Normal Infant Trust Cycle

• Parent responds with food, comfort, nurturance, eye contact, sound, rocking motion, & warmth of human contact

• Child learns adults can be relied upon to meet his needs

Trust Development

Unpleasant Arousal

Need Satisfied

Need

Action to Address Need

Recognitio

n

Com

pleted

Cycle

Decreased

Arousal

Baby Cries

Infant Trust Cycle ATTACHMENT DISORDER

• Infant rage

• Rigidity

• Extreme dependency

• Suppressed abilities

• Lack of foundation

Lack of Trust

Unpleasant Arousal

Infant’s Needs Not

Met

Need

Lack of Adult Response to Infant’s

Needs

Recognitio

n

Cannot

Recognize

Ow

n Needs

Cycle

Incomplete

Baby Cries

Early Childhood Trust of Limits Cycle

• Unpleasant Arousal is Continuous

• Needs = Control

• Action— “I must take care of this myself”

• Limits = Obstacle

• Reinforced Arousal—“ I knew I had to do this myself”

No Trust of Limits-

Attachment Disorder

Unpleasant Arousal

Reinforced Arousal

Need

Placement of Limits

Action to Meet Need

Needs Never Totally Met

Dynamics of Attachment Disorder

Attachment Figure Unavailable

Negative Response Cycle

Self Protective Distancing

Loss of Caregivers

Unmet Needs

Lack of Pleasure in Relationships

Traumatic Stress Leading to Attachment Disorder

• Denial of pregnancy

• Dislike for father of child

• Substance abuse

• Prematurity risk factors

• Variable family support

• Inadequate diet; poor self-care

• Resentment

Pre-Natal

Factors

Traumatic Stress Leading to Attachment Disorder

• Lack of parenting skills

• Various caregivers

• Ongoing substance abuse

• “Mechanical parenting”

• Neglectful/Abusive parental reactions

• Prematurity factors

• Undetected/Unrelieved pain in the child

Post-Natal

Factors

Behavioral Checklist

• Indiscriminate affection towards strangers, willingness to go with them

• Face to face compliance with passive-aggressive resistance

• Absence of guilt; no remorse; lack of conscience development

• Provoking of anger in others almost continually

• Lack of ability to give and receive affection unless on their terms

Behavioral Checklist

• Chronic, non-sensical lying - “crazy lying”

• Theatrical displays of emotion

• Stealing or hoarding food; food refusal or gorging

• Cruelty to animals and/or children, especially younger children

• Firesetting - “controlled” fires

• Preoccupation with blood, fire, gore

Behavioral Checklist• Lack of cause & effect thinking - does not learn from consequences

• Poor eye contact

• Denial of accountability

• Self-injurious behavior

• Refusal to answer simple questions

• Unusual speech patterns or problems

• Poor peer relationships

• Learning disorders

• Theft, vandalism & destructiveness

• Seductive behavior or clothing

• Toileting issues

Attachment on a Continuum

0 60 10030 80Attachment Issues Overindulged

Unattached Child

Healthy Attachment-

Trust Development

Emotional Makeup of Attachment Disorder

Hopelessness Loss

Abandonment

Helplessness No Trust

Anger

PROFOUND SADNESS

FearRage

Parenting a Child With RAD

Post Traumatic Stress Disorder In Parents

Repeated rejection by child—no reciprocity

Personal and family changes out of

control

Avoidance of thoughts and feelings

Decreased affect—detachment from

others

Psychological and physical distress

Relentless control battles—constant

self-control

Primary Symptoms

Causes

Secondary Symptoms

Sleep problems; hypervigilant, irritable, angry

Victim identity; fatigue and

depression; loss of security

Feeling unlike others; emotions

out of control

Hopelessness

Helplessness

ANGER

RAGE

Adult Characteristics for Successful Parenting of Children With RAD

• Healthy sense of humor• Consistency with behavior management, yet flexible• Ability to handle interruptions to social schedules• Understanding that one parents a needy child, with parent’s personal needs met elsewhere• Ability to advocate for child in a

positive manner• Ability to promote positive growth• Sense of hope for the future, plus tolerance and perseverance

