What causes attachment disorder if there was no trauma?

[NumberEight]

Posting here for traffic.

My DD(9) has some quite severe difficulties. She has crippling low self esteem and anxiety which manifests as violent meltdowns, suicidal thoughts and self harm attempts. She had some other issues such as sensory issues.

After many years trying to seek help, we finally got CAMHS to see us and had 8 sessions with a psychologist. They are about to discharge her from the service and are saying it's an attachment disorder.

I have read around the subject and note that it is usually caused by early trauma or detached parenting (obviously simplifying there). However, I do not recognise any of this from her early life. I was a totally devoted mother. I co-slept, breast fed, made all organic baby food. I was a SAHM at the time and took her to endless baby groups and played with her constantly. I was only 15 when I had my first child so when DD came along in my 20's, I enjoyed motherhood so much more as I had none of those first time mother anxieties and was much older and able to cope. I totally devoted myself to her.

Things are more difficult now as I have a chronic illness and our circumstances have changed but her issues manifested before this came about. So why has this happened to my DD? I feel like I've gone badly wrong somewhere but can't pinpoint exactly what or where this happened.

Has anyone got an insight into ADs that could explain it to me please?

It does seem a bit weird - Reactive Attachment Disorder is pretty much associated with fostering/adoption/disrupted early life/trauma etc. If you had a significant change in life circumstances post infancy this could contribute; attachment is ongoing after all even though the infant period is usually the one most focussed on. Some infants who are securely attached go on to become insecurely attached in later childhood- which can be down to stressful life events.

However, I just copied this from a 2013 study (Minnis et al., 2013 if anyone is desperate to check my refs...) - "Both DSM-IV and ICD-10 suggest that RAD should only be diagnosed in the presence of a history of ‘pathogenic care’... Although the great majority of children diagnosed with RAD had a history of maltreatment, we were unable to confidently establish that all had been maltreated. This underlines the problems inherent in a history of maltreatment being part of the diagnosis of RAD, yet this requirement is likely to be retained in DSM-V."

So in the absence of life disruption or demonstrably sub-optimal parenting it does seem a bit odd.

captain, yes, I've been to the GP several times and most recently asked if they could directly refer to an autism assessment centre bypassing CAMHS (who do the assessments here). They said no unfortunately. I've also spoken to NAS who emailed some info that I need to go over at some point. Most of it centred on complaining about the service we've received but I just don't have any fight left in me.

cory, that's interesting. Certainly her anxiety is one of her main issues. We have MH problems as a family (DM, DSiS and I all have anxiety) so I've considered that as a possibility. A lot of her anxiety centres around school. Since they have gone back, she is having daily nosebleeds in the car on the way home which I'm sure is related to her anxiety around school. She also goes through phases of wetting the bed.

It's really difficult to find the right help or just knowing what to do at home with her. She's very closed off about her emotions and will shut down or melt down if we attempt to discuss anything of that nature.

I did ask the CAMHS psychologist what might have caused an AD in my DD and he listed things like trauma etc and I stated that I didn't recognise any of these features in her early life. He said he couldn't tell me without going through my life with a fine tooth comb but there genuinely isn't anything except my difficult pregnancy. He then started going on about her developmental age/stage but I think it is being acknowledged by all the professionals currently involved that her bahviour isnt 'standard' or what you'd expect from a 9 yo.

Also pickleme might be thinking about insecure attachments, which I don't think are the same as fully fledged attachment disorders? You can have an insecure attachment in infancy but if the quality of parenting is good as you grow up you are not necessarily at a disadvantage, or going to develop an attachment disorder.

It is a pretty vague theory when you really get into it tbh - I had to research it in some detail and was surprised how pervasive it was when actually the theory and the evidence are patchy at times.

Attachment disorders and RAD are completely different in intensity. Also there is a new diagnosis of unemotional and lacking empathy, or some such (not suggesting it for your dc, by the way) so things are being rewritten all the time.

Whatever the underlying cause, most children respond better to both therapeutic/attachment parenting and autism parenting. Clear, calm consistent, avoiding triggers, working on understanding her own emotions/triggers etc.

