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Reactive Attachment Disorder: A Journey of Hope

Family Adoption Stories Bonding & Attachment

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  Written by Nancy G. on 01 Jan 2006

Our story begins on April 3, 1996, the day we brought our then 4- year- old son home from a Romanian orphanage.

Our story begins on April 3, 1996, the day we brought our then 4- year- old son home from a Romanian orphanage.  From the moment he came home, he was a whirlwind of hyperactivity - touching everything, defiant, destructive, loud, violent and rageful.

I noticed some other strange behaviors right away.  Rocking back and forth and from side to side, refusing to eat, lack of eye contact, an apparent need to be in control of everyone and every situation, and a propensity to illicit angry responses from both myself and my husband - what we called "pushing our buttons".

He had no fear of strangers often just walking up to a stranger and touching them and talking to them.  He would hug me with his back when I would go for a hug and he flinched when I touched him yet he would be happy to give hugs to anyone not in his immediate family. 

I suppose the worst behaviors were the defiant ones - bossiness, arguing, and sassiness.  No amount of behavior modification - sticker charts, etc. - worked with him.  He just didn't seem to learn from his mistakes.  I read all the traditional parenting books and tried many different techniques.  Sometimes, they would work for a small amount of time but inevitably; we would end up back at the beginning.  I started to think it was my fault.  That I wasn't loving him enough, that I needed to give him more time and be more patient.  By the time he went to kindergarten and then first grade, he was a constant behavioral problem.  

An insightful teacher told me to check the Internet for information on issues that international adoptees might face.  That is when I stumbled across the Parents Network for Post Institutionalized Children .  They have a very insightful newsletter that ran through the many issues that some international adoptees suffer from (not only the international adoptee but children adopted domestically, foster children, and even biological children can be diagnosed with attachment disorder).  There was a list of symptoms for reactive attachment disorder and at first I was excited as I thought okay, I'm not crazy this is real.  But the more I read the more frightened I became.  It is a very serious illness and tough to recover from. An important point to remember is that not all children who are adopted domestically, internationally, or children in foster care will come to you with attachment disorder.  Not only is it the environment that these children lived in but also a lot depends on the child’s temperament, strengths, weakness, etc.  I would never hesitate to adopt again.  In fact, this past year we adopted a baby from Guatemala at four and half months old.   I did notice a few signs of attachment problems – lack of eye contact and stiffening when being held – but this time, I was informed and could start working on the attachment process from day one.  It is just logical to become as informed as you can about attachment problems but don’t let it make you fear adoption or foster care. Attachment is on a continuum from securely attached to severely attachment disordered.  Some children may suffer from attachment issues, some from mild attachment disorder and some from severe attachment disorder as in my son’s case.  They all can benefit from treatment and therapeutic parenting and should receive both to help them become securely attached.   

Our son was diagnosed with reactive attachment disorder and we then had him screened for other disorders.  Sensory Integration Disorder was one of the disorders that he received treatment for as well.  It is very important to find out if your child suffers from other disorders that may exist with reactive attachment disorder.   

Next, it was off to the neurologist where he was promptly diagnosed with ADHD.  He takes Adderall for the ADHD and Wellbutrin for depression and anxiety.  I fought the idea of giving him medication for a long time but the neurologist explained to me that my son’s brain did not develop normally due to the deprivation and lack of attachment he suffered in his early years and that the medication would help him.  The doctor was correct. 

I had shied away from holding therapy for a year feeling it was too intrusive.  Finally, we decided to find a therapist who specialized in holdings and other attachment work.  We had to travel three hours each way but it was well worth having a therapist who knew how to help us.   

So we had the right kind of therapy in place for our son and then we had to learn therapeutic parenting.  Typical parenting techniques do not work with attachment disordered children.  We used the parenting techniques that are designed specifically for children with reactive attachment disorder.  I also found a local support system and participated in an Internet support group. 

We started out with a boy who hated the world.  A boy who couldn't love, obey the simplest request, trust, or be joyful.  We now have a child who laughs, hugs, loves, smiles, trusts, and can live within the boundaries we set for him - it is an amazing site to behold.  God is merciful. 

Once you deal effectively with all of the pieces to the puzzle - the parenting, therapy, medication if needed, take care of other disorders, deal effectively with school, and take care of yourself, you can effect positive change in your attachment disordered child.   

Description of Reactive Attachment Disorder

Reactive attachment disorder is a very real illness.  Children with reactive attachment disorder are reacting to events in their early life that may include neglect, abuse, or something subtler like ongoing, undiagnosed painful medical issues (see Potential Causes below).  Due to these events, many children are unable to attach to a primary caregiver and go through the normal development that is required in order to function in relationships.  My explanation is somewhat simplified but may be helpful to you.  It does not replace a diagnosis from a qualified 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: 

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:

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 "Potential Causes" below)   

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.  

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:

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, and 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.  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.  

Coupled with an understanding of what went wrong in the first few years of my son's life, another major key in helping him was for me to begin to understand his behaviors and find out how my son looked at himself and the world around him. I needed to know what his belief system was.  I needed to learn why he felt that it was necessary to do the things he did. 

