Download Achieving Permanency For Children Diagnosed With Reactive

The Institute for Attachment and
Child Development
“Achieving Permanency For Children Diagnosed With Reactive
Attachment Disorder”
Presented by:
Forrest R. Lien, LCSW-Director
Email: [email protected]
P.O. Box 730 – Kittredge, CO 80457
(303) 674-1910-phone (303) 670-3983-Fax
www.InstituteForAttachment.org
Attachment Cycles
1st Year
Necessary ingredients
of development of
basic trust and
attachment:
Need
Relaxation
of Tension
(trust)
Trust
Of
Caretaking
Satisfaction of
Need
(gratification)
State of
High
Arousal
(rage)
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Eye Contact
Food
Motion
Touch
Verbal Contact
Emotional Contact
Smiles
Attachment Cycles
2nd Year
Wants
Mutual good
Feelings
Trust
Of
Control
Acceptance
Of
Limits
TRUST
State of
High
Arousal
(rage)
Necessary ingredients
of development of
autonomy, good
character foundation
and conscience.
Maintain parental
control while allowing
child to explore and
begin to make good
choices for themselves.
AUTONOMY
ATTACHMENT
Sub-Types of Attachment Disorder
1. AVOIDANT-isolation, avoid closeness, seldom seek comfort,
avoid relationships, passive-aggressive, avoid feelings, intense
sadness and loneliness, believe their rejection by birth mom was
justified
2. ANXIOUS-crazy liars, fake emotions, emotionally empty,
“good actors”, chameleons, often fool therapists that they’re
normal and parents aren’t
3. DISORGANIZED-disorganized, odd, and bizarre behaviors.
Other psychiatric disorders, unpredictable moods, excessively
excitable, frequent sensory or neurological problems, difficult
to manage
4. AMBIVALENT-openly angry, defiant, destructive, dangerous,
superficially charming, lack of empathy, delinquent acts, most
prevalent subtype in mental health systems
Brain Organization/Development
simple to complex
Brain is responsible for :
Survival/Biological responses,
i.e.
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Heart rate
Temperature
Blood pressure
Arousal states
Limbic/Midbrain responsible
for:
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Emotion
Attachment
Affect regulation
Cortex is responsible for:
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Abstract reasoning
Complex language
Brainstem
(arrives hard-wired and online)
Limbic/Midbrain
(carries blue-print only)
Cortex
(arrives blue-print only)
Abuse
Traumatic Event
(Physical, Sexual abuse)
Domestic violence
Release of
Stress-Based
Hormones
(catecholamine)
PROLONGED ALARM
REACTION
AROUSAL CONTINUUM
Normal stress
Response is
reversible
DISSOCIATIVE
CONTINUUM
Two distinct neuronal response
patterns
“adaptive style”
ALTERED BRAIN
DEVELOPMENT
“STATES BECOME TRAITS”
Sensitized to external cues
Causes
Any of the following conditions put a
child at high risk of developing an
attachment disorder. The critical
period is from conception to about
twenty-six months of age.
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Genetic predisposition
Maternal ambivalence toward pregnancy
Traumatic prenatal experience, in-utero exposure to alcohol/drugs
Birth trauma
Sudden separation from primary caretaker ( i.e. illness or death of mother or
sudden illness or hospitalization of child.)
Undiagnosed and/or painful illness, such as colic or ear infections
Inconsistent or inadequate day care
Unprepared mothers with poor parenting skills
Abuse ( physical, emotional, sexual)
Neglect
Frequent moves and/or placements ( foster care, failed adoptions)
ABUSIVE BIRTH PARENTS AND PSYCHIATRIC DIAGNOSIS
1.
ANTISOCIAL (SOCIOPATHIC) PERSONALITY DISORDER
Many of the diagnostic characteristics of children with Reactive Attachment Disorder also fit adult characteristics
of Antisocial Personality Disorder. These include substantial conduct disorders including cruelty to people or animals,
lying, stealing, fire setting, failure to conform to social norms, irritability, aggressively and impulsivity. These people
have little regard for the truth, and lack empathy and remorse. Many of these adults were themselves abused or
neglected in early childhood.
2.
BORDERLINE PERSONALITY DISORDER
3.
PARANOID SCHIZOPHRENIA is a complex disorder, usually strongly genetically influenced and is
The etiology of Borderline Personality Disorder
is not well understood, but there is evidence of both genetic and psychological influences, to some degree
attributable to poor parenting (neglect or over-protective) between birth and three years of age. Borderline
Personality Disorder manifests as long-term patterns of unstable mood, interpersonal relationships and self image.
characterized by though disturbances such as delusions and hallucinations. In a delusional or hallucinatory state they
are capable of abuse or neglect, though uncommonly.
4.
ALCOHOL/SUBSTANCE ABUSE
In my experience working with abused kids, this is the single most common characteristic of abusing parents,.
