One of the known risks of adopting a child from an orphanage
is Reactive Attachment Disorder. Individuals with the most serious level of
this personality disorder are unable to give and receive love. They cannot
develop the ability to form successful relationships, or accept responsibility
for their actions, and lack cause-and-effect thinking, empathy towards others,
and a conscience. They are typically angry, oppositional, defiant and do not
trust others. Insecure attachment can be ambivalent, avoidant or disoriented-disorganized.
Reactive Attachment Disorder is a continuum, from very mild attachment issues
to the severe cases of extreme autistic or sociopathic behavior. Some people
prefer to label milder cases as attachment problems, and limit the term Reactive
Attachment Disorder to serious cases.
Until recently, many adoptive parents assumed that only
post-institutionalized children adopted as toddlers and older were at risk of
developing Reactive Attachment Disorder and that babies under age one would
quickly and completely overcome early emotional deprivation once they were in a
loving family. Indeed, this may be a factor in choosing only to adopt an
infant. But many adoptive parents are discovering that children who seemed to
have attached well as infants begin to display symptoms of attachment problems
as toddlers, preschoolers, or in elementary school. As they grow older, new
inappropriate behaviors, typically more extreme or excessive than
developmentally normal, may indicate emerging unresolved attachment issues.
WHY DO POST-INSTITUTIONALIZED CHILDREN DEVELOP ATTACHMENT
For normal emotional development, babies need a primary
caregiver who responds quickly, consistently and lovingly to their demands, so
they learn that their needs for food, clean diapers, pain relief, etc will be
met. Through these interactions, they develop trust and attachment. Babies need
to feel that their world is safe and secure. The baby has an internal cycle of
need-rage-relief-trust, which should be completed hundreds and hundreds of
times. Babies also need a one-on-one interaction with a caring individual who
cuddles, plays interactive games, sings and talks to them. They need to be
touched, to receive and give smiles, and to get lots of eye contact from a
loving caregiver. This consistent, constant, warm and playful interaction with
the caregiver is how a baby learns to receive and to give love.
Orphanages cannot provide continuous individual one-on-one
care. In many institutions, a succession of nurses give minimal physical care,
changing diapers infrequently, occasionally washing the babies, and propping
bottles so the babies feed themselves. Babies are left alone for long hours in
their cribs. With a ratio of one caregiver to perhaps ten or twenty babies, she
cannot attend to each infant when the baby cries from hunger, pain, and
discomfort, or for attention. When she does not respond to crying, the babies
never learn to trust that their demands will be met. Nor do they get the cuddling,
baby games, baby talk, and other playful interaction they need.. As a result,
babies may give up trying to get their needs met, and feel only the emotions of
rage, helplessness, fear and shame, never developing the trust, and the sense
that the world is safe and secure, that are essential for successful
BUT MY BABY BONDED RIGHT AWAY!
Internationally-adopted children are unattached when they
first meet their new parents: after all, they are total strangers! The child
initially regards the new parent as a yet another caregiver. Children who were
already attached to a caregiver will be distressed at being handed over. They
will grieve for days, weeks and even months, acting withdrawn and passive, or
endlessly crying, or furiously angry. A child who shows no feelings of loss but
is happy and smiling from the start may actually have significant attachment
problems. A baby who clings desperately to the new mom, and shrieks when
separated for a moment, is not instantly bonded, but terrified. It is a trauma
bond necessary for survival. Most internationally-adopted children resolve
their grief, and gradually and successfully bond with their new parents. Within
a few days, the baby or toddler usually shows a preference for mom and dad, has
good eye contact, and accepts caresses and comfort. Even unattached babies
often learn to love within a few weeks and months, with the care and attention
of a loving family.
RECOGNIZING ATTACHMENT PROBLEMS
If a baby continues to refuses to make eye contact or
interact with parents, and has no preference for them; dislikes being held and
cuddled; does not hold on when held; never cries, even when soiled, hungry or
in pain, or cries all the time and throws terrible tantrums; continues to be
totally clingy (the velcro baby) and fearful of separation; has severe sleep
problems; and self-injuring repetitive behaviors, the parents usually recognize
that their child has attachment problems, and seek help. Parents who adopt
older children also recognize attachment problems quickly, as they are
generally educated beforehand about the known risks of attachment problems in
older-child adoptions, and the symptoms of Reactive Attachment Disorder in
school-age children are well-known.
