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?

"A lot of her anxiety centres around school."

That is dd all over again. Eventually it turned into complete school refusal. In her case it was a mix between general anxiety and the specific anxiety related to hypermobility, that your body will suddenly give way on you (and that nobody will believe you).

She also had continence problems, again almost certainly due to hypermobility (muscles not strong enough) and was on medication for a while.

It may be that your DD has disclosed something which has contributed to this diagnosis. However, any diagnosis given should be fully explained. Ask the diagnosing clinician for full explanation and for their written formulation (this should be provided anyway in assessment or discharge letter - if it's not, request this - if not provided step up to ask from team manager). You can also ask for second opinion.

I feel really sorry for you and fear that you are being fobbed off with the easy/cheaper/in fashion AD diagnosis of the day.
Parental blame, 'poor parenting' seems to be their evaluation 90% of course he time these days.

It's like the "refrigerator mothers" of a few decades ago all over again.

Thank you so much everyone. I'm a proper push over when it comes to 'professionals' and authority figures so it really helps to come on here and hear alternative views.

I'll be honest and say that the whole thing has felt like an attempt to dissuade me from pushing for ASD assessment. The psychologist has met my DD around 4 times and she has not engaged with his questioning at all which is something he commented on. I told him during the initial meeting that she struggles with males and during our last phone call, he said she struggles with men like he was giving me some insight. Um, I already told you that!

When we went through the Coventry grid, I was able to say she met criteria from both columns. About half way through, he asked me what I was thinking and I said it could be either. At the end he said, 'we are both in agreement that she presents as AD'. Actually, I didn't agree but I couldn't bring myself to say it. Most of the sessions with me on my own have been him asking quite specific questions and I feel like he's dismissive if I talk about wider concerns not related to his line of questioning. I could be imagining it but he has quite a patronising tone with his questions and does that classic psychologist thing of, 'I already know the answer, my questions are so you will realise I'm right'.

I do feel quite judged by him. At the last session, I had to bring younger DD as I had no childcare. DD refuses to see him on his own so we were all in the session. He commented after that I seem very protective of DD2 and wanted to know why. It was because the session was for DD1 and DD2 was trying to interfere (I brought her a separate activity to do and kept redirecting her to that) and also DD1 can be very violent towards DD2 if she gets in her space too much so I was trying to avoid that. I feel like I can't bloody breathe without being judged and it forming part of their professional opinion.

I'm perfectly happy to be told she has no underlying condition and it is 'just' MH problems but I think they need to rule out potential underlying conditions such as ASD as I feel she possibly meets a lot of the criteria. I'm sure he has based his opinion on his interactions with DD in part. One of the things he used as an example of why it can't be ASD: He wanted her to do an activity with sand. She doesn't like her hands being 'dirty' so was saying she didn't want to do it. However, it was an arty type activity (one of her obsessive interests is art related) so she did it but kept commenting on not liking the feeling of the sand. He said that as she was willing to do it, that is not compatible with ASD. Another thing was looking forward to activities. She can get quite anxious at having to try new things but will often look forward to doing them until actually faced with participating and then might refuse. If we can get her past that initial anxiety, she often enjoys it and will continue but the issue is in actually participating in the first place. Apparently looking forward to new activities is AD and incompatible with ASD. I don't know what to think - I'm not the expert ultimately. Also, we played a game at the last session and she was able to take turns and help me and DD2 but it was only because she wanted him to lose Again, this is incompatible with ASD.

DD copes ok at school but problems are creeping in. Generally I find that she will not melt down violently in public anymore but will get very upset and will sometimes bolt from the situation. The equivalent at home is that she will properly melt down and become angry and violent. The school have said she is an emotional child who gets upset at very minor things, cannot work effectively in groups and is on the periphery of friendship groups. She also at times cannot cope with the noise of the classroom and has to be moved outside. She often accuses other children of bullying her but this is usually proven to be her misinterpreting what was said. The social worker reported that she does this as an attention seeking behaviour. Maybe I'm wrong but DD does often misinterpret what people have said to her and will feel offended when that was not the intention. I think this is a genuine misunderstanding rather than attention seeking though. I don't know what the school have said to the CAMHS psychologist but when I told him the above, he said it must be a miscommunication between teachers as they have changed what they are saying. Again, very dismissive.

