to explore relationships based on satisfaction and displeasure, rather than life and death.

With siblings, the child begins engaging in common activities and play that utilize and practice more complex emotional relationships. When the child experiences the play as rewarding or pleasant his brain produces dopamine, a neurochemical that interacts with pleasure centers in the brain. If the child does not experience play or a common activity as pleasant, dopamine is not produced. Both the production of dopamine and many of the dopamine receptors are located in the midbrain.

It is at this stage that children practice both receptive and expressive communication skills that they will employ in future relationships later in life. The child learns to read the facial expressions, not only of mother, but of others in the household. In relationship to the mother, the child now learns that an expression of displeasure from her does not necessarily mean death. The child learns to express feelings more complex than "I'm hungry" or "I'm cold." Now he can giggle to show amusement or frown to show sadness.

In the still very sheltered and relatively safe environment of the family, the child has an opportunity to observe how different people express similar emotions, and to observe the effect of his own expressions on different people. Through this process, the child develops a spectrum of experiences or scale against which he can evaluate future interactions with others with whom he is not already familiar.

The family is the testing ground in which the child develops his skill at reading and expressing emotion. The development of function at the midbrain level equips the child with the neurological tools that he needs to further develop his emotional functions, by developing the areas of our brain that play active roles in our emotional responses.

The Debutante

After developing his experiences within the family as well as reaching the cortical stage of development, the child is ready to make his debut in the world. With some basic experience under his belt, and a sense of safety and self-confidence fostered by mother's nurturing and care and his society at home, the child now is ready to venture into society at large and develop emotional relationships with others outside the sphere of the family.

The child is aided in this task, both internally and externally. Internally, as he matures in his cortical development he begins to be able to apply reason to his emotional experiences. This is a balance that we depend on extensively as adults. The child can now begin to evaluate how extenuating circumstances may affect another's emotional response to him. For example, if a child meets a friend who is sad he will begin to be able to assess whether the friend is sad about something he did, or if the friend is sad about some experience the child did not witness. In other words, "my friend's experiences may be different than mine, and therefore his emotions may not be what I expect based on what I know of his experiences." If we do not develop this ability to mitigate our emotional experiences based on our reasoning ability, we live lives of emotional tumult.

Externally, the process of venturing out into society should be aided by the father. At the same time that the relationship between the mother and child is progressing from one of absolute dependence to one of increasing independence, the relationship between the father and child is progressing from one of fairly minimal engagement to one of increasing engagement. While the child works to achieve growing independence from the mother, the father can step in as a role model for wider social interaction. This is not to say that mothers should cut off relationship with their children as they get older and submit to fathers. On the contrary, the biological facts of the relationship of the child to each parent equip each with the ideal forum for fostering and nurturing their child in different ways which complement each other.

From this point on the child develops ever-increasing skill at using the emotional functions first established in infancy. He will form friendships, love relationships, marriage, and finally relationships with his own children, all based on the primal relationship of mother and baby developed and expanded.


This concept of emotional development has significant implications. First, it must be agreed that every effort, both individually and societal, must be made to preserve, support, and foster the strong and close bond between infants and mothers. This includes recognizing and honoring the irreplaceable contribution that mothers make to society through the act of mothering. It also includes providing resources to support mothers financially, emotionally and socially.

Also, it is clear that the role of father is not extraneous to the emotional development of the child. Children need male figures in their lives to complete their emotional development. Though this person need not be a biological father, he must be more than a nominal figure or a photo on the shelf. As a society, we are already paying dearly for our ignorance of these basic developmental facts. It is imperative that we begin to make wise and informed decisions about how we will foster our children's emotional, as well as neurological, development.
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Emotional Development; A Discussion of Abnormal Function By Susan Scott, NW Neurodevelopmental Training Center

Normal Emotional Development Interrupted

Emotions are like a filter through which we experience the actions and events in our lives. Consequently, incomplete emotional development can misdirect the course of our lives by influencing our reaction to our experiences.

What might happen if our emotional development were interrupted at the stage where the infant perceives that he and the mother are the same? Since this infant has no reasoning ability and as yet no life experience upon which to make assessments, he lives in a world of absolutes: hungry/satisfied, cold/warm, alive/dead. The infant relies on mother not only to provide essential care, but also to regulate his own autonomic nervous system. To be separated from mother at this stage, through some separation event such as a medical crisis, is to have his very identity stripped away. Before the infant has even begun to integrate a sense of "self", the very basis for that sense of "self" is gone.

From this point on the infant's very sense of survival is compromised. Every moment will be focused on the question "Am I still alive?" "Do I exist?" (Keep in mind that this is not meant to represent a conscious thought process.) In life we must have a sense of "self" or of our actual existence in the world. If we don't, it becomes necessary to direct our efforts and attention to a) proving the existence of "self," and b) defending against perceived challenges from others to our "self." This vital and consuming task leaves nothing left over to devote to building and exploring relationship with others, let alone any enjoyment of life and its experience. For the infant this might manifest as constant crying, the baby's way of getting attention. As the child grows older, this attention seeking to prove his existence may take on other forms such as acting out, or whining and complaining. The most frequent challenge to our "self" that we encounter from others is to be ignored. For a child or adult with this type of emotional wound, being ignored is excruciating.

People in this state may be very isolated, and very defensive. They may have difficulty interacting with others on even the most basic levels. Interruption of emotional development at this stage leaves no opportunity to develop emotional maturity without significant outside intervention.

What might cause such an interruption? Clearly, we have already stated separation from the mother. This might occur due to a number of reasons, including health problems of the mother or the infant, family crises, neglect, or adoption. Regardless of the reason, it is imperative to address the resulting effects for the wellbeing of the child and for society.

Level two of emotional development occurs when the infant perceives that he and the mother are two separate individuals. After a short period of frustration regarding this fact, mother and baby begin a love affair that will form the model for every future relationship. Ideally, this first relationship that the baby has is one that is mutually satisfying, tender, and loving. This helps the baby form a sense of being welcomed in the world. However, if the relationship is disrupted, the baby may again be left with a sense of isolation.

