Adopting Children with

Attachment Problems

Daniel A. Hughes

This article describes children with significant attach-

ment problems and summarizes the actions needed to
increase the probability that such children can be suc-
cessfully adopted. Healthy and disordered attachment
patterns are detailed, as well as the principles and
strategies that are important in parenting such children
and the parenting characteristics that should be sought
in selecting families for children with attachment disor-
der. Psychological treatment and other postadoption
services necessary to support the adoption and the
child's ability to successfully form a secure attachment
with the adoptive parents are also highlighted.

Daniel A. Hughes, Ph.D., is a psychologist in private practice. South China, Maine.

0009-4021/99/050541-20 $3.00 1999 Child Welfare League of America 541

542 CHILD WELFARE Vol. LXXVIII, #5 September/October

A successful adoption presupposes that the adopted child

will gradually, and yet in a timely manner, develop a
secure attachment with his or her new family. Most chil-
dren are, in fact, able to form such bonds and the resulting at-
tachment becomes the foundation for both their integration into
the family and for their ongoing psychological development.
Certain children, most often following months or years of se-
vere neglect and abuse as well as multiple placements and
caregivers, develop gaps in their development that impede their
readiness and ability to form attachments with their adoptive
families, no matter how loving and committed those families are.
To facilitate the ability of such children to become a part of fami-
lies, adoption professionals need to understand and develop spe-
cialized programs for them.
The behaviors and needs of children with attachment prob-
lems challenge the professionals responsible for them. After in-
terviewing and observing a particular child, and describing him
or her as being friendly, charming, affectionate, and engaging, an
evaluator may often conclude that the child is able to form an
attachment with adoptive parents. The author, however, used
similar adjectives in describing an 8-year-old girl whom he evalu-
ated a number of years ago. This girl left him confused and
troubled when she asked if he could arrange for her to move from
foster home to foster home every three monthsher idea of an
ideal life.
Those evaluating children for adoption need to be aware of
the observations and findings of professionals and researchers
studying children in institutionalized settings. In 1937, Levy de-
scribed one such child as being "superficially affectionate and
charming" [Levy 1937]. Almost three decades later, Provence and
Lipton [1962] described many children in orphanages as "indis-
criminately friendly." About the same time, Ainsworth [1961] de-
scribed children with a history of maternal deprivation as overly
friendly and "socially promiscuous." A child who initially is
Daniel A. Hughes 543

friendly and engaging can easily lead prospective adoptive par-

ents into assuming that he or she wantsand is able to accept
a reciprocal and positive parent-child bond. Adoption profession-
als must understand and communicate to prospective parents that
such friendliness may indicate the child has difficulty establish-
ing selective attachments.
Children with significant attachment problems manifest fairly
typical behavioral patterns, which, in turn, tend to elicit fairly
common responses from their parents. Such children may have
little or no understanding about what constitutes a parent-child
bond or the interest a parent has in acting upon the child's best
interests. They don't understand that their parents' enjoyment of
and commitment to them is far deeper than their own particular
words or actions. Such children are often friendly with anyone
since they have found such friendliness to induce most adults to
be "nice." By smiling and being charming, they control the situa-
tion, and, to a large part, the behaviors of the adults. The child
determines, without thinking, what is best for him or her and
believes that the task is to get the adult to do as he or she wants.
For children with significant attachment problems, the adult-
child relationship itself is of little interest. It does not occur to
children who lack an understanding of the parent-child relation-
ship that adults would try to understand what was best for them
and then meet their needs. As a result, these children assume that
the adult must be manipulated or intimidated. Once the adult
has given the child what he or she wants, there is little desire for
a relationship with the adult until the next wish comes along. If
an adult grants many wishes and then says "no," the child will
have little use for that person and will try to find another adult
who will provide what is desired. If no other adult is present, the
child will turn back to the first adult and, aware that charm did
not work, will try to wear the adult down through intimidation,
angry outbursts, threats, and defiant behaviors. If that fails, the
child will punish the adult for being "mean," usually by stealing
544 CHILD WELFARE Vol. LXXVIII, #5 September/October

