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Fifty Years of Research and the Big Controversy
By Linda Farkas

Attachment disorder, reactive attachment disorder, attachment deficit, attachment problems, attachment difficulties, attachment issues, these are just a few of the many ways professionals have begun to describe the result of an infant who does not form a secure attachment to his/her primary caretaker. There is so much debate and controversy within the medical and psychological community on what to call it and if anything can be done to treat it that it has put the parents of these children smack dab in the middle of a boxing match. News agencies are confused as to how to even describe the problem and are left with reporting about only the most extreme of cases.

The importance of mother/infant bonding has been known since the 1940's. Everyone in the attachment and bonding field knows of works done by Spitz, Bolwby, and Ainsworth. In 1946-48 Renee Spitz did a remarkable study on infants born to felon mothers. At the time it was believed if they removed an infant from a felon mother and placed the child in a foundling home which would give the infant the best of professional care the infant would thrive. Whereas if they left the infant with the felon mother, it was believed the infant would not flourish as well and would learn to become a felon itself. But instead by 1 year of age 25% of the infants in the foundling home died, compared to zero infants that remained with their mothers. At two years of age an astounding 37% of the infants in the foundling home died, compared to zero infants that remained with their mothers! At age 1, on the average infants in the foundling home had an IQ of 72 vs 105 of those who remained with their mothers. At 2 years of age all of the infants that remained with their mothers were gusty, running, playing, and many fed themselves with a spoon. In the foundling home 5 of 21 walked unassisted, 9 of 21 ate w/spoon, 1 of 21 spoke 12 words, 3 of 21 were of normal weight.

Mary Ainsworth studied cultures all over the world and found the same responses in ALL cultures. She ended up defining 3 basic types of attachment found in all infants.
1) Advoidant/insecure/anxious
2) Securely attached
3) Ambivalent/resistant

Later Ainsworth's students defined one other group that had not been classified

4) Disorganized Attachment

From the work of Spitz, Bolwby, and Ainsworth, follows over 50 years of research! For 50 years we have been studying the attachment of children and the closest we come to fixing this problem is a continuing debate on how these children should be classified and whether or not there are any treatments that would reduce, reverse, or even help those infants who did not form a secure attachment to their primary caretaker during the first years of life.

However, there has been a move to educate parents on how to bond with their infants, thus preventing any bonding breaks from occuring.  In the 90's the modern mom practices what they call "attachment parenting" More and more mothers are learning how important that initial bond with their child is. The focus is on prevention as that is the best cure for anything! If it can be prevented in the first place, then it solves the future problems.

Despite the growing move to educate parents on how to attach with their newborn, there is an epidemic of children who are not forming secure attachments to their primary caregivers.  Unfortunately, no matter how much we focus on prevention, there is still a group of children who are missing out on this primary bond. They are unable to securely attach. Some of the reasons being:

medical implications that even the best attachment parenting does not solve
sudden separation from the primary caregiver
illness of primary caregiver
inadequate daycare
neglect
abuse
drug & alcohol use by primary caregiver
dysfunctional parents.

Many of these children have been adopted from the U.S.A. and abroad after they were abused or institutionalized. Many of these children are currently foster children. Many were foster children and now have been adopted out of the social services system. Many of the adoptive parents are kindhearted individuals whose goal is to help these children and give them a better chance in life. Some are biological parents whose child has had multiple medical implications, abusive daycare, inconsistent daycare, illness of mother, etc. Some are biological parents who did neglect their child, have recovered and are working towards undoing and living with the damage that was done. Some are stepparents. And yes, there also is that population who abused their child and continues to abuse their child. You usually don't run into the current abusive home seeking help though.

