Attachment Disorder: What is it?
Does your child/client have it? What do
you do?
Melissa Nichols, M.A., L.M.F.T.
Family Attachment and Counseling Center of Minnesota
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Model and Meaning
Attachment
Relationships
Meaning
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Model and Meaning
Attachment
Relationships
Life Events
Trauma
Meaning
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Model and Meaning
Attachment
Relationships
Life Events
Trauma
Meaning
Development
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Possible Impact of Attachment on Development
• Physical
• Emotional
• Cognitive
• Social
• Spiritual
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Patterns of Attachment
I.
Organized
• Secure
• Insecure
-Avoidant Attachment
-Ambivalent Attachment
II.
Disorganized
• Insecure
© Family Attachment Counseling Center of Minnesota 952-475-2818
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Behavioral Clues to a Child’s Beliefs
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•
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•
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Indiscriminate in affection? Superficially charming?
Able to ask for help? Able to accept help?
Inappropriately demanding of attention?
Excessively controlling?
Passive-aggressive?
Prolonged temper tantrums or rages?
Receives a compliment well?
Wants to please his caregiver?
Responds appropriately to the good fortune of others?
Physically and/or verbally aggressive when doesn’t get
way?
• Zone out or dissociate?
© Family Attachment Counseling Center of Minnesota 952-475-2818
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Two Important Factors for Attachment Repair
• Attunement
• Regulation
© Family Attachment Counseling Center of Minnesota 952-475-2818
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Attunement
Attunement
The ability of a parent to accurately read the
emotional state and motivations of his or her
child, reflect what he or she is feeling with
words, and appropriately meet his or her need.
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Healthy Effects
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•
•
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Regulate emotional state
Helps form healthy concept of self and others
Supports language development
Assists a child in learning about a relationshipcooperative partnership
• Supports development of a coherent narrative
© Family Attachment Counseling Center of Minnesota 952-475-2818
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Unhealthy Effects
•
•
•
•
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Dysregulated emotional state
Negative concept of others and self
Impaired language development
Insecure relationship with caregiver
Incoherent narrative
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Factors which can affect attunement
• Parents' model of attachment
• Mental state of a parent
• Amount of time spent with a child
• How supported a parent feels
• The child’s perspective
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Regulation
Regulation
A person’s ability to calm--to regulate body,
emotions, and states of mind. Parents help
children to regulate.
© Family Attachment Counseling Center of Minnesota 952-475-2818
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Children with Poor Regulation
• Moody
• Frequent Temper Tantrums
• Aggressive
• Compulsive Behaviors
• Retreat/Withdraw
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Techniques to Promote
Attunement and Regulation
• Mind-Body Connection
• Family Attachment Narrative Therapy
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Mind-Body Connection
• Sensory Input/Developmental Movement to Regulate
• Nutrition & Exercise
• Digital Audio Visual Entrainment
• EMDR/TFT/NLP
• Medication
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Shifting
Inner Working Model
with Narratives
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Why Do Stories Work?
 Stories are culturally universal and timeless
 Organizes memories and gives meaning to life
(coherent narrative)
 Stories promote neural integration of thinking and
feeling
 Stories channel a different perspective of life
events--Change the story, change self
understanding
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Constructing Stories

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Setting
Props
Perspective
Hero
Message
© Family Attachment Counseling Center of Minnesota 952-475-2818
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Types of Narratives
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Claiming
Developmental
Trauma
Successful Child
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Claiming Narratives
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Strengthens emotional bond
Facilitates trust
Establishes birth order
Extended family
Passes on traditions, history, rituals
© Family Attachment Counseling Center of Minnesota 952-475-2818
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Developmental Narratives
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Facilitates cognitive development
Enhances emotional regulation
Builds relationships
Remedial skill building
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Narrative Themes
From the first, you were a child that
deserved to be loved and cared
for by parents you could trust.
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Trauma Narratives
 Heals pain of trauma
 Creates empathy
 Fosters understanding
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Trauma Narratives
 Heals pain of trauma
 Creates empathy
 Fosters understanding
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Narrative Themes
Even though you experienced
abuse, abandonment,
neglect, you deserved to be
loved and cared for by
responsible parents.
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Successful Child Narratives
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Teaches values
Reinforces cause and effect thinking
Presents alternative behaviors
Explains basics of “How To Do” life
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Narrative Themes
Your problem behavior does not
define your value and we will
be there to love and support
you as you make changes.
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Additional Resources
 Parenting with Stories: Creating a foundation of
attachment for parenting your child (Nichols,
Lacher & May, 2002)
 Connecting with Kids (Lacher, Nichols, Nichols &
May, 2012)
 First Steps for Strengthening Adoptive
Families (DVD & Study Guide)
 Website: www.familyattachment.com
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
DSM-IV Definition of 313.89
Reactive Attachment Disorder
Diagnostic criteria for 313.89 Reactive Attachment Disorder of Infancy or Early childhood
A. Markedly disturbed and developmentally inappropriate social relatedness in most contexts beginning before age 5
years, as evidenced by either (1) or (2):
1. Persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions, as
manifest by excessively inhibited, hyper vigilant, or highly ambivalent and contradictory response (e.g., the child
may respond to caregivers with a mixture of approach, avoidance, and resistance to comforting or may exhibit
frozen watchfulness)
2. Diffuse attachments as manifest by excessively inhibited, hyper vigilant, or highly ambivalent and
contradictory response (e.g., excessive familiarity with relative stranger or lack of selectivity in choice of
attachment figures)
B. The disturbance in Criterion A is not accounted for solely by developmental delay (as Mental Retardation) and does
not meet criteria for a Pervasive Developmental Disorder.