or breaking things or by doing things meant to make the adult

angry and upset. The child essentially is saying, "You made me
unhappy, so I'll make you unhappy too."
In the typical case, parents of such children begin the adop-
tive placement by saying "yes" many times to try to build trust
and reassure their children that they truly want to meet their
needs. They overlook many situations in which a "no" might be
indicated, hoping that, once the child's wishes have been met
often enough, the child will accept the rules and expectations that
are a part of living in their home. These children, however, will
not learn to accept the rules because they are focused on taking
care of their own wishes and have little empathy or concern for
their parents or the interests of the rest of the family. When chil-
dren with attachment problems do not begin to show any recip-
rocal interest in the family, parents begin to blame themselves
and question their decisions and parenting capacities. After a time,
they blame their children and come to believe that they are wanted
by their children only for what they will provide at a particular
moment. They despair that their children will ever want a posi-
tive, reciprocal, parent-child bond, a despair grounded on the re-
alities of attachment problems.
Children with serious attachment problems are unaware of
what is missing in their relationships with their parents. Even if
they were aware of this missing aspect of the relationship, how-
ever, they would not choose to work for such a relationship. En-
tering into a reciprocal parent-child relationship would require
them to give up the control and self-reliance that have enabled
them to survive years of neglect and emotional isolation.
This article delineates an approach that adoption profession-
als and programs can use to lessen the likelihood that the above
scenario will occur. Professionals must understand healthy de-
velopmental attachment and the effects on children when it fails
to occur. Prospective adoptive parents also must understand a
particular child's attachment problems and, in conjunction with
Daniel A. Hughes 545

adoption professionals, decide whether they have the ability and

motivation to adopt such a child. Parents who make the decision
to adopt must receive training in parenting the child so they can
maintain the emotional stability of their home while slowly fa-
cilitating the child's ability to form an attachment with them. They
and their child will need specialized treatment that facilitates this
process and a range of postadoption supportive services.
The disruption of an adoption does not necessarily mean that
the child had significant attachment problems. Adoptions dis-
rupt for a variety of reasons. The adoptive parents may not have
engaged in good parenting because of factors that have nothing
to do with the child: there may have been a poor match between
the child and family; or the child may have manifested disrup-
tive testing behaviors during the initial months of the placement
that may reflect anxiety about forming an attachment rather than
problems forming an attachment. The nature of a child's attach-
ment-related behaviors should always be identified by a quali-
fied professional to determine whether the child's functioning
represents significant attachment difficulties or other factors.

The Development of Attachment

Normal Developmental Attachment
During the first year of life, infants are social beings whose sen-
sory systems focus on interacting with their primary caregivers.
The child's mother easily senses how much attention her infant
needs and joyfully and repeatedly offers it to him.* She touches
and holds him, moves and rocks, sings, smiles, and uses exag-
gerated facial expressions and "babytalk" to communicate her
emotions. During such interactions, which some researchers have
called "attunement" (referring to the sharing of affect between
* The feminine and masculine genders are used here for ease of reading and are not
meant to imply that fathers do not form attachments with their infants, or that male
children develop attachment disorders at a higher rate than female.
546 CHILD WELFARE Vol. LXXVIII, #5 September/October

