There are physiological features considered as risk factors for the formation of RRS. The instability of the autonomic nervous system, the imbalance of the hypothalamic-pituitary-adrenal axis reduce the resistance to stress. The probability of pathological emotional, behavioral reactions increases.
The immediate causes of the development of attachment disorders are situations where the child does not have the ability to establish and maintain a stable relationship with the parents:
- Defective maternal contact. RRP develops in children whose mothers abuse alcohol, drugs, suffer from postpartum depression, mental disorders, do not take the child (unwanted pregnancy), use violence and humiliation.
- Absence of parents (guardians). The provoking factor is early separation from the mother, placement of the child in a hospital, a baby house, orphanage. The functions of adults are limited to performing hygienic, medical procedures. Establishing emotional ties are quickly destroyed due to a change in the place of residence of the child, the work schedule of staff, staff turnover, refusal to take custody of adoptive parents.
The basis of the development of attachment disorders is the negative experience of establishing close, friendly relations. The child is crying, trying to attract attention, to express their needs (hunger, discomfort, loneliness).
If he does not receive help from an adult or receives an inadequate answer – swearing, beating – the situation becomes stressful. Malfunctions occur at the physiological level: the concentration of hormones changes, the excitation processes in the nervous system predominate, and muscle tension.
Gradually, the environment begins to be perceived as dangerous. There is a need to defend, to show aggression, to independently control the situation. Trust, affection are replaced by hostility, indifference to the mother, father, guardian.
Classification of affection disorders in children
Attachment disorders are classified by clinical manifestations. Given this, there are two types of violations:
- Disinfected. It is called disinhibited. Characterized by a comprehensive clinical picture. The child has no selectivity to establish contacts. Social relationships are not sufficiently modulated. Infants do not show wariness towards strangers, older children are illegible in the choice of friends. This form is the result of frequent changes of an adult (parent, caregiver, guardian).
- Inhibited. Symptoms are mild. Social contacts are suppressed, inhibited, and often have an ambivalent focus – hate-love, acceptance-rejection. Depression, an aggressive reaction to suffering, prevails. This type of disorder is formed as a result of the abuse of an adult with a baby.
Another classification is more accurate descriptive. It takes into account the etiological factor, the orientation of the child’s behavior, especially the establishment of contact.
There are four types of attachment:
- Negative. The reasons are neglect or hypertext. The behavior of the child is aimed at provoking negative attention, irritation, punishment.
- Ambivalent. The basis is hysterical reactions, inconsistency of adults. It manifests itself as categorical, duality (aggressiveness-kindness, caress-beating) interactions with others.
- Avoiding. Develops after breaking relationships with mom, dad, guardian. It manifests closeness, gloom, distrust.
- Disorganized. Arises after cruel treatment, violence. Characteristic manifestations of cruelty, resistance to attempts to interact.
Symptoms of affection disorders in children
Attachment disorders manifest a spectrum of symptoms, the severity and fullness of which increases from single reactions to a reactive disorder formed. Infants, children up to 5-6 years old avoid eye contact, rarely smile, are not happy about the approach of an adult. In the inhibited form of the disorder, they reject attempts to establish contact, get close, calm down. Do not stretch for a toy proposed by an adult. Left alone, remain calm. Are indifferent to the care of another person. Often there is inconsolable quiet crying without a reason. When disinfected form, children are extremely dependent, looking for comfort, safety from strangers, seeking to establish contacts with them, but reject the parents.
The lack of a confidential emotional interaction with a significant adult contributes to a lag in the development of the psyche: infants are immobile, babbling is absent, there is no sounding, the development of speech is delayed in children, the play interest is weak. With age, mental retardation becomes more pronounced, the child has difficulty mastering the curriculum. Children of preschool and school age develop an aversion to touch, hug. Attempts to establish physical contact cause inadequate reactions of laughter, crying, anger, fright.
The need to maintain control, to protect oneself, is manifested in the desire to maintain distance. With the psychological rapprochement, children become disobedient, impudent. Anger is expressed through hysteria, manipulation, aggressive behavior. Growing up, patients begin to understand the social unacceptability of anger, disguise it with “random” actions – hitting the ball, a painful handshake or a hug. The difficulties of identifying one’s own feelings, the feelings of others, the lack of understanding of the true purpose of affection, stroking, close relationships are manifested by the chaotic construction of relationships: strangers cause interest, kindness, and parents, relatives – indifference. After making mistakes, unacceptable behavior, there is no sense of guilt.
