1. Attachment Disorders
Identifying Symptoms, Challenges, and
Treatment of Attachment Disordered Youth

2. Attachment Disorders
 Jennifer Vernon, MS, LPC – Clinical Manager of Child and
Family Services
 Michelle Anspaugh, MS, LPC – Child and Family Therapist
 Synergy Services, Inc.
 How many of you have been to attachment trainings?
 How many of you currently do attachment work?

3. Attachment Styles of Youth
 Secure Attachment
 Avoidant Attachment
 Anxious Attachment
 Ambivalent/Disorganized Attachment

4. Secure Attachment
 Seek primary attachment figure when distressed.
 Curious and responsive to environment
 Self-confident and good self-esteem
 Empathetic, humorous, playful
 Will try in the face of adversity
 Can ask for help when needed/balanced with
developing independence.
 In shelters for situation specific (parent lost job) or
conflict w/ parent

5. Avoidant Attachment
 Develops when caregiver is rejecting and unresponsive
 Moms/parents – often depressed, drugs/alcohol problems
 Passive and withdrawn behavior – doesn’t express distress
 Avoids closeness to others
 Avoids feelings
 Seldom seeks comfort
 Passive-aggressive
 Don’t expect much/minimize expectations
 Have minimal narrative-facts (explicit memory) vs. emotional
memories (implicit memory)

6. Anxious Attachment
 Develops when caregiver is inconsistent responding to child.
 Anxiety connected to fear of abandonment
 Seeks emotional closeness as “valium” to quiet anxiety.
 Can be charming or whiny/complain
 Non-stop talking, constantly interrupting, or asking questions
 Looks like ADHD
 Uses “impression management”/people pleasers
 Behavior varies depending on who is present
 Rarely openly defiant or passive-aggressive
 Fall in love easily – focus on “other”

7. Ambivalent/Disorganized Attachment
 Most severe attachment disorders
 Often develop into personality disorders and sociopaths
 Root cause is often Betrayal Trauma - occurs when the people or
institutions we depend on for survival violate us in some way
 Child/teen responds with extreme self-reliance
 Very controlling with others
 Push-pull style
 Odd behaviors and unpredictable moods
 Focus on injustices done to them/consider themselves victims
 Openly angry, defy rules, high-risk behaviors, superficially charming, lack
empathy, delinquent acts, self-harm, suicide attempts, cry to get others to
engage, lying, aggression, promiscuity
 RAD, ODD, CD, Complex/Developmental Trauma

8. Experiences That Lead to Attachment Problems
 Abuse and neglect
 Loss of parent
 Unavailability of parent
 Premature birth
 Medical problems (especially before age 2)
 Chronic pain
 Poor prenatal care

9. Challenges of Treatment
 Availability of attachment figure
 Attachment and trauma hx of attachment figures
 Time in tx
 Fears of clients:
 Trusting us
 Allowing others to help
 Being let down (again)
 Being hurt
 Being vulnerable – dangerous

10. Treatment
 PACE
 Connection vs. Correction
 Create a Coherent Narrative
 Connect client’s story to current
behaviors/feelings
 Trauma work
 Educate caregivers/ staff about Therapeutic
Parenting

11. PACE ATTITUDE
Daniel Hughes – Attachment-Focused Family Therapy
 Playfulness
 Acceptance
 Curiosity
 Empathy
Therapist engages youth with this attitude, helping youth engage
relationally in a different way.
Therapist helps the parent/caregiver engage in PACE attitude to
become emotionally connected to youth.

12. How do we get in?
 Connnection vs. Correction:
 Feels counter-intuitive
 Reflect youth’s feelings/inner thoughts before
giving consequences/lecture
 Changing neural feedback loops of interacting
 Speaking to
 Speaking for
 Speaking about

13. Create A Coherent Narrative
 Connect youth’s story to thoughts/feelings
 Trauma Work – Trauma effects attachment.
Ask youth to bridge the gap between
distressing event and emotions/thoughts/body
sensations – between explicit and implicit
memory.
 EMDR, TFCBT, etc.

14. Any Questions?

15. Thank you for attending today

16. References
 Attach.org
 Clark, Mindi Higgins Kessler. (2009) Diagnostic and Treatment
Features of Reactive Attachment Disorder
 Emdria.org
 Forbes, Heather T. and Post, Bryan B. (2009) Beyond Consequences,
Logic, and Control: A Love Based Approach to Helping Children With
Severe Behaviors
 Freyd, Jennifer J., What is Betrayal Trauma? What is Betrayal Trauma
Theory? http://dynamic.uoregon.edu/~jif/defineBT.html
 Hughes (2007). Attachment-Focused Family Therapy