mother and infant), the infant's brain is stimulated, positive emo-

tions of interest and joy develop, and the child begins to feel spe-
cial [Stern 1985; Schore.1994]. During the first year, the child in-
creasingly prefers his mother and becomes selective in his choice
of adults with whom to relate. He also discovers that interactions
with certain adults are the source of much meaning and enjoy-
ment in life.
In contrast to the first year, when the mother teaches her in-
fant that he is special, during the second year, the mother teaches
her toddler that other members of the family are special as well.
She begins to actively socialize her child by saying "no," chan-
neling his behaviors, setting limits, and not responding to all of
his wishes. When she frustrates her child's wishes, he feels shame,
which is the mother's primary socialization intervention [Schore
1994]. During these interactions, there is no attunement and the
toddler avoids eye contact, tries to hide, and becomes motionless
and speechless. This experience of shame causes emotional dis-
tress, which the mother intuitively recognizes. She reattunes with
her child with a smile, touch, or supportive word, and reassures
him that he is special but also that he must be aware of the rights
and feelings of others. Within moments, the toddler feels special
again as his mother has comforted him in his distress, which she
had caused by saying "no."
Begirming in the second year and well into the third year, the
young child, within the safety of this secure attachment, learns to
integrate both attunement and shame as well as his own wishes
and the demands of socialization. He learns how to remain close
to his mother, the source of both pleasure and distress. As he learns
to accept fully the "good" and "bad" mother as the same person,
he learns to integrate and accept the "good" and "bad" parts of
himself. This integration is crucial if he is to internalize all fea-
tures of his mother and incorporate his attachment to her into his
developing sense of self [Mahler et al. 1975]. The child develops
the ability to consistently feel empathy, tolerate frustrations, regu-
late his emotions, control his behaviors, and recognize the differ-
Daniel A. Hughes 547

ence between right and wrong. He becomes aware of and able to

articulate his thoughts and feelings and begins to soothe himself.
As he "downloads" his parents' love into his developing self, he
trusts that they will do what is best for him and will keep him
safe. A secure attachment and a well-integrated self are two sides
of the same reality, enabling the child to feel that he is special.
Securely attached, he can proceed with the developmental tasks
that lie ahead [Greenspan & Lieberman 1988].
Over the past 50 years, the importance of attachment in the
parent-child relationship has been studied extensively [Karen
1994]. Attachment theory, which originated in the work of John
Bowlby and Mary Ainsworth, has come to refer to the role of
attachment in both healthy psychological development and in
developmental psychopathology [Bowlby 1988; Ainsworth 1978].
Attachment is thought to have a central role in future relation-
ships and psychopathology because the original parent-child
bond is believed to provide the working model for all subsequent
meaningful relationships [Cicchetti et al. 1995]. The readiness and
ability to engage in reciprocal, enjoyable relationships through-
out life is based on the countless attunement experiences that
occur during the first few years of life. The ability to experience
and resolve conflict is based on early experiences of shame that
are followed by reassurance and reattunement with primary at-
tachment figures. The ability to integrate the need for intimacy
with the need for autonomy depends upon how successfully the
individual internalizes primary attachments into early identity
development. Given its central role in early psychological devel-
opment, it is easy to see why a secure attachment is thought to be
central in a child's developing ability to regulate emotions, con-
trol behavior, and establish an integrated sense of self [Schore
1994].
The Effects of Abuse and Neglect on Attachment
Child abuse and neglect have been shown to greatly impede the
development of secure attachment [Crittenden & Ainsworth
548 CHILD WELFARE Vol. LXXVIII, #5 September/October