The post-institutionalized children who do not get the help
they need with attachment problems are those whose symptoms are not obvious
from the start. They seem to attach well, but gradually show more and more
symptoms as they grow older. When they are toddlers, many parents fail to
recognize signs of Reactive Attachment Disorder, as the behaviors are often
typical of normal toddlers. But when these children become preschoolers, and
still misbehave like toddlers, their parents become concerned. Typically,
parents have an instinctive gut feeling that something is very wrong with their
child. Yet they, and the pediatricians, social workers, psychologists and
counselors they consult, often misdiagnose the problem as Attention Deficient
Hyperactivity Disorder, Oppositional-Defiant Disorder, autism etc. and turn to
treatments and therapies that are not effective. One reason they do not
consider Reactive Attachment Disorder is that children age two to five do not
exhibit most of the symptoms recognized in school-age children. Another is that
often the child appears well behaved and affectionate to others, reserving the
misbehavior for Mom alone.
SYMPTOMS OF REACTIVE ATTACHMENT DISORDER
Symptoms of Reactive Attachment
Disorder in toddlers and preschoolers include toddler behaviors that are more
intense and persistent than in normal toddlers:
out-of-control tantrums. Unusually defiant and disobedient. Flies into a
rage for the least little thing. Deliberately soils in inappropriate
places. Destructive of property. Normal methods of discipline are ineffective.
“velcro kid”, unwilling to be separated from Mom for any time at all.
Cries incessantly when parted, insists on keeping Mom in sight at all
times. Scared to go to sleep alone at night, and wakes in the night to
check on whether Mom is there.
to control Mom at all times. This can be achieved in many ways:
active toddler, constantly on the go. This risk-taking hyperactivity is
intended to keep her constantly vigilant and at his side. A nightmare to
take shopping, to a restaurant etc
when Mom is on the phone or talking to other adults, very jealous of
attention to other siblings. Will whine, cling, hit, chatter, to
monopolize Mom’s attention - again, insecure or anxious attachment.
to cooperate or excessively demanding with eating, going to the toilet,
dressing etc. Refuses to eat meals or most foods. Demands food or drink
frequently, wants Mom to accompany bathroom visits, wipe and wash hands,
to play alone, insists that mother or other family member plays or
interacts with him or her at all times
affection on his or her terms - asks repeatedly for hugs, tells Mom, “I
love you” endlessly.
All of these behaviors eventually result in the parents’
limiting or curtailing any outings or social contact involving the child. Other
behaviors that parents of normally-attached children would find worrisome are:
being cuddled and kissed, refuses to give eye contact, wriggles and gets
down from Mom’s lap when held
affectionate and trusting behavior towards visitors and strangers.
intense hostility, jealousy and violence towards siblings and pets,
especially when competing for Mom’s attention.
of affect - remote and detached, with flat emotions.
WHY DO THESE CHILDREN BEHAVE LIKE THIS?
They feel shame, that they were unwanted by their
birthmothers, and believe they must have been bad or defective to be rejected
and abandoned. The lack of loving attention in the orphanage only reinforces
that shame. They remain convinced that they will eventually be “thrown out”
again, for being bad. These children usually feel anger towards their
birthmother and birth family, for abandoning them. Their anger towards their
adoptive mothers is actually directed at their birthmothers: they have not
differentiated them. They may also feel anger towards the orphanage caregivers
for the neglect and abuse they endured, and towards the adoptive parents for
not rescuing them sooner. They may even feel anger about being removed from
their country of origin. They are not convinced that they are really loved, and
that they are permanently part of the family. To protect themselves from being
hurt again by the loss of love, they may reject parents’ attempts to attach,
and use distancing behaviors, refusing to interact or communicate with parents.
Children with insecure or anxious attachment often believe that if Mom did not
give her full attention, she does not love them. If she is absent, or paying
someone else attention, she has stopped loving them. Deprived in the orphanages
of the constant care they needed, these children do not trust adults to meet
their needs; they felt responsible for their own survival. So these children
lack trust, and need to be in control at all times.
There are, of course, other causes of atypical behaviors,
such as other mental illnesses, Post-Traumatic Stress Disorder, Sensory
Processing Dysfunction etc -- many arising from the same early deprivation,
neglect and abuse that causes attachment problems. But if a child does have
Reactive Attachment Disorder, whether mild or serious, none of the therapies
for other mental illnesses or learning disorders will be effective. The
underlying cause remains, and behavior will very likely worsen. There are
specific therapies which work for attachment disorder, both for the child and
for the family. But they are most effective when the child is young. The sooner
these hurt children get appropriate therapies, the more rapidly they will heal,
developing the capacity to give and receive love, learning to trust, and coming
to see themselves as loveable and worthwhile individuals.