Understanding Attachment Disorder
There is a great deal of literature available about attachment disorder. And a great deal of confusion and even controversy about what attachment disorder is.
Many older adopted children come to us with a diagnosis of Reactive Attachment Disorder (RAD), which is considered the most extreme form of attachment problems. Intensity and health of attachment is often described or labeled as insecure, ambivalent, anxious or disorganized. Essentially it means that a child has failed to learn that adults can be trusted to keep them safe. Attachment difficulties develop in the first few years of life. The behaviors and symptoms are commonly observed in all ages of children, not just older children.
The Science
Attachment formation is really a neurobiological process. It has everything to do with how a child's brain develops in the early years, based on experiences that the child has.
The brain dictates all human behavior. Our brain is the organ that allows us to feel emotions, manage our emotions, and learn from our mistakes. It warns us when we are in danger, and facilitates the process that we call love. When a child does not receive consistent positive caregiving, they can lose the capacity to develop reciprocal, healthy relationships later in life.
As an adoptive parent, one of the biggest challenges is to figure out how to continually love a child who can't or won't return it. It is possible that the child never developed the neural pathways that allow them to experience joy or comfort with another person. The ability to feel remorse, to empathize, and to be introspective are all functions that the brain masters over time. If a child fails to learn this early on, when their brain is most prepared and able to learn these functions, learning them later in life is extremely hard. Hard for you, hard for them.
The child with attachment wounds and impairments has a developmental delay. This has nothing to do with how smart or bright they are. It means that part of their developmental processes got stalled and the child is behind where she/he should be. Many attachment-disordered children are birth years older than their internal emotional age. It is almost always more effective to address the raging four-year-old inside the 16-year-old body than the other way around.
We intuitively know that crying babies need comfort and typically don't resent their demands. We are more likely to react negatively at the oppositional 12-year-old who might really just be a crying baby in need of comfort. Babies don't want a lecture, they want comfort.
The typically developed child is motivated to please his/her parent and they feel good when they see the pleasure they bring their parent. This process is often absent with a child who has experienced attachment wounds. The adopted child will often feel that they need to be in control. They view compliance as a loss of control, which they equate with vulnerability. They feel threatened and anxious when they are not in charge, as that is how they experienced previous relationships. They often crave elevated levels of stimulation, and have difficulty enjoying quiet, solitude, or calm. They avoid intimacy and will create conflict simply to avoid it. It is not that they do need or want it. They can't afford to allow themselves to get close, as they believe it will ultimately end up in rejection. This belief shapes their behavior. They will not be aware of this dynamic, but the adoptive parent needs to be.
Myths and Misperceptions
There are a number of myths about the process of attachment formation that undermine a parent's ability to fully understand the challenges they and their child will face.
1. The effect of trauma. For a long time it was believed that young children are not affected by moves and losses or trauma. We now know that this is not true. Very young children are deeply affected by the loss of a birth parent. They might not have the words or ability to express this, but it is still a profound loss. As the child ages, they will continue to grieve about the absent family who gave them away. They will internalize this as a failure on their part to be lovable enough, and thus have a sense that they are faulty and unworthy. In addition, as the infant or young child's brain is developing and becoming neurologically attuned to a certain caregiver, the loss of that caregiver has a significant impact on the developing neurological process for the child. This varies a great deal from child to child, but losing a birth parent, even a neglectful one, is a loss. The younger a child is when they are traumatized, the worse it is.
2. Time does not automatically heal. We used to think, "The child will get over it." It is typically true that the older a child is when he or she comes to your home, the more losses, traumas and moves they have had to tolerate. Their past trauma history is critical information for you to have, as it will have profound impact on their future development and the challenges you will face in parenting them. The grief experiences these children carry with them have accumulated over the years. They will not address their grief honestly and begin to heal until they are with someone they trust enough to be vulnerable with. Once the process of trust (attachment) begins, the child might recall or begin to talk about - sometimes for the very first time - past experiences of loss or abuse.
As the adoptive parent begins to appreciate how hurt their child has been, you are better able to accept their sadness and anger. At times they will be happy, at times they will pretend they are happy. Sometimes, after you have had one of your best days or moments, they will have a terrible day. This is their way of demonstrating how fearful they are of getting too close and they do the only thing they know how to do, which is to push you away so they don't get hurt. Their anger and rejection is really just a clever, adaptive strategy for survival.
3. Starting over. The child who comes to you through adoption is not getting a fresh start. They are not starting over, in terms of learning how to trust and love. They bring with them all of the negative messages they have already learned about relationships. Their attachment patterns that are already developed will be extremely hard to unlearn for them, as they are embedded in the child's brain, as neural pathways. Teaching a child to trust, to tell the truth and to experience positive emotions requires patience, endurance, and an understanding that you are asking the child to reshape how their brain manages the world around them. Just because you logically figure it out does not mean that they will.
4. Can't or won't. The child's impaired attachment relationships will impede their ability to behave or respond in the way we want. Don't assume that your child is making a poor choice or misbehaving as a matter of choice. Sometimes they just won't do what you want them to, but many times, they simply can't. Prenatal exposure to alcohol and other drugs dramatically affect a child's brain development. It is often a hidden disability. Willful, defiant behavior is the best the child can do in certain circumstances. You will not be able to fix everything that is broken.
5. Loyalty to birth parent. An adopted child will never forget about being adopted. They will always wonder, at some level, where they came from, what their life would have been like, and will have fantasies about the absent family or parent. This can be a very challenging dynamic when, as the adoptive parent, you know that the very people these children yearn for and fantasize about might have neglected and abused the child you love. It is difficult not to be angry at the birth parent for the harm they did. You are entitled to these feelings. Honor them and discuss them, just not with your child.
Parenting a child with attachment wounds and early, multiple losses requires a great deal from the adoptive parent. It is a one-way street for a long time. The adoptive child will not be grateful or appreciative, for the most part. No child wants to be adopted, in that they would not typically choose to lose the family of origin. Adoption is a default position for them. You choose them, and ultimately you hope one day they will choose you.
In the meantime, it is essential for new parents to embrace the concept of claiming your adopted child. This implies the public and private decision to raise a child no matter what. It is a belief that the child belongs in your family. It is not love. It is security, stability and a future together. It is the critical component that keeps families together when they struggle, hurt or feel a loss. Claiming is a profound commitment to the child. Until a child feels claimed, they will not trust.
Children do heal. Attachment wounds do become less problematic over time. Adoption does work and families make the difference.
Healing attachment wounds can only be done within the context of a caring, committed, compassionate relationship. Work with these children is always about relationships. Strategies that involve cooperation, negotiation and organization are hard to do, at first. These children will respond to tactile stimulation that is safe and nurturing. They need a home environment that will increase their capacity to use their thinking skills and their body.
When living with a child with attachment wounds, the adage "talk less, do more" is probably wise. Tough love is not a useful concept, as it is the only form of love these children have experienced already.
Unconditional love, with no contingencies and no exceptions will be the most useful way to manage. Easy to say, hard to do.