We actually have one session left and he has asked to see DD. I'm thinking now that I will go alone with a list of questions. Does that seem like a good strategy? I will post the questions I am thinking of asking. If anyone could suggest any to add, I'd be so grateful .

Questions:

• are you formally diagnosing DD with AD?
• what type of AD do you think she has?
• why have you come to this conclusion?
• are you qualified to make this type of diagnosis?
• is it possible to have ASD and AD together?
• are you qualified to assess ASD?
• how have you been able to rule out ASD and how have you done this?
• do you think that the Coventry grid is an effective tool at diagnosing AD and/or ASD?
• are you aware of the diagnosing guidelines for AD?
• how are you able to diagnose AD in the absence of abuse, neglect and/or trauma?
• do you think it is appropriate to rule out ASD via assessment by a qualified diagnostic team? If so, will you refer or her or how do we get a referral?
• what help and support is available in treating DD's AD?
• will she be offered any therapeutic services?
• how do we access this help?
• will you be writing a report on your findings?

My friend's daughter was diagnosed with an attachment disorder. However, she has more recently been given a pda / autism diagnosis and AD is no longer on her information.

I have an attachment disorder. I entered services at 15 and have spent years in therapy with a similar question: "Why am am like this when I wasn't traumatised"?

Obviously I cannot possibly say what the right diagnosis is for your DD. Regardless I hope that you get the support and help you need.

My mother would (and has) said very similar things as you have. Your love for her is clear:

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 adored DD and threw myself into parenting

I was never away from DD for longer than a few hours

Attachment disorders can develop from cold/removed/neglectful parenting, but it can also develop from being overly attached. The psychologists comment about you being over-protective didn't surprise me. My mother utterly smothered me until the age of 15 (when I got into an abusive relationship, in part, as I didn't understand boundaries).

Forming a secure attachment with a baby means engaging with them and mirroring them, but it also means giving them space when they look away and space to become a person separate form you:

www.psychalive.org/understanding-ambivalent-anxious-attachment/​

Refrigerator mothers/over-protective mothers - you can't win.

All I hope for is that you don't reject the AD diagnosis outright because it is easier to bear and in turn create more problems for her.

DD copes ok at school but problems are creeping in. Generally I find that she will not melt down violently in public anymore but will get very upset and will sometimes bolt from the situation. The equivalent at home is that she will properly melt down and become angry and violent. The school have said she is an emotional child who gets upset at very minor things, cannot work effectively in groups and is on the periphery of friendship groups. She also at times cannot cope with the noise of the classroom and has to be moved outside. She often accuses other children of bullying her but this is usually proven to be her misinterpreting what was said. The social worker reported that she does this as an attention seeking behaviour.

To me this is screaming out typical autistic behaviour.
I am honestly so pissed off and frustrated on you behalf!

School behaviour described does sounds quite ASD in nature, as does the masking (hiding her true feelings) at school. What do school think?

Is he a clinical psychologist? If you feel able I would ask for a second opinion... if they could even do the screening questionnaire for ASD it would be a start, although I know some services are moving away from that to a more multi disciplinary team approach.

It's true that over attached parenting can cause issues but her behaviour does sound more ASD to me. If you're not happy with the conclusions drawn then you can complain - it happens fairly often ime!

Just a question as l have very little knowledge of AD but could the trauma not be rejection by her dad?. You sound like you did very well but she had two parents.

