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's not that I don't think these experiences were traumatic, but from my reading of attachment disorders, it has to have occurred in the first three years of life, the first 9 months being particularly important for bonding. If I've understood correctly, at least one bonded relationship is sufficient. The diagnostic criteria specifically relates to trauma in early life, ie. before the age of three. The problems didn't come about until we moved in with him when she was three. Before this, I was living with my parents. DD has a very close relationship with my mother in particular. She had experienced no other loss in her life.

Like I said, I'm not discounting AD but I still don't know if this is an actual diagnosis or what kind of AD they are saying she has. They are not offering any therapy or work with her, they want yo discharge us from the service after 8 sessions (only half of which have been with DD present). They will not even consider sending her for an assessment for ASD which I feel strongly should be ruled out first. She doesn't just struggle with her emotions, she has sensory issues and struggles socially.

Attachment disorders can happen at any developmental age of a child. To say it has to have happened before age 3 is like saying blondes are more likely to be vegetarian.

It depends on the child. Their history. Their family. Their personalities. Their birth and pre birth experience. Their siblings group. Their social experience. Even their diet and sleep, whether they were sick when they suffered a trauma etc. Honestly it's great that your educating yourself but it's just not that simple.

You need to be far more open minded about this op.

You also just said your DD had a really close relationship with your mum but was moved into what turned out to be a traumatic situation with her dad. There's another loss of her grandmother living with her at an early age.

Like I said it can be the smallest bits that add up over time.

She doesn't just struggle with her emotions, she has sensory issues and struggles socially

This is my sister. We were told aged 3 that she had an attachment disorder, there was nothing that could be done and to 'go home'. There was no trauma here at all.
We struggled for 10 years, until 2 years ago. Paediatrician told us the 'attachment disorder' was in actual fact ASD.

We saw CAMHS 2 years ago (before diagnosis) and they said nothing was wrong and they couldn't help!

I'll PM you with full story later

I didn't mean for my message to sound so brief and rushed. It's because my phone battery is going to die! - I will definantly come back and post full story later! (whilst I go back and read the thread!)

It's really tough and muddy, but you had sterling support at that meeting OP, well done!

I prefer developmental trauma as a term instead of AD. It's more helpful I think. It gives a better sense of the impediments to healthy development that can happen. The uncertainty of relationships, people coming and going, patchy moments of care can all add up especially if a child is genetically predetermined to be sensitive.

Whether it ends up being ASD or AD or both, she is fortunate in having a focussed, motivated mum like you.

You're still discounting the issues with her father.
Should occur up to 3, but she was 3 - that's splitting hairs, isn't it?
And she was really close to your mum and living with her - but then moved out. So - a loss.
I'm not saying your daughter had AD and I'm not saying witnessing her father's abuse of you is the cause.
But I am saying, don't dismiss the impact of these things.

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.

My ds, who has ASD is just like this. His psychologist asked him what he thinks will happen if he tells us about things that upset him. But he also said its quite common in children with asd to react this way and shut down but commented that is because we have such a strong attachment (also raised him alone) that I manage to make him home life non demanding and relaxing to control his anxiety as best we can.

Pretty much the opposite of what you're being told.

As I said way upthread, before you mentioned the abuse, the two separate kids I know that have AD have abusive fathers. Both girls, and both are the youngest of a few siblings. Siblings unaffected. I can't get to grips with why you would split hairs over the "up to age three" thing. It's a guideline, and wouldn't just cease to be relevant because she's passed her third birthday. I can totally understand why you would find it all difficult to accept, is it because you do you NOT want the abuse to be the cause because then you would feel guilty about having let him back into your lives? Children are all different, some children go through all sorts of horrors, and grow up to super level-headed leaders in whichever field they choose, for some they can never move forward from it. I'm talking even in the same families. It's worth mentioning that one of the little girls I know with AD, yes the dad is abusive, but additionally her mum grew up in a home where there was regular DV. She didn't have an attachment disorder, but did grow up and end up married to an equally abusive man, and her self esteem is through the floor. Now she has kids and the older siblings are fine, youngest has AD. They won't all react in the same way. There's lots of things that don't bother me, I have a high tolerance for pain and stress, I work and volunteer with very vulnerable people, but watch me if even hear talk about going to see the film IT - that sets me off almost hyperventilating with terror! I pretty much lock myself up at Halloween, but have had various procedures without anaesthetic, have done CPR on strangers without panicking. I grew up in a house with DV. No attachment disorders, but I have a very gentle and stable husband, he's really not even very spontaneous or wild at all. Siblings all are in abusive relationships. What does that tell you? Absolutely nothing. It tells you nothing. Other than that everybody responds differently. You can't say one DD isn't affected so therefore it's all ok, and didn't harm them - it doesn't work like that. The nature/nurture debate, as far as I'm aware, always comes up with that it's a bit of both. No two children will react in the same way to abuse. They will be predisposed to certain characteristics, and events in their lives will be coped with accordingly.

