Attachment Disorders

Identifying Symptoms, Challenges, and

Treatment of Attachment Disordered Youth

Attachment Disorders

Jennifer Vernon, MS, LPC – Clinical Manager of Child and

Family Services

Michelle Anspaugh, MS, LPC – Child and Family Therapist

Synergy Services, Inc.

How many of you have been to attachment trainings?

How many of you currently do attachment work?

Attachment Styles of Youth

Secure Attachment

Avoidant Attachment

Anxious Attachment

Ambivalent/Disorganized Attachment

Secure Attachment

Seek primary attachment figure when distressed.

Curious and responsive to environment

Self-confident and good self-esteem

Empathetic, humorous, playful

Will try in the face of adversity

Can ask for help when needed/balanced with

developing independence.

In shelters for situation specific (parent lost job) or

conflict w/ parent

Avoidant Attachment

Develops when caregiver is rejecting and unresponsive

Moms/parents – often depressed, drugs/alcohol problems

Passive and withdrawn behavior – doesn’t express distress

Avoids closeness to others

Avoids feelings

Seldom seeks comfort

Passive-aggressive

Don’t expect much/minimize expectations

Have minimal narrative-facts (explicit memory) vs. emotional

memories (implicit memory)

Anxious Attachment

Develops when caregiver is inconsistent responding to child.

Anxiety connected to fear of abandonment

Seeks emotional closeness as “valium” to quiet anxiety.

Can be charming or whiny/complain

Non-stop talking, constantly interrupting, or asking questions

Looks like ADHD

Uses “impression management”/people pleasers

Behavior varies depending on who is present

Rarely openly defiant or passive-aggressive

Fall in love easily – focus on “other”

Ambivalent/Disorganized Attachment

Most severe attachment disorders

Often develop into personality disorders and sociopaths

Root cause is often Betrayal Trauma - occurs when the people or

institutions we depend on for survival violate us in some way

Child/teen responds with extreme self-reliance

Very controlling with others

Push-pull style

Odd behaviors and unpredictable moods

Focus on injustices done to them/consider themselves victims

Openly angry, defy rules, high-risk behaviors, superficially charming, lack

empathy, delinquent acts, self-harm, suicide attempts, cry to get others to

engage, lying, aggression, promiscuity

RAD, ODD, CD, Complex/Developmental Trauma

Experiences That Lead to Attachment Problems

Abuse and neglect

Loss of parent

Unavailability of parent

Premature birth

Medical problems (especially before age 2)

Chronic pain

Poor prenatal care

Challenges of Treatment

Availability of attachment figure

Attachment and trauma hx of attachment figures

Time in tx

Fears of clients:

Trusting us

Allowing others to help

Being let down (again)

Being hurt

Being vulnerable – dangerous

Treatment

PACE

Connection vs. Correction

Create a Coherent Narrative

Connect client’s story to current

behaviors/feelings

Trauma work

Educate caregivers/ staff about Therapeutic

Parenting

PACE ATTITUDEDaniel Hughes – Attachment-Focused Family Therapy

Playfulness

Acceptance

Curiosity

EmpathyTherapist engages youth with this attitude, helping youth engage

relationally in a different way.

Therapist helps the parent/caregiver engage in PACE attitude to

become emotionally connected to youth.

How do we get in?

Connnection vs. Correction:

Feels counter-intuitive

Reflect youth’s feelings/inner thoughts before

giving consequences/lecture

Changing neural feedback loops of interacting

Speaking to

Speaking for

Speaking about

Create A Coherent Narrative

Connect youth’s story to thoughts/feelings

Trauma Work – Trauma effects attachment.

Ask youth to bridge the gap between

distressing event and emotions/thoughts/body

sensations – between explicit and implicit

memory.

EMDR, TFCBT, etc.

Any Questions?

Thank you for attending today

References Attach.org

Clark, Mindi Higgins Kessler. (2009) Diagnostic and Treatment

Features of Reactive Attachment Disorder

Emdria.org

Forbes, Heather T. and Post, Bryan B. (2009) Beyond Consequences,

Logic, and Control: A Love Based Approach to Helping Children With

Severe Behaviors

Freyd, Jennifer J., What is Betrayal Trauma? What is Betrayal Trauma

Theory? http://dynamic.uoregon.edu/~jif/defineBT.html

Hughes (2007). Attachment-Focused Family Therapy