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Thursday, 27 April 2017
Bonding and Attachment Print
By Susan Scott, NW Neurodevelopmental Training Center

They are called unattached, or unbonded, attachment disordered, or attachment impaired. They are children and adults from all walks of life, who fail to form strong and appropriate relationships. They are the bane of counselors and psychologists, because they do not respond to conventional methods of treatment. They fill our prisons, in the person of sociopaths, compulsive criminals, and serial killers. They make headlines when they kill their parents or spouse. And they are our children.

Many people will read this description and say, "Thank goodness, I don't know anyone like that." But, chances are, you do. As with any other neurological condition, this one occurs on a continuum from the very mild to the very severe. So, lets look at some of the characteristics of attachment impaired children as they fall on the continuum.

Attachment disordered children may seem either remote or clingy or both. Parents may say of their child "He never sleeps in his own bed," or "He won't go to sleep unless he is in our bed." Sometimes they report that the child is remote and doesn't respond to displays of love and affection. Though these two behaviors may seem paradoxical and contradictory, they stem from the same root. They both result from the child's inability to receive and interpret love.

This child may appear to lack empathy for others or he may seem to be overly attentive to the feelings and wishes of others. The child's teacher may comment, "He may hurt one of this classmates and then laugh about it." He may also go out of his way to appease the people around him. Both of these behaviors result because the child doesn't have a way to know what others are feeling. In the first case, he cannot compare the hurt that his classmate is feeling to any event in his own experience and, therefore, has no empathy for the classmate. In the second case, it is his inability to know what those around him are feeling that causes him to feel the need to be conciliatory. They may be mad at him or may be pleased, but without a way to know, he must assume the worst and do whatever is in his power to prevent it.

For a similar reason these children may seem to be cruel or merciless. Because of their incapacity for empathy, they do not have the same restraint on their behavior that other children have. They may abuse animals or siblings without showing any understanding that this behavior is wrong. For them there is no link between their own experiences and the experiences of those they are abusing.

The attachment impaired child may appear exceptionally shy or socially promiscuous. ("Socially promiscuous" is a phrase coined by Florence Scott, R.N., which refers to a child who tries to win the favor and attention of almost everyone he meets, as if he does not have a clear idea of who his caretaker is.) Again, although these behaviors seem contradictory, they arise from the same cause. Because this child does not have the capacity to receive and interpret social signals, he may fail to receive the messages sent by others inviting him to participate in a social life. And as a result he may become withdrawn and reclusive. On the other hand, this same inability to receive and interpret social signals may result in the child failing to discriminate between his relationships with parents and family members and his relationship with those outside the family circle. He may walk off with a stranger while on a trip to the store, or share personal family information with someone he has just met.

Finally, this child may respond in ways that are not appropriate to the circumstances, leading people to believe that he is "putting on an act." He may operate by a set of rules that are very complex, but never expressed and he may expect others to follow these rules as well. If those around him fail to operate within his rules, he may become angry. Again, this is often not expressed. As a consequence, though, the child may feel confirmed in his belief that the world is hostile and unsupportive. The child makes his rules in the first place because he does not necessarily perceive the guidelines that we ordinarily operate by in society. Without these external guidelines, he feels at a loss and tries to gain as much control as possible in order to have security. As a result of this, he may appear rigid and inflexible to those around him.

The net affect of this condition is that the child operates as if he is living in a different world from those around him. His responses do not match the circumstances and his relationships do not form along normal lines. A picturesque way to describe him is that he interacts with the world as if he is wrapped entirely in cotton batting. The stimulus that comes to him is muffled and distorted and all of this outreach to the world is restricted by his condition.

What is it then, that underlies this behavior? The children and adults who demonstrate these behaviors almost universally have an injury to the area of the brain known as the pons. The pons is the area of our brain that is primarily responsible for life preservation functions. It is the part that we use when we feel extremes of heat, cold, pain, and hunger. It identifies threats to our life and person. And, significantly, it is far below our cortex in the developmental process, and therefore, it has no language. It is not possible to express in words the experiences that we have at this level.