• Support in the marital relationship; communication and belief in what the other spouse says• Ability to react calmly; ability to display parental control of attitudes and abilities in the presence of the child• Ability to accept appropriate confrontation if it promotes positive changes• Ability to constantly redefine parental goals and expectations for the child; able to redefine “success”• Ability to withstand criticism & condemnation from family, friends and community

Adult Characteristics for Successful Parenting of Children With RAD

ATTACHMENT DISORDERParental Response Cycle

• The cycle is solely dependent on adult reactions

• Child’s response is directly relevant to degree of adult’s commitment & amount of consistency in terms of non-abusive or rejecting reactions

Building Trust

Capabilities

Unpleasant Arousal

CONFUSION Need

RAGE

Consisten

t

Inconsisten

cy

CO

MM

ITMEN

T

NON ABUSIV

E

Support

Response

Supportive

Control

Child’s View of Adult-Child Interactions

• Someone wins; Someone loses• Adult doesn’t take charge when child is out of control• Child senses this and becomes frightened• Child continues to set up opportunities for adult to take charge• When adult is unwilling or unable to take control, child’s out of control behavior escalates

Adult Attachment Disorder Progression

Unstable and

ImpulsiveSelf

Absorbed

Emotional and

Attention Seeking

Disregard for Others

BORDERLINE PERSONALITY

DISORDER

ANTISOCIAL PERSONALITY

DISORDER

HISTRIONIC PERSONALITY

DISORDER

NARCISSITIC PERSONALITY

DISORDER

The Child Welfare SYSTEM

State Child Welfare

Agencies

Local Child Welfare

Agencies

Private Service

Providers

Courts

Medicaid

Public Agencies

Welfare, Public

Assistance

Substance Abuse

Treatment

Mental Health

Counseling

Foster Care Statistics 2001

• 3 Million referrals made to CPS• 900,000 children found to be victims of maltreatment• 290,000 entered the foster care system• 800,000 children spent some time in the foster care system• 540,000 children in foster care at any given time*

*The Future of Children Winter 2004 www.futureofchildren.org

Foster Care Statistics 2001

*The Future of Children Winter 2004 www.futureofchildren.org

• Nearly one-third of maltreated children were under the age of 3• Forty percent of all child fatalities due to child abuse were infants under age 1• Over the past 10 years, the number of infants and toddlers coming into foster care has increased by 110%• Approximately 1 in 5 of the children entering foster care for the first time are infants under age 1*

Is Uncle Sam a Good Parent?

When the state assumes custody of a child, in

effect the government is stating that it can do a better job of protecting and providing for this child than his or her birth parents can.*

*The Future of Children Winter 2004 www.futureofchildren.org

Assessing the Degree of Attachment Damage

*The Future of Children Winter 2004 www.futureofchildren.org

To uphold the government’s responsibility to children in

foster care, addressing children’s needs must begin at

entry with initial health screening and continue with

regular assessments throughout a child’s time in

care.*

Pay Now or Pay Later

*Juvenile Offenders With Mental Health Disorders

Who Are They and What Do We Do With Them? By Lisa Melanie Boesky, Ph.D.

There is clear evidence that a significant

number of youth in the juvenile justice system

are suffering from serious emotional and behavioral disorders.*

Diathesis-Stress Model of Illness

*Hakim-Larson & Essau, 1999, Juvenile Offenders With Mental Health Disorders… Who Are They and What Do We Do With Them?

By Lisa Melanie Boesky, Ph.D.

“Diathesis” = Being vulnerable to, or having a predisposition to, develop a particular disorder. Psychopathology is thought to result when a diathesis interacts with stressful life events, unless there are ample protective factors or resources to offset it.*

Diathesis-Stress Model of Illness

Juvenile Offenders With Mental Health Disorders… Who Are They and What Do We Do With Them? By Lisa Melanie Boesky, Ph.D.

Mental health disorders are likely the result of a combination of juveniles’ :• Inherited biological or psychological vulnerabilities• Environmental stressors• Environmental supports• Particular abilities and coping skills

Post Traumatic Stress Disorder

Juvenile Offenders With Mental Health Disorders… Who Are They and What Do We Do With Them? By Lisa Melanie Boesky, Ph.D.

Biological influences = MR or ADHD

Environmental influences may be more

significant for youth suffering from Post-

traumatic Stress Disorder.