“Subtle Signs”

Subtle Signs
by Arthur Becker-Weidman, Ph.D.

This article was written by the author after spending a weekend at a Chinese Cultural Camp and observing adopted children at an Asian Connection group.

Gail tells her seven-year-old daughter, Sally, to pick up the napkin Sally had dropped. As Sally crosses her arms a sad and angry pout darkens her face. Gail says, “Sally, I told you to pick up the napkin and throw it away.” Sally stomps over to the napkin, picks it up, and throws it away. Crying and whining, Sally stands with her back to Gail. Sally, angry and unhappy is exhibiting one of the subtle signs of attachment sensitivity that nearly all children adopted at a young age demonstrate. An informal survey I conducted of children adopted from Asia between the ages of four months and two years of age revealed that over half the children showed subtle signs.

Attachment is an interpersonal, interactive process that results in a child feeling safe, secure, and able to develop healthy, emotionally meaningful relationships. The process requires a sensitive, responsive parent who is capable of emotional engagement and participation in contingent collaborative communication (responsive communication) at nonverbal and verbal levels. The parent’s ability to respond to the child’s emotional state is what will prevent attachment sensitivities from becoming problems of a more severe nature.

What are the subtle signs?

1. Sensitivity to rejection and to disruptions in the normally attuned connection between mother and child.
2. Avoiding comfort when the child’s feelings are hurt, although the child will turn to the parent for comfort when physically hurt.
3. Difficulty discussing angry feelings or hurt feelings.
4. Over valuing looks, appearances, and clothes.
5. Sleep disturbances. Not wanting to sleep alone.
6. Precocious independence. A level of independence that is more frequently seen in slightly older children.
7. Reticence and anxiety about changes.
8. Picking at scabs and sores.

Internationally adopted children experience at least two significant changes during the first few months of life that can have a profound impact on later development and security. Birth mother to orphanage or foster care and then orphanage to adoptive home are two transitions. We know from extensive research that prenatal, post-natal, and subsequent experiences create lasting impressions on a child. During the first few minutes, days, and weeks of life, the infant clearly recognizes the birth mother’s voice, smell, and taste. Changes in caregivers are disruptive. The new caregivers look different, smell different, sound different, taste different. In the orphanage there are often many care givers but no one special caregiver. Adoption brings with it a whole new, strange, and initially frightening world. These moves and disruptions have profound effects on a child’s emotional, interpersonal, cognitive, and behavioral development. The longer a child is in alternate care, the more these subtle signs become pervasive.

There are effective ways for a parent to help his or her child.

Parents and the right parenting are vital to preventing subtle signs from becoming anything more than sensitivities. Parenting consistently with clear and firm limits is essential. Discipline should be enforced with an attitude of sensitive and responsive empathy, acceptance, curiosity, love, and playfulness. This provides the most healing and protective way to correct a child.

As Sally walks away to pout, Gail comes up behind her, scoops her up, and begins rocking her gently while crooning in Sally’s ear. Gail sings songs and tells Sally she loves her and understands Sally is angry at being told what to do. Gail expresses sadness that Sally is so unhappy. At first Sally resists a bit, but she soon calms down and listens as Gail tells her how much she loves Sally. Sally is sensitive to feelings of rejection and abandonment that are evoked by her mother’s displeasure, so Gail brings Sally closer to reassure Sally nonverbally. It is by experience that the subtle signs are addressed and managed. Nonverbal experience is much more powerful than verbal experience since most of the subtle signs have their origin in nonverbal experience and nonverbal memory.

These sensitivities are not a mental illness or Reactive Attachment Disorder. They are subtle signs of attachment sensitivities. So, what can you do?

First, as Gail does with Sally, bringing the child in close is better than allowing the child to be alone or isolate him or her self.

Second, as Gail does with Sally, talk for the child. Putting words to what the child is feeling. This allows the child to feel understood by you, maintains a connection, and helps assuage the fear of rejection and abandonment.

Third, don’t make food a battle. A child who steals food or hoards food usually has sound emotional reasons for this. Providing the child with food so that your child experiences you as provider is often the solution. Put a bowl of fruit in the child’s room. (Be sure to keep if filled. It does not good if you provide and then leave an empty bowl!) In some instances, I’ve recommended that the parents provide the child with a fanny pack and keep it stocked with snacks. This usually quickly ends hoarding and stealing of food.

Fourth, for the child who is overly independent, doing for the child and not encouraging precocious independence is helpful. So, making a game of brushing your six-year old’s teeth, dressing your seven-year-old, or playing at feeding a nine-year-old, are all ways to demonstrate that you will care for the child. Keeping it playful and light, allows the child to experience what the child needs and helps eliminate hurtful battles.