The effects on the baby of separation from mom at stage two are similar to those at stage one. However, we might draw the distinction that separation from mother at stage two affects the baby's sense of "self worth" rather than "self", because at this stage the baby has already begun to develop a sense of identity. Consequently, what the child experiences as he grows older is a sense of abandonment. He may seek to validate his worthiness to be loved by trying to win approval from those around him through perfect behavior or anticipating the wishes of others. For the infant, having the nurturing contact with his mother cut off or limited is akin to a small boat being set adrift in the ocean. The boat may sink or it may not. It may run aground, or it may not. But, whatever happens is completely out of the control of the boat. Similarly, whatever happens to a baby set adrift from his mother is out of his control. The only emotional development that can come from this situation is learned helplessness.

What about breaks in the process of emotional development taking place at level three? At this time the baby is beginning to broaden his social sphere to include immediate family members and the relationships that he is forming are more complex. Opportunities for disruption are more diverse. This is a time for the baby to implement and practice the skills that he will use in interactions with others throughout his life. Consequently, failure to complete this stage of development may lead to the child being socially awkward or maladapted later in life. We have all met such people who get on other's nerves, who are unable to read social situations, and always seem to be on the periphery of groups. They do not doubt their right to be members of the group, but seem to lack the tools necessary to become integrated.

A variety of circumstances may compromise the development of these tools. People familiar with normal neurological development will be aware that neurological dysfunctions which inhibit our perceptions or expressions at the midbrain level can profoundly affect our ability to read or express such non-verbal communication as facial expression and tone of voice.

But what about other things that may interfere with emotional development at this stage? At this time in a baby's life, mom acts like an interpreter of a foreign language for the baby. Mom and baby have a common "vocabulary" of emotion based on the development they have already done together. Now as the baby begins to interact with others, he looks to his mother's reactions for clues about how to respond to new situations. If she is calm and open to the new contact, so will the baby be. If she is anxious or concerned, that is how the baby will read the situation. Therefore, if the mother is absent the baby will have difficulty decoding communication from others. If the mother is emotionally impaired herself, for example if she is depressed, this will color the way that the baby interprets social contacts.

Because the mother at first acts as an intermediary between the baby and his next ring of social contacts, the family, how she does her job can also influence the emotional development of the baby. If she is reluctant to relinquish her singular role in the baby's life, the baby may not begin to internally incorporate the tools of emotional interaction. If the mother is uninvolved or disinterested in her role as interpreter, the baby will not be able to recognize consistent patterns in emotional communications and may consequently become uncertain about forming future relationships. Or he may become inattentive and perhaps reckless about emotional communication.

If the baby perceives that the mother is not an active participant in emotional interchanges (that is, in control) he may feel a need either to regress to a more dependent state, as in stage two, or to strive to gain control himself, becoming manipulative. Here again, it is important to note that this does not imply conscious or reasoned choice on the part of the baby, but reactive responses to his perceptions. If the mother is in a physically or emotionally abusive relationship, she will certainly not be perceived to be an active participant in emotional interchanges. Even if the mother is not in a blatantly abusive relationship, but is herself emotionally retarded, she will not have the tools or skills to participate actively in relationships. Thus the cycle can be perpetuated, unintentionally, from generation to generation. In adulthood this problem may exhibit itself in a person who is either very emotionally dependent on others, or one who is very emotionally controlling.

If, on the other hand, the baby's efforts to expand his social world are met with resistance from those he is reaching out to, a different set of complications ensues. If the baby's efforts at emotional communication are not acknowledges by immediate family members, or are rejected, or are responded to inconsistently, the baby will have no opportunity to practice and hone his emotional communication skills. The baby may react to this by becoming unexpressive. As the child grows he may appear sullen, introverted, and passive.

It seems important here to clarify that we are talking about a developmental process that is taking place when the baby is about six months to one year old, and that the social environment into which the baby is moving is still within the family. A justification often used to excuse sending babies to daycare is that they need the opportunity to socialize. This is not true. If the baby is moved too soon into a wide social sphere, without having had a chance to develop and exercise his social skills in the family, he can be overwhelmed. The baby may become emotionally "hyperactive." As he grows older this might show itself in the inability to tailor his emotional expression to appropriately communicate with the person he is interacting with. Babies do not need to be pushed into social situations with peers, and are not prepared to do so.

Children begin to be ready to interact with the community they enter at stage four of their emotional development. This corresponds with the cortical stage of neurological development. In the same way that a child gains sophistication in his cortical function from about one year to eight years of age, he also spends this time gaining sophistication in his emotional function. He puts to use the skills that he has gained in the family in a wider social sphere.

At this time, the father serves as an interpreter in much the same way that the mother did in stage three. The father serves to role model emotional responses in community interactions. From the father, the child should learn such complex emotional skills as compromise.

At a later stage children do a great deal of role-playing with peers and with other adults. This affords an opportunity, with minimal risk, to try out more complex emotional interactions and learn the "what ifs." Each drama played out represents a potential scenario that the child will encounter in his adult life. Each "you be the mommy, and you be the baby, and I'll be the daddy" is an opportunity for the child to rehearse emotional interchanges that he will play out for real in the future. As the well-known adage states, "practice makes perfect." Without an opportunity to do this role-playing, the child may become maladapted at handling emotions as he grows older.

This practice time can be undermined by too much restriction placed on the child's social time either by parents, daycare providers, or schools. Left to their own devices, children's infinite imaginations can concoct and work through innumerable practice scenarios. If the nature and number of their social encounters is dictated or limited, children may fail to internalize the lessons that they would be learning at this time. For this reason, being in a daycare or school situation that is strictly regimented and does not make ample time for free play is detrimental to a child's emotional development. This is not to say that children at this age should be unsupervised or go without consistent boundaries. In safe and appropriate boundaries they should be allowed to follow their own internal guides.

This leads us to a discussion of the detrimental effect of a lack of adult participation at this stage. While children are role playing and experimenting with emotions, adults serve as referees or mediators. They help to resolve conflicts and model emotional problem solving. Without guidance and examples set by adults, children will find ways of resolving conflicts and problem solving but they may not be ways that we would find socially acceptable. How many of you have read The Lord of the Flies? In fact, this very problem is occurring now in overcrowded daycare centers and schools where there is insufficient adult participation. Children are turning to their peers for social guidance rather than to adults who are absent from their lives.

