college 6 - attachment disorders Flashcards
attachment theory - 4 stages
pre-attachment (0-6 weeks)
attachment in making (6 weeks - 6/8 months)
clear cut attachment (6/8 months - 18/24 months)
formation of reciprocal relations (24 m)
secure attachment
positve model others: low avoidancee
psitive model self: low anxiety
anxious-ambivilent
positive model others: low avoidance
negative model self: high anxiety
avoidant attachment
neegative model others: high avoidance
positive model self: low anxiety
disorganized/fearfull attachment
nega model others: high avoidance
nega model self: high anxiety
RAD -DSM
A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers
A persistent social or emotional disturbance characterized
The child has experienced a pattern of extremes of insufficient care
The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the lack of adequate care in Criterion C).
The criteria are not met for autism spectrum disorder.
The disturbance is evident before age 5 years
The child has a developmental age of at least nine month
DSED
A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits
The behaviors in Criterion A are not limited to impulsivity (as in ADHD) but include socially disinhibited behavior.
The child has exhibited a pattern of extremes of insufficient care
The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the pathogenic care in Criterion C).
The child has a developmental age of at least nine months
research evidence
→there is a lack of clarity around the definitions related to attachment disorders
→measurement concerns: psychometrically-sound assessments may not be used
→difficulty in obtaining normative data
therapy & therapeutic tools
- family oriented preferred over individual
- neglect: provision of emotionally available & sensitive caregiver
therapeutic tools:
- Safe & stable living situation
- Psychologically supportive, low-conflict environment
- Development of positive interactions with caregivers
- Systemic approach
RAD appropriate treatment
- child parent psychotherapy
- attachment & biobehvioural catch up
- behavioural managment training
- video based intervention positive parenting
- circle of security
-involving teacher
DSED appropriate treatment
- play therapy
- art therapy
CBT - parent child interaction therapy
-behaviour management strategies
RAD & DSED DON’Ts
- medication (only for comorbidity)
- therapeutic holding
- rebirthing therapy
- age regression techniques
Holding therapy - Allen
The Z-process therapy for autistic children postulated that the anger and aggression often displayed by these children was the result of problematic attachment relationships that resulted in children developing a reservoir of repressed anger
- adults hold child and force to look in eyes while they poke child > anger outburst and thus relieve > attachment to person looking in eyes
- weinig onderzoek naar gedaan; 1 zegt wel effectuef maarr: the sample size was small, the analyses performed during the research are suspect, the assignment of children to conditions was not randomized, and the authors appeared to present the intervention as devoid of any intentional infliction of agitation or provocation
- kinderen overleden
- nieuwe versie: alleen vasthouden, wiegen, en coo-en, maar ook niet evidence based
“theoretical justifications”
-Attachment Repair: Advocates claim forced holding repairs attachment disruptions caused by trauma, arguing it teaches children to seek comfort from caregivers during distress.
- Desensitization: Some propose it acts as “flooding therapy,” desensitizing children to caregiver touch through prolonged physical contact
critique
- Safety Contradiction: Attachment theory prioritizes safety-seeking behaviors. Forcing proximity with a perceived threat (e.g., an abusive caregiver) increases anxiety and undermines trust, potentially re-traumatizing the child.
- Non-Therapeutic Coercion: Secure attachment develops from responsive care, not forced restraint. Overriding a child’s avoidance signals contradicts Bowlby’s principle
- retraumatizing
age regression - Allen
intentionally treat a child as if he or she were a younger age (e.g., cradling, rocking, bottle feeding).
no basis in attachment theory
not cognitive level appropriate
no evidence on effectivity
Theraplay - Allen
play based intervention
> by returning ‘‘to the stage at which the child’s emotional development was derailed and provide the experience which can restart the healthy cycle of interaction
> teaching parents to be responsive care givers (e.g. nurturing skills suchs as lotion smeren)
no basis in attachment theory
no evidence/ weak
not cognitive level appropriate
Dyadic development therapy - Allen
a relationship-based intervention grounded in attachment theory that incorporates cognitive, behavioral, and experiential approaches
no manual
not cognitive level- age appropriate (eg. brushing teeth 6 y o)
principles justifiable treatment - Allen
- The establishment of an adequate relationship with a discriminated attachment figure serves as the primary vehicle for modification of the child’s maladaptive internal working models that are contributing to problematic behaviors and emotions, and the development of appropriate emotion regulation skills
- that adult needs to learn to identify, understand, and respond to the child’s emotions and behaviors.
- Intervention should be present-focused and designed to foster the development of the child and the caregiver– child relationship in the current context
- consider cognitive level of child
RAD and biological factors - Zeahnah
reduced gray matter volume in the left primary visual cortex in children with RAD compared to that in typically developing children. Reduced gray matter volume was associated with an increased number of internalizing problems.
Reward processing has been proposed as a deficit in RAD
>The problem is that diminished reward sensitivity has been shown to be reduced in children who have experienced adversity, so whether the findings are specific to RAD is unclear
assessment recommendations - Zeahnah
- For young children with a history of foster care, adoption, or institutional rearing, clinicians should inquire routinely about a) whether the child demonstrates attachment behaviors and b) whether the child is reticent with strangers (clinical standard)
- The clinician conducting a diagnostic assessment of RAD and DSED should obtain direct evidence from both a history of the child’s patterns of attachment behavior with his or her primary caregivers and observations of the child interacting with these caregivers (clinical standard)
- The clinician may be aided in making the diagnosis of RAD and DSED by a structured observational paradigm that compares the child’s behavior with familiar and unfamiliar adults (clinical option)
- Clinicians should perform a comprehensive psychiatric assessment of children with RAD or DSED to determine the presence of comorbid disorders. (clinical standard)
- The clinician should assess the safety of the current placement for previously maltreated children with negative behaviors who are at high risk for being re-traumatized (clinical standard)
treatment recommendations - Zeahnah
- The most important intervention for young children diagnosed with RAD or DSED is ensuring that they are provided with an emotionally available attachment figure (clinical standard)
- For young children diagnosed with DSED, limiting contacts with noncaregiving adults may reduce signs of the disorder (clinical option)
- Clinicians should recommend adjunctive interventions for children who display aggressive and/or oppositional behavior that is comorbid with DSED (clinical standard)
- Psychopharmacological interventions are not indicated for the core features of RAD or DSED. [NE] (not endorsed)
- Clinicians should not administer interventions designed to enhance attachment that involve noncontingent physical restraint or coercion (e.g., “therapeutic holding” or “compression holding”), “reworking” of trauma (e.g., “rebirthing therapy”), or promotion of regression for “reattachment” because they have no empirical support and have been associated with serious harm, including death. [NE]
