Friday, 10 January 2014

Attachment Disorder

The following article was written by Ronnie Young for Special Children magazine and is printed with her kind permission.
The target audience was classroom teachers, however what Ronnie says is highly relevant to everyone, whether you realise it, or not.


"The relationship doesn’t have to be perfect to create a good bond"

"Consistency and predictability are essential"

"Empathise, but do not pity the child"


Attachment disorder

Ronnie Young outlines what it is, the signs to look out for and how to support children with the condition

Do you have anyone in your classes who displays many of the symptoms of attention deficit hyperactivity disorder, but only intermittently? Do you teach someone who appears to be on the autistic spectrum but is very manipulative? Have you come across a pupil who doesn't respond to behaviour management policies that work perfectly well with most of their peers? Could they have attachment disorder (AD)?

Attachment disorder is not new and was first recorded in the early 1950s. It is now appearing more frequently in our schools, however, yet not many members of staff will have heard of it, and fewer still will understand what it entails.

One thing that sets it apart from other special needs is the root cause. This is a condition created, not by nature, but by nurture.

Attachment: a basic human need

Attachment is the bond that develops between children and their primary carers (usually a parent) during infancy and early childhood. It is a unique and exclusive relationship that will colour the way they see the world and other people for the rest of their lives. The knowledge that someone dependable is available to provide appropriate care, be responsive and offer comfort in times of need gives babies security. As they grow into toddlers and then children, they feel worthwhile, safe and protected; they can regulate their emotions and they can trust.

Attachment disorder is a mental and emotional condition that develops when this fundamental bond fails to materialise because the caregiver is unresponsive, unreliable, inconsistent or threatening. Deprived of a secure and protective environment in which to flourish, the child grows up feeling worthless, unsafe, weak and afraid. Continually rejected, they learn that the only person they can trust is themselves.
It is commonly seen in children whose home lives are inconsistent, who receive inadequate parenting or who are looked after, especially if they have been moved from caregiver to caregiver. It can also develop in children who have loving parents but who were advised by professionals to ‘let the baby cry’ – for example, children who had colic or glue ear as babies.

It is worth noting, however, that the relationship doesn’t have to be perfect to create a good bond. If the child receives appropriate, responsive care for a third of the time or more, that is usually enough to create a secure relationship.

Brain development

The brain processes information by forming networks of neurons which communicate with one another via electrical and chemical signals. The junctions which allow this to happen are called synapses. These begin to be formed before birth and proliferate at an astonishing rate after a child is born, creating far more than will ever be needed in adulthood. Neural connections that prove surplus to requirements are gradually eliminated during childhood and adolescence.

Synapses capture experiences which help humans to adapt to their environment and are an essential a survival tool. When they are stimulated through repeated experiences, they grow stronger and stabilise, while those that receive no stimulation become weaker and may eventually be discarded: the use-it or lose-it principle. Hence the architecture of a child’s brain is determined by what happens to them during the first five years of life.

The first circuits in the brain to be ‘wired’ are those that process basic information. If these lower-level circuits are not wired properly, this will impede the development of higher-level capabilities, such as memory, emotional literacy and abstract thought. As the child grows older and brain circuits stabilise, it becomes more difficult to alter them and hard-wired behaviours become more resistant to change.

Early experiences are therefore uniquely important in establishing brain circuitry. Nurturing and responsive relationships will build a healthy brain architecture that provides a strong foundation for learning, behaviour and health. However, when relationships are not protective, elevated levels of stress hormones interfere with the formation of healthy neural circuits, further hampering brain development.

Four main conditions

Attachment disorder is a spectrum condition ranging from difficulties forming trusting and/or loving relationships to a complex psychiatric disorder.

There are four main types: avoidant, anxious, ambivalent and neurologically disorganised attachment disorder.