In his book, The Origins of Love and Hate, Dr. Ian Suttie traces these and other diversions from normal emotional development to their extreme consequences, which are various forms of mental illnesses. Of course, not everyone who experiences less than perfect parental guidance in his emotional growth becomes mentally ill. There is a spectrum of consequences ranging from mild to severe. The point of this article is to raise awareness of the fact that how we guide our children's emotional development does matter. It impacts the child, his family, and society at large. It behooves us to do the best possible job and to assess each decision that we make, both individually and as a society, in context of the impact on our children.
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Bonding and Attachment By Susan Scott, NW Neurodevelopmental Training Center

They are called unattached, or unbonded, attachment disordered, or attachment impaired. They are children and adults from all walks of life, who fail to form strong and appropriate relationships. They are the bane of counselors and psychologists, because they do not respond to conventional methods of treatment. They fill our prisons, in the person of sociopaths, compulsive criminals, and serial killers. They make headlines when they kill their parents or spouse. And they are our children.

Many people will read this description and say, "Thank goodness, I don't know anyone like that." But, chances are, you do. As with any other neurological condition, this one occurs on a continuum from the very mild to the very severe. So, lets look at some of the characteristics of attachment impaired children as they fall on the continuum.

Attachment disordered children may seem either remote or clingy or both. Parents may say of their child "He never sleeps in his own bed," or "He won't go to sleep unless he is in our bed." Sometimes they report that the child is remote and doesn't respond to displays of love and affection. Though these two behaviors may seem paradoxical and contradictory, they stem from the same root. They both result from the child's inability to receive and interpret love.

This child may appear to lack empathy for others or he may seem to be overly attentive to the feelings and wishes of others. The child's teacher may comment, "He may hurt one of this classmates and then laugh about it." He may also go out of his way to appease the people around him. Both of these behaviors result because the child doesn't have a way to know what others are feeling. In the first case, he cannot compare the hurt that his classmate is feeling to any event in his own experience and, therefore, has no empathy for the classmate. In the second case, it is his inability to know what those around him are feeling that causes him to feel the need to be conciliatory. They may be mad at him or may be pleased, but without a way to know, he must assume the worst and do whatever is in his power to prevent it.

For a similar reason these children may seem to be cruel or merciless. Because of their incapacity for empathy, they do not have the same restraint on their behavior that other children have. They may abuse animals or siblings without showing any understanding that this behavior is wrong. For them there is no link between their own experiences and the experiences of those they are abusing.

The attachment impaired child may appear exceptionally shy or socially promiscuous. ("Socially promiscuous" is a phrase coined by Florence Scott, R.N., which refers to a child who tries to win the favor and attention of almost everyone he meets, as if he does not have a clear idea of who his caretaker is.) Again, although these behaviors seem contradictory, they arise from the same cause. Because this child does not have the capacity to receive and interpret social signals, he may fail to receive the messages sent by others inviting him to participate in a social life. And as a result he may become withdrawn and reclusive. On the other hand, this same inability to receive and interpret social signals may result in the child failing to discriminate between his relationships with parents and family members and his relationship with those outside the family circle. He may walk off with a stranger while on a trip to the store, or share personal family information with someone he has just met.

Finally, this child may respond in ways that are not appropriate to the circumstances, leading people to believe that he is "putting on an act." He may operate by a set of rules that are very complex, but never expressed and he may expect others to follow these rules as well. If those around him fail to operate within his rules, he may become angry. Again, this is often not expressed. As a consequence, though, the child may feel confirmed in his belief that the world is hostile and unsupportive. The child makes his rules in the first place because he does not necessarily perceive the guidelines that we ordinarily operate by in society. Without these external guidelines, he feels at a loss and tries to gain as much control as possible in order to have security. As a result of this, he may appear rigid and inflexible to those around him.

The net affect of this condition is that the child operates as if he is living in a different world from those around him. His responses do not match the circumstances and his relationships do not form along normal lines. A picturesque way to describe him is that he interacts with the world as if he is wrapped entirely in cotton batting. The stimulus that comes to him is muffled and distorted and all of this outreach to the world is restricted by his condition.

What is it then, that underlies this behavior? The children and adults who demonstrate these behaviors almost universally have an injury to the area of the brain known as the pons. The pons is the area of our brain that is primarily responsible for life preservation functions. It is the part that we use when we feel extremes of heat, cold, pain, and hunger. It identifies threats to our life and person. And, significantly, it is far below our cortex in the developmental process, and therefore, it has no language. It is not possible to express in words the experiences that we have at this level.

When I say that the pons is responsible for life preservation functions, I mean just that. It controls our respiration, heart rate, and other functions without which we could not survive. People with severe injuries in this area do not live. Those who die in car accidents often die because they have injured their pons. The function of this area of our brain is critical to our survival.

As part of its life preservation functions, the pons is the part of our brain that perceives extreme sensory messages of heat, cold, pain, and hunger. While most of our sensory input is monitored by our mid-brain, these particular sensations bear directly on our health and survival and are monitored by the pons. If we become too hot, we will die. If we become too cold, we will die. If we become too hungry, we will die. And, if we are in a situation that is causing us pain, we are also in danger of losing our life. People who have injuries to this area of the brain (not so severe that they result in death) are often unable to perceive these sensations. Surprisingly, people with these deficits and those around them are often unaware that their sensations are not "normal." Parents and teachers might report "He's a tough one. If he gets a scraped knee, he just picks himself up and goes on playing." In a biography of T.E. Lawrence, better known as Lawrence of Arabia, it is reported that as a youth he broke his ankle during recess at school one day and walked on it for the rest of the day without saying a word about it. A person with normal pain perception would not have been able to do this, no matter how hard he tried. As a result of this deficit, people with pons injuries are isolated from the world around them. They do not receive critical information that they need to orient themselves in their environment. Without knowing that it is happening, they are being cut off from the outside world. People in this position sometimes make an attempt to reconnect with the world by committing acts of self-mutilation. For example, some people cut the skin on their bodies with razor blades or knives. Some people do an extreme form of nail biting and chew the skin off their fingers. When asked to explain why they do it, these people often respond that, "I just wanted to feel something, anything at all." This lack of pain perception affects their ability to empathize with others. If affects their ability to form relationships, and it affects their sense of placement in the world.