I'd also ask him about what he can tell you about how ASD may present differently in girls than boys. I have female friends who have been (finally) diagnosed when older, who say that they were fobbed off as children because it "can't be ASD because it's not typical [insert ASD boy behaviour]".

Thank you again everyone.

We had the CIN meeting yesterday which felt positive in that the professionals are mostly agreeing with me that CAMHS are failing in their duty towards DD.

She had a medical with a nurse recently and she's been flagged as high risk for MH problems and at risk of self harm/suicide. Young carers echoed this in their assessment as did the school. Everyone agreed that she shuts down when having to discuss feelings and emotions and we had a discussion around DD's apparent lack of empathy. During our first appointment with CAMHS, I was crying and DD sat there without really reacting. This is not unusual for her, she is frequently amused/confused by strong emotional reactions in others and generally doesn't recognise her own emotional state (she will deny having been angry/upset following a meltdown and will maintain that she has behaved normally). Anyway, following this, the CAMHS worker asked me why DD is angry with me and everyone round the table agreed that this was a bit of a leap to make when it could equally be explained by DD's issues with emotions.

The staff member from school (who is the resident behaviour expert) was particularly critical of CAMHS and was not at all happy that they are discharging her without having really addressed her problems. She noted that despite having been brought up in the same environment, DD2 displays none of these issues and queried why CAMHS don't appear to be taking this into account. She also talked about how DDs issues are now affecting her school work and reiterated that this was NOT attention seeking behaviour. I nearly cried when she talked about how distressed DD becomes during meltdown and how she screams .

The SW had spoken to the CAMHS psychologist and he had told her that she presents as having attachment problems. However, she said he was not formally diagnosing this as he isn't qualified to do so. Both me and the school were adamant that he is using the term attachment disorder which sounds very much like a diagnosis to me!

The school ended up calling CAMHS to ask them not to discharge DD from the service and to allocate her a female worker (something nobody could understand why this hasn't happened in the first place). Apparently they are going to look into this.

I was also complimented on the fact that I have engaged well at every stage and have been open to every suggestion presented to me. It was nice to have this acknowledged.

I am definitely not discounting the possibility that this is AD but I am frustrated that they will not consider the potential for ASD as she does meet so much of the criteria for female presentation. They are not qualified to make this judgement yet are the gatekeepers to assessment. Without their agreement and cooperation, we are totally stuck.

What do pp's make of my suggestion to go armed with some questions? The other thing I can ask about is the fact that she was referred at tier 3 but still hasn't been assessed by them (long story but the worker allocated at tier 3 was a man who the school described as 'someone who should not be working with children' and I agree!) so I could push for that. It is tier 3 who do the assessments for ASD. I agree with pp that as a minimum I should be asked to fill out an ASD questionnaire. They simply don't have enough insight to be making these judgements IMO.

OP, sorry you’re all going through this. For some DC separation of parents, visiting parents in different homes, perhaps some arguments etc will be trauma. All DC are different and not all are resilient enough to cope with this.

Also, just wondering, does she see her dad away from you? May this have been a cause of additional trauma for you/her.

The youth justice board are doing some really interesting work around trauma and recovery at the moment. Perhaps have a read - they’re looking at work that can improve things for young people.

Don’t blame yourself. Modern life isn’t easy for anyone.

It's a long story with her dad. We didn't live with him until she was around the age of three (we got back together after his relationship with the 16yo ended) but he visited her at my home frequently.

At the time, I hadn't realised he was abusive, but certainly both my DC witnessed abusive episodes. He never really involved himself in childcare and worked away during the week and then went out all weekend so I have practically been a single parent throughout.

He began having them alone after we separated when DD was around age 6 and initially this went well. When I met my (now ex) DP, he ramped up his abusive behaviour towards me and was low level neglectful of the DC. Neither child is currently having contact with him at both their request and the advice of SS.

