Effects of Attachment Disorder on Psychosocial Development

Key Features of Attachment Disorder

One of the key features of children with attachment disorder is a maladaptive view of self, world and others. The representations of attachment disorder in children include such thoughts as: “I am bad and unlovable,” “my caregiver will not protect me from traumatic experiences,” and I am not able to get my caregiver to “respond consistently to my needs” (Pearce, 2010). According to Pearce (2010), “these children view their caregivers as unreliable, unresponsive, rejecting, and threatening” (p. 37).

Another key feature of children with attachment disorder is the constant elevated state of cortical arousal. Unlike securely attached children who rarely reach the anxiety overload threshold, these children frequently respond in the fight-flight-freeze mode, functioning in a high state of anxiety. These children should be responded to with empathy and calm as a means to reduce their arousal, as opposed to anger and discipline which can heighten the adverse physiological and behavioral outcomes the child is experiencing.

One study aimed to test Bowlby’s theory of insecure working models of attachment in the development of symptoms of anxiety and depression with 4-year old children. Analysis of play patterns revealed support for Bowbly’s findings that children may react with fear, anxiety and depression when they have not internalized trust in their attachment figures’ availability or in their own capacity to elicit care (Miljkovitch, Pierrehumbert, & Halfon, 2007).

In caring for children with attachment disorder it is imperative that they are responded to with acceptance and understanding of their behavior and intentions so that they may incorporate new ideas of a deserving self, caring others, and a non-threatening world (Pearce, 2010).

The Triple-A Approach

This approach focuses on the response of adults to maladaptive behavior of the attachment-disordered child. The emphasis is on responding with understanding to the need as well as the behavior. A key feature of this approach is verbalizing understanding of the child’s thoughts, feelings and intentions. Caregivers must be careful not to punish and discipline these children in a negative way as it will result in a self fulfilling prophecy.

Through negative attachments, the child views themselves as unworthy of affection and positive interaction with adults, which heightens displays of anger and outward aggression. Being punished for acting-out serves to confirm the child’s belief that they are unlovable and unwanted. The following statements are examples of thought patterns internalized by children with attachment disorder. Adults can verbalize empathy and understanding by voicing these fears and concerns towards the child:

• You worry that I won’t come back for you.
• You worry that I don’t like you anymore.
• You know you have done something wrong and you worry that I won’t like/love you anymore.

Clinical experience has shown that such statements reduce the attachment-disordered child’s anxiety and associated preoccupations and compulsive attempts to reassure themselves about accessibility to needs provision. In working with older children, a role reversal of security is a helpful tool. In this scenario, the caregiver would actively seek out the child to touch base physically and emotionally before the child has to come looking for them (Pearce, 2010). This helps the child experience adults as aware of them and responsive to them without the child having to act-out first to get attention. Emotional refueling in reverse is crucial because it erodes the child’s beliefs that the only way they can get their needs met is through controlling everyone and everything in their environment (Pearce, 2010).

Implications and Outcomes in Childhood

One meta-analysis report of 13 studies found that attachment insecurity was strongly associated with borderline personality disorder. It was also found that attachment style may be correlated with personality disorder measures (Hardy, 2007). In the Diagnostic and Statistical Manual of MentalDisorders (DSM) the only pathology that is officially related to attachment is reactive attachmentdisorder (RAD) of infancy or early childhood (American Psychiatric Association, 2000). The diagnostic criteria for this disorder include: a pattern of disturbed and developmentally inappropriate social relationships prior to age five, a history of pathogenic care that predates the presentation of the disturbances, and the assumption that the disturbances are not better accounted for by other diagnoses (Hardy, 2007).

The DSM classifies two types of RAD: inhibited and disinhibited. The inhibited type of RAD results from having caregivers who did not provide emotional support and comfort when needed. Behaviors that are typically associated with this pattern include withdrawal from others, avoidance of comforting gestures, self-soothing behaviors, vigilance, aggression, and awkwardness in social situations (Hardy, 2007). What distinguishes RAD is the degree and pervasiveness of the child’s unresponsiveness in the context of minimal or no attachment behaviors (Zeanah & Smyke, 2008).