Well worth following those kinds of methods. Other parents sometimes think you are being too harsh/soft though!

Ah @picklemepopcorn... so when OP has been told there is an attachment disorder that means there is an insecure attachment? They would be very different! I was assuming attachment disorder meant a proper attachment disorder not just one of the insecure types. That's why it seemed so strange! Yes, they don't have to be caused by severe trauma and certainly therapeutic parenting would be a good approach.

first reaction: oh god not this again! ie you are not making any progress with sorting it all out.

Also: I think you are suffering from young mother syndrome... or rather are the victim.

is there any way that you can afford a private diagnosis?

I was assuming attachment disorder meant a proper attachment disorder not just one of the insecure types.

@Emilee... well, I was! Searching 'Attachment disorder' produces results for RAD, insecure attachment is different. It's sometimes referred to as 'disordered attachment' but obviously, as me and PPs have pointed out, RAD has it's origins in trauma or disruption and is seemingly rare whereas insecure attachments can develop in less drastic circumstances.

I've only approached attachment from an academic perspective so I don't know how 'attachment disorder' is used in practice - but it's obv problematic as googling it will bring up all the trauma stuff that OP has found that isn't necessarily relevant.

eg. as pickleme pointed out, maternal depression is a risk factor for insecure attachment. So you could have an infant who does not have a secure attachment at 18 months because their mother has experienced depression, but by age 5 the child could demonstrate a secure attachment to their carer if their mum has had help support etc. and is not experiencing depression. So the child has had an insecure attachment but not an attachment disorder.

I don't know enough on Attachment Disorder, but do know autism - agree it could be being missed here. It's very much harder for them to pin down symptoms in girls with autism, as they mask it so well. I would suggest reading lots of books on both subjects and trying to get a feel of what individual symptoms of each/either disorder she is having and managing them individually and holistically. Many, many of these conditions have such a huge amount of crossover symptoms, it's something that we all strive for, a definitive diagnosis, but I don't think it's genuinely helpful to us as parents when it's all a bit unsure. I think that the key is to understand your kid, regardless of diagnosis (although I agree you need one), and for you to regain your confidence in your ability to be an amazing mum. There's so much subtle blame towards yourself in your posts, all pointless and a waste of energy, although again I know the feeling, and the need for answers. Nobody will ever be able to tell you the reason why your child has this condition, you can go to the best doctors and psychs in the world and all you will ever have is speculation. You have no choice but to make your peace with it and address her day to day wellbeing, and finding a way forward. As I said, I know fairly little about attachment disorder, but the 2 kids I've come across that have it have two noticeable things in common: very, very loving and kind and wonderful mums, and mean and abusive dads. Both are girls that don't know each other and go to different schools.

I did ask about RAD and insecure attachment - the CAMHS psychologist said he isn't a psychiatrist so could say what type of AD he thinks she has, just that she has it. I'm finding it all very confusing and have already been told we won't get any further help from CAMHS. We have a CIN meeting tomorrow though so maybe they will tell me what the plan is.

BlackEyedSusan, yes, still going through the motions without anything actually moving forward. It's so upsetting and frustrating but I never feel listened to. What is young mother syndrome? I haven't heard of that before.

Thanks mygorgeousmilo. I think you're right about accepting it. I suppose my real worry is that I will do something 'wrong' and make things worse. I have read quite a lot on ASD in girls and around ADs but at this point, I still feel like it could be either. From my understanding, they both have different strategies to use and without any input from someone who knows what they are talking about, I feel paralysed into inaction, although obviously I'm dealing with her day to day the best I know how.

Things are slightly better at the moment as she isn't melting down as much but she's still anxious, upset, and violent. I feel a little more in control right now and as we're about to be discharged from CAMHS, I feel like it's the time to start thinking about what comes next.

"no other trauma than that caused by the hypermobility."

Sorry to derail the thread, but what on earth does this mean, Cory ?

@NumberEight what an incredibly unhelpful response from the psychologist! That really doesn't sound good enough. I was going to say that the most practical advice would be to confirm with CAMHS what exactly they meant by 'attachment disorder'. Properly grumpy on your behalf now!