                                    Avoidant AD

These are the tough guys who don’t care, whose predominant emotion is sadness, related to a significant sense of loneliness. They will do everything they can to stop feeling sad and the safest way is to be in emotional denial. They believe they can care for all their own needs by themselves and do not need other people, especially their mothers (or mother figures).
Although they may be superficially engaging, their emotions lack depth and they do not enjoy being around others because they don’t feel safe. This can lead them to appear condescending and aloof, or they might be sullen and openly oppositional in a passive-aggressive way. Some may resort to direct physical aggression in order to create distance.
Physical and emotional closeness is viewed as too dangerous by these children because they can't bear the consequences if it all goes wrong and they may perceive adult efforts to promote closer ties as malicious.
They are terrified of anything that may trigger sadness, and will minimise the chances of this by, for example, using nuisance behaviours to create tension or doing tasks slowly to provoke frustration in others. Tension and anger always feel better than sadness. They are liable to mutter unintelligibly to create irritation and block the sadness, but such behaviour usually means that sadness has been stirred.

                            Managing avoidant AD

Leave the child alone, especially if they need space. Never force closeness, even if you feel they need comfort. Always ask permission. Understand that physical contact may be met with stiffness, flinching or pulling away and don’t take it personally.
Create trust by being totally predictable and consistent, and wait for the child to take the lead. If they get angry, give them space to calm down rather than punishing them, which will destroy any trust you have established.


                                   Anxious AD

Terrified of rejection and abandonment, children with this type of attachment disorder have an inner emptiness and sense of not existing. They work constantly to protect themselves from rejection and strive to confirm their existence is by seeking attention from others. They crave emotional and physical closeness to calm their inner terror, although they do not understand human relationships.
Their behaviour stems from real experience of abandonment. They may have been deserted by their parents, or grown up in an environment where they were consistently ignored or scapegoated. Terror lurks continually, and they tend to be over clingy and exhibit extreme separation anxiety when very young.
Features of the condition include incessant chattering (to control conversations) and being eager to please adults (to ‘manage’ adults into liking them). If not motivated to be charming, they may whine, complain or engage in baby talk to gain attention. They tend to lie a lot, especially about their feelings, and rarely express these because the idea of being authentic is so frightening. As a result, they are hyper-vigilant about appearing as they think others would like them to be.

These children often do well in school because this is a way of getting teachers to like them. On the other hand, they also have a poor understanding of teasing, sarcasm and banter and can take offence or see insults where none are intended. Indeed, they often take criticism at face value and so give up.

They may be intrusive spatially and conversationally. Not only does being left out stir anxiety, they may not know how to behave with others. This makes them extremely vulnerable: they may steal to buy friendship or, in the case of adolescent girls, indulge in sexual promiscuity. They can also be open to substance abuse to alleviate their anxiety and terror. They put great value on possessions, which they may hoard, including food.


                            Managing anxious AD

Understand that the child's constant attention seeking actually reflects a deep need for reassurance that they are OK: a smile, a thumbs up or just a touch on the hand may be all it takes to calm the inner terror. Build up their confidence and praise them for who they are.
Consistency and predictability are essential so they understand that even if you have to make a negative comment about their work, it is only to improve it.
Social skills groups of the type provided for children on the autistic spectrum can help them learn how to behave in conformist ways.

                                     Ambivalent AD

The thinking here is, ‘If you are hurt by me it is your fault for being in my way.’ These children believe that other people do not matter and they should take what they want because nobody is going to give it to them. Other people are just resources to be exploited and their feelings and needs are irrelevant.
Children with ambivalent AD are angry and defiant, maybe violent, and their condition is sometimes misdiagnosed as oppositional defiant disorder or conduct disorder. They are almost incapable of giving or receiving affection, but will use it if they want something.
They see touch as meaningless and are explicit in telling others to get away from them. They are destructive to their own and others’ belongings and tend to sabotage or destroy anything positive that happens to them. They have few friends, if any, because they inflict hurt on their peers and lack empathy, often showing cruelty.

