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Childhood DisordersChildhood DisordersChildhood DisordersChildhood DisordersReactive Attachment Disorder of Infancy & Reactive Attachment Disorder of Infancy &

Early ChildhoodEarly ChildhoodCarolyn R. Fallahi, Ph. D.Carolyn R. Fallahi, Ph. D.

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Common Associated Diagnoses

Axis I: Reactive Attachment disorder of infancy & early childhood.

Attention Deficit Hyperactivity DisorderMajor Depressive DisorderDysthmic DisorderAdjustment DisorderPosttraumatic Stress DisorderObsessive-Compulsive DisorderOppositional Defiant DisorderConduct DisorderAntisocial Personality Disorder

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Behavioral Definitions• Brought into family through adoption

after coming from an abusive, neglectful biological family.

• Consistent pattern of failing to initiate or respond to social interactions.

• Pattern of becoming too friendly too quickly with strangers.

• Pattern of showing indiscriminate affection to strangers.

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Behavioral Definitions• Resists accepting care from others.• Hoarding or gorging food.• Aggressive behavior.• Frequent lying.• Stealing.• No signs of a conscience.

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Behavioral Definitions• Excessive clinginess.• Persistent disregard for emotional

or physical needs.• Subjected to frequent changes in

caregivers.

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History of Attachment• History of Attachment

– John Bowlby– Stages: Protest, Despair,

Detachment– Mother-child bond adaptive &

important for survival– Karl Lorenz & imprinting

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Critical period for the development of

attachment• Age range?• Model for future relationships.

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Mary Ainsworth’s Research Model

• The Strange Situation– 8 episodes measuring 4 behaviors

• Willingness to explore• Separation anxiety• Stranger anxiety• Reunion behavior

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Infant Characteristics that promote attachment

• “kewpie doll” appearance• Rooting, sucking, grasping reflexes• Cooing, babbling• Smiling• Crying• Responsiveness to social overtures

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Infant & Mother characteristics that hinder attachment

• Physically unattractive• Reflexes weak• Irritable• Little pleasant vocalization• Easily over stimulated• Maternal depression• Abused mother• Mother insensitive to baby’s cues• Several children in family• Marital problems

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Schaffer & Emerson Stages in Social

Attachment• Asocial stage – 0-6 weeks• Indiscriminate attachment stage –

6 weeks to 6-7 months• Specific attachment stage – 7-9

months• Multiple attachment stage –

shortly after stage 3

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Theories of Attachment• Psychoanalytical• Learning • Ethological

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Types of Attachment• Secure attachment• Insecure attachment

(anxious/resistant)• Insecure attachment

(anxious/avoidant)• Insecure attachment

(disorganized/disoriented)

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Ainsworth’s Caregiving Hypothesis

• Quality of attachment• Inconsistent caregiving• Impatient caregiving• Abusive caregiving

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Kagan’s Temperament Hypothesis

• Easy temperment• Difficult temperment• Slow to warm up temperment

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Reactive Attachment Disorder

• Infancy & early childhood• Older children & adolescents• adults

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Therapy• Holding therapy – controversial.• Failure-to-thrive cases.• Therapy techniques.• Adolescents & adults.

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Long-term goals• Establish & maintain bond.• Form healthy connections with

others.• Has a desire for & initiates

connections with others.• Tolerates reasonable absence

from caregiver.