Reactive Attachment Disorder Follow-up
- Author: Roy H Lubit, MD, PhD; Chief Editor: Caroly Pataki, MD more...
Further Inpatient Care
No specific indication exists for treatment of attachment disorders with inpatient hospitalization; however, occasionally, some children and, particularly, adolescents may require a period of inpatient hospitalization to address issues such as mistrust or lack of emotional involvement with others. For instance, with the adolescent who has had multiple placements, foster homes, or group homes, a period of inpatient treatment may be beneficial in helping the child face fears of becoming close to any person.[11] Also, therapy during hospitalization may help the child work on overcoming the fear of acknowledging dependency needs and the fear of acknowledging desires for attention and affection.
Unfortunately, intermediate or longer-term hospitalization is no longer available in today's economic climate. Day hospital, partial hospital, or residential care in a placement skilled in treating very disruptive, poorly attached children may be a suitable alternative to prevent further foster care placement failures.
Further Outpatient Care
Child therapy and relational therapy (eg, parent-child, parent-infant) may be useful for many children and caregivers. Caregivers may struggle with disciplining the child while trying to foster the child's ability to relate and trust. Establishing a positively oriented and developmentally appropriate behavioral management program is very important to avoid further punishment or prolonged abandonment in excessive time outs. In the context of relational play, or narrative therapy, the child can develop a theme that describes what is in the child's mind. New caregivers may need considerable emotional support to deal with challenging and difficult behaviors in their children.
Inpatient & Outpatient Medications
No pharmacologic treatments specifically indicated for attachment disorders exist; however, children with this condition may exhibit complications in their behavior, such as aggression, defiance, or attention deficit. Medications may be geared toward those symptoms. The treatment of these problems is covered in the respective articles.
Deterrence/Prevention
Providing support and safe environments to stressed families and single parents is crucial to children having a good early experience and forming bonds. It is important for child welfare services and the courts to understand that removing a child from parents does harm and is not a benign intervention.
Complications
Children with attachment disorders are difficult to parent, to teach, and to befriend. As a result, these children are likely to have additional problematic experiences that will complicate attempts to heal.
The basic problems that led to the attachment disorder (abuse and abandonment by parents because of substance abuse, emotional problems, stress) are likely to lead to other problems for the child, including poor medical care and injuries.
Children who have experienced multiple losses and who have developed attachment problems tend to engage in defiant behavior, are noncooperative with adults, experience pervasive anger and resentment, and develop an exploitative attitude toward other people.
Persistence of the nonattachment or the superficial exploitation of people, with fear of closeness and intimacy, is a major complication. When children become parents, they may transmit difficulties in attachment (ie, the parents may be insensitive emotionally and may be unavailable) to their own children and perpetuate an intergenerational cycle of problems.
When the child has experienced multiple disruptions in placements and has witnessed violence, he or she may develop conduct disorder, experience difficulties in social settings, and/or be prone to antisocial behavior because he or she lacks empathy and appropriate models of coping and caring behavior.
The child with disruptions of attachments faces academic difficulties related to maltreatment and to mistrust of adults. Academic difficulties may also be related to attention problems and hyperarousal associated with posttraumatic stress. Additionally, the child may have learning disabilities and language difficulties if exposed to drugs in utero or because of a genetic loading.[12, 13] These disabilities may have led to the difficulties the parents had in caring for their child in the first place. Even without all of those challenges, children with multiple placements and disruptions in their living situations are at risk of experiencing academic problems. A specific educational program designed to address those needs is necessary. If the child is a ward of the state and the school system does not promptly and appropriately respond, state-supported legal assistance is usually available to enforce compliance with federally mandated educational assessment and management.
Prognosis
Without treatment and new attachments, the chance for normal emotional development, building trusting relationships, and experiencing and tolerating intimacy and closeness with other human beings is very poor.
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