Attachment Disorder : What is it? Does your child/client have it? What do you do?

1. 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

2. Model and Meaning Attachment Relationships Meaning

3. Model and Meaning Attachment Relationships Life Events Trauma Meaning

4. Model and Meaning Attachment Relationships Life Events Trauma Meaning Development

5. Possible Impact of Attachment on Development Physical Emotional Cognitive Social Spiritual

6. Patterns of Attachment I. Organized Secure Insecure -Avoidant Attachment -Ambivalent Attachment II. Disorganized Insecure

7. Behavioral Clues to a Child’s Beliefs 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?

8. Two Important Factors for Attachment Repair Attunement Regulation

9. 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.

10. Healthy Effects Regulate emotional state Helps form healthy concept of self and others Supports language development Assists a child in learning about a relationship-cooperative partnership Supports development of a coherent narrative

11. Unhealthy Effects Dysregulated emotional state Negative concept of others and self Impaired language development Insecure relationship with caregiver Incoherent narrative

12. 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

13. Regulation Regulation A person’s ability to calm--to regulate body, emotions, and states of mind. Parents help children to regulate.

14. Children with Poor Regulation Moody Frequent Temper Tantrums Aggressive Compulsive Behaviors Retreat/Withdraw

15. Techniques to Promote Attunement and Regulation Mind-Body Connection Family Attachment Narrative Therapy

16. Mind-Body Connection Sensory Input/Developmental Movement to Regulate Nutrition & Exercise Digital Audio Visual Entrainment EMDR/TFT/NLP Medication

17. Shifting Inner Working Model with Narratives

18. 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

19. Constructing Stories Setting Props Perspective Hero Message

20. Types of Narratives Claiming Developmental Trauma Successful Child

21. Claiming Narratives Strengthens emotional bond Facilitates trust Establishes birth order Extended family Passes on traditions, history, rituals

22. Developmental Narratives Facilitates cognitive development Enhances emotional regulation Builds relationships Remedial skill building

23. Narrative Themes From the first, you were a child that deserved to be loved and cared for by parents you could trust.

24. Trauma Narratives Heals pain of trauma Creates empathy Fosters understanding

25. Trauma Narratives Heals pain of trauma Creates empathy Fosters understanding

26. Narrative Themes Even though you experienced abuse, abandonment, neglect, you deserved to be loved and cared for by responsible parents.

27. Successful Child Narratives Teaches values Reinforces cause and effect thinking Presents alternative behaviors Explains basics of “How To Do” life

28. Narrative Themes Your problem behavior does not define your value and we will be there to love and support you as you make changes.

29. 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

30. 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) DSM-IV Definition of 313.89 Reactive Attachment Disorder

31. 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 derKolk & 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.

32. 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. 649-670). 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.

33. 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.

34. Family Attachment Center 18322C Minnetonka Blvd Deephaven, MN 55391 952-475-2818 www.familyattachment.com