1989]. Increasingly, the central factor in the intergenerational trans-

mission of childhood maltreatment is thought to be disorders of
attachment [Cicchetti 1989].
Difficulties in establishing and maintaining a secure attach-
ment with one's primary caregivers are likely to exist on a con-
tinuum from mild to severe. Many children who have been
abused, neglected, and/or subjected to multiple caregivers have
symptoms that may not meet the full diagnostic criteria for sig-
nificant attachment disorders, yet they may manifest various char-
acteristics that reflect a disorganized, anxious-ambivalent, or anx-
ious-avoidant attachment with their primary caregivers
[Crittenden & Ainsworth 1989]. Other children manifest severe
difficulties with related attachment.
The developmental sequence that characterizes a secure at-
tachment contrasts significantly with that of a child who experi-
ences chronic neglect, abuse, and placement with multiple
caregivers. Often, the maltreated child does not discover that he
is special; does not learn the joy and interest that is elicited from
experiences of shared affect with his mother; and does not feel
affirmed, identified, or important. Instead, he increasingly feels
isolation and sadness and may eventually feel despair and that
there is little to live for. Because his basic needs for food, warmth,
and physical comfort are most likely not consistently met, his
interests increasingly turn to meeting these fundamentals. He
lacks confidence in his own developing abilities and in his par-
ents, whom he sees as not concerned with his best interests.
Eventually, the child discovers options that may help get his
needs metscreaming at, charming, or manipulating others to
somehow "make" them do things for him, or finding ways to get
what he needs on his own. He becomes increasingly self-reliant,
rejecting the urge to be supported and comforted, and chooses
instead to try to control his environment.
The maltreated child is also shamed constantly, first with non-
verbal messages that his parents have little interest in him, and
Daniel A. Hughes 549

then by rejection when he begins to be mobile and to elicit his

parents' rage [Schore 1994]. He quickly learns to dissociate him-
self from the intense shame and his profound feelings of worth-
lessness and to deny the shame. He withdraws into fantasy and/
or obsessive plotting about controlling the future, and places the
source of his pain outside of himself, assuming a "tough guy"
attitude and/or that of an "innocent victim." The child becomes
increasingly successful at concealing his pain and his vulnerabil-
ity, first from others and then from himself.
Pervasive shame becomes a major part of the child's exist-
ence as his shame "experiences" are seldom followed by reassur-
ance and comfort [Schore 1994]. Gradually, he begins to resist
others' efforts to comfort him and learns to deny feelings of want-
ing to be nurtured and comforted. He experiences what little com-
fort he can through controlling others, causing them distress,
learning to manipulate and intimidate, and acquiring objects in
which he has little interest.
When a child with this background is invited into an adop-
tive family and offered the opportunity to have a positive recip-
rocal relationship with someone who wants to meet his needs, he
is likely to be confused and frightened. He begins to reexperi-
ence feelings from his infancy, i.e., the wish for attunement that
never was fulfilled, as well as pervasive shame, but he quickly
minimizes and denies these feelings. The child rejects the affec-
tion and playful interactions that are offered because he feels vul-
nerable and has no confidence they will last. He also rejects rou-
tine socialization and discipline because he associates discipline
with feelings of intense shame. Because of his past experiences,
he is not interested in a reciprocal relationship or in mutual en-
joyment and shared responsibilities. A child without a history of
secure attachments is likely to develop a variety of symptoms
that reflect an isolated and painful developmental path: little em-
pathy for others, limited awareness of the consequences of his
behavior, little guilt and remorse, difficulty expressing thoughts
550 CHILD WELFARE Vol. LXXVIII, #5 September/October

and feelings, and poor discrimination among relationships. The

regulation of bodily functions, emotions, and behavior may be
poor, with much variability among situations and experiences.
At the same time, the child often has an excessive need to control
every situation.

Reactive Attachment Disorder

When a child manifests most of the above symptoms to a signifi-

cant degree, he may meet the diagnostic criteria for Reactive At-
tachment Disorder (RAD). This disorder is defined as "markedly
disturbed and developmentally inappropriate social relatedness
in most contexts, begirming before five years of age." RAD may
be characterized as either "inhibited" or "uninhibited." In the
inhibited type, social interactions are "excessively inhibited,
hypervigilant, or highly ambivalent and contradictory responses;"
in the uninhibited type, the child manifests "indiscriminate so-
ciability" without "appropriate selective attachments" [Ameri-
can Psychiatric Association 1994]. As yet, there is no clear evi-
dence that one type of attachment disorder is more severe than
the other. It is also not clear whether most children with RAD
manifest both types to some degree. At present, differentiating
between the two types of RAD does not have implications for
treatment or prognostic considerations.
Many children who have been abused and neglected mani-
fest attachment problems to some degree, although they do not
meet the criteria for Reactive Attachment Disorder [Cicchetti
1989]. An assessment of the severity of a child's attachment prob-
lems should include a description of the child's specific symp-
toms as well as answers to the following questions:
1. How severe, chronic, and pervasive were the child's experi-
ences of neglect and abuse?
2. How many caregivers did the child have? (Disrupted rela-
tionships with foster parents are each likely to be experienced
as rejection and abandonment. With each subsequent disrup-
Daniel A. Hughes 551

