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Previously, we have looked at attachment disorders and how children whose early lives have been characterised by disruption, abuse and/or neglect that affects their relationship with their primary caregiver in a negative way, may develop a range of attachment disorders that can have a pejorative effect on their entire life.

There are three main types of attachment that can be formed:

  • Secure attachment
  • Insecure attachment, and
  • Disorganised attachment

For children who have attachment issues, they can develop attachment disorders. The Diagnostic and Statistical Manual for Mental Disorders (DSM 5) recognises two types of attachment disorders. These are diagnosed during childhood when a child has experienced extremes of insufficient care and are:

Reactive Attachment Disorder (RAD) is characterised by emotionally withdrawn behaviour where the child finds it difficult to connect with others and manage their emotions. They can often feel scared and alone and be resistant to comfort. They often find it difficult to trust adults and can have poor self-worth, often needing to be in control.

Disinhibited Social Engagement Disorder (DSED) is characterised by over-familiar social behaviour where the child may seek comfort and attention for virtually anyone, even strangers. Normal social boundaries can be overstepped without regard for safety. Although they can be overfamiliar with many people. Children with DSED often find it difficult to form meaningful relationships and may seem to flit from one connection to another.

How do these children present?

As with most things, children with attachment disorders can present in unique ways, however, there are certain behaviours that might indicate an attachment disorder. Depending on the type of attachment disorder, these can include:

  • Emotionally volatile/aggressive behaviour
  • Low self-esteem
  • Quick to make and break friendships
  • Difficulty in making friends – prefers their own company
  • Mistrusting adults
  • Intense reactions to changes in routine
  • A need to be in control
  • Lack of empathy/emotionally detached
  • Disinterest or lack of engagement in any activity
  • Inappropriate coping strategies
  • Poor concentration or overly fixated on one thing
  • High-risk behaviours such as substance abuse (usually in older children/teenagers)

Maslow’s hierarchy of needs suggests that if children feel unsafe, they will not be able to focus on other things like love, friendships, learning and self-esteem until that feeling has been addressed and children with attachment disorders may spend most of their day feeling unsafe. There is no ‘one size fits all’ therapy or solution for the problem and practitioners should understand the need to treat all children as individuals to best support their needs.

Co-morbidities

Another point to remember is that many children who present with attachment disorders also present with other challenges as well such as:

  • Autism
  • ADHD or ADD
  • PTSD
  • Learning difficulties or disabilities
  • Sensory needs

Many of the symptoms can be confused with autism so a specialist diagnosis by a qualified medical practitioner is needed.

How is child attachment disorder treated?

Attachment disorder is primarily caused by the child not having a loving and responsive carer in the first years of life, so the main treatment is to make sure they feel loved by their parent or main caregiver and that they feel that new relationships are safe and secure. Since many children with attachment disorders are in the care system, this may mean working with foster carers or adoptive parents to achieve this.

Specialist advice should be available through the local children’s social services, and they may initiate training for parents and carers. In many cases, once children are in safe and secure environments, many symptoms of RAD improve quickly, however, some children with DSED may continue to have the symptoms even after they are well cared for.

There is no medication treatment for attachment disorders. Instead, it is treated in practical ways, by improving the environment. Sometimes talking (psychological) therapy is used for the difficult behaviours that children with attachment disorder develop.

According to information on patient.info, professional healthcare strategies which may be used, depending on the age and situation of the child include:

  • Finding the child a stable, permanent and caring placement if they are in care
  • Video feedback training programmes for parents or caregivers
  • Other training programmes or support for parents or caregivers (including sensitivity and behavioural therapy)
  • Parent-child talking therapy (psychotherapy)
  • Play therapy in groups
  • Training and support for foster carers, guardians and adoptive parents
  • Cognitive behavioural therapy (CBT). This is a type of talking therapy which may be used to give young people who have been maltreated, help in coming to terms with the problems they have had

How to help a child in your setting

Children with attachment disorders can present with challenging behaviours which require a lot of patience, understanding and a non-judgemental attitude. Remember, it is not the child’s fault. The most important thing is that the adults around them make them feel safe and secure in a world where they may not have felt this ever before. This includes early years practitioners.

You can help a child or young person feel safe and secure by:

  • Remaining patient, calm, and non-judgemental
  • Allowing opportunities for one-to-one interactions
  • Giving the child your full attention
  • Being physically and emotionally available
  • Setting consistent limits and boundaries, and clearly explaining why they are set
  • Being sensitive to children’s thoughts and feelings
  • Repairing relationships when needed (e.g., saying sorry)
  • Creating opportunities for success to increase the child’s self-esteem
  • Providing specific praise for effort and achievement
  • Engaging in activities and working together

A child’s eating, sleep, and exercise habits are also important in helping reduce stress, but these are even more important in children with attachment problems. Therefore, settings should encourage healthy lifestyle choices regarding diet, exercise, and sleep where possible.

And finally - remember that no matter how detached or insecure a child seems, or how exhausting and frustrating it is for the carers when challenging behaviours appear, it is possible to repair or improve the lives of children with attachment disorders. What is needed is lots of love, patience and understanding.

Reading resources

  • “The Explosive Child”, by Ross W. Greene
  • “Feelings and Emotions: Feeling Angry”, by Katie Douglas
  • A series of books on attachment, written by Sir John Timpson CBE – these are free resources

References and more information

https://www.helpguide.org/articles/parenting-family/attachment-issues-and-reactive-attachment-disorders.htm

https://www.attachmenttraumanetwork.org/what-are-attachment-disorders/

https://patient.info/doctor/child-attachment-disorder-pro

https://www.nice.org.uk/guidance/qs133

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