This chapter addresses the problem of violence among children and attachment disorder in families, the child welfare system, and society. Attachment disorder is one of the most easily diagnosed and yet commonly misunderstood parent-child disorders. Many social service and mental health professionals, although adept at assessing behavioral and emotional disorders in children, are not familiar with attachment concepts. Children with attachment disorder have internalized antisocial values, belief system, and patterns of relating: dishonesty, coercion, aggression, mistrust, betrayal, and selfishness. These children lack the ability to identify and manage emotions, communicate honestly, regulate impulses, and solve problems effectively. Treatment must emphasize prosocial coping skills so that they can function successfully in families and in society. Teaching prosocial coping skills not only reduces acting-out, but also builds self-confidence and self-esteem. Specialized parenting skills are required in order to be successful in their parenting role. A significant amount of evidence accumulated over the past 25 years indicates that early intervention and prevention programs are effective for at-risk children and families. Early intervention and prevention programs have shown to enhance parent–children attachment, foster children's cognitive and social development, and reduce later violence.

Attachment theory assumes that the developing infant's early attachment-related experiences are in time represented cognitively in the form of internal working models of self and other, which in turn affect personality functioning and relationships throughout life. This chapter discusses and integrates Western psychological theories and Buddhist views of attachment as they relate to the evolving personal theoretical orientation and psychotherapy practice. While Western psychological theory focuses on how attachment, separation, and loss affect development, the Buddhist concept of attachment and aversion focus on one's characteristic interaction with experience. From the Buddhist perspective, aversion is actually negative attachment. While the integration of Buddhist principles of attachment and nonattachment may expand the interpretive possibilities, it probably is the case that not all psychological problems and issues are rooted in attachment-related experiences. A limitation of the integration of Western and Buddhist models is the difficulty, in general, of integrating approaches that are based on differing assumptions. Paradoxically, this may also be a strength, depending on one's experience and ability to understand and hold contradictions. In short, both Western psychological theory and Buddhism offer paths toward wholeness and mental health by focusing on different sides, angles, and dimensions of the attachment experience.

Attachment theory is a theory of the close affectional bonds which remain with people throughout life. Further, attachment theory can be viewed as a theory of trauma where the absence of or break in secure connection to others is a source of anxiety and traumatic stress. This chapter takes the position that attachment theory provides a natural theoretical frame for couples therapy interventions when couples complain of conflict and isolation, often accompanied by depression and despair. One of the key developments in the field of couples therapy since the late 1980s has been an empirically guided delineation of the nature of marital distress. Three aspects that have been investigated are the experiencing and communication of emotion between partners, patterns of interaction of distressed couples, and attributions each partner makes concerning the other's behaviors. Emotionally focused therapy (EFT) is a clinical intervention that addresses separation distress and attachment insecurity in adults. Attachment theory provides a needed theoretical base for marital therapy interventions, interventions designed to create not just more skilled negotiation, but secure attachment. In the EFT approach the first task of the therapist is to create a secure base in the therapy sessions. Research suggests that if partners believe that their spouse genuinely cares for them it is easier for them to engage with the therapist and the therapeutic process.

This chapter examines four critical aspects of substitute care that can have an important influence on supporting or fostering healthy attachment in dependent children in the child welfare system. These areas are assessment, recruitment of substitute families, training and support of foster and adoptive families, and special issues. In each area of focus, the chapter presents a case from the work with children and families that illustrates potential problems, strategies, and solutions. Moreover, the chapter presents some structural considerations for the agency or organization that is aware that its policies and procedures can have a profound impact on a child's experience with and capacity for attachment as he or she moves through the system of care. A comprehensive assessment should be conducted by a clinician with a good working knowledge of attachment theory, the signs of insecure attachment, and signs of attachment disorder. It must be acknowledged that it is difficult, but not impossible, to do appropriate and accurate screening during the initial removal of a child from his or her home. It is incumbent on the clinician to communicate empathy, interest, and a genuine desire to learn from the family any information that will help the agency effectively care for their child. Extensive information regarding the prenatal and infant/toddler years of the child as well as the parent's impressions of his or her own childhood, and the affect and intonation with which they speak about these issues, provide beginning clues to the bond that flows between parent and child.

This chapter explores the issues of attachment disorders and community-focused services and describes a program which incorporates some of these principles. It also highlights some steps which could be taken to reduce the impact of attachment disorder on individuals and on society. With an increasing awareness of the risk factors for the development of attachment disorder and an increasing awareness of the difficulty in successfully treating a child with attachment disorder, it makes sense for society to begin to address those risk factors. Prevention of attachment disorder should be our primary goal. Successfully treating a child with attachment disorder requires a coordinated team approach, enlisting the assistance of significant others and community systems. Attachment disorder is not addressed by focusing only on the child. Failure to recognize the severity of this problem or to address it from a societal level, has serious consequences at all levels of our society. The costs of ignoring this problem are great, both on a financial level and in terms of human lives. The first step is to increase awareness of attachment disorder, including its etiology and impact on society. The next step is to brainstorm about the services currently in place that might be altered or adapted to address this problem. Communities can work together to prevent attachment disorder and to treat children with attachment disorder or they will end up working together to pay for the impact of attachment disorder on their community.