tion, a child's readiness to form an attachment with the next

caregiver is likely to be less.)
3. Were there any positive, continuing relationships during the
first two years of the child's life?
4. Has the child begun to show any significant improvements
in his current family foster home?
5. Is there any selectivity in the child's attachments?
6. Has the child ever shown grief over loss?
7. Does the child accept help and comforting?
8. Can the child enjoy, without disrupting them, close and play-
ful interactions that are similar to the attunement interactions
mothers have with their infants?
9. Does the child ever directly show shame over his behaviors?
10. Does the child ever show sadness over the consequences of
his behaviors, rather than being enraged over their perceived
unfairness?
11. Can the child experience and give expression to sadness and
to fears?

The Right Match

If a child has not shown signs of developing a secure attachment
with a caregiver, it cannot be assumed that he will begin to do so
when given the permanency of adoption, but neither can it be
assumed that he will not do so. Professionals working with the
child should neither falsely promise positive results to prospec-
tive parents nor conclude that the child is hopeless. Instead, they
should strive to understand the child's attachment problems and
to help the adoptive parents choose a child with whom they are
well matched.
The decision to adopt a child with significant attachment prob-
lems is one that should be made only with full knowledge about
the child and after much deliberation. The adoptive parents
should receive information on all aspects of the child's history
and symptom patterns; have opportunities to speak to the child's
552 CHILD WELFARE Vol. LXXVIII, #5 September/October

foster parents about the nature of their relationships with him

and whether these relationships have changed over time; be
helped to assess how the child's symptoms and needs may relate
to their own personalities and desires; and be given a realistic
appraisal of the challenges that they will face and the skills they
will need to parent the child. Professionals should help the par-
ents to understand that key skills include the ability to regulate
their own emotions, deal with their child's rejection of them with-
out taking it personally, and relate to their child with affection
and empathy w^hile remaining firm and persistent in socializing
the child. Parents also must have the ability to remain committed
to their child even if he fails to make significant progress in his
ability to develop a secure attachment with them. Finally, the
adoptive parents should be provided with appropriate training,
support, and treatment services to help them maximize their
child's ability to securely attach with them.

Parenting Principles and Skills

When parents are able to help their child develop a secure at-
tachment for the first time in that child's life, they are facilitating
the "psychological birth" of their child. To reach that goal, how-
ever, parents must recognize and overcome numerous conflicts
and challenges.
Parenting children with significant attachment disorders re-
quires the ability to engage the child in a manner that facilitates
the same type of shared affective experiences other parents have
with their infants. A parental attitude that communicates empa-
thy, acceptance, affection, curiosity, and playfulness increases the
child's ability to respond to the parent in the same marmer as
would an infant who was securely attached. This parental atti-
tude, which is communicated when the parent places limits on
the child, allows the child to tolerate the shame that discipline
elicits and lessens the likelihood that the child will react with rage.
Daniel A. Hughes 553

