About two weeks ago, I received the email letter posted below. I promised the correspondent that I would respond to this heartfelt plea on this blog. As I sit down writing this response, I rue making that promise. The origins of “Reactive Attachment Disorder” are difficult to explain, and strategies to ameliorate it are equally difficult to wrestle with. Let’s begin talking about it after you read the first part of the email message that induced my response.
“Our adopted granddaughter (3 1/2 years old) has been diagnosed with Reactive Attachment disorder. Our daughter and husband have been doing therapeutic parenting, Nancy Thomas, Dr. Buenning, Dr. Hughes, amino acids, auditory programs, neural developmental programs etc. with little progress in her relationship to her new parents. We understand the neglect and orphanage experience has had a big effect on her inability to trust and bond with her parents. She is (of) at least normal intelligence but the RAD and possibly mild autism leave us stymied.
Do you have anything to suggest that might help us provide the best environment to help her brain overcome her early experiences and be able to accept the love of her parents? This is such a painful situation to be in, to hear her tell her mom that she doesn’t love her and will never love her. At times she seems quite normal , especially in front of visitors, but when left alone with Mom she can’t reciprocate love or empathy. We are really worn out with night terrors, rejection of parents who love her dearly and the expense of trying to find a solution to her problems.
If you know of a program that allows for the plasticity of the brain to overcome early trauma we would appreciate any help you can give us.”
The grandmother of this child went on to describe personal information about her granddaughter. Suffice it to say that she was adopted as a one-year-old from a Chinese orphanage.
Let’s begin our conversation about the neurology of this kind of problem by initially reflecting (in necessarily abbreviated terms) on what underlies the development of an attachment between a mother (primary care-giver) and a child. We shall then briefly discuss the special problems for attachment that can apply for a family making a home for an offshore orphan. Finally, I shall not attempt to prescribe any special thing that might work — as that would be practicing the healing arts without a license — but will try to consider how we can think of busted emotional attachments and their possible repair, from my limited neurological perspective. Finally, I shall invite you, the readers of this blog, to offer your own advice and assistance to this frustrated grandmother.
If you look up “reactive attachment disorder” and “neuroscience” or “neurology” on the usual government and library web sites, you quickly discover that this is just another one of a long list of big problems that plagues humankind that we scientists really don’t study very much. How fundamental can you get, for God’s sake!?? A baby or child with this disorder can have little evident affection for their parent or guardian; and in fact their interactions can be predominantly negative and rejecting, rather than loving and accepting. It’s pretty important stuff, in a household in which it occurs — yet our studies of it are remarkably limited, and superficial.
By observing children raised in different home environments, we do know that (on a statistical basis) early, extensive contact between the infant and a caregiver is very important. It has been argued that child-infant bonding is not strictly dependent upon the quantity of connecting interactions, but rather on how the parent reacts in the more limited set of interactions in which the CHILD is requesting a specific emotional parental response. There is some level of attachment problem in an estimated 40% of American children (numbers in U.S. studies actually range between 10 and 90%).
In the U.S., we often take up the ‘blame the parenting’ cudgel as we try to explain these large numbers. There are two things wrong with this approach. First, attachment disorders often run in families. A young parent who is inherently detached from others because their own childhood that impairs their own instincts for bonding can hardly be at fault for not being more effective at growing an attachment with their infant. Second, we place only limited value on parental education, and family support in educating mom and dad about parenting is not exactly on the rise. It could be argued that a society is foolish NOT to educate young parents about (among many other things) how to develop a stronger, more-loving relationship with their child. In any event, as a society, we just don’t do a very good job at that.
The development of an attachment is a perfectly natural biological process. The primary attachment is most often a two-way connection that grows between an infant and mother. As the mother carries her child-to-be, she massively associates it with her Self. By the time the baby is born, it has already become, through millions of associations, a significant part of the Person who shall be its mother. When the baby is born, if all is going well, the mother grows this association in an elaborate new way through nursing, and through playing with and caring for the infant.
To understand what I’m talking about neurologically, let’s step back a bit and consider where YOU, YOUR Self has come from. When we take in information from the world, we associate it with other important or interesting things that are occuring within proximate time. Those connections are actually established through brain plasticity processes, which build our enormous associational repertoires as we operate in the world. We know and have recorded that cows live in barns, birds nest in trees, hammers go with nails — and that hundreds of thousands of other things belong with one another, with roughly predicted probabilities. All of this massive associational database has been constructed through experience and learning, and recorded through enduring brain change.