I didn't realise she witnessed domestic violence. That's really traumatic. Without a secure attachment style help mediate that then AD makes a lot of sense.
Would CAMHs s not asses for ASD?

Are people actually reading what I've posted? Where have I said I wholly reject the possibility of her issues being down to an AD? I haven't. What I have said is that I feel my DD potentially has ASD and I would like her to be assessed. I'm not saying she definitely has that either. I'm open minded about what is causing this, AD, ASD, or 'just' MH problems. I'm not sure how else I'm meant to convey this in any other way other than what I've actually written.

I started the thread precisely because I don't understand ADs. My knowledge comes from what I have read. If I don't properly understand a condition that my DD has apparently been diagnosed with, then what does that say about the people (person) that has done the diagnosis?

My argument is that DD is being let down. I'm being urged to go along with this 'diagnosis' because why? we have been offered no therapy, no additional sessions, no advice on where to go or what to do. They want to discharge us and if it wasn't for the other excellent professionals involved (who happen to agree that we are being let down) it would have been case closed. Good bye. Get on with it. How is that meant to help me or my DD?

Is he definitely a clinical psychologist as that would mean he can diagnose...

A question I would recommend you ask is what his formulation of your daughter's problems is - if he is a clinical psychologist and hasn't done a formulation i would be very concerned about his level of expertise and be asking to talk to his supervisor! A formulation is a way of understanding how someone might have got to their current situation, based on their early and more recent life experiences.

I agree that it could be both attachment and ASD - disordered attachment is a pretty serious and relatively rare outcome of developmental trauma though as it means the child swings between seeking comfort from an attachment figure and feeling too unsafe to do so (based on prior inconsistent responses from that person). A classic example is when a child is abused when they display emotion once and then comforted the next time. They don't know whether they're coming or going in other words and constantly feel unsafe (Which activates the attachment system)

Hope that makes sense! At least CIN are being helpful for once...

I meant to add, so it may be more that your dd displays insecure attachment.

No I get that you are not being given all available options from your local team. They should never just vaguely say they think it could be something, or nothing, or what have you, and leave you dangling with no support. It's true that you are being let down. What I'm saying above is that at the start of the thread you were insistent that your DD had never experienced trauma in her life, and that thefore it was somehow less likely to be some form of AD, because it's usually caused by trauma. As the thread goes along you say that in fact there WAS lots of awful trauma and upheaval for her, but she was 3 and her sister is fine and has not been affected and so it sounds as though you are almost minimising the potential trauma that has caused. You said that at one stage that you hadn't realised your relationship was abusive. I was pointing out that maybe you have also not realised how traumatic it was for your DD to be moved from a loved one and into an abusive situation. You only mentioned it part of the way through the thread, after previously saying she'd had no trauma. This is what I'm getting at. I also totally agree with you that it could still be autism, and that you need a full assessment, not just generalised remarks from someone unqualified to do so. Absolutely could be ASD, or AD, and could be both, or neither! You must get her seen by a professional. At this stage I would contact your local MP, head of department where she's been seen so far, head of Health and social care at the council, and school SENCO if they're any good. They all need to know this is not good enough and that you're not going to go away.

Oh, I see what you mean. When I wrote the op, I was under the genuine impression that attachment is formed during the first three years and I can honestly say there was no trauma during those years. We had s good attachment and relationship. Things were good between me when I first moved in. The problems crept in later when he got a job he could commute to and was around more.

I have read things like this en.m.wikipedia.org/wiki/Attachment_disorder about the disorder.

I suppose in some ways I'm defensive because the tone of CAMHS is this must be a parental issue and with it, a certain level of blame. I don't think I'm imagining it because dozens of other people report feeling that same blame when they have had to access CAMHS for their children. It's almost like they are looking for something to hang all the problems on and you are almost interrogated in pursuit of that.

If it's AD, then no problem. I'll accept that. But prove to me first that this definitely isn't caused by ASD. There's a simple way to do that, refer her for assessment. But they absolutely, point blank, will not. I already know why, it's a cost cutting exercise because they're overstretched. I have a reasonable level of sympathy with that. But this is my child we are talking about. What price can you put on a young child's life? She isn't just a sodding NHS number, she's a person who is in extreme pain and emotional distress and I do not have the expertise to help her. Plus this is affecting her whole family.