Most are parents, whether adoptive, biological, or foster, who are seeking help for their child. When they seek help, what they are finding is a boxing match within the medical and psychological communities! Professionals arguing over diagnosis', treatments, medications, parenting techniques, counseling techniques, and ultimately blaming the parent (whether it is their fault or not) for the child's problems. Very few offer any advise, help, counseling, education, or guidance to the parent. Few can even offer understanding, most offer judgments and condemnation towards the parents. Many professionals can't even imagine what the real implications of living with a child who did not form a secure attachment are; they are clueless. Societies' answer to the problem is to give the child more love, it's a phase, or in time it will work itself out and if it doesn't then the parent must be a very uncaring, unloving, inadequate parent.

The DSM IV lists reactive attachment disorder of infancy. But professionals don't agree amongst themselves with the description. You either find a professional who says that diagnosis rarely exists as those are the infants who died or came close to dying (failure to thrive) or you find a professional where they say that diagnosis is incomplete. If one uses that description as a diagnosis then another is skeptical of it and vice versa. The parent and child are stuck in the middle being told different things by each professional. It has come to pass that many parents and professionals are afraid to say the words "reactive attachment disorder" or "attachment disorder" as it will just begin a useless debate. Many medical doctors put the parent right in the middle of the debate, arbitrarily prescribe medications, and assure the parent there is nothing wrong with her child that this medication can't fix.

Many professionals can't discuss treatment plans because they can't even agree on how to diagnose the problem or whether or not a problem exists. Don't get me wrong, there are some professionals out there who have moved passed this obstacle and are doing everything they can to help these children and these families. Research on treatment may be slimmer, but they are doing everything they can to assist, help, treat, and solve these problems. Many of them have been very successful. The problem is those professionals unwilling to standardize and recognize there is a problem here. The parents of these children have been telling people for years there is a problem here! They have been asking for professional advise, they have been asking for assistance in helping these children, they have been asking for more education on the subject, they have been asking to be recognized not as inadequate parents, but as parents who adopted a hurt child in need of help. The parents don't care what you call the problem, they just want everyone to recognize there is a major problem here and instead of fighting over what you call it, lets start working on what we can do to help these children and help their families. Above all, you surely are not qualified to give advise on the matter, if you have not even read at least of the research the parent has.

It seems evident to me that Mary Ainsworth and her students pretty much defined the problem and everyone in the professional arena agree with her conclusions. So can't we get some diagnosing standards from her work that everyone can agree on and move to the next step which would be treating the problem or helping these families? Fifty years of research and people are to busy bickering amongst themselves how they will acknowledge the problem or if there is a problem. At least with cancer research, everyone recognizes there is a problem.

In the meantime, I am wondering if maybe it would be appropriate to also evaluate the child according the categories Mary Ainsworth has set up. Then in Axis II of the diagnosis list that as contributing to the Axis I diagnoses? Maybe this could be an interim solution that could work until the community can agree on the standardized way they will acknowledge the problem. It also keeps the parent out of the boxing arena and lets the professionals' work on helping these children.

Unfortunately, there is so much debate and controversy out there, it has reduced the professional community into a bunch of bickering hens, unable to standardize even diagnosis and it is putting the parents and children right in the middle.  The parents don't care if you call it "five toe syndrome". What they do care about is that the community and the professionals realize there is a problem and they are seeking advise, professionalism, consultants, case managers, education, treatment plans, support, and above all understanding, and asking that everyone stop throwing the stones at them. These families have real problems and can describe the problems to you, take the time to listen to what these families have to say without dismissing them as inadequate, unknowing, or blaming the parent. If you are a professional and you are not offering all of those things to a parent, then  it is more likely you are not even a part of the solution. Make sure you don't mislead the parent into thinking that what you are working on is the only solution they need.

What has over 50 years of research done to help these children and their families?

Lets all join together (parent, teacher, therapist, social worker, etc), pool our resources, and start helping those children! "Snowflakes are one of nature's most fragile things, but just look at what they can do when they stick together."

 

"Men can only be happy when they do not assume that the object of life is happiness."
         George Orwell

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