By means of the perception of the extreme heat, cold, pain, and hunger, the pons is able to recognize threats from the world around us. One of its life preserving functions is to identify these threats and put us "on guard." When we are in a situation that may pose a threat to our safety, our pons helps us to stay alert and carefully evaluate what is happening. However, when an injury occurs in this area of the brain, this function becomes dysfunctional. The child may become hyperalert and anxious, because the pons is working overtime and perceiving everything as a threat. Children in this position are the ones who cannot sleep alone or become hysterical at the possibility of being left with a baby sitter. Adults with this dysfunction often report that they feel a constant and undefined anxiety. They might say "I always feel like something awful is going to happen, but I don't know what." Sometimes, instead of the pons working overtime, it doesn't do its job at all. Children and adults in this position often behave recklessly and in some cases deliberately do harm to themselves, because they do not receive the messages from the pons that should tell them that they are in danger. They seem to act without discretion, unaware of the danger signals that most people recognize. In either case, the child becomes "disconnected" from the world as a result of the failure of the pons to do its job properly.

This isolation from the world is further compounded by the inability of the individual to express his feelings verbally. The isolation that is brought about by this type of injury can elicit deep feelings of loneliness, abandonment, and despair, but since these emotions originate as a result of the injury, not in response to an external fact, it is next to impossible for the individual to verbalize them. Our pons cannot express itself in words, and so the injured person if left helpless to describe the fear and anxiety that he feels. This places yet one more barrier between the individual and the outside world.

Finally, disconnection from the world can be accompanied by a disconnected sense of time. Pons injured individuals may not perceive time as a continuous flow of one minute to the next. An event may not appear to have a consequence in another time. It is no consolation to say to a child with these perceptions, "Don't worry. I won't be gone long; I'll be back in half an hour." It is also useless to threaten such a child by saying "If you don't behave, I'll send you to your room for an hour."

The cumulative effect of this collection of symptoms is that the injured individual feels that there is no place for him in the world. He may express this by saying "I just don't feel like I belong here" or "I ought to be dead. I don't deserve to live." This syndrome can also result in a deep lack of trust on the part of the injured child. Without sufficient means of receiving signals from the world or evaluating them if they are received, this child cannot learn to trust his own experiences and consequently cannot trust the world and actions of others. Eventually, when these feelings cannot be explained or justified, the child may choose to turn them off altogether. This can lead to the kind of cruelty that is observed in some unattached individuals. In an interview with convicted child molester and murderer, Wesley Allen Dodd, he said, "I don't have any feelings about what I did. I don't remember ever having any feelings."

How, then, does a child become injured in this way? Any blow to the head, high temperature or shortage of oxygen might cause damage to the pons. The pons can be injured in the same ways that any other area of the brain can be injured. So, for example, a car accident, a drowning, an illness resulting in an extreme fever, or being hit in the head at Little League with a bat could possibly result in a person developing some or all of the symptoms that have been described. However, many children (and adults) who have this syndrome develop it as a result of a separation from their birth mother in the first two years of life, rather than by some documental brain trauma. Children who have been hospitalized in their first year or two of life, usually involving surgery and usually involving having their movements restrained, often develop these symptoms. Sometimes if the mother is hospitalized and does not have contact with the child, the same thing can result. In some cases the child may be restricted in contact with the mother, and in movement, because he (the child) is in a cast for treatment of a broken bone or orthopedic problem. In some cases the separation is brought about by abuse and neglect. In any of these cases what has happened is that the process of bonding between the mother and child has been interrupted and often the child's ability to do the developmental movements appropriate to his age has also been restricted. It is very important to realize that the combination of emotional stress resulting from the separation and the inability to complete the necessary developmental activities results not just in a delay of function of the pons, but in an actual dysfunction. Function will not return when circumstances return to normal. The dysfunction will continue until it is treated. No amount of love or extra quality time spent with the child after that point will restore his emotional and neurological health until the problem in the pons is addressed.

There is a way to do this. Get a functional neurological examination and follow the program as instructed.

When a person begins treatment for this type of pons injury, he may likely experience some nearly overwhelming feelings of grief and/or anger. These feelings can be surprising and difficult to deal with because they do not seem to be in response to surrounding circumstances. It is therefore important to recognize that the feelings are arising because the treatment is directly stimulating the pons where the feelings are located, not because something is currently happening outside the individual that might elicit them. One person expressed it in this way: "Every time I get down on the floor to crawl, the tears start to come. As soon as I sit up, they stop again." Others have reported that they weep over television commercials or at any other slight provocation. Almost everyone who undergoes treatment for this type of injury experiences a similar outpouring of grief and sometimes anger. The feelings that they have been unable to express before seem to explode to the surface and erupt all at once. It is critical at this point for the caretaker, whether that person is a parent, a spouse, or a friend, to accept these emotions without taking them personally. They are an indication of important and beneficial changes taking place neurologically. The most helpful thing that the caretaker can do is listen patiently and offer support to the individual while he wades through these deep and confusing emotions. The individual may also experience some degree of resistance, both to his swelling emotions and to the treatment itself. He may complain and object to having to do the activities involved in treatment. Here again, the caretaker can offer structure and support to persist in doing the treatment every day. Eventually, however, after the flow of emotion begins to subside, the individual begins to form bonds with the people in his life with whom he has relationships. He will start to trust his own perceptions of the world and consequently be able to trust those around him. He will be able to identify and respect his own boundaries and those of others. His behaviors will changes and become more appropriate to his current circumstances.

