Attachment Disorders in Children and Teenagers

All human beings, from the moment we are born, until the day we die, need love and a sense of belonging, of attachment, of safety, and the need to be valued and supported. So, imagine what it is like for an infant or young child who does not experience love and safety and belonging. According to the Psychiatric Times, an attachment disorder is a broad term used to describe disorders of mood, behaviour and social relationships arising from a failure to form normal attachments to primary caregivers in early childhood (www.psychiatrictimes.com).

This disorder begins in infancy with attachment problems beginning from the ages of 1 to 5 years old. We have already learnt that any traumatic experiences in the growing child’s environment, can affect the normal development of the brain and increases the likelihood of the child developing a mental disorder. A child who lives in foster care, or has multiple caregivers at the same time, or loses a primary caregiver will lack a sense of permanence, of safety and security and the development of long-term caring and nurturing relationships.

To help you better understand the needs of a growing infant, toddler, child, please take at a look at the two illustrations below:

Abraham Maslow’s Hierarchy of Needs Erik Erikson’s Theory of Psychosocial Development

There are two types of attachment disorder:

  • Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED).
  • Reactive Attachment Disorder (RAD)

This disorder is usually found in children who have received gross negligent care and do not form normal, healthy, emotional attachments with a primary caregiver, usually the mother, before the age of 5 years. The child’s most basic needs of affection, comfort and nurturing are not met. RAD is an acquired disorder and occurs during the critical periods of brain development: the need for affection, comfort and forming a nurturing relationship. A child whose basic needs are not met, is more likely to withdraw and refuse to connect with caregivers e.g. does not seek comfort when hurt, exhibits a low response when comfort is given, and often looks sad, irritated, fearful when interacting with a caregiver or any adult.

Signs and Symptoms

  • Aversion to touch and physical contact (perceived as a threat)
  • Feels unsafe and alone
  • Early symptoms of RAD are similar to symptoms of Autism and ADHD
  • Control issues: disobedient, defiant, and argumentative to avoid feeling helpless
  • Anger: tantrums, acting out, manipulative
  • Difficulty showing genuine care and affection

RAD in Teenagers
Even though teens with RAD may look like other teens on the outside, they have much younger brains, essentially, they are “stuck” in the developmental stage of a toddler. Teens with RAD are cognitively and emotionally less mature than their peers. Like a toddler, they will take or do what they desire in the moment without forethought and will make poor choices without empathy for others. Whilst it is normal for teenagers to spend more time with friends as they get older, teenagers with RAD have little to no attachment to their families/caregiver and will follow their peers without question.

Consequently, many teenagers will have abnormal relationships, they want to be in control in order to feel safe, and they desperately want to attach to another person, and it is not unusual for them to develop emotionally and sexually inappropriate relationships. They can also get obsessive about relationships and engaging in a sexual relationship may be the only way they feel as though another person cares for them.

Treatment
Whilst there is no medication that can reduce the symptoms, therapy has been found to be very effective:

  • Family therapy
  • Individual counselling
  • Play therapy
  • Special education services and supports in school

If untreated, the effects of RAD in adults is significant: difficulty forming relationships, unable to develop a positive sense of self and other mental health problems.

What Can You Do?

  • Stay patient
  • Focus on small efforts
  • Maintain a safe, supportive and loving environment
  • Be realistic, this is a long road
  • Express joy, laughter
  • Sets limits and boundaries
  • Take charge, remain calm (angry parents confirm the belief that the world is scary and unreliable)
  • Don’t engage in arguments, if your child/teen is engaging you in an argument, less is more.
  • Be kind and empathetic but firm and to the point. Tell him/her that you love him/her too much to argue and move on
  • Maintain routines
  • Follow up with therapy options
  • Listen, talk with and play/engage in fun activities e.g. movie, sports activity, family board games
  • Promote healthy lifestyle habits will help reduce stress levels
  • Keep your child/teenager safe, remember he/she has the cognitive and emotional capacities of a toddler
  • Monitor use and limit time on social media. Social media provides too many opportunities for a child/teenager with RAD to establish superficial relationships, false identities, and inappropriate emotional and sexual relationships with others
  • Set firm limits and parent with empathy

Disinhibited Social Engagement Disorder (DSED)
In DSED the child/teenager shows no fear and will approach strangers as if he/she has always known them and then engages in overly familiar behaviour. Children with this disorder are more likely to use superficial charm and engagement to win approval and get needs met. This attachment disorder is caused by disruptions in a child’s attachment to or negative experiences with a primary caregiver. For example: social neglect and deprivation, childhood trauma, extreme abuse or neglect, death of one or both parents, early sexual abuse, being raised by a parent(s) with substance abuse, repeated changes of primary caregivers, being raised in unusual settings that limit the opportunity to form attachments.

Symptoms of DSED center on the child’s physical, verbal and emotional overfamiliarity and impulsivity with adult strangers. Whilst impulsivity is common in disorders such as ADHD and ASD, the difference in DSED is the child will display socially disinhibited behaviours e.g. approaching strangers and ask for a hug.

Signs and Symptoms

  • Absence of normal restraint and discretion with adults and unfamiliar people
  • Interacts comfortably with strangers
  • Receives toys and gifts from strangers
  • Willingly hugs and touches strangers
  • Will walk off with a stranger
  • Not shy or afraid of strangers
  • Will walk up to strangers and ask for food, money, comfort
  • Enjoy going out or sharing secrets with strangers and unknown adults instead of their primary caregiver/parents
  • May behave rudely to or ignore their primary caregiver/parents

For a conclusive diagnosis of DSED, the child/teenager must show a pattern of behaviour where he/she actively approaches and interacts with complete strangers, especially adults and exhibits at least two of the following behaviours:

  1. No reticence approaching strangers
  2. Overly ‘familiar’ (not age-appropriate/culturally acceptable) in verbal and physical behaviours
  3. Will walk away from adults and not check back
  4. Willingness to go off with a stranger

Treatment
Treatment generally focuses on building healthy dynamics between the child/teenager and his/her primary caregiver/parent(s). It usually involves a course of psychotherapy and family sessions:

  • With treatment and support, full recovery if possible
  • Play and art therapy (expressive therapies)
  • Individual counselling/talk therapy
  • Family therapy

What can you do?
The most important thing is helping the child/teenager feel safe, cared for, and loved. This enables him/her to trust adults and begin to build healthy and appropriate relationships.

  • Maintain a consistent routine
  • Safe, stable and loving environment
  • Maintain caring, supportive relationship
  • Long-term consistent treatment is key to healing
  • Be patient

In my next Blog #13
I will be discussing suicide in children and teenagers

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