Because this attitude is not easy to maintain in the face of con-

tinuing oppositional behaviors and angry outbursts, parents must
be able to regulate their own emotions and not allow their child
to control them. They must be able to express anger in response
to specific behaviors in a quick, direct manner, and then follow
that expression with reassurances and comfort. Parents should
not take personally their child's rejection of their discipline and
affection.
Often, it is necessary to begin an adoptive placement by keep-
ing the child in close physical proximity to his new parents so
they can make many of his choices for him and provide him w^ith
a sense of safety. The child can begin to rely on his parents to
decide which behaviors represent the best choice for him in the
new setting. This results in fewer consequences for misbehavior
because there are fewer misbehaviors, and the child is not re-
peatedly engaged in experiences of failure and shame. This level
of physical presence may need to be present for weeks, or even
months before the child will begin to internalize the choices,
wishes, and values of his parents. Most children with attachment
problems, however, do adapt to this level of parental presence.
As the parents begins to give the child choices and unsuper-
vised time, he is likely to initially make poor choices and respond
to limits with oppositional behaviors and/or angry outbursts.
Through the use of natural and logical consequences, parents can
accept the child's choices and provide him with empathy for the
consequences, striving to be "sad for" his distress over the conse-
quence rather than being "mad at" him for his behavior. If, how-
ever, the child repeatedly engages in the same misbehavior, con-
sequences may need to be more comprehensive and of longer
duration than is customary in raising children without attach-
ment problems. Increased limits on the child as a natural and
logical consequence may be needed to prompt the child to ab-
stain from the significant misbehaviors. When given with empa-
thy and acceptance, natural and logical consequences are not pu-
554 CHILD WELFARE Vol. LXXVIII, #5 September/October

nitive or rejecting and do not put a child at risk of reexperiencing

the abuse and rejection that characterized his original insecure
attachments.
A child who repeatedly misbehaves is unlikely to respond to
positive reinforcement, increased activities with his parents, or
the receipt of concrete objects. The best response to constant mis-
behavior is to give the child the opportunity to be physically close
to his parents once again, as his behavior signals that he is not
ready for independence and freedom of choice. This required
closeness should be explained with empathy and acceptance, and
with assurances that eventually the child will have the opportu-
nity for greater separateness.

Psychological Treatment of Children with Significant

Attachment Problems

Strategies based on traditional treatment principles are not likely

to be effective with children who have significant attachment
problems because of the nature and severity of their psychologi-
cal problems and deficiencies [Hughes 1997; James 1994; Levy &
Orlans 1998]. Traditional therapy presupposes that the child has
the readiness and ability to form a therapeutic relationship that
can be utilized to resolve past traumas and form a more stable
and positive sense of self [Greenspan 1989; Hughes 1997]. Chil-
dren with significant attachment problems are not likely to enter
into a relationship with a therapist that would facilitate such
progress, as they are likely to attempt to manipulate or intimi-
date others, and a trusting relationship is not likely to develop.
Thus, allowing the child to set the pace and direction, as is cus-
tomary in traditional therapy, will lead to continuing avoidance.
The pervasive sense of shame that characterizes these children's
psychological status will generate intense resistance to routine
therapeutic efforts; such children are likely to dissociate from
negative affective experiences as a result. Additionally, because
Daniel A. Hughes 555

traditional therapy sessions do not routinely involve parents, they

fail to incorporate a crucial factor in facilitating a parent-child
attachment.
Therapy for children with significant attachment problems
should be structured to replicate the attachment sequences that
characterize normal developmental attachment. The sequence of
attunement, socialization/shame, and reattunement must be the
central therapeutic experience. With a primary emphasis on par-
ent and therapist attunement with the child's ongoing affective
states, the therapist should work to elicit and share positive af-
fect with the child and provide the child with an opportunity to
experience surprise and delight in response to the adults' active
engagement with him. The child should be helped to feel safe
and tolerate the affective intensity that is generated.
Once the child achieves some level of comfort and relaxation,
the therapist should actively engage the child and help him ex-
plore the sense of shame he has associated with both earlier ex-
periences of neglect and abuse and current experiences of disci-
pline and frustration in his adoptive family. Often, children
strongly resist becoming engaged with the therapist and their
parents and exploring their feelings of shame, fear, rage, and de-
spair [Hughes 1997; Levy & Orlans 1998]. The therapist must work
with this resistance, empathizing the difficulty of the work, and
should approach the resistance with acceptance, playfulness, and
curiosity. The therapist may be the person who initially voices
the realities of the child's early experiences of neglect and abuse,
and should do so with empathy and understanding for the in-
tense affect this information generates within the child. If the child
is to become ready to develop a secure attachment, the therapist
and the child's parents must support and comfort him as he gradu-
ally faces these issues.
Frequently, parents and/or the therapist will touch and hold
the child as he becomes engaged in the stressful and intensely
emotional work. Physical contact may serve the same purpose as
556 CHILD WELFARE Vol. LXXVIII, #5 September/October