In conclusion, subtle signs are important reminders that our children have ongoing sensitivities that as parents we must address in a responsive and sensitive manner. Responsive and sensitive communication is essential. Attachment is a function of reciprocal, sensitive, and responsive communication; attachment does not reside in the child alone. It is very important for the parent to manage and facilitate this attuned connection within a framework of clear limits and boundaries, natural consequences, and firm loving discipline.

Arthur Becker-Weidman Offers Dyadic Developmental Psychotherapy Masterclass

Dr. Arthur Becker-Weidman, founder of the Center for Family Development, announces a masterclass in Dyadic Developmental Psychotherapy.

Arthur Becker-Weidman Now on LiveJournal!

You can now find me here.

Dr. Arthur Becker-Weidman Interview

Dr. Becker-Weidman discusses dyadic developmental psychotherapy, family therapy and other issues in an interview with Heather Forbes, LCSW. You can listen to the interview here.

Dr. Arthur Becker-Weidman: Founder of the Center for Family Development

Arthur Becker-Weidman, Ph.D. received his Ph.D. from the University of Maryland’s Institute for Child Study. He has achieved Diplomat Status in Child Psychology and Forensic Psychology from the American Board of Psychological Specialties. Dr. Becker-Weidman is a Registered Clinician with the Association for the Treatment and Training in the Attachment of Children.

He has been treating the families of internationally adopted children and foster children for over two decades. As Director of the Center for Family Development Dr. Becker-Weidman consults with Departments of Social Services, Residential Treatment Centers, Mental Health Clinics, and School districts. Dr. Becker-Weidman provides training and workshops to parents and professionals across the U.S., Canada, and overseas. He is co-editor of the book, Creating Capacity for Attachment. Dr. Becker-Weidman is on the Board of ATTACh where he chairs the clinical registration committee. He is an adjunct Clinical Professor at the State University of New York at Buffalo. Dr. Becker-Weidman has published many articles in peer-reviewed professional publications and presented at numerous international, regional, and state professional meetings.

Attachment Disorder Checklist, Part 2

A professional assessment is necessary to determine whether or not a child has an Attachment disorder. At the Center for Family Development we use several tests as part of a comprehensive assessment to determine what attachment issues are causing problems and what will be the most effective treatment plan. We work very closely with the parents to develop a plan to help remediate attachment problems. This check list can help you identify areas of potential problem. This check list is not meant to substitute for a professional assessment and treatment plan.

1. My child doesn’t seem to feel age-appropriate guilt when my child does something wrong.
2. My child is impulsive. My child seems unable or unwilling to stop doing something my child wants to do.
3. My child teases, hurts, or is cruel to animals.
4. My child steals, or shows up with things that belong to others with unbelievable, unusual, or suspicious reasons for how my child got these things.
5. My child likes to sneak things without permission, even though my child could have had these things if my child had asked.
6. My child doesn’t seem to learn from mistakes, consequences, or punishments (my child continues the behavior despite the consequences).
7. My child makes false reports of abuse or neglect. My child tries to get sympathy from others, or tries to get us in trouble, by telling others that I abuse, don’t feed, or don’t provide the basic necessities.
8. My child seems not to experience pain when hurt, refusing to let anyone provide comfort.
9. My child does not usually ask for things. My child demands things.
10. My child lies, often about obvious or ridiculous things, or when it would have been easier to tell the truth.

Arthur Becker-Weidman

Part 1 is here.

An Overview of Adoption Problems

By Dr. Arthur Becker-Weidman:

Many adopted and foster children have had very difficult and painful histories with their first parents. These children have experienced chronic early maltreatment within a caregiving relationship.

Such a history can lead to the development of Complex Trauma (Cook et. al., 2003; Cook et. al., 2005), disorders of attachment, and Reactive Attachment Disorder. Children with histories of maltreatment, such as physical and psychological neglect, physical abuse, and sexual abuse, are at risk of developing severe psychiatric problems (Gauthier, Stollak, Messe, & Arnoff, 1996; Malinosky-Rummell & Hansen, 1993). These children are likely to develop Reactive Attachment Disorder (Greenberg, 1999; Lyons-Ruth & Jacobvitz, 1999).

