Friday, September 18, 2009

Attachment: “Love Is Just a Starting Point”

By Martha Nichols for Adopt-a-tude

Attachment disorder is a big bugaboo in the adoption community. In one post on, a writer wonders what the difference is between “attachment disorder” and “reactive attachment disorder”:
“I have seen this on several different discussion groups,” she writes, “and it’s been bothering me. Parents are willing to accept that their child has attachment issues, but when it is diagnosed as “full blown RAD”, then they panic.”
Sometimes there's no reason for the panic. The first night I spent with our son in Vietnam, he was strangely quiet for a five-month-old baby. My husband and I managed to coax a few smiles from him, but we also videoed his difficulties rolling over to show to doctors back home. Two months later, by the time we were on an airplane heading to the United States, he'd perked up and started crawling.

He wasn't a crier—such a good baby! the uninitiated would coo—but our little guy let loose a wail when we first stepped into the foggy cold outside the San Francisco Airport. A friend with us, an experienced dad, reassured me there was nothing wrong: "He's just pissed." Looking back, I can see that my boy's angry sobs were a very good sign.

Still, after our first weeks together, I only felt like his favorite nanny. I was not yet mom. I arranged for a social worker from the Early Intervention Program to come for a visit in order to evaluate our "attachment issues." Within moments of observing us together in our house, she laughed. "Every time you talk or move, his eyes follow you," she said. "His attachment is fine."

And she was right. But bonding with a child is a process, not a button-push.

How often do adoptees or foster children end up with a clinical diagnosis of attachment disorder, reactive or otherwise? Traditional psychiatric sources cite its prevalence as 1% of the general population of kids under five but claim that attachment disorder is far more common among orphaned children. How common is the question.

Available government statistics about adoption disruptions and dissolutions—one measure, theoretically, of attachment problems—put the rate at anywhere in the United States from 25% among older children at the time of adoption to 5% of planned adoptions from foster care. But sampling varies widely from state to state, as do the populations studied. In any case, little research has been carried out to determine how well adoptees with this diagnosis ultimately adjust.

Like so many aspects of adoption, there's scant evidence to clarify what's going on. Adoption industry experts offer soothing claims about the infrequency of attachment problems, but most parents can tell tales, often in hushed tones, about some kid who's emotionally checked out, unresponsive to touch, or prone to violent outbursts.

These anecdotes are scary. Add a highly charged piece about a terminated adoption like Anita Tedaldi’s “My Adopted Son” in a recent New York Times’s blog, and fear and loathing tend to rule the debate. Tedaldi bravely details her own inability to bond with her son, but she leaves hanging the question of whether this might not have happened, even with all his manifold problems, if he'd been her biological child (she already had five biological daughters at the time of the adoption).

Sometimes personal stories are the only things that convey a complicated set of decisions or events. Yet the knee-jerk response to attachment disorder can obscure the ways families actually live with it. The media misrepresents the fear, too, because attachment disorder is not only suffered by adoptees in Chinese or Romanian orphanages or said “orphans” in Hollywood movies. Children raised in their biological families can also suffer from it, especially in traumatic circumstances.

I’m grateful to a former student of mine, Fran Cronin, for allowing me to tell a piece of her family’s story. I believe a more complex view of attachment disorder—and an honest discussion of the challenges faced by adoptees with this diagnosis—are more helpful for children than the overly rosy version promoted by the adoption industry.

Cronin, a widowed single mother in Cambridge, Massachusetts, with two kids—one a teenage biological daughter, the other an eleven-year-old son adopted from Russia—says she began the adoption process by thinking, “if I love my child enough, all will be right with his world.” As she’s since discovered, “the love is just a starting point.”

Cronin’s son was only five months old when he joined her family, but he made no sounds until a whimper at seven months. More weeks passed before he finally cried. She describes a testing process now with her son, who has been diagnosed with attachment issues, learning disabilities, and a shifting series of labels that indicates how hard it is to pin down what's due to post-traumatic stress and what's organic.

Whenever he throws things or swears at her, she thinks he’s actually asking, “If I’m really bad, are you going to give me up, too?”

For Cronin, getting professional help with her son—and for herself—has been a life-saver. She’s had to learn to stay calm and to not argue back. Otherwise, she kept getting “sucked into his same angry world,” she says.

Yet this same “tough child” has also learned empathy. His grandmother, Paula Cronin, says she believes much of his bad behavior is driven by fear. It’s an emotion he knows so well that when she herself has felt “seriously frightened…, [he] was instantly at my side, holding me tight, staying with me and talking to me until I calmed down.”

Perhaps attachment disorder isn’t a single, monolithic diagnosis but a state of being for children. Such a child might feel too frightened at times to reach out to anybody; at others, his empathy might fill an ocean. That doesn’t make it easy. But a son like Fran Cronin’s isn’t lost to human society or a victim of circumstance or stuck with a label.

“I didn’t raise you to go to jail!” She admits to yelling at him in heated moments. Yet such emotional engagement—offering backrubs and screaming frustration, as Cronin does—probably seems more genuine to her son than pretending sweet perfection.

So here are some questions for readers: What do you think about attachment disorder? How do you feel about the challenges for adoptive families—and the misperceptions about attachment disorder in the adoption community and media? Most especially, do you have a complex family story of your own to share?

For those struggling with these issues, check out the website for ATTACh, the Association for Treatment and Training in the Attachment of Children.


Arthur Becker-Weidman, Ph.D. said...

The National Adoption Center found that 52% of adoptable children (in that study meaning children in the US child-welfare system) has symptoms of "attachment disorder."
80 % of maltreated infants exhibit attachment disorder symptoms (the disorganized/disoriented pattern of attachment) Cicchetti & Barnett, 1991.
30% of the children adopted from Eastern Europe and the former Sovie Union have been severely traumatized and are significantly disordered.
However, with proper parenting and treatment many/most children can heal

2worlds1family said...

I think the word attachment misrepresents what a lot of adoptees go through. First I don't think most parents understand that attachment, even for a bio child, is a 2-3 year process. My understanding is that the attachment process begins and grows stronger as the child learns to trust.

I think lots of adoptive parents go down the checklists about attachment, see that things seem to be on track, and think their family is going to be without adoption issues all together. If they're attached, we're good.

But my experience with our son (who came home as an infant and has been home three years) shows something different. He's attached, no doubt. But issues still come up when experiences or situations strain our connection--something that he thinks is proof that another big change is coming in his life. And often it's a situation that wouldn't faze a bio child. But with the separations and trauma our son has experienced, he views these situations differently.

I think adoptive parents need to be more aware of strains that can occur in connection and not see attachment as a one-time done deal.

Martha Nichols said...

I've always thought my son, who is very closely bonded with us at this point, has a far tougher time with certain kinds of transitions than other kids. All the points here are very good, I think--that with treatment and good parenting, most children can heal (although, sadly, probably not all); that "connection" may be the term we should really focus on, especially in the way that a child's sense of self develops through all the developmental stages of his or her life.