Making a difference in the Life of a Child:
The Relationship is Key
What’s the Problem?
Have you ever had a child in your home that resisted doing anything you asked? Did he yell at you? Did she hit her brothers and sisters? Did he hit his peers? Did she have a meltdown if she did not get her way? Maybe it was not your child, but a friend’s and the friend struggled with knowing how to bring normalcy back to their family. Maybe you are the clinician who has been called upon to help this child and family. Were you at a loss as to what to do to help the child? Did you watch the child and family decompensate right before your eyes? If this sounds like something you have experienced, then perhaps this information can help.
Children with disorganized attachment can be diagnosed with oppositional defiant disorder, conduct disorder or even adjustment disorder when the clinician worries about putting a terminal label on the child. The medical community and many clinicians believe giving a child an attachment diagnosis is terminal because they do not see our children heal from such a disorder. However, our experience is different.
I will share what has worked for us with the families we have served. This does not necessarily mean our approach will work for everyone. As with all mental health issues, I encourage you to check with your own counselor and follow their guidance. If you are a mental health counselor, I invite you to check in with your supervisor.
Children who are raised in an environment where the adult caregiver who is needed for nurturing and survival is also the person who is to be feared because of the pain that caregiver inflicts, develop a disorganized style of attachment. A child reared in such an environment develops a come here/go away approach to interacting with adults. The mental health community labels this as a reactive attachment disorder. Based on our experience with over three hundred children a year, diagnosed with reactive attachment disorder (RAD), and based on the tremendous changes we have witnessed in a child’s behavior, it is our belief children diagnosed with RAD not only get better, but in the right environment, actually thrive and excel.
Due to the child’s abuse and/or neglectful experiences, their disorganized style of relating to others does not make him or her a good candidate for therapeutic approaches that are focused on behaviors. Additionally, behavioral focused therapies that leave the child’s adult caregiver in the lobby, are not helping to heal the real issue – the child’s inability to engage in a healthy relationship with a nurturing caregiver.
Behaviorally focused treatments are based on the premise that the child looks to the adult to meet his or her needs. In this perspective there is also the assumption that children care about what their parents want. This is the perspective from which most parents raise their children. Parenting becomes especially challenging if the child is being raised by an adoptive parent, a foster parent, a grandparent or an extended family member. If the child has entered the home at a later stage of life, parenting has unique challenges. Some children simply do not care what adults want from them, because their early childhood experiences have taught them to expect pain and to continually scan for danger.
Instead of adults being someone the child has learned to turn to for safety and nurturing, the adults are people to fear. When a child has the kind of experience where the caregiver is both someone to seek for physical care and someone to fear, there is confusion over trusting that adult. In order to ensure safety, the child’s survival mechanism generalizes this maladaptive approach to all adults, just to be sure. Not only does the child employ “come here – go away” tactics with that particular adult caregiver, but this is the method of interacting with all adults.
This may look like is a child with exceptional charm. With strangers the child is a little angel. Teachers, neighbors, friends may not understand your frustration over parenting this child. With others, the child smiles and says all the right things. The child can seem caring and attentive to the needs of others, until…the parent says, “No”, or the child does not get her way. Then another side of this child is displayed. The child may yell and scream obscenities at the caregiver. She may become extremely aggressive with her words and actions. The child is now seen as defiant and oppositional. The parent may feel frustrated as all the skills that worked with that parent’s birth children are failing miserably now.
What do you do in this situation? What have you done? Has it been effective? How did you feel at the end of the encounter? Do you feel like you need some additional tools to help with these extreme behaviors? Would you like to provide an environment which fosters nurturing, safe and fun parenting? Read on. There may be a few things to be learned from the field of neuroscience and attachment.
Why is this happening?
Neuroscience is the study of how the brain works. There are neural fibers in our brain that come together in networks. These networks correspond to behaviors. In order to change behavior, it is important to change the connections within these neural networks. Neuroscience informs us that there are two components necessary to changing the wiring of the brain. The first is that experience changes the structure of the brain and secondly, the brain changes in relation to another brain (Siegal, 1999).
Neuroplasticity is the concept that the brain is always changing. From the time we are born until we die, our brains are changing based on the experiences we have. For children the critical brain is the adult caregiver’s brain. When the adult caregiver is unable to meet the child’s physical and emotional needs, the child turns elsewhere to get that need met. Our child is also learning that adults are unsafe.
The most important emotional need to be met in childhood is that of attachment. According to John Bowlby (1988), one’s initial attachment occurs within the first two years of life. During this critical time period, the infant learns to look to the caregiver to meet his physical needs, provide safety and protection as well as emotional comfort and regulation.
The nature of the attachment relationship is determined by how responsive the adult caregiver is to the infant. When the infant’s physical and emotional needs are met on a consistent basis, the infant learns to trust that someone outside of himself will meet his needs, as the diagram indicates below. Consequently, as the infant grows into adulthood, he communicates his needs clearly to others, with the expectation that those needs will be consistently met. A child who has his needs consistently met is said to be Securely Attached. This child also learns emotional resiliency. When needs are not met infrequently, it is not devastating. A child’s needs do not have to be met all the time, just most of the time. If in the early years, a child does not learn to trust others, but rather learns to depend on adults as an older child or as an adult, we say the person is Earned Secure…
This has been an excerpt from The Science of Psychotherapy April 2021. For the rest of this story and other great articles on the science of psychotherapy please subscribe…