When I say that the pons is responsible for life preservation functions, I mean just that. It controls our respiration, heart rate, and other functions without which we could not survive. People with severe injuries in this area do not live. Those who die in car accidents often die because they have injured their pons. The function of this area of our brain is critical to our survival.

As part of its life preservation functions, the pons is the part of our brain that perceives extreme sensory messages of heat, cold, pain, and hunger. While most of our sensory input is monitored by our mid-brain, these particular sensations bear directly on our health and survival and are monitored by the pons. If we become too hot, we will die. If we become too cold, we will die. If we become too hungry, we will die. And, if we are in a situation that is causing us pain, we are also in danger of losing our life. People who have injuries to this area of the brain (not so severe that they result in death) are often unable to perceive these sensations. Surprisingly, people with these deficits and those around them are often unaware that their sensations are not "normal." Parents and teachers might report "He's a tough one. If he gets a scraped knee, he just picks himself up and goes on playing." In a biography of T.E. Lawrence, better known as Lawrence of Arabia, it is reported that as a youth he broke his ankle during recess at school one day and walked on it for the rest of the day without saying a word about it. A person with normal pain perception would not have been able to do this, no matter how hard he tried. As a result of this deficit, people with pons injuries are isolated from the world around them. They do not receive critical information that they need to orient themselves in their environment. Without knowing that it is happening, they are being cut off from the outside world. People in this position sometimes make an attempt to reconnect with the world by committing acts of self-mutilation. For example, some people cut the skin on their bodies with razor blades or knives. Some people do an extreme form of nail biting and chew the skin off their fingers. When asked to explain why they do it, these people often respond that, "I just wanted to feel something, anything at all." This lack of pain perception affects their ability to empathize with others. If affects their ability to form relationships, and it affects their sense of placement in the world.

By means of the perception of the extreme heat, cold, pain, and hunger, the pons is able to recognize threats from the world around us. One of its life preserving functions is to identify these threats and put us "on guard." When we are in a situation that may pose a threat to our safety, our pons helps us to stay alert and carefully evaluate what is happening. However, when an injury occurs in this area of the brain, this function becomes dysfunctional. The child may become hyperalert and anxious, because the pons is working overtime and perceiving everything as a threat. Children in this position are the ones who cannot sleep alone or become hysterical at the possibility of being left with a baby sitter. Adults with this dysfunction often report that they feel a constant and undefined anxiety. They might say "I always feel like something awful is going to happen, but I don't know what." Sometimes, instead of the pons working overtime, it doesn't do its job at all. Children and adults in this position often behave recklessly and in some cases deliberately do harm to themselves, because they do not receive the messages from the pons that should tell them that they are in danger. They seem to act without discretion, unaware of the danger signals that most people recognize. In either case, the child becomes "disconnected" from the world as a result of the failure of the pons to do its job properly.

This isolation from the world is further compounded by the inability of the individual to express his feelings verbally. The isolation that is brought about by this type of injury can elicit deep feelings of loneliness, abandonment, and despair, but since these emotions originate as a result of the injury, not in response to an external fact, it is next to impossible for the individual to verbalize them. Our pons cannot express itself in words, and so the injured person if left helpless to describe the fear and anxiety that he feels. This places yet one more barrier between the individual and the outside world.

Finally, disconnection from the world can be accompanied by a disconnected sense of time. Pons injured individuals may not perceive time as a continuous flow of one minute to the next. An event may not appear to have a consequence in another time. It is no consolation to say to a child with these perceptions, "Don't worry. I won't be gone long; I'll be back in half an hour." It is also useless to threaten such a child by saying "If you don't behave, I'll send you to your room for an hour."

