Most of what I read in the popular literature makes attachment sound like a rope that runs between a child and a parent. Either your child is holding the rope and is "attached" or he/she has dropped the rope and has attachment problems. Needless to say, this is a simplistic image. The fact is, attachment is a complex relationship between parent and child and there are a wide range of variations and problems. Both parent and child contribute to the health of this special relationship.
I think of attachment as many woven strands between parent and child. These strands grow gradually and continually throughout the relationship. Both parent and child have to work at creating the weaving. When the weaving progresses smoothly, and the relationship is mainly cooperative, we call the attachment "secure". Secure attachment provides the child with a safe base (a parent) who helps the child maintain physical and emotional balance as the child moves away from the parent-base to explore the world and become an individual person. Reconnecting with the parent is a way for the child to regain equilibrium and to process experiences.
Before a parent can be a "secure base", infants have to know how to locate and signal or call the parent. When a parent initially anticipates and then responds to the signals, infants learn to communicate and trust that adult. There are a multitude of ways that this intimacy helps a child maintain physical and emotional balance. If the tasks of development (trust, social relationships, mastery of skills, identity) are the high wire act, then attachment is the combination of the ladders, guywires, balance pole, and of course, the ever-present safety net.
When a child looses birthmom, has a succession of caregivers, and finally is adopted, I imagine the base feels more like a foundation for a building constructed by several different construction crews. Each crew had it's own set of plans, and poured separate concrete slabs next to and/or on top of each other. To make matters worse, the building that must rest upon this base is grieving for the departed contractors.
To gain a child's trust, an adoptive parent must acknowledge not only the piecemeal foundation but the fact the child may still be waiting for past workers to return. This expectation resurfaces each time a developmental reorganization occurs. No matter how early the separations occurred, the child will be cognizant on some level of the patched together pieces. Without the acknowledgement of these facts by the adoptive parent, the child feels a bit crazy, "Am I imagining something? Why do I feel this way?" The infant or child cannot relax and trust deeply no matter how good or kind or consistent the adoptive parents may be. This unshared piece leads children to become "very busy" or "always happy" as a way to avoid feeling puzzlement, grief and the gap in the present relationship. This is initially a small but real hole in the fabric of attachment. However, as adolescence arrives, the hole widens, precisely because it was previously unaddressed. It offers teens an additional excuse to feel distrust for their parents. When adoptive parents address the issue, the child feels completely "known" by the parent, this is calming and the child can "play" and "feel" more fully.
A child with a patched base history may become demanding, coercive, helpless or threatening in the attachment relationship. Indiscriminant friendliness, or difficulty maintaining emotional or physical balance, difficulties in sensory integration may also occur. When these behaviors prevent the child from accomplishing developmental tasks or interfere with the parent-child relationship the attachment is called "atypical". The weaving has knots or gaps with strands in need of strengthening or repair. Adoptive families may have secure or atypical attachments, just as non-adoptive families do. In early childhood these issues are subtle and resemble difficult phases or temperament. Left unattended, these strands of early childhood difficulties can affect learning, behavior and social relationships.
Reactive attachment disorder (RAD) is quite different than what has been described so far. It occurs when a child has experienced global neglect, that is neglect of every need for many months or years. It is when all or nearly all of the strands that form attachments have been torn to the point the child no longer wants to enter into a genuine, interdependent relationship with an adult. From time to time, nearly all children with complex histories will show behavior that resembles an individual symptom of reactive attachment disorder. These behaviors stem from the time when there was no consistent or responsive caregiver available. Most children and their adoptive parents have the will to repair the strands, and to tolerate the melt-downs that are part of growing up in a family following a difficult early life.
Normally, children become disorganized emotionally and physically before each developmental leap whether it's rolling over, crawling, talking, going to pre-school, learning to read, or preparing for college. Children get cranky and have more than the usual number of a melt-downs. The communication suddenly shifts to baby talk and tantrums. Under the stress of disorganizing, adopted children frequently regress, or revert to survival skills they developed in institutions. These behaviors are typical when a child's brain is reorganizing. (They are also typical when a child is overstimulated, tired, or getting too little attention from a parent to remain in emotional balance.) During periods of reorganization, children need more help from their parent to maintain emotional balance. Since children cannot notify parents of what is happening to them, parents need to anticipate, or at least recognize, these points of disorganization, by learning about child development. A child needs parents to restrict stimulation and demands during this period. It is not the time to start a new music class or increase household chores. T. Berry Brazelton has calls these points of disorganization "touchpoints" because they offer parents and children a powerful opportunity to deepen their attachment.