Individuals within the military suffer losses and separations and continually cope with the anticipation of those in the future, whether planned or not. Children within the military setting have significant issues with regard to separations, changes from one geographic area to another, having a variety of caregivers prior to entering a school setting, and being able to develop relationships in a foreign environment. The combination of these and other factors may induce fears of abandonment within a child with consequent depression, anxiety, and behavioral acting-out of these feeling through withdrawal and/or aggression. Also, the child may be living in a home where one or both of the parents have problems surrounding the use of chemical substances and the child's needs are not appropriately met and inappropriate boundaries are established. The child may respond to these situations with avoidance, aggressiveness, indifference, or any combination of behaviors. Interventions can include a variety of steps from mild reminders to the child, to intensive outpatient treatment, to inpatient treatment with parent retraining as to how to appropriately manage a child who has had severe attachment breaks. The child, even as old as age ten, can receive interventions that ameliorate the undesired behavior to the extent that the child is able to function relatively well in typical social settings. This is an outcome that is devoutly to be wished for since the alternative is ongoing conflict with societal rules and regulations that may result in the child being unable to lead a fairly happy, rewarding life.

Adopted children have significant connections to at least two family systems—one by biology, birth, and ancestry; the other by law, learning, and day-to-day parenting. All adopted children have prior bonds with their birth parents, but not all develop secure attachments with their adoptive parents. All adopted children have at least one significant loss—the loss of the genetic and birth bond with their biological parents and families. The “searching,” either literal or emotional, done by most adoptees is driven by this loss. Many adopted children have additional significant losses as well as maltreatment and trauma. Understanding and assessing the family system when treating children with attachment disorder is crucial to treatment success. Since compromised and disrupted attachment occurs in the context of the family, not just the caregiver-child relationship, treatment must also focus on the family. Treatment always involves the child and parents. The treatment program focuses on five primary areas within the family system—Child (addresses prior psychosocial trauma and disrupted attachment and improve internal working model (belief system) and prosocial coping skills); parent–child relationship (facilitates secure attachment patterns, including trust, emotional closeness, and positive reciprocity); family dynamics (modifies negative patterns of relating, enhance stability, support, and positive emotional climate); parents (addresses family-of-origin issues that inhibit effective personal and interpersonal functioning); and parenting skills (learns the concepts, attitudes, and skills of Corrective Attachment Parenting).

This chapter explores a number of cases in which recognition, diagnosis, and treatment of childhood mood disorders have greatly enhanced the quality of life of attachment-disordered children and their families. Medical treatment plans for maltreated children are capable of either promoting or inhibiting a child's well-being. Medications, with the help of other effective treatment techniques, are capable of enormously enhancing the child's abilities to demonstrate attachment behavior, or conversely, contribute to a child's lack of sufficient progress in developing attachment behavior. Many children have made dramatic progress with a reconceptualization of the etiology of their symptom complexes. With a new understanding of the physiological contributions in attachment-disordered children, psychopharmacological intervention has contributed substantial improvement in large numbers of maltreated (abused and/or neglected) children with associated attachment difficulties. Diagnoses are formulated by evaluating three separate criteria. These are the child's personal and family history, emotional and behavioral symptoms, and mental status, the latter being an assessment of his or her current functional ability. An examination of these criteria is important to explain how childhood mood disorders correlate with Reactive Attachment Disorder.

Attention Deficit Hyperactivity Disorder (ADHD) has recently become one of the most controversial of the so-called psychiatric disorders because of a startling rise in its incidence in American children and because it is most commonly treated with the psychostimulant medication Ritalin, which is classified as a controlled substance. This escalating controversy has increased competition, criticism, and conflict between parents, teachers, physicians, and psychotherapists. This debate continues to swirl, primarily in the areas of education and mental health, because no consensus on the origin and nature of ADHD or on the most appropriate ways to treat the disorder has been achieved. Children are programmed for health and have a tremendous capacity for self-healing. For this reason, interventions that promote permanent internal healing for children, like family therapy, are preferred over temporary drug-induced relief that does not bring about real change. More importantly, medications that maintain a child in a state of lethargy or euphoria can be major obstructions in the course of family therapy. There are times, however, when a therapist's best option might be to encourage caregivers to seek medication for their child or to continue its present use.

Parents of a Reactive Attachment Disordered (RAD) child often silently carry bruises where their child has inflicted pain on their bodies and their hearts, yet they still seek answers and solutions rather than turn away. In order to understand and have a well-defined perspective of the solutions, one must clearly see the problem. Until the child can see the way out, feel safe enough to try and have someone love them enough to lower a steady ladder, the disturbed child will find ways to remain isolated. As the loving caregivers lower the ladder of skills that require trust and the child grabs hold of the concepts and climbs, each step brings him closer to the top. The parents' feet must be on solid ground and steadied before they can reach out to their child. They then can lower a ladder with the steps to success necessary for the child to succeed. Parents need to prepare by—resting, gaining power through knowledge, gathering a support system, reestablishing authority, and facing the problem. As the child reaches for each of the rungs of the ladder and continues the ascent they become stronger. As the child attains new strength he or she becomes more able to handle more privileges. When parents are clear that this child is now on steady ground and ready to move forward with his or her life, then returning some of those items or activities that were enjoyed together is a possibility. Adding them too soon may sabotage their progress.