to wonder why attachment disorder is so often dx in children with neuro diversity? n

[staydazzling]

its something i read a lot of, especially children, dx coming from CAHMS with parents saying their children were dx with Attachment Disorder. Im a bit curious really, my understanding is that attachment disorder is due to trauma or trauma based from mother/parents and that the child doesn't form an appropriate attachment? it sounds a bit like refrigerator mother, which i thought became outdated in terms of ASD decades ago?, sorry i thinking out loud a bit, any views, ideas appreciated just trying to make sense of it xx

Is attachment "disorder" not a bit dated anyhow? It's not really in my experience a diagnosis as such now.

I think they can present quite similarly, at least superficially. I certainly know of a couple of adopted children who were initially diagnosed w attachment disorder but later diagnosed with asd. When treated as children w asd rather than children with attachment disorder, they did much better.

My daughter is overly attached to me because I interpret the world for her, and she feels safe with me. An attachment disorder was hinted at but it’s much more than that, I think.

Also, some of the neuronal malformation / incorrect development that happens in trauma has similarities to brain anomalies in SEN children, if I recall correctly.

They are different, but as barbarian says they can have superficial similarities. Attachment disorder is not some out dated reference to refrigerator mothers and autism, but a genuine dx caused by early lack of attachment. The fact that some people might not be able to separate the superficial similarities doesn't make it outdated in itself or a slur on Autism.

It's probably out dated but then I don't like neuro.diverse either it completely minimizes how severe autism can affect people .

I work with children in the youth offending service, attachment disorder can look very similar to several other disorders (ASD, ADHD and depression, for example). I think doctors sometimes get it wrong, and sometimes it is just lazy diagnosis where other options haven't properly been explored.

Attachment disorder is a valid diagnosis - but should only be considered when the child has a history of early attachment trauma like separation or abuse. I have heard this diganosis thrown around (mainly by CAMHs practitioners) for children where this couldn't be further than the truth, and I do wonder what they're basing it on...

The term neurodiverse isn't just relating to autism, though, I'm neurodiverse because I have adhd and other issues.

AD and ASD present very similarly. And there are cross overs with strategies to help both issues.

I haven't heard of refrigerator mother, I'm off to google it.

Warning - Idiot here.

Are you considered to have an attachment disorder if you didn't have a primary carer, like babies in children's homes, and adopted children.

Because the things that look like developmental disorders can also look like attachment disorders. It's not at all unusual for children who have attachment disorders due to how they were cared for as very small children to come from families with a history of ASD and other developmental disorders.

It takes time to untangle what is developmental and what is attachment based. Some children will have both, some being more affected by one than the other. Other children will only have one, but that's often not obvious until they're older.

I'm an adoptive mum, and both our children have attachment disorder, caused by early neglect and abuse. It's a very real challenge faced by many many adopted children. They also have FASD and the oldest has ADHD, and there's a definite overlap in a lot of the characteristics.

I have 2 with ASD - both pushing towards severe - and I'm fine with neurodiverse because they're far from identical and the rest of us in the wider family are far from NT.

drabarni my understanding is that it's a bit more complex. At the extreme end the Romanian orphanages are an example. But dc can have a supposed primary carer such as a birth parent that is abusive and have ad, or several people providing loving primary care and not do. It's more about early experience shaping the ability to bond/ attach than about physical situations beyond the extreme. I believe it's more common in adopted children because of the reasons for adoption in the first place, rather than adoption itself causing it.

Also agree with modra re neuro diversity.

Hmm. I think attachment disorder has become very likely to be bandied about by people who have insufficient knowledge about neurodiversity.

Too nag to post here. Read up on Margaret Mahler and Michael Rutter.
It was Bettleheim who described refrigerator parents but that’s more or less been debunked.
The thought is that the parent child relationship is reciprocal. Usually as babies respond to their mothers, then the mothers adjust their reaction to meet the infants emotional needs. All is good.
Problems occur where this symbiosis is disrupted and attachment disorders can develop. Either a mother isn’t able, for whatever reason, to meet the babies emotional needs so the attachment fails or a child has developmental idiosyncrasies that means it cannot give the feedback to its mother to promote a healthy attachment.
Obviously children with ASD often cannot engage with their mother when they are babies. That’s then a challenge mothers need to overcome to encourage strong attachment and healthy development. Some mothers may be able to do this but for many it’s too difficult and the child develops an attachment disorder alongside and exacerbating their ASD.

I have NC to protect my DC's identity and because there is always stigma around attachment difficulties.

Attachment difficulties aren't always down to neglect or poor parenting. I have a DC with attachment difficulties (diagnosed as that, not attachment disorder) due to a bereavement, it is co-morbid with PTSD. They think everyone is going to leave them. I often get people, including some HCPs, asking if they've got ASD - some are quite persistent. DC hasn't, specialist trauma CAMHS professionals working with us agree they don't, though I have other DC who do. In some ways they present similarly and in other ways they don't.

