The DSM-IV indicates that Reactive Attachment Disorder (RAD) may arises from the “repeated changes of primary caregiver that prevent formation of stable attachments (e.g. frequent change in foster care.)”
Childhood Mental Illness
Intermittent placement and non-attachment can result in mental illness. The trauma begins when a young child is removed from a situation of abuse or neglect. Frightened, bewildered, upset, he comes to a new and totally unknown home. In time he becomes accustomed to the home, grows to like it, and attaches to the people in the home. Suddenly his caseworker comes and moves him to another home. These people are also kind to him. He likes his room, he likes the food. But he is cautious about growing attached to them. Sure enough, six months later, he moves to yet a third foster home. This time he may greet the new people warmly and smile at the right time; he may get used to the food and the bed and the new school. But he no longer feels any attachment to the family. On the outside he wears the mask of compliance. On the inside he remains apart and alone. He has learned how painful broken attachments are, and he will no longer expose himself to that kind of pain.
“Two psychiatric syndromes and two sorts of associated symptoms are consistently found to be preceded by a high incidence of disrupted affectional bonds during childhood. The syndromes are psychopathic (or sociopathic) personality and depression; the symptoms (lead to) delinquency and suicide…..The psychopath (or sociopath) is a person who, whilst not being psychotic or mentally subnormal, persistently engages in: (1) acts against society, e.g. crime; (2) acts against the family, e.g. neglect, cruelty, promiscuity, or perversion; (3) acts against himself, e.g. addiction, suicide, or attempted suicide, repeatedly abandoning his job.” (Bowlby, 1979)
Bowlby writes further of the short-term effect of disrupted bonds: “In the separated children, two forms of disturbance of affectional behavior were seen, neither of which was observed in the comparison group of non-separated children. One form is that of emotional detachment; the other its apparent opposite, namely an unrelenting demand to be close to mother.” (1979)
Kulp summarizes the common pathologies of foster children that are worsened by a continuing lack of permanence. (1993)
- Delayed development in personal hygiene.
- Immaturity and poor social skills.
- Problems with authority figures (feelings of powerlessness, acting out, etc.)
- Stress reactions (fire setting, animal abuse, etc.)
- Self-destructive behaviors (lying, stealing, running away, suicide attempts, etc.)
- Difficulty in relating to others (passivity, dissociation, etc.)
- Attachment and separation problems
- Psychosomatic complaints (nightmares, stomach aches, etc.)
- Physical and mental impairments
Others followed, documenting similar lists of childhood mental disorders resulting from multiple moves. (Karen, 1994), (Main, 1996), (Clark et al, 1998)
“Neglect, abuse, and/or multiple moves set the stage for a reactive attachment disorder resulting in children who resist relationships. These children develop pseudo-relationships with others that on the surface appear engaging, but in actuality are highly manipulative and self-serving, lacking the warmth and empathy necessary to sustain any true bonding….Examples of attachment-disordered behaviors that do not allow reciprocity include manipulation, promiscuity, instigating conflict, and theft.” (Steinhauer, 1998)
Attachment problems may be an important factor that increases risk for a number of forms of childhood psychopathology. (Greenberg, 1999)
The American Psychiatric Association identifies foster care drift as one cause of “Reactive Attachment Disorder” (RAD.) If we remove a child from the biological home to protect him from abuse or neglect, then subject him to a series of foster care placements, we may have corrected the initial problem while creating another.
The American Academy of Pediatrics authorized a Committee on Early Childhood, Adoption, and Dependent Care. In their 2000 report, they stated: “The following important concepts should guide pediatricians’ activities as they advocate for the child:
- Biologic parenthood does not necessarily confer the desire or ability to care for a child adequately.
- Supportive nurturing by primary caregivers is crucial to early brain growth and to the physical, emotional, and developmental needs of children.
- Children need continuity, consistency, and predictability from their caregiver. Multiple placements are injurious.
- Attachment, sense of time and developmental level of the child are key factors in their adjustment to environmental and internal stresses.”
Interrupted bonding frequently leads to other psychiatric ailments in children. Included in the list of common childhood diagnoses caused by moving youngsters around are:
- Separation Anxiety Disorder
- Adjustment Disorders
- Attention-Deficit/Hyperactivity Disorder (AD/HD)
- Oppositional Defiant Disorder
- Developmental Delay
- Learning Disorder
Separation Anxiety Disorder (SAD) is characterized by inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached. SAD may appear as a fear of getting lost or kidnapped, a fear that attachment figures may suffer harm, refusal to attend school, a fear of being alone, sleep problems, nightmares, and repeated complaints of physical symptoms. (DSM-IV)
Adjustment Disorders are described as expressing “clinically significant emotional or behavioral symptoms in response to an identifiable psychosocial stressor or stressors.” (DSM-IV) The symptoms may include depression, anxiety, flattened emotions, and/or misbehavior. The obvious stressor in foster care drift and delay is the separation of the child from a situation where he felt safe and loved.
AD/HD is described as “a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development.” (DSM-IV) In a child who suffers the loss of a significant relationship, the failure to focus attention may be a spin-off of nonattachment. The hyperactivity, often expressed in misconduct, may be the result of anxiety and pervasive anger generated by separation.
Oppositional Defiant Disorder is described as “a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that persists for at least six months.” (DSM-IV) Included among the many symptoms are loss of temper, arguing, refusing to comply, annoying others deliberately, blaming others, and being angry and vindictive. It is not difficult to surmise that being separated from a secure base may be a causative factor in the development of such strong resentment.
Being moved and shuffled around can cause a delay in development. Experts have speculated that foster children are often one to two years behind academically and emotionally. Developmental delay can appear in a variety of areas. (DSM-IV) Although developmental delay is more often due primarily to genetic and physical causes, it may also be the result of a separated child who simply decides it is easier to give up and not try.
Learning Disorders are diagnosed “when the individual’s achievement on individually administered standardized tests in reading, mathematics, or written expression is substantially below that expected for age, schooling, and level of intelligence. The learning problems significantly interfere with academic achievement or activities of daily living.” (DSM-IV) As with developmental delay, learning disorders may develop as the result of being shifted from home to home, from school to school.