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In some cases we speak of the bond disorder when there have been traumatic ruptures in the child-mother affective bond from the earliest stages. The causes can be diverse: abandonment, abuse, separations, children admitted to reception centers and later adopted, children who have been in incubators, etc. The symptoms are manifested from extreme withdrawal to disruptive behaviors that include hyperactivity, attention deficit and impulsivity, among others. But it doesn't always take great trauma for a child to develop bonding problems.
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The long hours of work of many parents, temporary substitutes, the nursery in stages before 2 years, do not make it easy to establish the times and quality of relationship that many children need. The majority of children who present alterations in the affective bond tend to constantly test their parents' love and the bonds they have in common. The most paradoxical thing is that they do it through a subtle process of demands, manipulations, lies and, even, using aggressive and violent behaviors towards the people they love. Also, sometimes, against themselves. It is as if they constantly need to reaffirm the physical presence and proximity of the parents, even if it is to scold them.
Other children have frequent somatizations (headaches, supposed illnesses to get the mother's attention). Verbal manifestations such as "nobody loves me" or "I would like to die" may appear. In fact, a bond disorder can lead to a depressive picture. Sometimes the symptoms appear late during the child's growth and when the security achieved at the time is lost due to some event that abruptly bursts into the child's life (mother's illness, parental separation, loss of some of parents, sudden changes of residence, etc).
Each child is different and therefore their own history and feelings as well as other factors will have to be carefully analyzed.risk present. However, on this page we will try to give some general tools to work with all those children who in one way or another manifest problems derived from an affective bond not properly established at the time or truncated, when it was already reached, due to new unforeseeable life circumstances and who lives in a painful way conditioning their behavior. Criteria for the diagnosis of Reactive Attachment Disorder in infancy or childhood A. Social relationships in most contexts highly altered and inadequate for the subject's developmental level, beginning before 5 years of age *, and revealed by 1 or 2:
- persistent inability to initiate or respond to most social interactions in a developmentally appropriate way, manifested by overly inhibited, hypervigilant, or highly ambivalent and contradictory responses (eg, child may respond to caregivers with a mixture of approach, avoidance and resistance to being comforted, or may manifest cold vigilance)
- diffuse ties manifested by indiscriminate sociability with a marked inability to manifest appropriate selective ties (e.g., excessive familiarity with strangers or lack of selectivity in the choice of attachment figures)
Criterion A disorder is not exclusively explained by developmental delay (as in mental retardation) and does not meet criteria for pervasive developmental disorder.
Pathogenic breeding is manifested by at least one of the following characteristics:
- permanent neglect of the child's basic emotional needs related to well-being, stimulation and affection
- persistent neglect of the child's basic physical needs
- repeated changes in primary caregivers, preventing the formation of stable bonds (eg, frequent changes in caregivers)
The type of parenting described in Criterion C is assumed to be responsible for the altered behavior described in Criterion A (eg, the disturbances in Criterion A began after the introduction of the pathogenic care listed in Criterion C). F94.1 Inhibited type: if Criterion A1 predominates in the clinical presentation F94.2 Disinhibited type: if Criterion A2 predominates in the clinical presentation Intervention and guidelines Intervention with children who present attachment disorders will depend on their current circumstances and, evidently, of its own history. In some cases, the therapist will not be able to modify environmental situations that generate and maintain the problem (loss of parents, separations, conditions of extreme poverty or marginal environments, etc.),so his work will focus on the child himself and the current people of reference.
In other cases, for example, children from normalized familieswho suffer from bonding problems for various reasons (adopted children, chronic maternal illness, forced separations, etc.), work can be carried out at the family level and in their immediate environment (school, etc.) with a better prognosis if there is no other risk factors. Although individual psychological work with the child may be necessary, in most cases one of the primary goals of the therapist will be to provide information and understanding about the problem to the child's parents or guardians. a) Individual psychological work In general terms, when there are bonding problems at an early age, the fundamental objective is to reinforce the emotional line of the child.The idea is that the child gains confidence in himself as we provide him with greater emotional support from the reference figures and a predictable and stable environment.
As part of the intervention, the child psychologist can work on specific aspects of the child's emotions and feelings. Depending on age and history, it may be necessary to rework old traumas or accompany the child in coping with new situations. Many of their maladaptive behaviors are still reactive manifestations in the face of current or past stressful life situations. Therefore, on a therapeutic level, we must try to correct them but without forgetting their emotional origin. In general terms, a better evolution is to be expected as soon as the affective bonds have been restored or reinforced after the first symptoms appear. b) Strategies for teaching parents or guardians The first objective is to explain to parents or guardians the origin of the problem.
Based on this understanding, as a general strategy, it is necessary to promote daily communication spaces with the child. Prioritize quality versus quantity in interaction. Encourage him to explain his feelings and emotions (sadness, joy, etc.) rather than what he has done (playing, going on a hike, etc.). In this regard, the Emotional Diary can be used where one thing that the child has experienced positively and another in which they should improve will be recorded daily. This should serve as a basis for parents to reason with him the aspects of his feelings and behavior that concern them. This can usually be done in the evening just before bedtime.
Mark very clearly the consequences of the behaviors that we want to correct (punishments) but, when the behavior occurs, do not yell at them or try to ask for explanations, or reason what happened. For this we can use the night space of the "Emotional Diary" where we are all more relaxed. When inappropriate behavior occurs that we want to correct, let us withdraw (as much as possible) the attention (time-out or others) and let him know that we are sad because he can do better. In this way, the child goes from being the victim to feeling responsible for the "sadness" of the parents. This can be very effective in children who precisely have fears of loss or emotional distancing from their parents, however it should be used with caution because we are talking about children with affective problems.We must reject the bad behaviors of the child, never the child himself. That is, we will tell him that he has behaved badly but not that he is a bad, disobedient, etc.
To work on specific aspects of their behavior, use the chip economy through visual graphics. Agree prizes in advance and define the rules of the game. Try to increase your free time together. Remind him how much we love him and how important he is to the family. Give them prominence and know how to praise them for the correct behavior or work immediately after they carry it out. If there are impulsivity or attention problems, we can incorporate games that encourage delay in response and thinking before acting.
It is better to set a daily schedule so that we can be with him together. These activities should be experienced by the child as a playful space, not as homework. Parents must be able to open, from an early age, a door in the child so that he can let out his feelings and emotions. Knowing how to listen, accompany, connect with the inner world of children, is the best way to build a young person without complexes and with good self-esteem. All of this is especially important in children who for one reason or another have seen the early bond cut short.
This article is merely informative, in Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.
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