Unlike children with other conditions, they understand the impact of their behaviour on those around them but do not care. They derive excitement from risk-taking regardless of the inherent dangers and are often interested by gore, fire and death. If untreated, this affinity may develop into sociopathic or psychopathic tendencies.

People with this condition may get suspended as early as pre-school because of their destructive behaviours. They are deliberate underachievers – the lower the expectations, the less they have to do. Many are classed as having low ability or special educational needs although in reality some are extremely able.

                        Neurologically disorganised AD

These children are psychologically damaged and display an often bizarre variety of symptoms. Their attachment difficulties are secondary to their neurological impairment, and their behaviour is often unrelated to the situation at hand.

Other issues that may affect them include foetal alcohol or substance syndrome, poor pre-natal nutrition, significant prematurity, post-natal neglect or abuse, and genetically inherited disorders.

They are susceptible to auditory hallucinations (which they often deny) and learning difficulties caused by neurological damage. They may be bipolar and their behaviour often shifts in form, leaving teachers forever chasing new problems.
While children with other forms of attachment disorder tend to be moody, these children are excessively excitable. They are often difficult to treat in therapy because they have so many problems and may therefore require medication.

Their overwhelming, chaotic anxiety can lead to disordered thinking, which may regress to psychotic levels. Their speech is frequently tangential and sprinkled with distorted syntax and neologisms, although they are often unaware of this.

They may feel remorse about their behaviour but since it is driven by anxiety and neurological fragility, this will not affect how they behave in future. Because they are oblivious to boundaries and personal space, they tend to be intrusive, which can make them socially isolated.

Managing ambivalent and neurologically disorganised AD

If you suspect either of these two conditions, a referral for psychological assessment is imperative. It is essential these children receive expert therapy to make sense of their story so their psyches can be healed.

Possible indications of attachment disorder

                                                 In young children

Patterns of lack of impulse control, self-destructive behaviours, deceit, rage, aggression towards others, destruction of property, lack of trust, cruelty to animals, bullying, inappropriate clinginess or stealing.

                                                                   In teens

A blatant disregard for rules, arguments, abrupt personality changes, lying, stealing, manipulative behaviour, blame shifting, non-acceptance of feedback and low self-esteem.

                                                          In all children

Lack of motivation, truancy, problems with authority, being easily misled, peer problems, defiance, running away, depression, suicide threats, self-harm, risky sexual behaviour and eating disorders.

How to respond

Remember, if you haven’t lived it, you don’t know it. Nor are you a therapist or a parent.

·         Empathise, but do not pity the child as this will reduce your effectiveness as an educationalist.
·         Keep your expectations high because these children are worthy of high expectations.
·         Be a positive and consistent role model who always tries to create win/win situations in a safe environment.
·         Use clear consistent guidelines and boundaries, emphasising choice, and always give measured, calm responses to confrontational situations.
·         Be honest and truthful, while showing sensitivity for their feelings. When you criticise something, make it abundantly clear that it is their behaviour or work that you don't like and not the person themselves.
Finally, do not lose faith in yourself. Children with attachment disorder do not become this way overnight and cannot be expected to change overnight. However, if you are positive, consistent and trustworthy, they may be able to find someone with whom they can connect.

Ronnie Young is an education consultant and writer.


  1. Fascinating. Thanks Ronnie and Richard

  2. We are grandparents of a 13 year old boy with Anxious Attachment Disorder who had been living with us since her was 3 he has just been taken into care because our relationship has broken down with him through his father coming back into his life and making things difficult. We are heartbroken.

    1. I can hardly comprehend you anguish.It must be heartbreaking after all those years of love and building a relationship with your grandson. I feel for you.
      Sadly, Ronnie Young, my cousin's wife, died in My last year from a cancer that developed into a brain tumour. Happily her work and understanding will live on and hopefully help others.
      Many thanks for sharing with us.