For every association we make between the things or actions or thoughts in the world (billions, in each passing year), we make a SECOND, parallel association, to the PERSON (YOU) who is the SOURCE of those zillion-and-one inputs, thoughts and actions. This massive association with the source of the brain’s actions (YOU) is the basis of our growing and continuously-changing SELF. Because billions of sensory inputs from the surfaces of our bodies are referenced to their source of origin, our SELF is embodied. The PERSON who is reading this blog entry is a product of billions of such source-referencing associations.
It should be understood that memory associations arise through brain plasticity. An almost unbelievably level of plasticity underlies the creation of the complex Self that is riding around within your skull.
Now let’s have a baby. Within the womb, especially in the third trimester when the fetus makes us very aware of its presence, it literally becomes a part of the Self that is its mother. Through millions of associations, the baby and her are, in her brain, an integrated entity. Is it hardly surprising, then, that in the natural course of things most mothers are almost super-naturally attached to their new-born infants. This attachment is further nurtured and elaborated through the mother’s close physical and emotional attachment ot the infant post-natally. That infant is a regular, constant, emotionally important part of the mother’s (father’s, grandparent’s, sibling’s) life on a level at which it is literally encorporated into THEIR selves. A mother or close and constant caregiver is LITERALLY bonded — attached — to the Person who loves them, in neurological as well as emotional terms.
In the normal case, the same kind of attachment is also growing in the backward direction, from the mother to the infant. In this case, attachment is less cerebral. The infant receives warmth, nourishment, and many other rewards from his or her mother. The mother is a source of food, safety, comfort, and countless little pleasures. The baby quickly understands that their mother (or other continous care-giver) provides a safe base of operations for exploration and adventure. One of the most non-intuitive discoveries in the study of infant-child bonding is that the most secure infants have (on the statistical average) the greatest curiosity and the strongest explorative and inventive instincts. It has been argued that this occurs because such a child is operating from the very secure base and reliability for having its primary needs met by its mother.
None of these conditions occurs in the normal way, for a parent or infant adopted from offshore, especially when the child is more than about one year old. Among the differences:
1) Such a child often has endured a history of major or minor neglect. Note that the latter can be damaging, if the child’s needs are not met WHEN THEY MATTER MOST to the infant itself. While it is sometimes achieved magnificently, it is hard to provide that kind of responsive, reactive, predictable environment within the walls of an institution.
2) Such a child has undergone neurological changes related to attachment that can now impede the establishment of normal bonding between child and parent. Significant un-learning may now have to precede the development of normal, loving bonds between child and parent.
3) An orphanage is commonly designed to provide a safe, predictable and secure environment. Removal of a young child from that setting to a new one that is chock full of surprises and uncertainty and change, all played out in a completely foreign language and environment, can contribute to a child’s insecurities and distresses.
4) A neurological price beyond the emotional costs of being raised in an orphanage environment is commonly borne by the detached child. Environmental deprivation and stress has been shown to give rise to changes in the learning brain (for example, expressed in the hippocampus) that lead to impairments in cognitive and language abilities. These problems must also be addressed, if successful recovery from this early period of deprivation is to be achieved.
5) Such a child comes into an English language environment in an American cultural environment from something very different from that. How can the parent of an adoptee develop a sensitivity to what the child wants or needs in the early period of development of their bonding? Unfortunately, a significant time lag in understanding these crucial signals can have a substantial inpact on the child’s — and ultimately, the parent’s — ability to bond.
6) Finally, that child has come into a family that has not had the attachment between mother and infant undergoing continuous growth and strengthening from a time well before birth, and that family does not have the understanding that comes from participating in that continous progression of growth in bonding. Adopted parents are instinctively full of love and affection for the small child that has come to their home. It is almost impossible for them to understand why, in its new, comfortable and loving environment, the child cannot not and does not automatically reciprocate.
People and institutions who arrange such adoptions should be required to provide a rigorous training course for adopting parents to minimize the trauma of foreign adoption for all concerned. As it is, Reactive Attachment Disorder and Cognitive Impairment (in the letter, embodied in the phrase “possible mild autism”) are all too often a MAJOR problem for these children and their families (because these conditions in the child impair the entire family). This would almost certainly less often be the case if the new parents were better prepared for the big job that they are probably taking on when they bring this child from another culture (in this case Orphanage-Chinese) into their home.
On the basis of these superficial premises, let’s consider the toughest part of the question: What can be done about it? I’m going to write some thoughts from a neuroscience perspective about this complex issue in my next blog. So hang on until tomorrow!