Many Foster Children have had very difficult and painful histories with their first parents. These children have experienced chronic early maltreatment within a caregiver relationship. Such a history can lead to the development of Complex Trauma, disorders of attachment, and Reactive Attachment Disorder. Children with histories of maltreatment, such as physical and psychological neglect, physical abuse, and sexual abuse, are at risk of developing severe psychiatric problems.
Attachment is the deep and lasting connection established between a child and caregiver in the first few years of life. It profoundly affects your child’s development and his or her ability to express emotions and develop relationships.
A child with insecure attachment or an attachment disorder doesn’t have the skills necessary to build meaningful relationships. However, with the right tools, and a healthy dose of time, effort, patience, and love, it is possible to treat and repair attachment difficulties. Between 50% and 80% of children place in Foster Care have attachment disorder symptoms. Many of these children are violent and aggressive, and as adults are at risk of developing a variety of psychological problems and personality disorders, including antisocial personality disorder, narcissistic personality disorder, borderline personality disorder, and psychopathic personality disorder. Therapeutic Parenting is often necessary to help these children heal.
This approach to parenting is often not familiar to most parents and requires a significant amount of work and preparation. Attachment facilitating parenting is grounded in attachment theory and is based on a set of principles that include:
• Following the child’s lead
• The sharing of congruent inter-subjective experiences
• Creating a sense of safety and security
The effective implementation of these principles requires parents who:
• Are strongly committed to the child.
• Have well developed reflective abilities
• Have good insight-fulness
• Have a relatively secure state of mind with respect to attachment
This type of parenting is consistent with an evidence-based and effective treatment for children with trauma and attachment disorders (Dyadic Developmental Psychotherapy). Many foster and adoptive parents find their children’s behaviors strange, frightening, disturbing, and upsetting. They often don’t understand why their child behaves as the child does; “after all, my child is now safe, doesn’t he get it?” It can be difficult to appreciate the depth and pervasiveness of the damage caused by earlier maltreatment.
Therapeutic parenting based on Dyadic Developmental Psychotherapy relies of helping parents understand what is causing the child’s behaviors. Looking deeper in order to understand what is motivating the child. All behavior is adaptive and functional; however sometimes the behaviors that were adaptive in one environment are ill-suited for the new home. If your first parents were neglectful, unreliable, and inconsistent so that you were often hungry and left alone for long periods of time, hoarding food, gorging, and going to “anyone” for help is adaptive. When that child is placed in a foster or adoptive home with caring, responsive, sensitive parents, that same behavior is no longer adaptive.
By understanding what is driving the behavior and appreciating the child’s fear, anxieties, shame, and anger, the new parent will be better able to respond to the emotions driving the behavior rather than the surface behavior or symptoms. Unless the underlying emotions are addressed with sensitivity and within a safe, unconditionally loving, and supportive home, the behavior or symptoms are not likely to stop…they may change into other problems, but if the underlying cause remains, then the problems will surface again and again.
The Principles Required
SENSITIVITY: Because children with trauma and attachment disorders are often unable to describe their internal states, emotions, or thoughts, it becomes the job of the parent to do this with and for the child so that the child learns to do this. Of course, this is precisely what one does with a newborn, toddler, and child. We often help children manage their internal states by doing that with them. When a baby cries, we pick up the baby, comfort the child, and by so doing, regulate the child’s level of arousal. Over time the infant becomes increasingly proficient at doing this independently. The parent of a foster or adopted child must be sensitive to the internal states of their child so that the parent can respond to the underlying emotions driving behavior.
RESPONSIVENESS: Once the underlying emotion is identified, the parent must respond to this need or emotion, with sensitivity. By meeting the child’s need (to feel safe, loved, cared about, for food, drink, joy, etc) the child will internalize new and healthier models of relationships and parents.
FOLLOWING THE CHILD’S LEAD: By this I mean that the parent will need to respond to the child and follow the child’s lead in the sense of providing what the child is needing (comfort, affection, support, structure, etc) and at the child’s pace. It is very important to move at the child’s pace to create the necessary sense of safety and security that these children need.
THE SHARING OF CONGRUENT INTER-SUBJECTIVE EXPERIENCES: Inter-subjectivity refers to shared emotion (also called attunement), share attention, and share intention. You can understand this if you think of playing a board game with your child. When you are playing some game together and enjoying the experience, you are sharing emotions (joy and a sense of competence), sharing attention (focusing on the game), and sharing intention (playing by the rules, both trying to win, having fun, etc.).
It is the sharing of congruent inter-subjective experiences, experiences in which all three elements are the shared, that helps the child heal and learn about intimacy and relationships.
CREATING A SENSE OF SAFETY AND SECURITY: Safety comes first. Unless the child is physically, emotionally, and psychologically safe, healing cannot occur. So, it is the job of the parent to create safety and security for the child. This then allows for the exploration of underlying feelings, thoughts, and memories. Without an alliance there can be no secure base. Without a secure base there can be no exploration. Without exploration there can be no integration. Without integration there can be no healing.
Unless the child feels safe, exploration is not possible.
Parenting a child with an attachment disorder: What you need to know
Parenting a child with insecure attachment or reactive attachment disorder can be exhausting, frustrating, and emotionally trying. It is hard to put your best parenting foot forward without the reassurance of a loving connection with your child. Sometimes you may wonder if your efforts are worth it, but be assured that they are. With time, patience, and concerted effort, attachment disorders can be repaired. The key is to remain calm, yet firm as you interact with your child. This will teach your child that he or she is safe and can trust you.
- Have realistic expectations. Helping your child with an attachment disorder may be a long road. Focus on making small steps forward and celebrate every sign of success.
