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Attachment Disorder (AD) arises when an infant or child under the age of five suffers an early life trauma and then fails to form normal loving relationships with their primary carers.

Children with AD have difficulty developing normal emotional attachments to others, usually formed within the first few months of life with a parent or caregiver.

It is an emotional and behavioural condition and symptoms include low self-esteem, lack of trust, difficult behaviour, mood swings and poor response to being comforted. Attachment disorder is the result of early childhood trauma, abandonment, abuse or neglect.

In a classroom situation, the child may experience difficulty with acquisition of core academic skills and forming relationships with adults and peers. This may result in poor language acquisition, impaired cognitive development, and contributes to negative behaviour patterns.

AD is just one strand of Developmental Trauma Disorder (DTD), which includes Reactive Attachment Disorder (RAD), characterised by withdrawal from social relationships and Disinhibited Social Engagement Disorder (DSED) in which a child may show excessive but inappropriate friendliness to strangers.

There can be an assumption that AD is only associated with looked after children but although 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.

Treatment focuses on creating a safe family environment and promoting positive relationships between the child and their trusted caregivers. It may include individual play therapy for the child as well as family therapy.

Causes of AD

  • Persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caring adults, through neglect or abuse
  • Frequent changes of carer eg foster care, resulting in insecurity or lack of trusting bonds with primary carer
  • Unusual early home life, such as being brought up in institutions with a lack of opportunity to form early relationships

Symptoms of AD

Children who have experienced early trauma may have difficulty with:

  • Expressing anger eg throwing tantrums or acting out
  • Poor eye contact
  • Seeking affection from strangers
  • Self-regulating behaviour and emotions
  • Lack of affection towards parents or caregivers
  • Inconsolability
  • Needing to control social situations
  • Low self-esteem

What can parents do?

A multi-pronged approach is necessary with professionals, which may involve family therapy, parent-child interaction and play therapy.

We spoke to Sarah Naish, author of The A-Z of Therapeutic Parenting and adoptive mother to five siblings, all of whom had attachment disorders. Her advice is:

  • Remember that your child may be functioning at a lower emotional age than their chronological age. If their behaviour is 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. 
  • Get organised. 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, and ask for a designated member of school staff that you can comunicate 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. 
  • Watch out for misdiagnosis. 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. 
  • 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

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.

The Good Schools Guide’s SEN consultants can help you to find schools which specialise in supporting children with attachment issues.

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