1. 1 Childhood Disorders Reactive Attachment Disorder of Infancy & Early Childhood Carolyn R. Fallahi, Ph. D.

2. 2 Common Associated Diagnoses Axis I: Reactive Attachment disorder of infancy & early childhood. Attention Deficit Hyperactivity Disorder Major Depressive Disorder Dysthmic Disorder Adjustment Disorder Posttraumatic Stress Disorder Obsessive-Compulsive Disorder Oppositional Defiant Disorder Conduct Disorder Antisocial Personality Disorder

3. 3 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.

4. 4 Behavioral Definitions Resists accepting care from others. Hoarding or gorging food. Aggressive behavior. Frequent lying. Stealing. No signs of a conscience.

5. 5 Behavioral Definitions Excessive clinginess. Persistent disregard for emotional or physical needs. Subjected to frequent changes in caregivers.

6. 6 History of Attachment –John Bowlby –Stages: Protest, Despair, Detachment –Mother-child bond adaptive & important for survival –Karl Lorenz & imprinting

7. 7 Critical period for the development of attachment Age range? Model for future relationships.

8. 8 Mary Ainsworth’s Research Model The Strange Situation –8 episodes measuring 4 behaviors Willingness to explore Separation anxiety Stranger anxiety Reunion behavior

9. 9 Infant Characteristics that promote attachment “kewpie doll” appearance Rooting, sucking, grasping reflexes Cooing, babbling Smiling Crying Responsiveness to social overtures

10. 10 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

11. 11 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

12. 12 Theories of Attachment Psychoanalytical Learning Ethological

13. 13 Types of Attachment Secure attachment Insecure attachment (anxious/resistant) Insecure attachment (anxious/avoidant) Insecure attachment (disorganized/disoriented)

14. 14 Ainsworth’s Caregiving Hypothesis Quality of attachment Inconsistent caregiving Impatient caregiving Abusive caregiving

15. 15 Kagan’s Temperament Hypothesis Easy temperment Difficult temperment Slow to warm up temperment

16. 16 Reactive Attachment Disorder Infancy & early childhood Older children & adolescents adults

17. 17 Therapy Holding therapy – controversial. Failure-to-thrive cases. Therapy techniques. Adolescents & adults.

18. 18 Long-term goals Establish & maintain bond. Form healthy connections with others. Has a desire for & initiates connections with others. Tolerates reasonable absence from caregiver.