If you are the parent or guardian of such a child, it is imperative to seek treatment as early as possible. By doing so, you can give your child a life of peace, security and happiness that will not be available to him otherwise. You may also save yourselves from years of frustration and worry over a child whose behavior is antisocial and even possibly dangerous to himself and others
[font=Comic Sans MS]And more...[/font]

Unexplained Behaviors Inconsolable Crying, Screaming, Raging Temper Tantrums

Early trauma (which includes separation from birth mother, multiple placements, hospitalizations, etc...) can cause impairment in a part of the brain (limbic system, Amygdala.) This becomes a nonverbal/emotional memory; the body remembers the trauma even though the conscious mind may not. This is "neuro-hijacking." Neurons in your heart, stomach, etc...send messages just like the brain does...and, because there are more neurons in the body than in the brain, it can in effect hijack the body. The body remembers!

The part of the brain in which this occurs is in a preverbal area; therefore, when a young child with this early trauma experiences one of these neuro-hijackings (which can look like unexplained crying, screaming, temper tantrums), it doesn't work to try to talk through it. His brain/body has been hi-jacked. He cannot hear you. In a similar vein, an older child with this issue cannot talk himself out of it. (You know the self-talk you give yourself--"It's going to be all right," "I feel nervous, but I know that it's going to be okay," etc...)

The good news is that you can help children to heal! But, because the part of the brain that you're dealing with is the non-verbal part, you have to learn to think differently. Traditional methods of discipline and trying to talk through these behaviors with children may be ineffective. In our son's case, I started to recognize that we had a problem** when:
[list=1]1. The discipline methods that I used with our other three children had no effect whatsoever. "No" meant nothing. I may as well have been talking to a brick wall.

2. I saw unexplained behaviorexcessive whining, unhappiness, crying, screaming, temper tantrums. If he had been my first child, I would have written the unexplained behavior off as terrible twos, teeth, tiredness, etc... I almost did anyway! Especially when well-meaning professionals also tried to write it off.
[/list]** Symptoms look different in every child; consult [url="http://www.a4everfamily.org/index.php?option=com_content&task=section&id=4&Itemid=71"]Symptoms[/url] for more information.

With the information we now have, we are able to deal with discipline and the unexplained behavior. The WONDERFUL thing about this is that the brain is so malleable up to the age of 33 months. We could have very easily written off his behavior as terrible twos and missed this incredible window of opportunity.

FAQ: So how do parents address the non-verbal part of the brain?

Wow. Isn't that the ten million dollar question?

Imagine trying to tame a feral cat. It is absolutely terrified of you. It claws and scratches and hisses at you at every turn. If you brought the cat indoors, chances are that if allowed to run lose, it would continue to be wild forever. You could say, דHere, kitty kitty. Its okay kitty,Ҕ until you turned blue, but it wouldnt tame the cat. Even under the best of circumstances with years and years of living with you, it probably would never allow you to hold and cuddle it. It might get "agreeable," but would never completely trust you҅or anyone else.

If, on the other hand, you pulled that cat in close--protected it from hurting itself or you--and then gave it very, very tight boundaries, it would probably start to feel safe. It wouldn't like it at first. But over time, with very tight boundaries and a ton of consistency, it would start to feel safe.

Alternately, imagine you have a very anxious dog. He is 100% loyal to you, but when visitors come to the door he either emotionally loses controlbarking & barking & jumpingחor he cowers, running to hide under the bed. For his quality of life to be the highest, you pull him close to derive calm from you so that he can eventually learn to self-regulate. Like the cat, this beloved pet will only feel safe after learning that you are trustworthy, loving, and very, very consistent.

In a similar way, kids with attachment disorders are wounded. Parents have to put pressure on to stop the loss of blood. They cannot let up or they'll lose the kid. These kids need extremely tight boundaries--much tighter than what "normal" kids need--given with the utmost love and confidence. The kids need to know that Mom & Dad are 100% in control so that they can feel safe. This form of parenting is often counter-intuitive. Even the most experienced parents benefit from supervision by an attachment specialist.

Of course, the parenting component doesn't fully address the brain issues. Ideally, a child also needs additional neurological support from professionals trained in the effects of early separation/trauma on the developing brain.

Straight Talk When a child undergoes sudden separation from the birth mother, the wiring in the brain may be affected. This doesnt just apply to international adoption. Attachment specialists work with children whose adoptive parents were present in the delivery room. Premature infants who remain with their biological families may develop attachment issues due to the separation inherent with hospitalization. But children who have been adopted internationally are at certain risk for attachment problems. They have undergone separation from birth mothers and subsequent caregivers. They may have been prenatally exposed to high levels of their birth mothersҒ stress hormones. Many have undergone painful medical procedures. All have sudden, dramatic change in environment and culture. These kids are at risk.

The Good News

Successful treatment for attachment disorders is as high as 100% for infants and 90% for toddlers. Up to about 33 months of age, the brain is very malleable. That window of opportunity is significant for the longterm emotional health of the child and the family.

Earlier the Better

Many parents of infants and toddlers miss attachment-related symptoms because they mirror normalӔ early childhood behaviors. Even with some concerns they may decide to "wait it out," hoping that what they're seeing is a developmental stage that the child will grow out of. But attachment disorders don't just go away--although symptoms may change as the child enters new developmental stages. For example, a baby who will go happily to any stranger may become a toddler who wanders off at the storeto a school child who seems to prefer other families to his ownŅto a teenager who is sexually promiscuous.

Therapists report that parents often bring children in for the first time when they reach school age. The child may have friendship problems or show aggressive behaviors. Learning problems may be related to a lack of concentrationhypervigilance that is often misdiagnosed as attention deficit hyperactivity disorder (ADHD.) Reading may be a struggle as eye movement is connected to the neurological problems in the pons portion of the brain.

As children with attachment problems grow, they may be misdiagnosed with a variety of conditions: ADHD, Aspergers or other autism spectrum disorders including PDD-NOS, Oppositional Defiant Disorder (ODD), or bipolar disorder. Medications may be effective in treating other conditions, but no medication will cure an attachment disorder. Families do well to consult with attachment professionals, even as they work with others in the medical community.