C. Pathogenic care as evidenced by at least one of the following:
(1) persistent disregard of the child’s basic emotional needs for comforting, stimulation, and affection
(2) persistent disregard of the child’s basic physical needs
(3) repeated changes of primary caregiver that prevent the formation of stable attachments (e.g., frequent
changes in foster care)
D. There is a presumption that the care in Criterion C is responsible for the disturbed behavior in Criterion A (e.g., the
disturbances in Criterion A began following the pathogenic care in Criterion C).
Specify Type:
Inhibited type: if Criterion A1 predominates in the clinical presentation
Disinhibited type: if Criterion A2 predominates in the clinical presentation
(American Psychological Association. 200, p. 130)
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Supporting Research
Bower, G.H. & Morrow, D. G. (1990). Mental Models in Narrative Comprehension. Hillsdale,
NJ: Lawrence-Erlbaum.
In order to make sense of a narrative or story, there must be an identification with a protagonist which allows a here and
now perspective to be adopted. In doing so, the narrative has the capacity to travel back and forward in time and space,
thus allowing the message to become immediately relevant.
Charon, J.M. (1985). Symbolic Interactionism: An Introduction, Interpretation, and Integration.
Englewood Cliffs, NJ: Prentice-Hall.
The process of verbally interacting with self and others is essential in the development of the ability to evaluate present
behavior and plan for change in the future.
Osofsky, J.D. (1993). Applied Psychoanalysis: How research with infants and adolescents at high
psychosocial risk informs psychoanalysis. Journal of American Psychoanalytic Association, 41, 193-207.
The inability to form a coherent strategy to ensure protection from the caregiver has been identified in the narratives of
maltreated children. Children exposed to disruption and family violence typically construct an incoherent, chaotic life
narrative.
Pynoos, R.S., Steinberg, A.M., & Goenjian, A. (1996). Tramatic Stress in Childhood and Adolescence:
Recent Developments and Current Controversies. In B.A. van der Kolk & A.C. McFarlane (Eds.) Traumatic
Stress (pp. 331-358). New York: Guilford Press.
When faced with a frightening situation, the inability to contemplate a solution seems to retard developmental
accomplishments and interfere with successful processing of subsequent traumatic events.
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Supporting Research
Siegel, D.J. (1999). The Developing Mind: toward a Neurobiology of Interpersonal Experience. New York:
Guilford Press.
Parent-child reflective dialogue that identifies the mental state that fuels behavior, perceptions, intentions, goals, beliefs and
desires seem to promote both secure attachment and the integrative process of co-construction of narratives.
Solomon, J. George, C., & DeJong, A. (1995). Children Classified as Controlling at Age Six: Evidence of
Disorganized Representational Strategies and Aggression at Home and School. Development and
Psychopathology. 7, 447-464.
Securely attached children typically tell stories in which the child protagonist struggles, finds a solution and ultimately lives
happily ever after.
Zwaan, R. A. (1999). Situation Models: The mental Leap into Imagined Worlds. Current Directions in
Psychological Science, 8, 15-18.
The experience of narrative is the same as being in or observing the real situation.
The Innate Quality of Attunement
George, C. & Solomon, J. (1999). Attachment and Caregiving: The Caregiving Behavioral System. In J.
Cassidy & P. Shaver (Eds.) Handbook of Attachment: Theory, Research and Clinical Applications (pp. 649670). New York: Guilford Press.
In order to ensure survival, the parent is biologically driven to provide care and protection in the same way the child seeks
proximity in order to be cared for and protected by the caregiver. Just as the infant is physiologically comforted when the
parent is available, the mother experiences strong emotions of pleasure and satisfaction when she is able to provide
protection and heightened anger, sadness or despair when her ability to be available to her child is threatened.
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Supporting Research
Stories & FANT
• Cozolino, L. (1997). The Neuroscience of Psychotherapy: Building and Rebuilding the Human Brain. New York:
Guilford Press.
• Lacher, D., Nichols, T., Nichols, M. & May, J. (2012) Connecting with Kids Through Stories: Using
Narratives to Facilitate Attachment in Adopted Children. London: Jessica Kingsley.
• Nichols, M., Lacher, D., & May, J. (2002) Parenting with Stories: Creating a foundation of attachment for
parenting your child. Deephaven, MN: Family Attachment Center.
• Nichols, M., Nichols, T., Lacher, D., & May, J. (2007) First Steps for Strengthening Adoptive Families: Tools
and Techniques for Meeting the Needs of Your Adopted Child. Minnesota: Skyhouse Productions.
• Nichols, M. & Nichols, T. (2007) First Steps for Strengthening Adoptive Families: Tools and Techniques for
Meeting the Needs of Your Adopted Child Study Guide. Deephaven, MN: Family Attachment Center.
• Perry, B. (1994). Neurobiological Sequelae of Childhood Trauma: Post traumatic stress disorders in
children. In Murburg, M. (Ed.) Catecholamine Function in Post Traumatic Stress Disorder: Emerging Concepts.
American Psychiatric Press.
• Siegel, D. & Hartzell, M. (2003). Parenting from the Inside Out: How a Deeper Self-understanding can Help You
Raise Children Who Thrive. Tarcher.
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com
Family Attachment Center
18322C Minnetonka Blvd
Deephaven, MN 55391
952-475-2818
www.familyattachment.com
© Family Attachment Counseling Center of Minnesota 952-475-2818
www.familyattachment.com