In any event, I do not recognise some of the symptoms of AD in my daughter. True, our relationship has suffered but precisely because of her behaviour. I walk on egg shells with her because the consequences of a meltdown can result in her attempting self harm. But generally, we are reasonably close. She can be awkward about it but she dies give me affection. She does not display inappropriate affection to strangers, she is not clingy with me. She, for the most part, accepts my boundaries. Her meltdowns revolve around a high level of perfection, very low self worth and self image, high anxiety and inability to make friends.

They have based their assessment on a tiny snap shot of my daughter in an unfamiliar setting with a male member of staff and tell me she makes good eye contact so she can't have autism, ie. incorrect diagnostic criteria that has already been debunked as essential to diagnosis.

I apologise for my defensiveness. It's just that I'm so frustrated that they won't listen to me and see my daughter as a priority and worthy of spending some of the NHS budget.

Find out who your local clinical commissioning group are and send them an email with exactly that in it. Believe me, it's frustrating working in it and knowing it's not good enough - commissioners need to know that too. Good luck with your daughter - and ask about that formulation...

AD have to occur before 3. After this children can suffer trauma certainly but not true attachment disorders.

Yes, that was my understanding Should.

A little update: I went to our final CAMHS appointment on my own with a list of questions. It could be my imagination, but the worker has changed his tune slightly and I think this is entirely down to the phone call the teacher made.

They are now saying it is not an attachment disorder, nor is it attachment issues. They are describing the issues as 'relational problems'. I have always been honest with everyone and said that my relationship with my DD is fractured at the moment but that is because she is so difficult. We had a very close relationship before all these problems manifested. I know I need to work on this with her, but I do not think our relationship is at the heart of the problems, more a consequence of whatever is going on. I can understand that this may be clouding the issues though.

I asked if there could be something else going on and he said yes, he is not qualified to discount or diagnose ASD, particularly as girls mask well but felt it isn't adhd. He explained that he was looking at the situation in terms of the most simple explanation and that is my relationship with DD. I asked how we get a referral for assessment. He said the school must do this via an exucational psychologist.

He acknowledged that we have not received a good service to date and gave some organisational reasons for this. To be fair, we had already been referred, then DD hit crisis point and so he met us at a particularly bad time. He felt communication between the various parties had not been good. They are trying to work out if she can have further sessions without having to be referred again and have a female worker but I'm not holding my breath.

On the point of the female worker, both me and the school told CAMHS that DD does not relate well to males but the psychologist says he never got that info. He asked why I had accepted a male worker so I had to explain all the times we were denied an appointment following referral by my GP and that I didn't feel in a position to be choosy. We'd already had to wait several months following our initial appointment and several years since I first asked for help.

So, still no further forward but I'm so glad my DD has other professions fighting her corner, particularly as at this point I'm so worn down dealing with her behaviour and just getting someone to listen to us. Thank you also to everyone here. I've posted a lot about this situation under various NNs and am so grateful to have a place to vent and get advice

Well, you are a bit further forward! Hang in there, it can feel like a long hard slog. Try and take care of you too- you need it!

I just wanted to say.I feel we are in a similar situation.Though Cahms were actually really good and never once did I ever hear the words "attachment disorder" in our 18 month engagement with them.After taking a full developmental history going right back to my childhood and with me being extremely honest and informing them about the trauma I'd suffered as a child,Cahms then did 6 observations of me and my son and then some further observations of my son alone and concluded within the first 3 months he needed an asc referral.10 months later my son who was 6 at the time was diagnosed with asc with a profile of extreme demand avoidance (pda)The asc team said there was no doubt when they were having thier discussion that the diagnosis was going to be given.Fast forward a further 7 months and ss (disabled children's team have offered no support at all)When I questioned why they said it's because he doesn't present like the other autistic children they work with.Right ok and what does that mean.A few months later my son saw a phychologist who said that even though she couldn't assess my son for attachment because he wouldn't engage with her and as is diagnosis of pda isn't formal (well it wouldn't be as it's not in the diagnostic Manuals yet his diagnosis is the closest they will get to diagnosing it)as he doesn't present stereotypically autistic he must have ad instead.Ive been struggling with this ever since.The phychologist was only an opinion not a diagnosis as by law she is t allowed to diagnose on her own so my sons original diagnosis still stands as far as everyone is concerned.However he's still not receiving any support and it feels to me like everyone disbeliefs his diagnosis which is shocking in essence that this diagnosis will stick and if some think it's wrong it needs re looking at.Or someone admits to me that the phychologist was just being how do I put it politely very incompetent so I can get back to doing my very best to meet my sons extra needs.Basically there is my story in line with this arguement because as far as I'm aware pda closely matches ad and was just wondering if you've looked into pda at all

Sorry that comment is rushed but about to dish up tea lol