If parents suspect attachment issues, they are wise to consult with a specialist as early as possible.
[font=Comic Sans MS]Gotta run...one more...for now. [/font]

[font=Monotype Corsiva]What is Attachment Disorder?[/font][font=Lucida Fax]

[font=Arial, Helvetica, sans-serif]An [/font][/font][font=Arial, Helvetica, sans-serif]Introduction[/font]

[font=Arial, Helvetica, sans-serif]Reactive Attachment Disorder is a very real illness. Children[font=Arial, Helvetica, sans-serif][font=Lucida Fax][/font][/font] with Reactive Attachment Disorder are reacting to events in their early life that may include neglect, abuse, or something more subtle (see causes below). Due to these events, many children are unable to attach to a primary caregiver and go through the normal development that children must go through in order to function in relationships. My explanation is somewhat simplified but may be helpful to you. It does not replace a diagnosis from an attachment therapist.

In the first two years of life, children go through healthy attachment cycles - the first year and second year attachment cycles. A healthy first year attachment cycle looks like this:

[font=Arial, Helvetica, sans-serif]As the baby has a need and signals that need by crying, the mother (primary caregiver) comes and soothes her baby and meets his needs. If this cycle is repeated over and over again and the baby's needs are consistently met in the proper way by the same caregiver, the baby often learns to trust. He will then be able to continue on in his development. Now, take a look at the disturbed attachment cycle:[/font]

[font=Arial, Helvetica, sans-serif]As you compare the Healthy Attachment Cycle to the Disturbed Attachment Cycle, you can see how the baby has a need, cries, but this time, the need is not met by his mother (primary caregiver). Sometimes, the need is met but it is inconsistent, or there are different caregivers who are not attuned to this particular baby. Sometimes the baby's cries go unanswered as in the case of neglect or the baby's cries are met with a slap as in the case of physical abuse. Whatever the cause, the baby's needs are not met in a consistent, appropriate way. (See[url="http://www.attachmentdisorder.net/Symptoms_Causes_Research.htm"] Potential Causes[/url])

Instead of learning to trust as the baby who experiences the Healthy Attachment Cycle, this baby learns that the world is an unsafe place, that he must take care of himself, that he can trust no one to meet his needs. He learns that he cannot depend on adults. Instead of trust developing, rage develops and is internalized. He learns that he must be in charge of his life for his very survival. Is it any wonder that a child with reactive attachment disorder feels the need to be in control? He thinks his very life depends on it.

[/font][font=Arial, Helvetica, sans-serif]If the child has been able to successfully go through the Healthy Attachment Cycle during his first year of life, then he most likely will be able to go through the next which is the Second Year Secure Attachment Cycle:[/font]

[font=Arial, Helvetica, sans-serif]It is only by going through this Second Year Secure Attachment Cycle that the child will ever be able to learn to accept limits on his behavior. It is by going through these two attachment cycles - the Healthy Attachment Cycle in the first year and then the Second Year Secure Attachment Cycle - that the child learns to trust, engage in reciprocity, to regulate his emotions. It is back there that he starts to develop a conscience, self- esteem, empathy, the foundations for logical thinking are laid down, etc. The breakdown of these two attachment cycles will damage all of the relationships he has for the rest of his life unless interventions are made.
[/font][font=Arial, Helvetica, sans-serif]
When the first cycle breaks down, the child cannot do the second year. To expect the child to function as a typical child when his normal development was completely stunted back in infant/toddlerhood is not rational. We must take them back and help them redo these steps.

[font=Comic Sans MS]OK, this is it...talks about China (from [url="http://www.attach-china.org/"]www.attach-china.org[/url]) but...attachment is attachment...[/font]

[font=Comic Sans MS]As you will see RAD has many different definitions...but these articles should help explain what happens, why it happens, and the levels on which a child may be impacted. I know, clear as mud....Wink Personally, I consider RAD to be the most severe cases, where a child does not have the ability or desire to attach...disorders are like my DS...struggles are normal...baby/child just learning what they should be doing...[/font]

Part I: Secure Attachment and Reactive Attachment Disorder

It is important for adoptive families to recognize how a child's early experiences can impact their future emotional development. Children adopted from China have experienced the loss of their birthmothers, physical abandonment, and multiple caretakers. Most have suffered deprivation and/or neglect in varying degrees. Some have endured physical and/or sexual abuse. These conditions interfere with the capacity to form secure attachments.

Secure attachment forms when a child's physical and emotional needs are consistently met during the first 2 years of life. Because she trusts that her parent will be there, she will internalize an image of her world as safe, stable, and dependable. She will develop independence while at the same time maintaining a connection with her parents. She will learn to engage in mutually enjoyable interactions where the interaction itself is the end goal.

Reactive Attachment Disorder (RAD) is any disruption in attachment resulting in a child's failure to form a SECURE bond/attachment with a parental figure. Secure Attachment and Reactive Attachment Disorder are best understood as a continuum. The most securely attached people are confident, high functioning individuals with a strong sense of self worth, highly developed empathy and the ability to engage in healthy, mutually enhancing relationships, both within and beyond their immediate families. The most unattached people are violent psychopaths, people without empathy or conscience, unable to relate to others except as objects to meet their needs.

Reactive Attachment Disorder includes the whole spectrum of children with symptoms ranging from mild to moderate to severe. Therefore, a child can be "attached" and still have RAD. Having 'attachment issues' or RAD does not mean your child doesn't love you. It does not mean that the adoptive parent is a poor or unloving parent. Nor does it mean that the child is of low intelligence or developmentally delayed. What it means is that the child's brain has been programmed to protect her from pain, thus preventing her from giving and receiving love. The child will need specific treatment to learn how to do this, just as she might need specific therapy to overcome any illness.

Scientific research has indicated that the bond between mother and child begins to form even while in the womb, so that at birth a child can recognize it's mother's voice and smell. Even a child who was abandoned at birth and subsequently received good care could experience the loss of her birthmother as traumatic.

Most Chinese adoptees are subjected to additional experiences that heighten their risk for RAD. If a mother knows that she may not be able to keep her baby, the child can experience rejection while still in the womb. The mother may risk her life giving birth in an unhealthy/unsafe place. Children might experience birth trauma due to inadequate medical care. There are women who want to keep their children but are under pressure from family or authorities to give them up. These children could be kept hidden, and not given proper care and love for an extended period prior to abandonment.