I don't doubt that this has had an effect on my DC but it is notable that despite having tougher circumstances and witnessing abuse from a much earlier age, DD2 is absolutely fine and has no behavioural problems whatsoever. I think it's complicated and there are lots of factors at play but it doesn't explain why dd1 has been left with huge emotional problems and dd2 is well rounded and quite resilient.

Oh OP, that’s very hard and most certainly traumatic. Be kind to yourself, you sound like you worked very hard to be a great parent but the wider circumstances are likely to have been difficult for your DC to manage. Even with one wonderful parent.

I personally do not believe an attachment disorder could exist without trauma. I would question this diagnosis

Also, OP, I hope you don’t mind me saying this but I think it’s important that you acknowledge that these experiences would’ve been difficult for her in the work that you’re doing now. Comparing how well your younger DC coped with these experiences and pointing out how much more ‘well rounded and resilient’ the little one is may feel to the older one like blame. Particularly if she’s a sensitive soul.

This is the problem Grace, they aren't actually doing any work with her. I'm just so disappointed about how it's been handled. Obviously I haven't covered everything that has happened, but she's been let down so many times over the years by the services that exist to help children like my DD. I certainly never compare them in ear shot, it's been said in meetings by the school and I have agreed.

OP, that's so hard. My DD1 has now been diagnosed with Attachment Disorder, she and her sister are adopted. I didn't understand how it could be possible initially as they both went straight into foster care and were then adopted, no time with their birth families at all, so I didn't understand at all. But then I found out that their older half sibling had been diagnosed with AD despite also going straight into foster care. So we asked for help with her.

I learned that in utero experiences can affect us so, as I understand it, it is possible that your DD was affected by the stress in the household during that time. At least, don't rule it out without considering it seriously.

In our case. DD1 had the same foster carers as her older sister, whereas DD2 had different foster carers and had a very strong bond, and she doesn't have AD. So there is another way of looking at it.

At the end of the day, you will never know for sure. The experts have looked at the symptoms and made a diagnosis, and will now look for the best way to help your DD. If you don't feel what they have recommended is helping her, then you should ask for a second opinion.

But please don't blame yourself, you're clearly a brilliant mum.

Trauma in AD terms doesn't exactly match with how it's used in common language. What you've described about her Dad is definitely a 'trauma' which will have affected how your daughter sees herself and her place in the world.

What it doesn't mean is that you haven't done your absolute best to keep your daughter physically and emotionally safe as you could or that you could have prevented it happening. It isn't a judgement on your parenting.

Google styles of attachment and this may help you understand why your daughter reacts the way she does in certain circumstances.

Most definitely hyper sensitivity. Unlikely to be attachment issues in the standard way but more likely due to her naturally anxious personality and feeling of insecurity which is not always caused by anything other a person's personality.

I would certainly be leaning towards her being on the ASD spectrum and it not being as obvious as some children.

Where is her dad in all this? Where are her grandparents, siblings etc. Has she suffered a loss at an early age? What were her experiences of nursery, school etc. Are there any signs of early psychosis. Voices, imaginary friends, hallucinating etc.

I'm not saying these things to scare you. It's all manageable but it can be so difficult to pin point.

I've just read about her dad. This is a huge thing for a sensitive child to go through. She will have known of the abuse. She will have felt the stress. As a sensitive person it will have hit her hard. Really hard.

With respect you need to begin to appreciate how much this has effected her!

She has an absent father, has suffered low level neglect (low level?) from him, has witnessed him abusing you and now doesn't see him at the advice of SS.

Yet... she's suffered no trauma?!

I think you're doing a great job caring for her, loving her, and advocating for her. I also think there's a lot going on here, and ASD is worth a proper investigation.

Her arsehole excuse for a father is not your fault.

But please don't dismiss her early experience as not traumatic, and definitely don't think "oh well it can't be that because her sister isn't affected". All children are different.

You should be aware that CAAMHS have been told to stop making to many ASD diagnoses- - and that your daughter presents as female HFA in my nine professional opinion