For many years after the end of World War II, Japanese soldiers left alone on a deserted island would greet those who tried to rescue them with gunfire. Why? Because they didn't know the war was over, so they were still in survival mode. For many children who have suffered poor care, abandonment, trauma, or multiple foster placements in the first two years of life, this is their reality. Even if they are placed in a safe environment with stable, loving caretakers, many of them have lost or never developed a basic ability to trust. Many Americans try to adopt these damaged, untrusting children, showering them with love and gifts, wishing to make up for past deprivation. Invariably in my practice, I hear these parents tell me their child doesn't seem to appreciate all that they have given him/her, and they often wonder if the child even loves them. What causes this?

Most children who have been street children or in foster care have either never developed a basic trust in primary caretakers (mother or father) or have had a break in that bond in the first 3 years of life. These children's brains don't develop in the normal way. According to Dr. Dan Amen, the key to this lies in the limbic system, which controls pleasure, emotion, and coping with threats. When a baby receives proper care, the limbic system causes satisfaction and pleasure to be associated with the parents. When the child is threatened or uncomfortable (for example, wet or hungry), the limbic system is flooded with cortisol and adrenaline. This flooding is part of the fight or flight response, which is an innate survival mechanism in the brain. The parents' efforts to soothe and meet the baby's needs help to override this and calm the limbic system. The association of pleasure and safety/relief in the brain comprises trust.

As the child's brain grows and matures (full maturation takes place at about age 20), another part of the brain, the pre-frontal cortex develops. This part of the brain is responsible for judgment, reason, focus, and cause-and-effect thinking. Parents' ability to help calm the limbic system in the lower brain enables the higher brain to kick in. Dr. Daniel Goleman, author of "Emotional Intelligence" says that something has to override the lower brain's natural response to stress/perceived threats in order for the flood of stress chemicals to not overwhelm the brain.

Children who have had major breaks in bonding or who have been abused or neglected have brains that are chronically on overload. They have habituated to the threat mode, and this can be triggered by something as simple as being told to sit down or stop throwing rocks. They cannot, on their own, override their natural stress response. In fact, they are easily over stimulated because the brain has not learned to let the frontal cortex kick in to self-regulate. This is why kids in survival mode don't feel gratified and simply satisfied with receiving love and gifts. To a lesser or greater degree, they suffer from Attachment Disorder (that is, a reaction to former abuse, neglect, or the loss of a parent).

Symptoms of Attachment Disorder are:

  • Controlling personality
  • Chronic stealing/lying
  • Cruelty to animals
  • Destroying property
  • Hurting self
  • Fire setting
  • Gorging or hoarding food
  • Outbursts of rage
  • Indiscriminate affection
  • Poor conscience development
  • Poor eye contact
  • Poor peer relationships
  • Preoccupation with fire, gore, and blood
  • Seductive behaviors
  • Bestiality
  • Triangulation (setting one adult against another through deception and manipulation)

How does a child heal? Is simply giving love and freedom enough? The answer, for these children, is "no." If you had a bucket with holes in it and you poured water in it, you would discover that you needed to fix the bucket if you wanted the water to stay in. With these kids, you need to help them have self-control and ability to value others if the love you give them is ever to go in and stay in (if you've ever seen a child who hugs and "loves" countless strangers, you know what I mean). Keep in mind that some kids go through horrendous histories and come out of it with attachment issues, but not the disorder (which ranges from mild to severe).

What is needed for a child with Attachment Disorder is a program administered by parents or a parent team that not only manages behavior, but facilitates attachment to a few enduring special people who are involved in their everyday lives. The goal is to help parents control themselves and the environment and avoid attempting to control or "fix" the child. We try to build in and incentivize the brains overriding survival mode behavior by emphasizing respect and responsibility. One basic in respect is saying "Yes, Mom" and "Yes, Dad" when their parent calls their name. An immediate "No" is a survival mode response, and we want to help the brain learn a new way. That also means speaking respectfully to other adults. Many of these children do not trust adults (because adults have abused or mistreated them in the past). However, they need help to override the immediate and global mistrust of all adults.

When children with Attachment Disorder are blatantly disrespectful to parents, I have the parents assign chores (in a non-angry way) as a consequence (not as punishment). The idea is that if they waste the parent's time and energy with disrespect, they need to pay back with time and energy in the form of work. This is a restitution model. It helps to build conscience and social empathy. It also helps their brain learn to exercise cause and effect, thus overriding the threat response over time.

Another important element of healing is chores. Children need to not only take care of themselves, but also to contribute to the rest of the "family" in order to feel valued. It helps them learn life skills.

It is important that when these children destroy property that they pay for it in some form or fashion, either with money, by fixing the thing they've broken or by doing other work to pay off the debt. They won't heal and come out of constant survival mode without this.

Privileges must be earned. And the children must show that they can handle freedoms and privileges to keep them. Children with Attachment Disorder are easily overwhelmed and flooded with stress chemicals, so you build in things that help them control that. For instance, a boy who is swimming and getting rough with other children is showing that he is not ready for swimming and needs to come out of the pool. A child who gets in trouble on the far side of the playground is not ready to be so far from the adults, and thus needs to stay closer until she demonstrates, through behavior, that she is ready to go by the rules.

Lastly, these kids need to learn to give good hugs and give good eye contact to parents or the parent team. Parents have to insist on this. Hugs are essential for children to bond with the special people in their lives.

This is not a comprehensive paper on Attachment Disorder or therapeutic parenting, but simply an attempt to address what the needs of these children are. It is vital for parents, educators, and social workers to work together and stay in communication to help these kids. Before they heal, they may try to triangulate educators against parents or social worker against parents. It is important to remember the fear, hurt, and anger underneath these behaviors and be ready with a plan (for instance, if the child tells a teacher his parents don't feed him lunch, the teacher and the child should talk to the parents together).

It is a challenge for parents and caretakers to learn these techniques. To the outsider they may seem to be lacking in compassion. But if you really want the bucket to hold the water, you have to understand the nature of the bucket, the holes in it, and how to fix it. The goal is for these kids to be able to hold onto the good that is given to them, to refrain from harming others as they have been harmed, and for them to be contributing members of society.