What is Attachment Disorder?
Attachment disorder (AD) arises when a child under the age of three suffers an early life trauma like abuse, separation from a parent, or illness. They miss out on the love, comfort and nurturing that they need, and fail to form normal loving relationships with their primary carers. This is turn can delay their cognitive and social development, affecting their behaviours and their ability to form relationships later in life.
AD is just one strand of Developmental Trauma Disorder (DTD), which covers all issues and developmental problems resulting from early life trauma, including attachment disorder.
There can be an assumption that AD is only associated with adopted children or children in care. While there is a strong correlation, many other children without this background are affected.
Children with attachment disorders are often misdiagnosed as many of the characteristics are also seen in conditions like autism, ODD and ADHD.
The long-term impact is hard to predict as children have different levels of resilience to trauma in the womb or neglect after birth. However, the overall prognosis is good; children can fully recover from AD with the correct care and attention.
Causes of Attachment Disorder
If, during the first three years of their life, any of the following occur, children are at risk of attachment disorders:
- Mother smoked, drank alcohol or took drugs during pregnancy.
- They are the result of an unwanted pregnancy.
- They suffer physical, emotional or sexual abuse.
- They have been neglected. This can be anything from not having a nappy changed when it is dirty to not being fed when hungry.
- Their primary carer suffers from depression.
- They were separated from their primary carer through the illness or death of a parent, or through being taken into care.
- They suffer from persistent and chronic pain.
- Their primary carers split up or divorce.
- Inconsistent parenting.
- They are raised in an emotionally empty or negative/abusive environment.
Signs of Attachment Disorder
Children who have experienced early trauma develop strategies or behaviours to help them to survive. These may include:
- Lack of expectation of care and comfort, known as the inhibited form of Reactive Attachment Disorder (RAD)
- Inappropriately affectionate and familiar towards strangers, known as the disinhibited form of Reactive Attachment Disorder (RAD)
- Become distressed when separated from carer but also resist contact when the carer returns. Known as anxious-ambivalent attachment.
- Poor eye contact.
- Difficulty showing affection. An aversion to touch and physical affection.
- Overly demanding or clingy.
- Lack of cause/effect thinking.
- Problems controlling and expressing anger, sometimes violent.
- A need to be in control.
- Erratic eating habits.
- Failure to show remorse or regret after behaving badly.
- Abnormally sociable or superficially charming.
- Tell lies or steal
- Ask persistent nonsense questions or incessant chatter
- Pseudo maturity
- Low self-esteem
What can parents do?
We spoke to Sarah Naish, adoptive mother to five siblings, all of whom had attachment disorders, and author of The A-Z of Therapeutic Parenting. Her advice to parents is:
- Remember that your child may be functioning at a lower emotional age than their chronological age. Look at their behaviour, if it’s more like a toddler then you must meet the needs of a toddler.
- Be more present. Parental presence was lacking in early life so it must now be put back in. The best therapist for your child is you, the parent.
- Teach natural consequences. Many children with AD struggle with cause and effect so if they insist on not wearing a coat to school on a rainy day, let them. Then help them, in a nurturing way, to see that they are now cold and wet. Sarah advises calling ahead to the school to let them know – nobody needs to be labelled a bad parent for sending their child out in a storm with no coat.
- Take responsibility. Leaving the house can be stressful so pack the car the night before with PE kits, packed lunches etc to alleviate some of the morning stress.
- Communicate with school and help them to understand your child. Sarah remembers her son’s school repeatedly telling her that ‘he looks normal’. She explained that he was functioning at a lower age so had different needs to his peers. Children with AD are often misdiagnosed with ADHD. If they are distracted in the classroom, their levels of cortisol will shoot up and they can’t sit still or do any work because they are unable to self-regulate. If this happens they need somebody to sit with them and help them to calm down before they can get on with any work.
- Ask to have a designated member of school staff that you can communicate with directly. Having the same person to do a direct handover with every morning and home time will mean that information about last night’s sleep and the school day can be relayed directly and efficiently.
- Say no to homework. Children with AD can struggle if their parent suddenly takes on the role of teacher at home. Speak to the school and explain that you and your child need time to work on your relationship before they can bring work home. Learning timetables can wait; your relationship must come first.
Further help with attachment disorder
Therapeutic parenting and Theraplay, a family therapy based on play, provide strategies for building attachments, self-esteem and trust.
Sarah Naish runs Inspire Training Group which offers therapeutic parenting advice to families of children with Developmental Trauma Disorder.
PAC-UK’s Education Service has produced a series of videos for teachers to help them understand the needs of cared-for and adopted children. These give guidance to teachers on how to organise the day so that routines can help build a strong sense of security and familiarity, and on topics that might cause distress, such as drawing a family tree.
The Good Schools Guide’s SEN consultants can help you to find schools which specialise in supporting children with attachment issues.