In looking for guidance, adoptive parents are thrown off track by parenting books and pediatricians who do not take into account our children's early experience with separation and loss. How many parents have had friends, family or pediatricians who say, "throw that bottle away!" just a few months after an infant or toddler has been adopted. These well meaning advisors are forgetting about the importance of sucking for comfort for a child who has recently lost everyone and everything familiar. Throughout an adoptive child's life, sensitive parents must ask themselves if a parenting strategy or technique takes their child's history into account. Many parents worry that a stage will be permanent if they don't immediately eradicate the behavior. Sensitive and authoritative parents can take a step or two back when necessary, while keeping reasonable expectations for the future.
Adoption issues often come up when developmental reorganization occurs. Along with learning to share and wait in line, adopted pre-schoolers want to know "who will take care of me if mommy or daddy dies?" (which non-adopted children almost never ask) As they master times-tables, reading and writing, school aged children want to know if they can be "readopted" to another family, (non-adopted children don't spend time worrying that their parents might give them away or "throw them in the trash.") When adolescents take foreign language classes and advanced chemistry, they threaten to run away to China to find and live with birthparents. All of these are expressions of anxiety about their "secure base", and a wish for reassurance. These demands on parents are more typical of children with complex histories and are not an indication that the attachment or parenting have failed. In fact, they are indications that the attachment is operating as it should, the child is working with the parent to regain equilibrium.
An adopted child may depend more, and for a longer time, on the help of parents. Making sense of adoption on a daily basis is a task that takes time and energy for both child and parent yet it promotes deeper, more meaningful attachment.
My seven year old is learning to read; we sit down to our twenty assigned minutes of homework. "You hate me and I won't read," my child announces. "No I don't hate you," I reassure her. She curls up in a ball, like she used to at four. "I'm a baby." she says. What sort of signal is this? I realize after several weeks of trying various parenting strategies that are "age appropriate" responses that the developmental leap of reading is causing her to reconsider her feelings about adoption. And the reading material is also stimulating questions about separation and loss. The next time we sit down to read, I ask her if the story of the elephant growing up and leaving his mother makes her think about her first parents. She gazes up at me, "I love you mom" she sighs. Now she knows that I know how she feels and our attachment wraps around us like a quilt. The oppositional reading struggles vanish.
At seven, and probably eight and eighteen, she will sometimes need me to intuit her needs when adoption issues arise. I keep re-learning that if we can connect about her feelings in this area, shortly thereafter she will meet my age appropriate expectations.
The growth of attachment after international adoption takes attention, work, and guidance from a parent. We can rebuild attachment relationships if we are mindful that attachment is not a rigid pattern described in the latest parenting book. Attachment begins with attentiveness, and is an elastic and changing process that fosters growth for parents as well as children.
Can Attachment Problems Turn Into Reactive Attachment Disorder?
Most adopted children have some issues with attachment, which is to say they have a more complicated attachment history that adoptive parents must integrate into the parent-child relationship. These children have occasional to frequent behavior difficulties which are judged atypical as compared to age appropriate behavior of securely attached non-adopted children. A few children who have spent their entire life in an institution or bouncing from one foster home to another, enter adoption with the symptoms of reactive attachment disorder.
Many adoptive parents are worried that somehow mild to moderate attachment difficulties (atypical attachment) will suddenly become RAD. Is this true? From my experience both in observation and reading of cases, I would say there are three reasons for atypical attachment to move towards RAD.
1. Parents deny or minimize or even normalize the atypical signs and symptoms, and therefore those needs of the child remain unaddressed.
2. Parents treat the symptoms as evidence of the child's "badness" or "willfulness" etc. instead of recognizing them as signals and communications. Many of these parents are struggling with their own early history of hurtful parents and feel the child's needs and/or demands are replays of prior abuse. Some parents come to the conclusion their child is "bad" based on philosophical or religious ideas.
3. Parents expect that because their adopted child is "doing well" they can give them the amount of attention and support a non-adopted secure child would receive. Having decided their child is "adjusted", they fail to leave time and space in their lives for the work of attachment. This neglect is felt deeply by the child and incorporated into the adoption and grief and loss issues. Because children with complex histories sometimes delay asking for help, or try to be "extra good" to get attention, the negative feelings are suppressed until some trigger releases them and they overflow.
Patty Cogen works in Seattle, Washington, as a Child Development Specialist and Family Therapist with expertise in international adoptions.