In the disinhibited type, behaviors are believed to be related to experience with caregivers who are not responsive but can be coerced into providing affection. This results in behaviors such as inappropriate familiarity and comfort-seeking with strangers, exaggeration of needs for assistance and a chronic anxious appearance (Hardy, 2007). It can also be seen in the failure of the child to check back with the caregiver in unfamiliar settings. Instead, they may display a tendency to wander off and a willingness to approach, interact with, and “go off” with a stranger (Zeanah, & Smyke, 2008).

Treatment for RAD

Treatment of disordered attachment and related behaviors tends to be focused in several areas: enhancing current attachment relationships, creating new attachment relationships, and reducing problematic symptoms and behaviors (Hardy, 2007). Preferred interventions include cognitive behavioral management of mood symptoms, behavioral modification, and psycho education. Since RAD is characterized by impaired social relationships, the addition of social support and coaching may enhance peer relationships. Interventions designed to enhance self-esteem and increase self-efficacy could also improve functioning (Hardy, 2007).

Another form of counseling that helps parents form secure bonds with their children is Parent and Child Therapy (PACT). The main focus in these sessions is on the caregiver overcoming resentment and issues with his/herself and their views of the child, on rewriting negative experiences, and on creating a bond through watching their child play from a one way mirror (Chambers, Amos, Allison, & Roeger, 2006). Becoming comfortable with watching the child for extended periods of time allows the parent insight into their child’s personality and aspects of their relationship that need to be worked on. Parents gain awareness into how their circumstances have affected bonding with the child, and ways that they work towards forming a new bonding experience directed away from neglect and aimed, of course, toward creating secure attachment (Chambers et al., 2006).

Implications Beyond Childhood

Childhood maltreatment has long been associated with the formation of insecure, disorganized attachment relationships in childhood and adulthood (Reyome, 2010). Previous research has shown a history of childhood emotional abuse as being linked to insecure attachment in late adolescence and adulthood and determined that insecure attachment style makes a significant contribution to functioning in romantic relationships in later life (Reyome, 2010). Individuals with insecure attachment demonstrate poor emotional regulation, ineffective coping strategies, low self-esteem, deficits in self-understanding, impaired social skills, and poor mental health.

One study conducted comprehensive interviews with participants who experienced some form of abuse or neglect in childhood. The interviewees reported difficulties in forming friendships and establishing roles in a community. They experienced similar patterns of isolation from the neighborhoods and communities they grew up in and found it difficult in later years to establish and maintain friendships with others. They reported having few friends and lack of a social network as adults (Frederick, and Goddard, 2008).

Early Attachment & Adult Romantic Relationships

A key factor in research concerning adult attachment types revolves around the interpretation of early childhood experiences by adults. Research has found that the way we perceive our early years can play a significant role in the functioning of our adult relationships. One particular study tested the notion that the way negative childhood experiences are processed is closely linked to patterns of psychosocial functioning in adulthood (McCarthy, & Maughan, 2010).

Our findings raise the possibility that the capacity to work through and come to terms with adverse childhood experiences may be linked to the capacity to achieve positive functioning in close relationships later in life. By contrast, a very strong association was found between insecure attachment status and poor functioning in adult relationships, suggesting that insecure ways of dealing with early adverse experience may contribute to problems in making and sustaining close intimate relationships in adult life (McCarthy, & Maughan, 2010). In other words, the most important thing is not so much the condition of one’s childhood, but rather, the ability to process and work through those experiences as adults.

The same study also discussed how emotionally secure adults were able to coherently process negative childhood experiences and have the ‘coherent state of mind’ associated with secure adult relationships. This is important because a secure working model of attachment enables individuals to explore a wide range of positive and negative thoughts and feelings (McCarthy, & Maughan, 2010). This suggests a possible link between the capacity to think in a coherent and unified way about attachment-related experiences and the ability to break negative cycles of psychosocial functioning.

Though we do not have control over our childhood experiences, we are capable of living full lives as adults and being involved in secure, loving relationships so long as we are able to effectively process the events of our childhood in ways that do not totally inhibit our ability to form such relationships. An emotionally balanced and healthy life therefore has more to do with internal working models and the ways in which we perceive ourselves and our world, rather than the reality of our past experiences.Continued on Next Page »