The cumulative effect of this collection of symptoms is that the injured individual feels that there is no place for him in the world. He may express this by saying "I just don't feel like I belong here" or "I ought to be dead. I don't deserve to live." This syndrome can also result in a deep lack of trust on the part of the injured child. Without sufficient means of receiving signals from the world or evaluating them if they are received, this child cannot learn to trust his own experiences and consequently cannot trust the world and actions of others. Eventually, when these feelings cannot be explained or justified, the child may choose to turn them off altogether. This can lead to the kind of cruelty that is observed in some unattached individuals. In an interview with convicted child molester and murderer, Wesley Allen Dodd, he said, "I don't have any feelings about what I did. I don't remember ever having any feelings."

How, then, does a child become injured in this way? Any blow to the head, high temperature or shortage of oxygen might cause damage to the pons. The pons can be injured in the same ways that any other area of the brain can be injured. So, for example, a car accident, a drowning, an illness resulting in an extreme fever, or being hit in the head at Little League with a bat could possibly result in a person developing some or all of the symptoms that have been described. However, many children (and adults) who have this syndrome develop it as a result of a separation from their birth mother in the first two years of life, rather than by some documental brain trauma. Children who have been hospitalized in their first year or two of life, usually involving surgery and usually involving having their movements restrained, often develop these symptoms. Sometimes if the mother is hospitalized and does not have contact with the child, the same thing can result. In some cases the child may be restricted in contact with the mother, and in movement, because he (the child) is in a cast for treatment of a broken bone or orthopedic problem. In some cases the separation is brought about by abuse and neglect. In any of these cases what has happened is that the process of bonding between the mother and child has been interrupted and often the child's ability to do the developmental movements appropriate to his age has also been restricted. It is very important to realize that the combination of emotional stress resulting from the separation and the inability to complete the necessary developmental activities results not just in a delay of function of the pons, but in an actual dysfunction. Function will not return when circumstances return to normal. The dysfunction will continue until it is treated. No amount of love or extra quality time spent with the child after that point will restore his emotional and neurological health until the problem in the pons is addressed.

There is a way to do this. Get a functional neurological examination and follow the program as instructed.

When a person begins treatment for this type of pons injury, he may likely experience some nearly overwhelming feelings of grief and/or anger. These feelings can be surprising and difficult to deal with because they do not seem to be in response to surrounding circumstances. It is therefore important to recognize that the feelings are arising because the treatment is directly stimulating the pons where the feelings are located, not because something is currently happening outside the individual that might elicit them. One person expressed it in this way: "Every time I get down on the floor to crawl, the tears start to come. As soon as I sit up, they stop again." Others have reported that they weep over television commercials or at any other slight provocation. Almost everyone who undergoes treatment for this type of injury experiences a similar outpouring of grief and sometimes anger. The feelings that they have been unable to express before seem to explode to the surface and erupt all at once. It is critical at this point for the caretaker, whether that person is a parent, a spouse, or a friend, to accept these emotions without taking them personally. They are an indication of important and beneficial changes taking place neurologically. The most helpful thing that the caretaker can do is listen patiently and offer support to the individual while he wades through these deep and confusing emotions. The individual may also experience some degree of resistance, both to his swelling emotions and to the treatment itself. He may complain and object to having to do the activities involved in treatment. Here again, the caretaker can offer structure and support to persist in doing the treatment every day. Eventually, however, after the flow of emotion begins to subside, the individual begins to form bonds with the people in his life with whom he has relationships. He will start to trust his own perceptions of the world and consequently be able to trust those around him. He will be able to identify and respect his own boundaries and those of others. His behaviors will changes and become more appropriate to his current circumstances.

If you are the parent or guardian of such a child, it is imperative to seek treatment as early as possible. By doing so, you can give your child a life of peace, security and happiness that will not be available to him otherwise. You may also save yourselves from years of frustration and worry over a child whose behavior is antisocial and even possibly dangerous to himself and others.

About the Author:

Susan Scott is Program Administrator at NW Neurodevelopmental Training Center in Woodburn, Oregon. Several families on A4everFamily credit Susan's skills with helping their children to recover from attachment problems.
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