Thursday, August 21, 2008

Family experience fosters insight

A version of this first published August 21, 2008 in the Henderson Home News, a Community Newspapers of Nevada publication.

A friend of mine sent me a compelling letter concerning her two adopted children and their journey to recovery from a disorder many people have not heard of: attachment disorder. Because of space constraints, I’m posting the entire commentary here on my blog. The names have been withheld to protect the boys’ identities.

A Chance at Life: Helping Children with Attachment Disorder

Even with the insights and empirical knowledge I acquired from twenty five years of working with the homeless mentally ill, I felt unprepared and ill equipped to respond effectively to the steady escalation of dangerous and disturbing "acting out" behaviors manifesting in my twelve and thirteen year old sons. They came into our lives at two and three years of age through the Nevada State foster care program. There were no serious signs of effects of the neglect they had endured before coming to us. They were animated happy children who brought joy into our lives. By the time they were four and five the adoption was finalized.

My personal journey into the suffering of my dear sons, Todd and Tyler, has informed my heart yet again in a new way of the urgent and essential life task of learning to love unconditionally. Through the tragic and terrifying turn of events that have shaken our family, I have been awakened to a deeper understanding of why so many that we see on the streets are so broken and seem to be caught in a never ending cycle of self destruction.

I have also realized that every fiber of experience and wisdom that has been woven into my heart over these years has prepared me for the unsentimental nonviolent love, imperative to the recovery of my two sons. I am reminded of the famous quote from Dostoevsky's Brothers Karamazov , "love in action is a harsh and dreadful thing compared to love in dreams and books." It is suddenly clear to me that my work with the homeless and my call to be mother are intimately entwined. Both requiring me to never give up on those who society would deem undeserving. Whether that be the homeless man on the street or the delinquent, "problem" child. Both experiences have shown me how to find and mend the heart of the dejected outcast. Indeed, in both instances I have learned what is possible when compassion and empathy replace punishment and rejection.

Presently, both of my sons are in treatment centers. Their placement was in response to their steadily escalating, dangerous, delinquent behaviors. At twelve and thirteen, they were showing signs that something was terribly wrong. We were well into crisis management before we found a therapist who actually understood what was happening. Hence, my husband and I have been living a crash course in the affects of disrupted attachment, sometimes known as Attachment Disorder. We have learned that children who suffer abuse or neglect during the first two years of life, develop an adaptation for survival. One of many serious consequences of this is their capacity to trust adults is severely damaged. Psychologically they have learned that in order to survive, (not die) they must be in complete control. So they manifest behaviors that are subsequently defiant and oppositional. In turn the adults who they already do not trust; parents, teachers, police etc. react with fear, anger or punishment, which in turn fuels the defiance and reinforces their psychological reality that adults are indeed unsafe and cannot be trusted.

There is also a high correlation between parents who neglect or abuse their children and mental illness, increasing the proclivity for mood disturbance in the children as well.

We learned that when children with a history of early trauma reach adolescence, they begin to psychologically relive the trauma suffered during those first two years of life. Indeed often they manifest the symptoms of post traumatic stress disorder. They begin to experience anxiety, depression and rage.

We pieced all these factors together to begin to understand why our children were self destructing, why they were not coming home at night, getting into fights at school, not going to school. At twelve and thirteen they were taking drugs and alcohol. They had no regard for our parental authority and would be thrown into a violent rage when we set very reasonable limits. We were getting called by the police in the middle of the night because they would sneak out and get into trouble. They were both caught shoplifting a number of times. It was all brought to a head when they were arrested for breaking into a vacant house. While my husband and I were desperately trying to get help we endured many visits from the police. Authorities consistently gave us well intended but misguided advice. They would inevitably remind us that we had the right to use physical discipline on our children and that if we did this we would have better control. One officer, thinking he was helping the situation, told our boys to behave or they would be sent back to child haven.

After many months of living through this nightmare we found a therapist who had personal experience with attachment disorder, he had foster adopted seven children. He helped us to understand what was happening and what we could do about it. At about the same time our research lead us to the Institute for Attachment and Child Development, a therapeutic program in Colorado specifically effective in treating children with disrupted attachment issues.

It was Holy Week, my husband and I were back in Colorado at the Institute for Attachment and Child Development. Tyler has been here for a month in a therapeutic foster home. Here, he was, with the help of highly skilled treatment parents put into a developmental box, bringing him to a younger psychological age. This process along with medications for mood disorder would prepare him for a long anticipated two-week intensive aimed at healing the wounds of his original trauma of early neglect as well as his relationship to Gary and I as his parents. The therapist warns that it will be a roller coast ride of emotions especially for Tyler and that we as parents need to stay on the platform comforting him through it all.

By day three my son is laying across my lap . He is weeping the tears of grief and disappointment that have been buried under layers of anger, confusion and pain. Together my husband and I held him secure, rocking and soothing the deep sobbing that was finally being released. This went on for about an hour before he became calm and the crying ceased. Then the therapist spoke with Tyler to help him understand what just occurred and when he asked Tyler how this all felt, Tyler smiled like a happy child and replied, "satisfying".

It is unfortunate that there are so many who are born, through no fault of their own, into dangerous and compromised circumstances and never find relief. Often they are inheriting a legacy of mental illness, drug and alcohol addictions, neglect and abuse. Nationally one in four former foster youth will be incarcerated two years after leaving foster care. Across the country, for many reasons, there has been a call to reform the foster care system. Part of this reformation should include efforts to provide effective treatment for these children. Perhaps it is time we do more for the future of these children than just building more prisons.