Even the best orphanages are unable to simulate the care and attention a child would receive in a family. Normally, babies go through the bonding cycle thousands of times during the first three years of life. When the baby is hungry, wet, cold or wants to be held, she becomes aroused. She feels angry or upset and cries. When that need is met, the baby feels gratification, and develops trust. Each time that cycle is disrupted, the baby feels helpless and angry and does not learn to trust.

Babies in orphanages often spend entire days lying in a crib, cold and wet. They are cared for on a schedule determined by the availability of orphanage staff. If bottles are propped, they will not associate being fed with human contact and warmth. Cries of distress can go unheeded for hours. After awhile, children fail to recognize their own body signals. Their feelings of need become so painful they shut them off. Even if their physical needs are met, they do not learn the joy that comes simply from engaging with another human being or the comfort that comes from having their upsets soothed by loving hands. They lack physical contact in a loving embrace. Infants who are not touched can develop failure to thrive.

Abandoned children who are not strong and tough die. Those that live, learn survival skills that are appropriate for an institution, but which may inhibit attachment within a family. Even foster care has its risks. Some foster parents are abusive and neglectful and are motivated more by the income than love. Some foster parents have several babies to care for. Many are poor and illiterate. Even children in good placements experience the original abandonment of their birthparents and then subsequent loss of their foster parents.

In Chinese adoption there is no gradual transition, no time to prepare for new situations or to mourn the loss of the old. Older children who might understand the process are not always prepared or honestly informed of what will happen to them. When their 'orphanage friends' are adopted, they see them disappear forever (causing further loss for the child who remains at the orphanage.) When adopted, the child is suddenly whisked away from everything familiar. To be placed in the hands of strangers can be terrifying. Americans who speak an unknown language, look, smell, eat and behave differently, also have different expectations. This experience mirrors their original abandonment where one moment they are in their mother's arms and the next moment mother is gone, and their life is dependent on strangers. Once they board the airplane, everything familiar disappears. No matter how hard they cry, the mother, or caregivers, or foster parents do not return. Thus, the act of adoption, while seemingly happy for the adoptive parents, can be perceived by the adoptee as a re-play of her initial abandonment.

It is not uncommon for Chinese adopted children to suffer from developmental delays and/or regulatory disorders. Patterns of behavior and symptoms can fall into many overlapping categories -- Post Traumatic Stress Disorder (PTSD), Sensory Integration Disorder (SID), Attention Deficit, Hyperactivity Disorder (ADD & ADHD), Oppositional Defiant Disorder (ODD), Pervasive Developmental Disorder (PDD), Autism, Grief, speech & language impairment, learning disabilities.

All of these regulatory and language disorders can exist on their own without RAD, or they can coexist with RAD. For instance, SID can be created by the same conditions (deprivation and neglect) that cause RAD, but is still a separate diagnosis. However, there is always some component of grief, loss and trauma in every child who has RAD. Trauma and RAD can also create symptoms that mimic many of these disorders (such as ADHD or PDD), as well other psychiatric disorders not mentioned above. It is important for parents to recognize that this overlap in symptoms makes getting a proper diagnosis and appropriate treatment confusing.

Any of these disorders can also interfere with the formation of secure attachment, even after the child is living in a safe environment. A grieving child may feel she is being disloyal to previous parents or caretakers if she allows herself to love her new parents. She may be too frightened of loss to risk loving again. Or too angry to let any other feelings in. Similarly, a traumatized child may find it impossible to trust that her new parents won't hurt or leave her. She may withdraw from touch or any kind of interaction initiated by them. Physiologically and emotionally, she may still be living in a state of inner terror. A child with SID, who is highly sensitive to touch, may reject and arch away from her parent's embrace. Language disorders interfere with a child's ability to communicate her needs and feelings. All these conditions may cause a child to engage in behaviors which new parents find distancing or frightening.

Part II: The RAD Continuum

We will identify three levels of attachment disorder. These descriptions merely illustrate the emotional logic behind different presentations of RAD. The pattern of symptoms is unique for each child. In addition, symptoms can overlap, and change as children develop and incorporate their current life experiences into past patterns of response.

Level One: The child is able to "attach" or "bond" with the adoptive parent in the sense that she recognizes the parent as the person she "belongs" to, but the quality of "trust" is lacking. She may "love" the parent, but does not allow or rely on the parent to meet her needs or to keep her safe. She doesn't understand the concept of permanence, and that she will forever remain with her adoptive mother.

This child may be overly clingy and/or suffer from severe separation anxiety. She panics when not physically (or visually) connected to the parent. She may be overly fearful of and/or have difficulty socializing with adults or children outside her family. She may exhibit controlling behavior in an attempt to maintain contact with the parent at all costs and to ensure that her needs will be met. She may be hyper-vigilant, ever on the alert for impending loss or hurt. Or she may be the "overly good" child, fearful lest she make a mistake and be abandoned again. She may also be a child who appears on the surface to have made a good adjustment and attachment to her family. She conforms to family rules and expectations, but is merely acting the part that she perceives has been given her in order to maintain her place in the family. She may be suppressing her true self and feelings because she does not believe they would be accepted.

Level Two: The child "wants" attachment/connection, but, because she is afraid that the parent might leave her, hurt her and/or not meet her needs, she "chooses" to control the terms of the attachment. In order to protect herself from the pain, grief and loss she believes is inherent with attachment, she rejects or withdraws from the relationship, especially when closeness is initiated by the parents. These distancing behaviors may be alternated with intense clingyness.

What differentiates this child from level one is the presence and/or intensity of her distancing behaviors. The child erects a wall between herself and her parents. She may be defiant and oppositional, expressing her rage directly at her parents. She may be charming and friendly to strangers. She may prefer dad to mom. She may refuse to be held or she may express affection on her terms only. She may have difficulty making eye contact, especially during times of intimacy or distress. She may be withdrawn, even to the point of exhibiting autistic spectrum behaviors. She may lack imitative behavior, pretend not to understand, and communicate only on her own terms. She may have difficulty acknowledging "good-bye" and/or "hello". However, despite the distancing behaviors, she can -- often in very subtle ways -- reveal that the connection to the parent does matter to her. For example, she may get busy and pretend not to care when her parent leaves for the day, but the very act of changing her behavior is an indication that the parent's departure does matter. What differentiates her from the child in level three, is that she is still aware, on at least some level, that she wants and needs connection.