StrangerstoLove, that was my wondering /thoughts aswell, especially in areas that 'dont recognise PDA' i find it interesting that theres no influx of concern about its over diagnosis aswell ... x2boys, thats interesting ive never heard anyone object to it before. i suppose it can in a way i was just trying to find a neutral term to cover all of them, asd, adhd, etc. By the way incase theres been any confusion im not doubting the existence of AD its the over diagnosis of ASD children im. asking about and why?

From my experience, attachment disorder can often form in kids from happy families too when babies form a bond with grandparents / aunts and uncles and then for some reason these adults can no longer see them / they die. Or when the mums are so overworked they leave their babies under the supervision of elderly grandparents who don’t interact with the baby.

It happens in a lot in Indian families and is considered to be one of the reasons why anxiety / depression is so common amongst children living in extended Indian families. One of the ‘treatments’ if caught early is for the baby to spend 1-2-1 time with their parents.

As an aspie i would love to answer that for you....unfortunately, the prodigal son was born 2.5 years after me and i kind of got forgotten and cast aside. Ended up being the black sheep in a family full of narcs

What i do know is that when i was about 3-4 years old i had imaginary friends and i preferred their company than humans.
At night i was an insomniac (still am to a large extent) so i would whisper to myself, just talking-out my daydream rather than imagining it.
I couldn't daydream about things until i'd allocated all my family members a storyline where they were safe and happy - and in their own home.
Then i could happily daydream about anything knowing that 'family' weren't part of the picture or my imaginary life.

My upbringing was abusive and family dynamics were toxic.
So even though i exhibit a lot of traits re an attachment disorder, i can't be certain how much of it's due to neurological wiring and how much is due to environment.

I hope it provides some sort of insight though.

It happens in a lot in Indian families and is considered to be one of the reasons why anxiety / depression is so common amongst children living in extended Indian families

omg teddy!
and i just kind of cross posted with you!

Thankyou for sharing that, you've just provided the missing link in my thoughts awesome! love it! Thankyou!

Attachment is a spectrum and relies on the interaction and reciprocity in a relationship between a child and their primary care giver. I dont like the term attachment disorder as it pathologies a human process, connection. I prefer and use the use disordered attachment style.

I have worked with individuals with RAD and autism. It must be really difficult for health professionals to determine whether difficulties with forming secure attachments derive mainly from the child's early experience in a challenging family context or because the characteristics of autism make the formation of secure attachments difficult.

I think, perhaps, the connotations that arise from each diagnostic label are somewhat more central to this discussion. If a child is 'diagnosed' with an attachment disorder, assumptions are made about the familial context and the environment in which the child has been raised, with autism, people assume the difficulties have a more 'pathological' root.

It happens in a lot in Indian families and is considered to be one of the reasons why anxiety / depression is so common amongst children living in extended Indian families

Is there an evidence base for this? The studies by Albert et al suggest less anxiety as a result of attachment in Indian teenagers compared to Germany.

The study you quoted doesn’t really focus on Indians. There are no definitive studies around the MH of Indian children mainly because MH is still a stigma. Parents often only go to the doctor when things are really bad and even then only tend to seek treatment for boys. In many Indian households girls are not quite neglected but definitely have their childhoods cut short - there is often an expectation to start learning how to cook / clean / be independent (and not play outside due to the fear of sex abuse) at 5-7 years old while boys are typically babied well into their teens but also seen as ‘immune’ to sexual abuse. There is only one proper Indian study sponsored by the government around abuse and it shows that 71% of the girls surveyed were neglected and over 50% of boys were sexually abused.

It’s like the statistics around breast cancer a few decades ago - western research said Indian / Pakistani women were less likely to get it for a variety of reasons but Indian doctors (and families) knew that was not the case & it seemed research wasn’t marrying up to anecdotal experience. Then it was identified that actually the biggest reason was they were dying from complications of undiagnosed breast cancer (or bc diagnosed too late) and now improved diagnosis has identified an increased risk of certain aggressive breast cancers amongst South Asian women. It’s the same with anxiety / attachment disorders - Indian psychiatrists and doctors know it’s happening and can see the symptoms, Indian parents living in extended families know their kids are often very different than those who don’t, but because being quiet and shy and wary of strangers is seen as a good thing culturally (especially in girls) it’s not seen as a problem unless it results in disruptive behaviour. We will probably see more definitive studies coming out of India as the size of Indian Middle Class families get smaller and more parents adopt a US style approach to MH.

Teddy ear45. No it focuses on a comparison and attachment is only a part of that.
If there is no evidence base, is it not simply untested opinion , anecdotal experience that is not necessarily reflective of the wider truth and possibly even racist conjecture?