Attachment Disorder and it's concurrent conditions ( is a very serious social ill that can and should be addressed. The therapies are specialized but not impossible to teach and learn. It is possible to find effective treatment to give these babies/children who experience abuse and or neglect a better chance at life. The institutions and bureaucracies that are set up to respond to these children first need to be willing to look at the studies and research on brain development and the effects of this on these babies. They need to take seriously the potential human and social costs that comes from not treating these children. They must be willing to teach potential adoptive and foster parents about these kids and how to parent these children. There needs to be treatment homes with trained treatment parents to care for these kids in every state.

Comprehensive structural changes in adoption/foster care systems will not only alleviate the suffering of families, it will sow the seeds for social transformation putting to rest legacies of abuse and neglect. Certainly this kind of structural change can and will over time yield a decline in the number of homeless mentally ill.

Tyler and Todd are finally both at home. They both successfully went through the treatment program at the Institute for Attachment and Child Development. They now have a new understanding of family. They were helped to face the truth of their original traumas. They were prescribed effective medication. They have a desire to be part of family and have tools and insight to continue the work of healing. My husband and I have also been given the parenting tools and support to help the boys navigate through their struggles. With continued therapy and medication management the prognosis is good. We are on the road to a brighter, healthier future for our family .

We are full of gratitude for the family and friends that have generously supported our efforts to obtain this specialized treatment for our boys. We only wish that someday this type of treatment will be accessible for all families who are raising children with disrupted attachment. We are heartened to see that there are local efforts being made to bring in experts on the subject to educate and work with local parents and clinicians in the field of foster care and adoption.

On September 11 & 12, 2008 at the West Charleston Library there will be an Attachment Disorder Training: Theory, Treatment and Parenting presented by Forrest Lien, LCSW and Konnie Stoltz, Therapeutic Foster Parent and Parent Trainer from the Institute for Attachment and Child Development. Contact information 702-375-2171

Signed: A local Mom


alan alier said...

An Attachment Disorder Training will take place on Sept. 11 & 12 in Las Vegas. Sessions include: What is Attachment Disorder?, Techniques for Clinicians, and Therapeutic Parenting. For info call Anne Rhu at (702) 375-2171 or e-mail for a copy of the poster.

Anonymous said...

Thank you, Mr. O'Callaghan, for printing and posting this article. I urge you to print it in all of your newspapers; our family lives in Summerlin and it would be terrific for people here to be exposed to this information.

I'm the mom of an adopted child whose behaviors due to Attachment Disorder and/or one of the other associated disorders make our family's life at best stressful and at worst a nightmare. We moved to Las Vegas recently and it is especially difficult for me to face people who tell me how charming our child is...when I know what lurks behind the surface charm. We are having to educate our neighbors, fellow church members, coworkers and others all over again--while trying to make friends in a totally new state. Imagine trying to explain to the mom of a new friend of our son's that she needs to hide all the family's valuables if our son comes to spend the night--instead we have to search his overnight bag, pockets, etc. and then try to explain to the hosts why their jewelry box, money, or video game was taken.

Las Vegas needs more mental health care, and more support for things like the Attachment Disorder Training coming up in Sept. By "support" I mean paying the $40 fee for foster/adoptive parents to attend the parent workshop. What may seem like a small amount for some is a barrier for others. The state and child welfare agencies need to offer trainings like this on a regular basis. By doing so, the multiple social problems--and their related costs--created down the road when these children are adults will be prevented. And the children will be able to pursue their dreams...and the families, friends, and neighbors will be able to sleep at night.

Tim O'Callaghan said...

I received this via email so I'm posting it here.

Dear Editor:

I read the recent column on "attachment therapy" for traumatized children with some distress. While the theory behind attachment therapy-- that trauma affects children profoundly, especially in the first years of life and disrupts their ability to form relationships-- is sound, the practice itself is not. In fact, there have been several deaths associated with this therapy and a number of prosecutions for child abuse of parents who used forcible restraint, denial of food and water or force-feeding of too much food and water. Some even kept their children in cages at the advice of such therapists, affiliated with the attachment therapy movement centered in Colorado.

Traumatized children respond by "acting defiant" and "seeking to be in control" because trauma is an experience of overwhelming powerlessness and helplessness. They use drugs to cope with the pain. Confrontation and forcible restraint-- which are part of attachment therapy-- merely retraumatize such children. While these tactics may produce impressive displays of emotion and subsequent compliance, there is no evidence that they produce lasting healing and quite a bit of evidence that they can do serious harm.

To recover from trauma, children need to control the treatment and feel safe and secure. This does not mean that they don't need structure and limits. But it does mean that something like physical contact-- which is extremely important to recovery-- needs to be controlled by the child so it becomes tolerable. This is done by slowly introducing greater levels of it, moving the child out of his comfort zone, but not into a panic zone of anxiety and pain. In other words, you teach a child to be affectionate by offering affection on his terms and repeating it till that's OK, then increasing the intensity-- not by overpowering the child and putting him in a strange, new environment where force is used on him.

I urge foster parents and those dealing with traumatized children to seek treatments that are evidence-based or at least do not carry serious risk of harm. Further information can be found at my co-author's website,


Maia Szalavitz
co-author, with Bruce Perry, MD, PhD, "The Boy Who Was Raised as a Dog and Other Stories from a Child Psychiatrist's Notebook: What Traumatized Children Can Teach Us about Loss, Love and Healing." (Basic, 2006).

Anonymous said...

Our child was treated by the Institute for Attachment in Colorado and was never restrained or starved or locked up. Before treatment he took drugs, broke into houses and was gone 30 of 60 days previous to treatment. Now he is home every night by 7 pm and responsible, respectful and fun to be around. His life was saved by this program so I don't know where the above writer gets their information from and I hope it doesn't sway anyone from seeking treatment at the Institute.

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