1. The Continuum of Attachment Attachment disorder can be seen as a continuum with the child often recreating the attachment environment that they first experienced.

2. Secure Attachment Secure attachments provide safety and protection, teaching basic trust and reciprocity. Secure attachment is the basis for self-esteem and self-concept. It promotes socialization, facilitates development of morality, empathy, conscience, creates a positive "inner working model", promotes health and physical development and increases resiliency. Seek primary care giver when distressed Easily comforted Absorbed play Curious Responsive to environment cues Reciprocity in relationships Use care giver as a secure base from which to explore

3. Insecure-Anxious Attachment Disorder May result from a dysfunctional attachment during the early years. There may have been some attachment to a caretaker but it may have been inconsistent, or abusive. Charming, superficial Appear emotionally empty Eager to please, chameleons, (hyper vigilant) Bossy, demanding of affection and attention Intrusive into others’ space Clingy and dependent Whines and pouts when limits set May hurt adult when being affectionate, or be seductive Lie, steal and hoard Buy friendships Manipulate, manipulate, manipulate

4. Insecure-Avoidant Attachment Probably caused by a neglectful environment. Make themselves very hard to like-which fulfills their belief about themselves and the world-that they deserved rejection. Avoid close relationships, loners, distant Self-reliant, believe they can meet their own needs Rarely distressed when caregiver leaves May reject caregiver following separation Feel safe when in control Do not seek out friends Hostile, passive-aggressive Avoid eye contact Chatter nonstop, ask nonsense questions Annoying behaviors that keep others at a distance Avoid feelings, may have flat affect or fake emotions Low self-esteem When held, complain, wiggle or itch

5. Insecure-Ambivalent Attachment Probably caused by an abusive early environment or one which was both abusive and neglectful with little predictability. Openly angry and defiant and destructive especially when limits set Distressed during separation, difficult to comfort Seeks contact yet may be angry and resist closeness upon return Destructive to self, others, animals and property Sneaky Lie and steal Superficial and manipulative to get what they want Stiffen in response to affection Sabotages closeness When stressed appears disorganized Regresses or acts immature when needing affection Lack of remorse Obsessed with fire, blood and gore.

6. Disorganized Attachment May have experienced a very chaotic environment in early years. May have experienced both nurturing and abuse Concurrent psychological disorders Odd, bizarre behavior Unpredictable, excitable, changeable Unable to maintain consistent attachment strategy when distressed Go from crisis to crisis Behavior marked by conflicting drives to approach and avoid Sudden bursts of anger followed by sudden freezing or dazed behavior May dissociate memory of abuse to maintain attachment

7. Children with Attachment Disorder Have Often Experienced : Abuse (physical, emotional, sexual) Neglect Prolonged separation from primary caretaker Undiagnosed and/or painful illnesses Frequent moves and/or placements Inconsistent or inadequate daycare Chronic maternal depression Poor parenting skills Separation due to death or divorce Prenatal injuries Organic or neurological insults

8. Behaviors Superficially engaging and charming behavior Indiscriminate affection toward strangers-affection on their terms only Lack of eye contact Persistent nonsense questions and incessant chatter Inappropriate demanding and clingy behavior Chronic, crazy lying Stealing Destructive of self, others and property Sexualized behavior Abnormal eating patterns Problems with impulse controls Learning lags and disorders Abnormal speech patterns Poor peer relationships Lack of cause and effect thinking Lack of guilt or remorse Cruelty to animals Preoccupation with fire, blood and gore Anger Passive-Aggressive behaviors

9. Associated Behaviors

10. Hierarchy of Brain Function Most Complex Most cells Develops later Least Complex Fewer cells Develops earlier Abstract thought Concrete thought Affiliation Attachment Sexual behavior Emotional reactivity Motor regulation Arousal Appetite/Satiety Sleep Blood pressure Heart rate Body temperature Limbic Cortical Midbrain Brainstem

11. Role of Amygdala Emotional Response Amygdala Sensory Thalamus Sensory Cortex Emotional Stimulus AD Reaction

12. Assessment History Discovering What the Parents Know Testing Observation Behavior

13. Attachment and Attunement AttunementLack of Attunement Supports making sense of experienceNo help making sense of experience Enhances emotional regulationOverwhelming emotions Gives coherent narrativeIncoherent narrative Supports language developmentImpaired language development Supports sense of selfDysfunctional sense of self Increases capacity to plan and inhibitDecreased ability to plan and inhibit

14. Attachment Behaviors Daily Checklist Check the behaviors you observed today ________________ (date). ____Accepts redirection, parental limits. ____Able to play independently but returns to parent to re-energize. ____Able to delay gratification for increasing periods of time. ____Exhibits feelings other than mad, such as sadness, fear, happiness. ____Enjoys games, time spent with parent. ____Smiles and makes eye contact for increasing length of time. ____Accepts cuddling or physical contact. ____Initiates physical contact. ____Allows parent to comfort them when distressed. ____Has been fun to be around today.