Approximately 2% of the population is adopted, and between 50% and 80% of such children have attachment disorder symptoms (Carlson, Cicchetti, Barnett, & Braunwald, 1995; Cicchetti, Cummings, Greenberg, & Marvin, 1990). Many of these children are violent (Robins, 1978) and aggressive (Prino & Peyrot, 1994) and as adults are at risk of developing a variety of psychological problems (Schreiber & Lyddon, 1998) and personality disorders, including antisocial personality disorder (Finzi, Cohen, Sapir, & Weizman, 2000), narcissistic personality disorder, borderline personality disorder, and psychopathic personality disorder (Dozier, Stovall, & Albus, 1999). Therapeutic Parenting is often necessary to help these children heal (Becker-Weidman, A., & Shell, D., 2005/2008). This approach to parenting is often not familiar to most parents and requires a significant amount of work and preparation. Attachment facilitating parenting is grounded in attachment theory and is based on a set of principles that include:

• Sensitivity
• Responsiveness
• Following the child’s lead
• The sharing of congruent intersubjective experiences
• Creating a sense of safety and security

The effective implementation of these principles requires parents who:
• Are strongly committed to the child.
• Have well developed reflective abilities
• Have good insightfulness
• Have a relatively secure state of mind with respect to attachment

This type of parenting is consistent with Dyadic Developmental Psychotherapy, which is an evidence-based and effective treatment for children with trauma and attachment disorders (Becker-Weidman & Hughes, 2008). Many foster and adoptive parents find their children’s behaviors strange, frightening, disturbing, and upsetting. They often don’t understand why their child behaves as the child does; “after all, my child is now safe, doesn’t he get it?” It can be difficult to appreciate the depth and pervasiveness of the damage caused by earlier maltreatment.

Therapeutic parenting based on Dyadic Developmental Psychotherapy relies of helping parents understand what is causing the child’s behaviors. Looking deeper in order to understand what is motivating the child. All behavior is adaptive and functional; however sometimes the behaviors that were adaptive in one environment are ill-suited for the new home. If your first parents were neglectful, unreliable, and inconsistent so that you were often hungry and left alone for long periods of time, hoarding food, gorging, and going to “anyone” for help is adaptive. When that child is placed in a foster or adoptive home with caring, responsive, sensitive parents, that same behavior is no longer adaptive. By understanding what is driving the behavior and appreciating the child’s fear, anxieties, shame, and anger, the new parent will be better able to respond to the emotions driving the behavior rather than the surface behavior or symptoms. Unless the underlying emotions are addressed with sensitivity and within a safe, unconditionally loving, and supportive home, the behavior or symptoms are not likely to stop…they may change into other problems, but if the underlying cause remains, then the problems will surface again and again.

Let’s discuss the principles required. These principles are more fully elaborated elsewhere (Becker-Weidman & Shell, 2005; Becker-Weidman, 2007)

SENSITIVITY. Because children with trauma and attachment disorders are often unable to describe their internal states, emotions, or thoughts, it becomes the job of the parent to do this with and for the child so that the child learns to do this. Of course, this is precisely what one does with a newborn, toddler, and child. We often help children manage their internal states by doing that with them. When a baby cries, we pick up the baby, comfort the child, and by so doing, regulate the child’s level of arousal. Over time the infant becomes increasingly proficient at doing this independently. The parent of a foster or adopted child must be sensitive to the internal states of their child so that the parent can respond to the underlying emotions driving behavior.

RESPONSIVENESS. Once the underlying emotion is identified, the parent must respond to this need or emotion, with sensitivity. By meeting the child’s need (to feel safe, loved, cared about, for food, drink, joy, etc) the child will internalize new and healthier models of relationships and parents.

FOLLOWING THE CHILD’S LEAD. By this I mean that the parent will need to respond to the child and follow the child’s lead in the sense of providing what the child is needing (comfort, affection, support, structure, etc) and at the child’s pace. It is very important to move at the child’s pace to create the necessary sense of safety and security that these children need.

THE SHARING OF CONGRUENT INTERSUBJECTIVE EXPERIENCES. Intersubjectivity refers to shared emotion (also called attunement), share attention, and share intention. You can understand this if you think of playing a board game with your child. When you are playing some game together and enjoying the experience, you are sharing emotions (joy and a sense of competence), sharing attention (focusing on the game), and sharing intention (playing by the rules, both trying to win, having fun, etc.). Or another example, when talking about the death of the child’s loved grandparent, you both may share the same emotions (grief), both are recalling memories of the grandparent (shared intention and attention). It is the sharing of congruent intersubjective experiences, experiences in which all three elements are the shared, that helps the child heal and learn about intimacy and relationships.

CREATING A SENSE OF SAFETY AND SECURITY. Safety comes first. Unless the child is physically, emotionally, and psychologically safe, healing cannot occur. So, it is the job of the parent to create safety and security for the child. This then allows for the exploration of underlying feelings, thoughts, and memories. Without an alliance there can be no secure base. Without a secure base there can be no exploration. Without exploration there can be no integration. Without integration there can be no healing.
Unless the child feels safe, exploration is not possible.

