Author's online class on working with attachment disorders.

Author's book on Attachment Disorders: Treatment Strategies for Traumatized Children

   adam

     Adam sat in the dirt at the edge of the playground rocking back and forth. Blonde hair and blue eyed, his rose colored cheeks were the hue of a healthy, robust child. Upon first glance he looked like any other typically developing four-year-old. But Adam was only semi-aware of the other children running around him in their super hero make-believe games. Even when a child nearly toppled over his outstretched legs he did not look up. His hands were clenched together and pressed between his plump thighs. His vacant eyes were locked on the area where hands met legs.

     When I approached, he looked up and instantly forced a superficial smile. I asked him what he was doing and he said nothing for a moment, then without making eye contact he looked down and carefully lifted his dirt-streaked hands to show me the accomplishments of his play. In his hand was a small twig that had been sharpened to a point at one end. Adam had been using it to gouge the meaty flesh on the inside of his thigh and there was blood in several places. When I did not react, the superficially charming demeanor returned and he said in a cheery voice, "Oops, Adam accidentally cut himself again." Adam always addressed himself in the third person, as if he were on the outside looking in.

     Adam had been referred to the mental health treatment facility I worked in by a local psychiatrist who had been treating him in the psychiatric ward of a nearby hospital. He had been admitted after his mother, Stephanie, found him trying to suffocate his younger, eight-month-old sister with a pillow. He did not show any indication that he even cared when she left him at the hospital. He never once cried or asked for her.

     This incident occurred two days after having pushed his baby sister down a flight of stairs, knocking out of of her brand new front teeth that had just recently emerged. He said it was an accident and Stephanie could not be sure if his action was deliberate or not. She just knew that there had been too many "accidents" when the baby was in Adam's presence. Likewise, the family cat had been found many times limping or acting as if in pain and it was dreadfully afraid of Adam. Stephanie wondered if Adam had anything to do with the four dead baby birds he had brought to her, taken from a tree in back yard. Adam said that he had found them on the ground already dead but now she wondered.

     At the hospital, Adam charmed the hospital staff and anyone visiting the unit. He would smile and climb onto anyone's lap who would allow him, even complete strangers. He sometimes asked them if they would take him home or tell them that he loved them, giving them smiles and hugs, and sometimes even kisses. Anyone who did not know Adam's dark side would believe there was nothing wrong with this handsome, charming young boy and would put the blame on his mother, or, they would feel sorry for him and shower him with the attention they felt he was lacking.

     Adam was diagnosed with Reactive Attachment Disorder (RAD) as a result of pathological care he received as a young child. Stephanie was a teen mom who played around with alcohol and drugs. She was often physically or emotionally unavailable to Adam as an infant. Adam was taken from her at the age of 8 months when Stephanie was reported to the Department of Children's Services and placed in an emergency respite home. He stayed there three weeks before being put into another foster home, but the placement failed and a third home was found for Adam. Stephanie entered rehab and was able to straighten out her life. It took her another full year to get Adam returned to her. By then, she had another baby but remained a single mother. She had heard from past foster parents and her case worker that Adam had been having significant behavior problems in his foster home and preschool but she likened this to the fact that he was not with her and missing her.

     Once Adam was returned to her care, there were no problems for about a month. This is called the 'honeymoon period,' a time where the child controls his behavior while he figures out his new setting and new relationships. After that, little things started to happen, such as the baby suddenly letting out a sharp cry while Adam played near by seemingly not aware of the baby's distress. Or, the cat being found locked in a small cupboard, which she discounted since cats often liked to explore small areas. But the incidents became more aggressive and frequent as time went on leading her to seek the help and advise of a child psychologist who placed Adam in the hospital for assessment.

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