Mental retardation becomes a frequent complication of attachment disorders. The lack of close contact with an adult leads to a decrease in cognitive interest: the kid does not reach for bright objects, toys, slowly masters manipulative actions, there is no desire to establish voice contact. Transfer and acceptance of experience violated. Developments lag thinking, active attention, speech.
If the RP is not diagnosed on time, social disadaptation increases. Willful, emotional disorders, behavioral abnormalities become stable traits of character. Adolescents develop psychopathy, neurosis, deviant behavior.
Diagnosis of affection disorders in children
Diagnosis of affection disorders in children is carried out by a psychiatrist, a clinical psychologist.
A comprehensive examination procedure includes:
- Poll. The doctor specifies the symptoms, their duration, severity. He asks about the composition of the family, the occupation of the parents, the presence of mental illness, pathological dependencies. It clarifies the features of the course of pregnancy, the relationship between mother and baby after birth, involvement in the process of raising a father, grandmothers and grandfathers, problems of socialization in kindergarten, school (does the child show aggression, shyness, pugnacity, hysteria).
- Observation The specialist focuses on parent-child relationships. Notes the goodwill, hostility, interest in contact, negativity, disobedience, acceptance of bodily contact, the desire to communicate. Defines the style of education.
- Collect additional data. The results of the conversation are complemented by the characteristics of teachers, teachers of orphanages, extracts of the conclusions of narrow specialists: a neurologist, an endocrinologist, an otolaryngologist, an ophthalmologist.
- Psychodiagnostics. Personal questionnaires, projective techniques reveal the features of self-esteem, the emotional-volitional sphere of the child, his focus on the establishment of social interactions, and attitude to others.
Important is the differentiation of attachment disorders from persistent intellectual disorders, childhood autism, acute stress reactions, attention deficit hyperactivity disorder. The key role is played by the parent-child relationship (lack of affection), normal learning.
Treatment of affection disorders in children
Psychotherapeutic treatment is the basis for changing the relationship of the child and parents, close relatives. Drug therapy is necessary for the correction of associated emotional, cognitive impairment.
An integrated approach includes the following types of treatment:
- Children’s psychotherapy. The purpose of the sessions – reducing emotional tension, the elimination of isolation, mistrust, fear. Conducted in the form of games, reading fairy tales, creative activities.
- Family psychotherapy. Psychotherapeutic exercises, tasks, conversations eliminate aloofness, restore emotional, verbal contact, physical acceptance of the parents by the child.
- Counseling parents. Psychologist, psychotherapist tells parents about the features of the course of the disorder, the reasons, methods of correction. Gives recommendations on building family relations, examines in detail typical conflict, complex interaction situations.
Drug treatment can improve the emotional background, relieve acute reactions, which provides a higher efficacy of psychotherapy. Independent use of drugs is inappropriate.
The earlier treatment of attachment pathologies is initiated, the more favorable the prognosis. When restoring loving, caring family relationships, infants and young children are almost completely rid of the disorder. Preschoolers, schoolchildren need specialized assistance, the outcome of treatment depends on the joint efforts of the parents and the therapist. Prevention of attachment disorders – the creation of psychological comfort, forming a sense of security, basic trust. The attitude of the mother is important, it lays the foundation of attachment, mental health.
Disorder of attachment in children is a complex of mental deviations that develops in the absence of emotional contact with caregivers: parents, guardians. It is manifested by fearfulness, caution, difficulties in adapting and establishing relationships, behavioral disorders (aggression, auto-aggression), lagging intellectual development.
The main diagnostic methods are history taking, clinical discussion, observation of the child’s behavior, and child-parent relationships. Psychodiagnostics is performed that reveals emotional and volitional disorders, deviations of the cognitive sphere. The treatment is carried out by the methods of individual, family psychotherapy, supplemented by drug correction, psychological counseling of parents and teachers.
Attached is a feeling of emotional intimacy, formed on the basis of sympathy, love, devotion. Under the attachment disorders (RP) in children understand the group of behavioral, emotional disorders. They are designated by psychiatrists as diagnosed with reactive attachment disorder (RRP). Its peculiarity is the absence of trusting relationships with guardians and parents as a result of pathological education.
The everyday understanding of the Republic of Poland includes unstable, “cold” relations with one of the parents, ancestors, and tutors of the orphanage. Such cases are more appropriately called unreliable attachment. They are a variant of normal development, they are not associated with social maladjustment. The prevalence of reactive attachment disorder is less than 1%, unreliable attachment is 40%.