The more we understand about children who have experienced a break in attachment in the early years of life, therapists have learned that attachment issues are more complex than is currently defined. Attachment disorder is currently diagnosed as Reactive Attachment Disorder (RAD) or Disinhibited Social Engagement Disorder (DSED). Yet for those of us living with children who struggle to maintain healthy relationships, these criteria are often not accurate or do not go far enough in distinguishing the patterns of behavior.
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Lawrence B. Smith of Attachment Disorder Maryland, along with the work of Elizabeth Randolph, Ph.D., has proposed that Attachment Disorder is a spectrum or continuum. See also Psychalive.org, Psychologytoday.com, and Psychcentral.com for discussion of these types of attachment issues, including affects into adulthood.)
The following 4 categories are proposed diagnoses or clusters of attachment disorder:
- Anxious Attachment Disorder
- Avoidant Attachment Disorder
- Ambivalent Attachment Disorder
- Neurologically Disorganized Attachment Disorder
According to Lawrence Smith, children with attachment disorder can attach but they cannot maintain it across time because they lack self and object constancy, or have a false sense of self.
Children with milder forms may be described as having attachment issues or attachment insecurities (the most mild form would be a child with separate anxiety), with the most severe being a child with attachment disorder.
A Word to Parents about Attachment Issues
The information presented on this website is informative only and not for treatment or diagnosis. Consult with a qualified professional.
As a fellow parent who is raising children who have experienced trauma, allow me to offer you a word of caution before you read the following information.
Information is power but it is never a replacement for what you know best — your child. Information like this is helpful in understanding our children’s perspective, but it can also become a negative projection.
Never allow these descriptions to supersede the good you know is in your child.
Your child needs you to believe the best in him, even when no diagnosis says it is true. You as the parent must believe in and see the good.
Be his champion.
Are you gift shopping for a child who has attachment issues? Be sure to check out our post, 15 Gifts that Promote Attachment and Bonding to find an idea present, while also promoting healthy relationships.
Listed below is a summary. Please go to Attachment Disorder Maryland for a full description of each of these disorders.
Anxious Attachment Disorder
Description: These children feel extreme anxiety connected to abandonment. Parents may have left the child or ignored the child in favor of a sibling. They have a terrifying inner emptiness. These children appear at first to relate emotionally to others. Attention from others helps to confirm their existence. When attention is gone, they feel they are fading away. They seek physical closeness as a treatment for the terror, rather than an actual desire to be close to other people in a meaningful way.
- impression management
- whining and complaining
- baby talk
- ADHD type hyperactivity
- manage adults into liking them
- lie often and highly proficient at it (will lie about lying)
- rarely express thoughts as truly their own
- devote hyper vigilant skills to determining what others want from them (“What do you want me to say?”)
- typically deceive adults outside the home
- behaviors vary dramatically depending on who they are with
- sometimes do well in school by getting teachers to like them
- intrusive, conversationally and in personal space
- may buy friendships with treats and money
- requires vigilant and highly skilled therapy to get past the facade
Avoidant Attachment Disorder
Description: Children with Avoidant Attachment Disorder feel predominant sadness related to emptiness and loneliness. They see their sadness as unending and go to great lengths to avoid expressing it, to the point that they often do not think they are sad. Avoidant children feel anxious and rarely relax so that the sadness does not creep up on them. They remain hyper vigilant and avoid physical and emotional closeness that might trigger the sadness. These children perceive adults efforts to be close as malicious.
- tasks are done slowly
- promises are broken
- speech is sprinkled with unintelligible muttering
- stiffen when touched and do not like physical contact (like hugging a board)
- pull away when touched or say it itches or hurts
- touching may result in physical aggression
- may complain of continual headaches, stomachaches, etc.
- overreact to minor cuts, bruises
- push away friendships or friends are years younger
- openly hostile when pushed into relationships
- therapy requires accessing the deep sadness and may require physical touch with parents to find it
Ambivalent Attachment Disorder
Description: For children with Ambivalent attachment disorder, the primary emotion is rage. These children are openly angry — verbally, behaviorally. This sub type is most interested in fire, gore, and death and least developed in terms of conscience.
- direct aggression
- not passive aggressive — overtly oppositional and demanding
- destroy own and other’s property
- carry potential to hurt animals and other children
- understand impact of their behavior but are indifferent
- verbally threatening. Carry through depends on their assessment of their own danger level
- derive excitement from risk-taking behavior and do not understand danger involved
- often misdiagnosed as Oppositional Defiant Disorder or Conduct Disorder
- operate on a scarcity model – “what is wanted should be taken”
- other people are to be exploited and their feelings are irrelevant
- Incapable of truly giving or receiving affection
- do not withdraw from touch, but it is meaningless
- friendships are short-lived
- untreated, have sociopathic or psychopathic potential
- academic underachievers
Neuorologically Disorganized Attachment Disorder
Description: The primary emotion of children with Neurologically Disorganized attachment is anxiety that is chaotic. This leads to highly disordered thinking that is illogical and at times hard to follow. Speech can be erratic with odd arrangements of words and sentences, although the child does not recognize the unusual patterns.
With this diagnosis, there is some neurological impairment present. Attachment difficulties are viewed as secondary to the neurological factor rather than the primary, making it different from the first 3 disorders. Children with this diagnosis are susceptible to dysregulation on multiple levels.
Some of the common reasons for a Neurologically Disorganized Attachment Disorder:
- Fetal alcohol exposure
- Fetal drug exposure
- significant prematurity
- grossly negligent/abusive pre- or post- natal care
- untreated postnatal injuries or illnesses
- genetic inheritance
- auditory hallucinations (hearing voices)
- unpredictable behavior
- learning difficulties
- unusual speech patterns
- behavior doesn’t relate to situation at hand
- bizarre behaviors
- problem behaviors shift in form
- child feels remorse afterwards
- excessively friendly with strangers
- oblivious to boundaries
- therapy focuses on minizing the time between melt-downs to allow the child’s nervous system to settle and regulate
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