However, in my experience, it is also most commonly a coexistent factor of abuse. In other words, while alcohol and
substance abusing parents may abuse their children, it is usually of less severity and is usually not in an ongoing
manner. Purely alcohol or substance abusing parents who over-indulge and neglect or abuse their children are
ordinarily regretful and remorseful of their actions.
5.
BIPOLAR DISORDER
This is a common psychiatric mood disorder representing 2 to 3 percent of the general population. It is a genetic,
inherited, familial disorder that ultimately results in biochemical imbalances within one’s central nervous system. It
manifests in manic (or hypomanic, a lesser form of manic) and/or depressive mood disturbances. In my professional
experience, this is by far the disorder that has the greatest coincidence with abuse or neglect of children and as
such is the genetic disorder that these children with coexistent Reactive Attachment Disorder also inherit. The
degree of self-centeredness, irritability and intensity of rage reactions while in a manic state is frequently
sufficient to create severe abusive conditions. Correspondingly, the degree of profound depression is likewise severe
and prolonged enough to create long standing neglectful circumstances.
Symptoms of Attachment Disorder
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Superficially engaging, charming (phoniness)
Lack of eye contact
Indiscriminately affectionate with strangers
Lacking ability to give and receive affection (not cuddly on parents
terms)
Extreme control problems: often manifest in covert or “sneaky” ways
Destructive to self, others, things
Cruelty to animals
Chronic lying
No impulse controls
Learning lags and disorders
Lacking cause and effect thinking
Lack of conscience
Abnormal eating patterns
Poor peer relationship
Preoccupied nonsense questions and incessant chatter
Inappropriately demanding and clingy
Abnormal speech patterns
Parents appear unreasonably hostile and angry
Characteristics of Attention Deficit Disorder, Bipolar Disorder,
and Reactive Attachment Disorder
John F. Alston, M.D., P.C.
Website: www.johnalstonmd.com
Symptoms
Age of Onset
Family History
Lifelong
Prevalence
Etiology
Attention Deficit
Disorder
Bipolar Disorder
Reactive Attachment
Disorder
Infancy to toddler,
6 years, 13 years
2 to 3 years, 6 years, 13
to 25 years
Birth to 3 years
ADHD, academic difficulties
(based on task incompletion),
alcohol and substance abuse
Any mood disorder
(depression or bipolar),
academic difficulties
(based on motivation
problems or opposition or
defiance), alcohol and
substance abuse, adoption,
ADHD
Abuse and neglect, severe
emotional and behavior
disorders, alcohol, and
substance abuse. Abuse
neglect in parents’ own early
life
3 to 6 % general population
3 to 5 % of general
population
Uncommon to common
Genetic, Neurochemical, fetal
development, brain traumas,
nutritional deficiencies,
exacerbated by stress
Genetic, exacerbated by
stress and hormones
Psycho physiologic secondary
to neglect, abuse,
mistreatment, abandonment
WORKING WITH PARENTS
Assess the developmental level and needs of parents.
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3.
Intact at-risk family – child remains in abusive situation.
a. High incidence of parents with poor attachment
histories of their own.
b. All of the qualities of unattached children still
present in grown up form.
c. Not available for education (cortex).
Foster families.
a) Assess availability for work of attachment.
b) Impact of personal trauma history – usually not
explored.
Adoptive families.
a) Education re: attachment and trauma
b) Family of origin history will become important and
needs to be explored over time.
c) Respite !!!!
Post Traumatic Stress in
Parents
Causes
Repeated rejections
by child – giving and
giving with little or no
lasting positive return
Relentless, unending
control battles – need
for incredible selfcontrol at all times
Changes within yourself &
family that seem out of your
control & are not apparent
choices
Primary Symptoms
Avoidance of thoughts &
feeling,, decreased interest
& participation in
significant events
Feeling that you are unlike
Others, damaged sense
of self-worth,
feeling out of control of emotion
Psychological/Physical
distress at exposure to
trigger events that
symbolize the trauma
Decreased affect & display
of feelings, sense of being
detached or estranged from
others
Secondary Symptoms & Effects
Selectivity in perceptions,
victim identity, fatigue and
depression, loss of security
Increase arousal sleep problems,
Irritable, angry,
hyper vigilance, higher startle
response
Helplessness
Hopelessness
Anger
RAGE
TREATMENT FOSTER CARE:
Developmental Model
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A) Creating a circle of security in a family setting
-Line of site safety-developmental circle of security with environmental controls
-Parents direct and redirect
-Children learn life skills living in a family i.e. doing chores, learning respectful communication,
cooperative play, build self-confidence
-Learn to trust that adults will keep you safe-children give up control
B) Skilled attachment therapist leads the team
- Empathic confrontation – therapist is coach/guide, providing balance of challenge and support
C) Creating a circle of community support
-school, police, caseworkers
D) Psychiatric Care and Neurofeedback
E) Working with Attachment Figure i.e. relative, adoptive parent, foster
parent
-creating safety with attachment figure by helping with emotional triggers, parent training, attachment
therapy