Parents should recognize that these behaviors are a cry for help. For example, the child does love the mother, and wants to be loved back, but because of the defensive mechanisms developed to protect herself from pain, she is unable to seek connection in appropriate ways. She does not have the problem-solving skills that would allow her to effectively communicate her conflicted feelings. Instead, her insecurities manifest themselves in abnormal behaviors that are misinterpreted. (i.e. Mommy, I was so scared when I woke up in the train station and my birth mother was gone, that now I'm afraid of losing you too. That's why I tore up my favorite book, or peed on the carpet, or some other indirect, aggressive act, when you went to the store without me.) (Mother thought she was just being naughty.) Parents need to be aware of the warning signs in order to reach out for their hurting children. It is not the adoptive parent's fault that their children behave the way they do.

Level Three: "Classic" RAD / "institutional autism" This child has given up and shut down. Connection/attachment is no longer a motivating life force. People are seen as interchangeable objects, existing only to serve the child. Her wall of defenses prevent her from reciprocal interaction with the human community.

These are the children who receive negative media attention. Their behavior is extreme. They may be physically destructive and violent in their families: destroying property, attacking parents and hurting younger siblings or animals. Because they never experienced empathy, they failed to develop a conscience. They are often bright and superficially charming, but lack inner depth. Other people don't matter.

This third degree of RAD is not common in Chinese adoptees because most of them are too young at placement for it to have developed this far. However, if left untreated, it is possible for children initially in level 1 or 2 to move into level 3 as they grow up.

Also in level 3 are the children who fail to 'catch up' once living in their adoptive homes. They can have severe language delays, SID issues and self-stimulating , repetitive and/or ritualistic behaviors. They may be misdiagnosed with Pervasive Developmental Disorder or Autism. Because these other syndromes produce behaviors that are difficult to differentiate from RAD, many parents spend a great deal of time seeking proper diagnosis and treatment, not knowing what lies at the core of their child's problems.

Part III: Healing and Treatment

RAD is inextricably intertwined with trauma, separation and loss. Anger, fear, grief and shame are the dominant emotions that drive RAD children. One emotion is usually more "tolerable" for the child to experience, and this emotion serves as a barrier to feeling the others; i.e. high levels of anger or fear will prevent the child from feeling grief and shame. In order to process grief and shame she first has to get through the anger/fear. The far end of anger would be an "anti-social" child. The far end of fear would be a child who has withdrawn into autistic-like behaviors. The symptoms we see in our children reflect the way they have internalized their individual experiences.

Shame is the most difficult emotion for a child to uncover and process. It lies at the core of her inability to attach. The most shameful thing an infant can experience is not being loved. An infant is supposed to experience herself as the center of the universe. It isn't until a child is much older that she can understand the political/cultural motives behind abandonment. The only way she can interpret it is that she was thrown away because she was bad/ deficient/ unworthy etc. This sense of shame is then heightened by the neglect and deprivation that usually follows in the orphanage. Not only was she unwanted in her birth family, but for a long time no one else wanted or cared for her either.

Thus, the child may develop a core self that is built around shame. She believes everything is her fault, even when it isn't, and that she is an intrinsically bad person who deserves nothing. Every "mistake" she makes is experienced as an assault to her being, a confirmation of her worthlessness and badness. To protect herself from this shame she erects a barrier of rage or terror. It is this shame that lies at the root of her inability to trust, to let in love -- and to change her behavior.

For treatment to be effective, it must ultimately release shameful feelings and help the child separate herself from her actions. So, when she makes a mistake, instead of internalizing that she is not a good girl, she will feel that she is a good girl who just made a mistake, and it's not so devastating.

Most attachment experts agree that traditional therapies such as play therapy do not work. This is because RAD interferes with the child's ability to form an emotional connection with the therapist, which is a prerequisite for success. To complicate the picture, early childhood trauma and memories are stored in the limbic portion of the brain - an area not connected to speech and language centers. These memories are stored as emotions, sensations (sounds, images, smells) and body memories (muscular tensions that can trigger emotional reactions). Traumatized children lack the ability to access these memories through verbal expression.

For RAD children, healing must begin by re-creating the mother/child regulatory bond. The child needs to regress through early stages of infancy to recreate the experience of healthy nurturing which she missed as a baby. She must learn to depend on her parents to care for her, comfort her and meet her needs. Only then will she learn to trust others. Helping your child attach words to her feelings and memories -- as well as to her present safety -- will also help her to organize and make sense out of her experience.

As part of the healing process, the child needs to express her terror, rage, grief and shame, and have these feelings accepted and validated by her adoptive mother. What happened to her was truly terrible. These buried feelings are a part of her experience and therefore a part of who she is -- just as much as her Chinese cultural heritage is a part of who she is. If these feelings are deemed unacceptable, denied, unrecognized, or ignored, then she will feel unacceptable and invisible in her deepest core self. Her feelings will go underground and will re-emerge later in life, being all the more powerful for having been repressed for so long.

However, to simply re-live or express these feelings by themselves is merely re-traumatizing. In order to heal, emotional and body memories must be re-experienced at high intensities in a theraputic setting. By re-living past trauma in the loving physical embrace of her new parents the child will learn that a different outcome is possible. She will feel safe enough to explore the world in a loving, reciprocal way. Only then will she be able to move beyond her past to become a whole human being.

Thanks Karen, You are a wonderful educator!
Thanks Karen as always. There are many new parents that have only been home a short time and really need to have a clear understanding of what it is like to parent a PI child, no matter how old. It also gives us oldtimers some check points to see exactly where we are in the process, thanks for taking on this awesome task and I hope and pray the newbies especially will read and understand what needs to be done. You should look into teaching for Childrens Hospital (for new adoptive parents to be) or for an agency, I guest speak for our homestudy agency on attachment parenting and IA at seminars.
Thanks Karen! You are awesome! It's good to have all of this in one place!
Good resources!
I've e-mailed them to myself so I'll always be able to find a copy. (My thread searching is not always as skillful as I'd like...)

Thanks, Karen. And my d2b thanks you, too.

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