Effective Treatment for Complex Trauma and Disorders of Attachment

Reactive Attachment Disorder is a severe developmental disorder caused by a chronic history of maltreatment during the first couple of years of life. Reactive Attachment Disorder is frequently misdiagnosed by mental health professionals who do not have the appropriate training and experience evaluating and treating such children and adults. Often, children in the child welfare system have a variety of previous diagnoses. The behaviors and symptoms that are the basis for these previous diagnoses are better conceptualized as resulting from disordered attachment. Oppositional Defiant Disorder behaviors are subsumed under Reactive Attachment Disorder. Post Traumatic Stress Disorder symptoms are the result of a significant history of abuse and neglect and are another dimension of attachment disorder. Attention problems, and even Psychotic Disorder symptoms are often seen in children with disorganized attachment 1.
Approximately 2% of the population is adopted, and between 50% and 80% of such children have attachment disorder symptoms[2]. Many of these children are violent[3] and aggressive[4] and as adults are at risk of developing a variety of psychological problems[5] and personality disorders, including antisocial personality disorder[6], narcissistic personality disorder, borderline personality disorder, and psychopathic personality disorder[7]. Neglected children are at risk of social withdrawal, social rejection, and pervasive feelings of incompetence[8]. Children who have histories of abuse and neglect are at significant risk of developing Post Traumatic Stress Disorder as adults[9]. Children who have been sexually abused are at significant risk of developing anxiety disorders (2.0 times the average), major depressive disorders (3.4 times average), alcohol abuse (2.5 times average), drug abuse (3.8 times average), and antisocial behavior (4.3 times average)[10] (MacMillian, 2001). The effective treatment of such children is a public health concern (Walker, Goodwin, & Warren, 1992).
Left untreated, children who have been abused and neglected and who have an attachment disorder become adults whose ability to develop and maintain healthy relationships is deeply damaged. Without placement in an appropriate permanent home and effective treatment, the condition will worsen. Many children with attachment disorders develop borderline personality disorder or anti-social personality disorder as adults[11].
So, what is a person to do? Is there effective treatment for disorders of attachment? The answer is yes; there is an effective treatment for disorders of attachment. Dyadic Developmental Psychotherapy[12] is an evidence-based treatment that has proven success treating attachment disorders[13]. Family therapy, individual therapy, play therapy, residential placements, and intensive outpatient treatment, among other treatments, are often used to treat attachment disorders. However, when compared with Dyadic Developmental Psychotherapy, these treatments proved to be ineffective. A follow-up study compared the effectiveness of Dyadic Developmental Psychotherapy and “usual care,” and found that Dyadic Developmental Psychotherapy produced clinically and statistically significant improvements one year after treatment ended. The study was composed of 34 families receiving Dyadic Developmental Psychotherapy and 30 families receiving “usual care.”
Before treatment/evaluation in both the treatment and control groups, Randolph Attachment Disorder Questionnaire scores and Child Behavior Checklist scale scores were elevated and in clinically significant ranges (more than two standard deviations above the mean for the CBCL). The extent and severity of these children’s disorder is underscored by the fact that 82% of the treatment group and 83% of the control-group subjects had received prior treatment using other methods. The average number of previous treatment episodes was 3.2 for the treatment group and 2.7 for the control group.
The results for the treatment-group were achieved among children aged six to fifteen years, averaging 9.4 years, who received an average of twenty-three sessions over eleven months. Results presented in Table 1 show clinically and statistically significant reductions in scores for the treatment group and Table 2 shows no change for the control group.