As RAD is seemingly caused by pretty big upheaval/trauma I suppose it is unlikely to be that; in which case the only reassuring thing I can say is that attachment status does fluctuate over time - so even if you DD's is currently 'disordered/insecure' it doesn't mean it will be forever.

Honestly the more you write the more I think she is not NT and you're being robbed off.
How can they diagnose her with something on the one hand yet not be sure what they've diagnosed her with?

Given how many older girls and young women are misdiagnosed with bipolar and borderline personality disorder when it actually turns out to be autism, and that BPD in particular is basically just attachment disorder all grown up - I'd push hard for ASD assessment.

Attachment injury can happen in utero, however, according to the latest thinking on BPD. That is in no way your fault though, even if she does have a problem with attachment.

young mother syndrome... ie. the patronising gits think you are inadequate due to your age... making assumptions.

also comes with the territory for single parents or victims of dv or if you are black. (sadly personal experience of at least one of those categories and a friend with the others.)

see if you are entitled to a second opinion.

When they went through the Coventry grid with you, did you agree with their answers? As that should differentiate.between ASD and attachment. It's freely available on the internet so you can always look at it again yourself. Did camhs suggest anything going forwards? Or was their role simply to do assessment? Definitely ask your CIN worker to fight your corner with camhs if necessary. Can you ask for the screening questionnaire for ASD at least?

How does she cope at school?

The Coventry grid is a very weak tool though, and all the answers are open to interpretation, and don't take into account the vast spectrum that autism is. It doesn't take into account different presentations of autism, demand avoidance (actually pathological demand avoidance - PDA - might be worth you looking at, particularly for strategies), masking etc, which again leads to incorrect assumptions.
For example, the image was one of the first to come up in a Google search for Coventry grid, the symptoms are for attachment disorder. However, they are all common but perhaps lesser known traits of autism, yet use of the CG and clinicians over zealous in their agenda to avoid autism at all costs leads to only the most stereotypical children being identified, and leaves others floundering without the correct support.

Most parents will have minor events or things such as depression, PND, etc, yet their children will be unaffected by this. If a child is neurodiverse they are more likely to be affected by things than a neurotypical child, but this (IMO) doesn't make this an attachment issue, it's a sign that there is something going on, like autism, that makes some children more vulnerable to apparently minor things going on.
I do hope CAMHS drop their insistence of dragging attachment disorder into things when it relies on them dragging through the past with a fine tooth comb, when most families will be found to have markers of difficulties at some point if you look hard enough. I've met too many people broken by CAMHS' lack of knowledge.

Forgot to add the image!

I wish there was more recognition of child mental illness. Sometimes anxiety and depression just happen. it doesn't need a label.

"I wish there was more recognition of child mental illness. Sometimes anxiety and depression just happen. it doesn't need a label."

Actually, I'd argue that a lot of anxiety and depression has roots in attachment problems.

Ah OP

For what it's worth some people are just this way . It's just the luck of the draw .

I know a little boys that is Close to me and he exhibits this . He has also had no trauma either . I also suspect he is on the spectrum and so do his parents

Just don't blame yourself as that won't help

Hang tight

I'm not impressed that he can't tell you 'what type of attachment disorder' she has. It's fairly straight forward- not as a clear cut box you can put her in but in terms of which behaviours are which. That suggests to me that it isn't attachment disorder.

I met a little girl who screamed attachment disorder to me, she had lots in common with my foster children, and a history of DV. Her mum felt the same. Eventually, she was diagnosed with ASD and that is the right diagnosis, although there is a bit of AD in there too! It isn't always easy to tell the difference.

I have parented both ASD and AD children. They both respond well to a similar basic approach. You need to be much more alert, sensitive and responsive than with a NT child. You parent around them rather than expecting them to fit in with you. That doesn't mean no boundaries, just a much more child focussed approach. If she can't cope with the garden centre, don't take her there (parent of ASD pupil I taught complained her DS kept having tantrums in the garden centre!)

From what i can work out, they like to say attachment disorder to make tge parent feel its their fault, when in reality its often ASD