So, what sort of parent is needed? We know form extensive research, that one of the best predictors of placement stability is the parent’s commitment to the child (Dozier, Grasso, Lindhiem, & Lewis, 2007). Therefore, building or rebuilding parental commitment is an important first step. Unless there is strong commitment, the child cannot feel safe and, as discussed above, safety is the most important first step in helping a hurt child heal.

Reflective capacity is also vital to placement stability and to the healing of adopted and foster children. The parent must be able to reflect on the child’s underlying emotions, how the past may be re-enacted in the present, and what in the parent’s own past is being triggered by the child. A well developed reflective function is necessary if the parent is to respond to the child in a healthy and healing manner. We all have buttons. The job of the therapeutic parent is to understand one’s buttons so that these can be disconnected so that when pushed, nothing happens.

Insightfulness (Koren-Karie, Oppenheim, Dolev, Sher, & Etzion-Carasso, 2002; Oppenheim, Koren-Karie, & Sagi, 2001; Oppenheim, & Koren-Karie, 2002; Oppenheim, Goldsmith, & Koren-Karie, 2005) is related to reflective capacity.

A parent’s state of mind with respect to attachment is the best predictor of the child’s. (Main, & Cassidy, 1988; Main, & Hesse, 1990). If the parent has a Secure state of mind with respect to attachment, then the adopted or foster child is more likely to develop a healthy and secure pattern of attachment and heal (Steele, Hodges, Kaniuk, Steele, Hillman, & Asquith, 2008). We know that when young children are placed in a foster home, the child will begin to develop a pattern of attachment that is the same as the foster parent’s state of mind with respect to attachment (Dozier, Stovall, Albus, & Bates, 2001). Obviously, in older children, this is a more difficult task. In the general population, about 60% of the adults have a secure state of mind with respect to attachment. For parents who have an insecure state of mind with respect to attachment, they can still learn to parent effectively with help (Becker-Weidman, A., & Shell, D., 2005/2008; Bick & Dozier, 2008).

USEFUL RESOURCES FOR PARENTS
1. Becker-Weidman, A., (2007). Principles of Attachment Parenting. 3-set DVD. Williamsville, NY: Center for Family Development.
2. Becker-Weidman, A., & Shell, D., (Eds.) (2005/2008) Creating Capacity for Attachment, Oklahoma City, OK: Wood N Barnes/ Williamsville, NY: Center For Family Development.
3. Golding, K., (2008). Nurturing Attachments. London: Jessica Kingsley.
4. Hughes, D. (2006) Building the Bonds of Attachment, 2nd edition, Jason Aronson, Lanham, MD. .
5. Siegel, D., & Hartzell, M., (2003). Parenting from the Inside out. Tarcher.

REFERENCES

Becker-Weidman, A., & Shell, D., (Eds.) (2005, 2008). Creating Capacity for Attachment, Oklahoma City, OK: Wood N Barnes & Williamsville, NY: Center for Family Development.

Becker-Weidman, A., (2007). Principles of Attachment Parenting. 3-set DVD. Williamsville, NY: Center for Family Development.

Becker-Weidman, A., & Hughes, D., (2008) “Dyadic Developmental Psychotherapy: An evidence-based treatment for children with complex trauma and disorders of attachment,” Child & Adolescent Social Work, 13, pp.329-337.

Bick, J., & Dozier, M., (2008). Helping Foster Parents Change. In H. Steele & M. Steele (Eds.), Clinical Applications of the Adult Attachment Interview (pp. 452-471). NY: Guilford.

Carlson, V., Cicchetti, D., Barnett, D., & Braunwald, K. (1995). Finding order in disorganization: Lessons from research on maltreated infants’ attachments to their caregivers. In D. Cicchetti & V. Carlson (Eds.), Child maltreatment: Theory and research on the causes and consequences of child abuse and neglect (pp. 135–157). NY: Cambridge University Press.

Cicchetti, D., Cummings, E. M., Greenberg, M. T., & Marvin, R. S. (1990). An organizational perspective on attachment beyond infancy. In M. Greenberg, D. Cicchetti & M. Cummings (Eds.), Attachment in the preschool years (pp. 3–50). Chicago: University of Chicago Press.

Cook, A., Blaustein, M., Spinazolla, J. & van der Kolk, B. (2003) Complex Trauma in Children and Adolescents. White Paper from the National Child Traumatic Stress Network Complex Trauma Task Force. National Center for Child Traumatic Stress, Los Angeles, CA.

Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M. et al. (2005) Complex trauma in children and adolescents. Psychiatric Annals, 35, 390–398.

Dozier, M., Stovall, K., Albus, K., & Bates, B. (2001). Attachment for infants in foster care: The role of caregiver state of mind. Child Development, 72, 1467-1477.

Dozier, M., Grasso, D., Lindhiem, O., & Lewis, E., (2007) “The role of caregiver commitment in foster care,” in D. Oppenheim & D. Goldsmith, (Eds.) Attachment Theory in Clinical Work with Children. NY: Guilford.

Dozier, M., Stovall, K. C., & Albus, K. (1999). Attachment and psychopathology in adulthood. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment (pp. 497–519). NY: Guilford Press.

Finzi, R., Cohen, O., Sapir, Y., & Weizman, A. (2000). Attachment styles in maltreated children: A comparative study. Child Development and Human Development, 31, 113–128.

Gauthier, L., Stollak, G., Messe, L., & Arnoff, J. (1996). Recall of childhood neglect and physical abuse as differential predictors of current psychological functioning. Child Abuse and Neglect, 20, 549–559.

Greenberg, M. (1999). Attachment and psychopathology in childhood. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment (pp. 469–496). NY: Guilford Press.

Koren-Karie, N., Oppenheim, D., Dolev S., Sher, E., & Etzion-Carasso, E. (2002). Mothers’ insightfulness regarding their infants’ internal experience: Relations with maternal sensitivity and infant attachment. Developmental Psychology, 38, 534-542.

Lyons-Ruth, K., & Jacobvitz, D. (1999). Attachment disorganization: Unresolved loss, relational violence and lapses in behavioral and attentional strategies. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment (pp. 520–554). NY: Guilford Press.

Main, M., & Cassidy, J. (1988). Categories of response to reunion with the parent at age six: Predictable from infant attachment classifications and stable over a one-month period. Developmental Psychology, 24, 415–426.

Main, M., & Hesse, E. (1990). Parents’ unresolved traumatic experiences are related to infant disorganized attachment status. In M. T. Greenberg, D. Ciccehetti & E. M. Cummings (Eds.), Attachment in the preschool years: Theory, research, and intervention (pp. 161–184). Chicago: University of Chicago Press.

Malinosky-Rummell, R., & Hansen, D. J. (1993). Long-term consequences of childhood physical abuse. Psychological Bulletin, 114, 68–69.

Oppenheim, D., Koren-Karie, N., & Sagi, A. (2001). Mothers’ empathic understanding of their preschoolers’ internal experience: Relations with early attachment. International Journal of Behavioral Development., 25, 16-26.

Oppenheim, D. & Koren-Karie, N. (2002). Mothers’ Insightfulness Regarding their Children’s Internal Worlds: The capacity underlying secure child-mother relationships. Infant Mental Health Journal, 23(6), 593-605.

Oppenheim, D., Goldsmith, D., & Koren-Karie, N. (2005). Maternal Insightfulness and preschoolers’ emotion and behavior problems: Reciprocal influences in a day-treatment program. Infant Mental Health Journal.

Prino, C. T., & Peyrot, M. (1994). The effect of child physical abuse and neglect on aggressive withdrawn, and prosocial behavior. Child Abuse and Neglect, 18, 871–884.

Robins, L. N. (1978). Longitudinal studies: Sturdy childhood predictors of adult antisocial behavior. Psychological Medicine, 8, 611–622.

Schreiber, R., & Lyddon, W. J. (1998). Parental bonding and current psychological functioning among childhood sexual abuse survivors. Journal of Counseling Psychology, 45, 358–362.

Steele, M., Hodges, J., Kaniuk, J., Steele, H., Hillman, S., & Asquith, K., (2008). Forcasting Outcomes in Previously Maltreated Children. In H. Steele & M. Steele (Eds.), Clinical Applications of the Adult Attachment Interview (pp. 427-452). NY: Guilford.

USEFUL RESOURCES FOR PARENTS:

1. Becker-Weidman, A., (2007). Principles of Attachment Parenting. 3-set DVD. Williamsville, NY: Center for Family Development.  ASIN: 098228831X

2. Becker-Weidman, A., & Shell, D., (Eds.) (2005/2008) Creating Capacity for Attachment, Oklahoma City, OK: Wood N Barnes/ Williamsville, NY: Center For Family Development.

3. Golding, K., (2008). Nurturing Attachments. London: Jessica Kingsley.

4. Hughes, D. (2006) Building the Bonds of Attachment, 2nd edition, Jason Aronson, Lanham, MD. .

5. Siegel, D., & Hartzell, M., (2003). Parenting from the Inside out. Tarcher.