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History of Attachment Theory
Spitz Anaclitic depression Children in an orphanage who
received
good physical care but no consistentaffection from a sole
caregiver
Emotional and physical developmentsuffered
Harlow Rhesus monkey experiments
Bowlby and Ainsworth Separation during first few months of
life
affects childs psychic organization
A Two Year Old Goes to the Hospital
Parent sensitivity = ability to reademotions in a baby and
respond in asupportive and positive way
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What is attachment?
Biologically kids are hardwired to have selectiveattachments
with caregivers, and environment candetermine the type of
attachment
Behaviors in infants infer emotions to the caregiver crying
and
clinging to get care and attention Instinct of caregiver strong
attraction to and need to care for
babies, soothing, mirroring infant
Attachment develops with repeated caregiver response toinfant
distress; child learns that someone cares, comforts,
and consoles
This CANNOT be suddenly replaced by someone else
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If it doesnt
Insecure people are not
caring, trust no one, one
is all alone in the world
Higher risk for psychiatricdisorders
There is a range of
problems
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Risk Factors
Abuse or neglect
Prolonged period of time in out of home placement
(orphanages, foster care, long hospital stays)
Overly harsh and/or unpredictable parenting styles
Frequent childhood losses
Traumatic childhood losses
Caregiver depression, addiction, or poor parenting skills
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Presentation
Feeding difficulties or abnormal behaviors (hoarding)
FTT
Detached behaviors
Difficulty being consoled
Defiant
Hesitant in social situations
Hypervigilance Learning and developmental delays
Inappropriate closeness or familiarity with strangers
Prolonged painful illnesses (colic)
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Clinical Observations
What does child do when interviewer enters the room?
What happens when caregiver leaves the room? When
they return?
What happens with a mildly distressing stimulus?
Compare childs interactions with caregiver and stranger
Should be done in serial observations with all
importantcaregivers
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Treatment
Nothing fixes it, but placement into a safe familyenvironment
can help (inhibited > disinhibited behaviors)
Therapy to help caregiver understand and reinterpret the
childs behavior so they can function as a more effectivebase; to
help child change internal self representations; tohelp parent gain
insight into dyad through providingcorrective experiences to parent
and child
Not Recommended: Holding therapies, rebirthing, or other
forced nurturing techniques
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Resources and References
AACAP Facts for Families:
http://www.aacap.org/cs/root/facts_for_families/reac
tive_attachment_disorder
Gleason MM and Zeanah C. Reactive AttachmentDisorder Lewiss
Child and Adolescent Psychiatry: A
Comprehensive Textbook. 4th ed.