Children with reactive attachment disorder see the world differently than we do.  They learned in those first few months or years that they could not rely on adults to keep them safe.  In many cases, they learned that adults were uncaring, mean, rejecting, violent, unreliable, unresponsive, or absent.  It doesn't matter how wonderful their new home is or how wonderful you are, they will perceive you the way they perceive all adults.  Even children who have come home at a very young age often cannot take in the love their parents try to give them.   Biological children who suffer a separation from their primary caregiver due to illness, etc., may not be able to take in mom's love.  The potential causes vary as seen below. 

As in my son's case, the child may learn as an infant/toddler that they must take care of themselves.  That they cannot depend on adults for their safety, hence their need for control to make sure they stay safe.  They believe that they stay safe if they push you away by making you angry, grossing you out, etc., any way they can to distance themselves from you emotionally and physically. 

Many times these hurt children really believe that if they do things your way by obeying you they will die. They don't think that doing things your way is what will keep them safe. They learned this in those first few years of life when they learned they had to depend on themselves. Bringing them into your home will not change this belief about all adults – including you. 

Although my son never knew his birthmother he thought that it was his fault she left him at the hospital - he must have been a bad baby.  He must have cried too much, been to demanding, was too ugly or she just looked at him and knew how bad he was.  He felt he was bad, dumb and stupid and unworthy of love and affection - it was all his fault.  That is much easier to believe than his own mother didn't want him.  Can you imagine the pain of that rejection?  No wonder it is easier to believe that you are the cause of your misfortune.   No amount of positive adoption language or stories would change my son’s mind about his birthmother.  Not until we tackled this subject in therapy with a trained attachment therapist was my son able to internalize a positive belief system about his birthmother, himself, and his new family. 

He learned all of this before he came to me. These beliefs about adults and himself did not go away because he came into my wonderful new home.  If you can understand why your child doesn't want to do things your way (he doesn't trust that your way is safe based on past experience), why your child tries to make you angry by pushing your buttons and using gross-out behaviors (because he doesn't want you to love him, he wants to keep you emotionally distanced to stay safe), why he sabotages special moments and events (because he feels unworthy), why he is so negative (because he feels bad about himself to the point of self-hatred) you are put in a better position to help him. 

By understanding my child's inner life I was better equipped at maintaining the right therapeutic parenting attitude needed to help facilitate healing.  I also stopped taking his behavior so personally and realized that he would behave this way regardless of his present circumstances.  He would reject any adoptive parent - it wasn't me, it was his illness. 

I was able to start seeing my son as a deeply wounded child who was denied the very basics in life – a mother's love and protection.  My focus switched from my hurt feelings and dashed dreams and started to focus on helping my son find his way back to the beginning and start the attachment cycles even at his advanced age that would in time, help him heal his broken heart.  Essentially, I came to terms with my disappointments and got down to the business of healing. 

In many cases healing is possible with the right tools!   

Intense control battles, very bossy and argumentative; defiance and anger

Resists affection on parental terms

Lack of eye contact, especially with parents - will look into your eyes when lying

Manipulative - superficially charming and engaging

Indiscriminately affectionate with strangers

Poor peer relationships

Steals

Lies about the obvious

Lack of conscience - shows no remorse

Destructive to property, self and/or others

Lack of impulse control

Hypervigilant/Hyperactive

Learning lags/delays

Speech and language problems

Incessant chatter and/or questions

Inappropriately demanding and/or clingy

Food issues - hordes, gorges, refuses to eat, eats strange things, hides food

Fascinated with fire, blood, gore, weapons, evil

Very concerned about tiny hurts but brushes off big hurts

Parents appear hostile and angry

The child was neglected, physically abused, and/or experienced the potential causes of attachment disorder in the first three years of life

Potential Causes of Reactive Attachment Disorder  

Neglect

Abuse

Separation from the primary caregiver

Changes in the primary caregiver

Frequent moves and/or placements

Traumatic experiences

Maternal depression 

Maternal addiction - drugs or alcohol

Undiagnosed, painful illness such as colic, ear infections, etc.

Lack of attunement between mother and child

Young or inexperienced mother with poor parenting skills

 Finding Help  

We can make a difference in our children’s lives and bring love into their hearts and into our homes with the right tools.  You can learn more about reactive attachment disorder by visiting my Attachment Disorder Site .  Topics include support, related disorders, treatment options, finding help in your area, parenting ideas, educational resources, informative links, school issues, conferences and trainings, adoption information, adult attachment problems, and more. 

 If you are living with an attachment disordered child, know you are not alone in your struggles.  You are welcome to join us at the Hope for Attachment Disordered Kids Email List .  I created this list for those dealing with children with reactive attachment disorder.   This is a hopeful, positive place where you can find support for day to day living with a child with attachment disorder.   The archives are for members only so as you join you can glean information and support from reading past messages.  You also may email me privately with any questions.  I am here to help. 

 




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