- Patience is essential. The process may not be as rapid as you like, and you can expect bumps along the way. But by remaining patient and focusing on small improvements, you create an atmosphere of safety for your child.
- Foster a sense of humor and joy. Joy and humor go a long way toward repairing attachment problems and energizing you even in the midst of hard work. Find at least a couple of people or activities that help you laugh and feel good.
- Take care of yourself and manage stress. Reduce other demands on your time and make time for yourself. Rest, good nutrition, and parenting breaks help you relax and recharge your batteries so you can give your attention to your child.
- Find support and ask for help. Rely on friends, family, community resources, and respite care (if available). Try to ask for help before you really need it to avoid getting stressed to a breaking point. You may also want to consider joining a support group for parents.
- Stay positive and hopeful. Be sensitive to the fact that children pick up on feelings. If they sense you’re discouraged, it will be discouraging to them. When you are feeling down, turn to others for reassurance.
Reactive attachment disorder: Tips for making your Child feel safe and secure
Safety is the core issue for children with reactive attachment disorder and other attachment problems. They are distant and distrustful because they feel unsafe in the world. They keep their guard up to protect themselves, but it also prevents them from accepting love and support. So before anything else, it is essential to build up your child’s sense of security. You can accomplish this by establishing clear expectations and rules of behavior, and by responding consistently so your child knows what to expect when he or she acts a certain way and—even more importantly—knows that no matter what happens, you can be counted on.
- Set limits and boundaries. Consistent, loving boundaries make the world seem more predictable and less scary to children with attachment problems such as reactive attachment disorder. It’s important that they understand what behavior is expected of them, what is and isn’t acceptable, and what the consequences will be if they disregard the rules. This also teaches them that they have more control over what happens to them than they think.
- Take charge, yet remain calm when your child is upset or misbehaving. Remember that “bad” behavior means that your child doesn’t know how to handle what he or she is feeling and needs your help. By staying calm, you show your child that the feeling is manageable. If he or she is being purposefully defiant, follow through with the pre-established consequences in a cool, matter-of-fact manner. But never discipline a child with an attachment disorder when you’re in an emotionally-charged state. This makes the child feel more unsafe and may even reinforce the bad behavior, since it’s clear it pushes your buttons.
- Be immediately available to reconnect following a conflict. Conflict can be especially disturbing for children with insecure attachment or attachment disorders. After a conflict or tantrum where you’ve had to discipline your child, be ready to reconnect as soon as he or she is ready. This reinforces your consistency and love, and will help your child develop a trust that you’ll be there through thick and thin.
- Own up to mistakes and initiate repair. When you let frustration or anger get the best of you or you do something you realize is insensitive, quickly address the mistake. Your willingness to take responsibility and make amends can strengthen the attachment bond. Children with reactive attachment disorder or other attachment problems need to learn that although you may not be perfect, they will be loved, no matter what.
- Try to maintain predictable routines and schedules. A child with an attachment disorder won’t instinctively rely on loved ones, and may feel threatened by transition and inconsistency—for example when traveling or during school vacations. A familiar routine or schedule can provide comfort during times of change.
Repairing reactive attachment disorders: Tips for helping your child feel loved
A child who has not bonded early in life will have a hard time accepting love, especially physical expressions of love. But you can help them learn to accept your love with time, consistency, and repetition. Trust and security come from seeing loving actions, hearing reassuring words, and feeling comforted over and over again.
- Find things that feel good to your child. If possible, show your child love through rocking, cuddling, and holding—attachment experiences he or she missed out on earlier. But always be respectful of what feels comfortable and good to your child. In cases of previous abuse and trauma, you may have to go very slowly because your child may be very resistant to physical touch.
- Respond to your child’s emotional age. Children with attachment disorders often act like younger children, both socially and emotionally. You may need to treat them as though they were much younger, using more non-verbal methods of soothing and comforting.
- Help your child identify emotions and express his or her needs. Children with attachment disorders may not know what they are feeling or how to ask for what they need. Reinforce the idea that all feelings are okay and show them healthy ways to express their emotions.
- Listen, talk, and play with your child. Carve out times when you’re able to give your child your full, focused attention in ways that feel comfortable to him or her. It may seem hard to drop everything, eliminate distractions, and just be in the moment, but quality time together provides a great opportunity for your child to open up to you and feel your focused attention and care.
Repairing reactive attachment disorder: Tips for supporting your child’s health
A child’s eating, sleep, and exercise habits are always important, but they’re even more so in kids with attachment problems. Healthy lifestyle habits can go a long way in reducing your child’s stress levels and leveling out mood swings. When children with attachment disorders are relaxed, well-rested, and feeling good, it will be much easier for them to handle life’s challenges.
- Diet – Make sure your child eats a diet full of whole grains, fruits, vegetables, and lean protein. Be sure to skip the sugar and add plenty of good fats – like fish, flax seed, avocados, and olive oil—for optimal brain health.
- Sleep –If your child is tired during the day, it will be that much harder for them to focus on learning new things. Make their sleep schedule (bedtime and wake time) consistent.
- Exercise – Exercise or any type of physical activity can be a great antidote to stress, frustration, and pent-up emotion, triggering endorphins to make your child feel good. Physical activity is especially important for the angry child. If your child isn’t naturally active, try some different classes or sports to find something that is appealing.
Any one of these things—food, rest and exercise—can make the difference between a good and a bad day with a child who has an attachment disorder. These basics will help ensure your child’s brain is healthy and ready to connect.
Professional treatment for reactive attachment disorder
If your child is suffering from a severe attachment problem, especially reactive attachment disorder, seek professional help. Extra support can make a dramatic and positive change in your child’s life, and the earlier you seek help, the better.