7.
Answer:
Love of a caregiver is more important than
food and other rewards.
Another Answer
That early love makes people stronger and
more resilient.
10.
Like the chick and Tom, Imprinting happens to
all humans, is biological and very powerful.
When disrupted, it can lead to serious
attachment problems.
17.
Question? Are babies and toddlers who cry
when their moms’ leave them and then fail to
be comforted by strangers in a Strange
Situation securely attached?
19.
Question:
What are three behaviors that babies with
secure attachments display that make their
current and future lives happier?
20.
Answer:
1. Seek to be physically close to a loved one
2. Seek comfort from a loved one when
distressed
3. Accept comfort from a loved one when
distressed
21.
Question
What symptoms do you see in an infant,
toddler, child or adolescent who suffers from
Reactive Attachment Disorder?
22.
A. A consistent pattern of inhibited,
emotionally withdrawn behavior toward adult
caregivers, manifested by both of the following:
1. The child rarely or minimally seeks comfort
when distressed.
2. The child rarely or minimally responds to
comfort when distressed.
23.
Question:
A child with no emotional problems, who has
been trained in the basics of Stranger Danger,
and who has stable and loving parents, is at
low risk of being abducted from a playground?
26.
A pattern of behaviors that involve culturally
inappropriate, overly familiar behavior with
strangers. The overly familiar behavior violates
the social boundaries of the culture. The
diagnosis cannot be made before age 9 months.
27.
A pattern of behavior in which a child actively
approaches and interacts with unfamiliar
adults and exhibits at least two of the
following:
28.
1. Reduced or absent reticence in approaching
and interacting with unfamiliar adults.
2. Overly familiar verbal or physical behavior
(that is not consistent with culturally
sanctioned and with age-appropriate social
boundaries).
29.
3. Diminished or absent checking back with
adult caregiver after venturing away, even in
unfamiliar settings.
4. Willingness to go off with an unfamiliar
adult with minimal or no hesitation.
31.
Most of the treatment disinhibited social
engagement disorder (DSED) is provided by
primary caregivers (e.g., parents or substitute
parents) in their everyday interactions with the
child (Mayo Clinic)
32.
Several therapeutic ingredients seem to be
important in the treatment of RAD and DSED.
When caregivers provide these ingredients, the
child may experience healthy dependency, come to
rely on someone, and begin trust a new person. In
other words, the child may become attached. These
therapeutic ingredients include the following:
Security
Stability
Sensitivity
33.
Security, or a sense of psychological safety, helps
promote the development of a new attachment
relationship. Constant or intense stress and anxiety do
not facilitate a sense of security; rather, they promote
guarding behavior.
To correct the scars of attachment disruption, the
clinician, parent, or caregiver must have time and be
ready to listen to the child without judging. Limits
must be set for the child, but these should be set in
the context of empathy and compassion. Only when
verbal children feel emotionally secure will they begin
talking about what has happened to them (and,
probably, to their siblings) and gradually develop trust
in the new caregiver.
34.
Stability refers to the permanence of the attachment
figure. It takes time for a child to develop trust in a new
primary caregiver. After experiencing disruption, children
need to learn to recognize their needs and to understand
that these needs can be met repeatedly by the same person.
It is common for these children to fear that the caregiver will
disappear, die, or go away, thus giving rise to another
disruption.
Some children take a long time (>1 y) to trust a caregiver
again; others trust a caregiver after receiving just a few
months of sensitive care. This may be a temperamental
feature (eg, orientation toward others versus inwardness) or
a reflection of the quality of the match between the child and
the new caregiver. Separations and disruptions may
reactivate a defensive isolation on the part of the child.
35.
Sensitivity, or emotional availability, refers
to attentiveness to the child’s needs. Substitute
caregivers should be informed that although
the child may or may not be mature
cognitively, his or her emotional development
is frequently delayed in areas such as
emotional expression, attachment, and ageappropriate independence. This delayed
development makes emotional availability on
the part of the caregiver especially important.
36.
Ideally, over the course of treatment, the child
will gradually begin to develop feelings of
dependency toward the primary caregiver once
he or she learns to expect that the caregiver will
be physically and emotionally available at
times of crisis. During this process, parents
should be cautioned to expect and tolerate
occasional regressive behaviors and to view
them as signs that the child is psychologically
working through earlier phases in
development.
37.
It is helpful to encourage parents to think of
the child, for the time being, as emotionally
younger and as having legitimate emotional
needs appropriate for his or her emotional age.
In a sensitive way, allow the child to express
and to experience dependency.
38.
Some children are almost frozen emotionally
and expressing age-appropriate emotions has
not been safe for them. At first, these children
might appear to be obedient because they do
not express anger and are not prone to
emotional outbursts. As time goes by. children
may start to feel that they can safely express
emotions such as anger, jealousy, and
neediness, and they may begin to direct temper
outbursts, jealousy, and anger toward
caregivers upon separation. This is good!
39.
In this scenario, things that previously seemed not
to matter to the child (e.g., whether the caregiver
comes or goes) may suddenly become highly
upsetting. For example, a child who never seemed
to mind separations may strongly protest the
parent’s leaving by clinging or going to the parent
for comfort. Caregivers should see these behaviors
as positive signs that a new attachment and a
deeper level of trust have formed because the child
now feels safe enough to be able to express his or
her developmentally appropriate dependency
needs.
40.
No specific pharmacologic treatment exists for
DSED. However, psychopharmacologic agents
may be used to address associated problems
such as explosive anger, hyperactivity, and
difficulty in focusing or sleeping. These agents
are used at similar doses and with the same
objectives as in other psychological disorders
41.
Consultations
Specialists should be consulted about
particular problems that may be associated
with experiences of detachment and neglect
(e.g., excessive eating and drinking), as follows:
Endocrinologist or nutritionist for short
stature and malnourishment
Pediatric gastroenterologist to rule out
gastroenterologic problems
42.
A psychotherapist, particularly in the presence of
the primary caregivers, may help the child
express emotional needs, fears, and anxieties..
Caregivers may become more sensitive to the
issues faced by their child (e.g., anger about
having been abandoned, maltreated, left alone,
or locked up). Also, children and teens may be
able to express their dependency needs in the
therapy setting quicker and more effectively
than without therapy.
43.
No specific diet is indicated; however, many
children who have experienced disruptions
and early neglect also have feeding disorders
and may require treatment. Also, some
children may have excessive appetite and
thirst.
44.
Question:
A 10 minute daily Non Directive, joyful
interactions between a youth and a caregiver can
change biological markers associated with stress
and mature the emotional part of the brain in
emotionally neglected children and teens.
