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Reactive Attachment Disorder
Transcript of Reactive Attachment Disorder
share and reflect child's "inner experience"
instruct child in understanding, labeling, and managing emotions
Often shared non-verbally and kinesthetically
6-point scale to assess attunement Parental Depression (esp. Post-Partum) and anxiety
Significant marital discord and domestic violence
Parental Substance Abuse
Culture of television dependence
Systemic problems in foster, adoption, and institutionalization structures Inhibited type Expressive Arts Therapies General R.A.D.
Symptoms Echo, Attune, and Unify: "Pathogenic Care" Abuse Neglect Persistent disregard for child's basic emotional needs for comfort, simulation, affection, and/or physical needs.
Repeated changes of primary caregiver that prevent formation of stable attachments (frequent changes in foster care). Physical
Emotional (DSM IV, 2004) Disinhibited type ignored cries as a ineffectivesurvival adaptation Sand Tray Therapy Music Therapy Play/Finial Therapy:
Dollhouse Signs , Symptoms, and Characteristics
Withdrawn, sad and listless appearance
Failure to smile
Lack of the normal tendency to follow others in the room with the eyes
Failure to reach out when picked up
No interest in playing peekaboo or other interactive games
No interest in playing with toys
Engaging in self-soothing behavior, such as rocking or self-stroking
Calm when left alone DSM-IV Diagnostic Criteria for R.A.D. Disturbed/developmentally inappropriate social relatedness beginning before age 5
1) Persistent failure to respond to social interactions in a developmentally appropriate way.
Responses are excessively inhibited, hypervigilant, contradictory, and ambivalent.
Mix of approach, avoidance, resistance to comforting, “frozen watchfulness.”
2) Diffuse attachments shown by indiscriminate sociability, inability to exhibit appropriate selective attachments.
Excessive familiarity and clinging to strangers, and lack of selectivity.
Behavior is not caused by or meet criteria for:
Pervasive Development Disorder
ADHD Avoiding or dismissing comforting comments or gestures
Acting aggressively toward peers
Watching others closely but not engaging in social interaction
Failing to ask for support or assistance
Obvious and consistent awkwardness or discomfort
Masking feelings of anger or distress
Alcohol or drug abuse in adolescents Responding Compassionately to Reactive Attachment Disorder Kristin Nelson/ MCC 625: Psychopathology/ Nov 17, 2012 Developing
receptivity to child's emotional experience. Learning to adapt in tandem with therapist, parents, and child. Sharing subjective experience through
non-verbal communication play, and simulation. Trauma often takes place at a pre-verbal stage & can be dissociated from explicit memory Damage to brainstem
Overactive adrenaline system- aggression
Limbec system- managing emotions
Cortisol & Stress- destroy connections
Alteration of neurotransmitters- changes symptoms similar to adult depression. Theories... Erickson: Psychosocial
Attunement that contribute to R.A.D. development Controversy So...what practical techniques
can foster connection with clients? Self Reflection:
My experience with
"Ashlyn" 1) gives thought to emotions & what she wants child to know.
2) empathizes with child's emotions
3) shows respect for experience of emotion
4) comforts child during emotion
5) talks about emotion when child is upset
6) wants to discuss emotions Parent... First Stage:
Trust vs. Mistrust Caregiver fails
Mistrust Depression, withdrawal, and potentially paranoia later in life Warm, intimate, and continuous relationship with mother (or substitute)
Rejected Freud's oral fixation theory
Infants are social as an evolutionary function (protection) "Attachment Therapy" Interactive
Utilizes non-verbal reflections
Provides space for simulation, testing, and resolution towards trust. Cognitive Behavioral
Therapy Dyadic Developmental
Psychotherapy Strong metaphor for attunement
Creates "echo exchanges" that can be applied to parent-child play Echo: Attune: Unify: shun relationships and attachments to everyone
especially strong resistance towards adult authority figures
may happen when a baby never has the chance to develop an attachment to any caregiver seek attention from everyone (adult and peer) including strangers.
may happen when child has multiple caregivers or frequent changes in caregivers.
frequently show extreme dependence & ask for help doing simplistic tasks
inappropriately childish behavior
highly anxious (Becker-Weidman, 2006) Focus on caregivers' & therapists' attachment strategies
Both are attuned to child's subjective experience, share, and reflect back
Help child create "autobiographical narrative"
Address misattunements and conflicts
Incorporate cognitive- behavioral strategies
Multiple session rooms for caregivers to observe, work with therapist
"PACE" and "PLACE"
Targets symptoms stemming from abuse (fear, anxiety, post-traumatic stress)
Teaching child positive coping & anxiety management skills
Psychoeducation re: abuse and gradual exposure to reduce trauma related fear.
(Hanson and Spratt, 2000)
Assumption of "suppressed rage"
"Rage must be released for child to function normally"
Complete control of child's functioning and social environment WARNING: (Chaffin et al., 2006) Psychological, physical, or aggressive means to provoke, dominate, and coerce.
Holding, binding, "rib cage stimulation," forced into prolonged eye contact.
Death of 10 year old Candace Newmaker during therapy in 2000; child deaths caused by parents "following therapists' instructions."
Helps child express "inter-world" of experience; enables therapist/caregiver to "see" child's world
Metaphor for sorting/organizing thoughts and archetypes
(Carmichael, 1994) Can potentially be used as assessment tool
Child can act out fantasies and conflicts
Gradual exposure to triggers in safe space