the mother who spends so much time holding her infant. When
an adult (the therapist or the parent) holds the child, the adult is
attuned to the child's affective states and creates a "holding envi-
ronment" that provides the child with the security he needs
[Hughes 1997,1998; Levy & Orlans 1998].
"Holding therapy," a form of attachment therapy, has gener-
ated some controversy. In early forms of this therapy, the thera-
pist provoked the child into a rage, then held the child against
his will [Hughes 1998]. Many questioned whether the child was
being retraumatized through this form of "holding" and whether
a "trauma bond" was being formed [James 1994]. Today, most
therapists who hold the child or have the parent hold the child
will first explain the intervention to the child and elicit the child's
consent [Hughes 1997, 1998; Keck 1995; Levy & Orlans 1998].
"Holding" then takes place in an environment of support and
nurturing that facilitates the child's ability and readiness to be-
come engaged in difficult therapeutic work.
The parents' presence in therapy is crucial. By being present,
they can provide their child with emotional support, attunement
experiences, and safety during the stresses of treatment; help the
child to differentiate them from the abusive and neglectful par-
ents in his past; and provide the child with the opportunity to
learn that he does not have to conceal his past from his parents.
The parents can model how to express thoughts and feelings, and
reassure their child about his worth in spite of his past experi-
ences and current behaviors. Parental participation in therapy
enables the therapist to understand how the child is functioning
at home, and provides an opportunity to "check out" the child's
perceptions and to reinforce the parents' authority to the child.
Significant attachment problems tend to be quite resistant to
therapeutic change [Hughes 1997; James 1994; Leyy & Orlans
1998]. As a result, a long period of time is often needed for at-
tachment therapy to facilitate an attachment that will have a major
influence on the child's functioning. When a child's attachment
Daniel A. Hughes 557

problems are mild, the child may respond to the specific inter-
ventions of attachment therapy in less than six to nine months.
More often, 18 to 24 months are required before significant
progress is achieved. Even then, some children, either because of
the severity of their early abuse and neglect or because of neuro-
logical or constitutional factors, do not achieve the gains neces-
sary for them to develop a secure attachment.

Other Postadoption Services

Children who resist forming attachments with their parents
present their adoptive families with intense, ongoing challenges.
For new parents to facilitate attachments with their children, they
need considerable support within the adoption communitysup-
port that is tailored to meet the unique needs of the poorly at-
tached child and his family.
Support groups for adoptive parents of children with attach-
ment problems can be of considerable benefit [Hughes 1998; Keck
1995; Levy & Orlans 1998]. Often, other parents have the greatest
understanding of the difficulties and stresses associated with rais-
ing children with attachment problems, and are best able to offer
support and guidance on parenting interventions that proved to
be effective with their own children. Other parents readily un-
derstand that the problems of children with attachment disor-
ders are intense, real, and longstanding.
Respite services should also be provided for adoptive par-
ents who are trying to meet their child's intense needs. Respite
care provides parents with time to relax and focus on their own
interests and on other relationships. The respite care provider
should understand the nature and severity of the child's attach-
ment problems, should be aware of the adoptive parents' rules
and expectations, and should be willing to follow those guide-
lines. The respite care provider must also be able to anticipate
that the child may portray his parents as mean and unfair through
558 CHILD WELFARE Vol. LXXVIII, #5 September/October

lies and half-truths. The respite care provider must understand

the important of making clear to the child his or her support of
and confidence in the child's parents.
Finally, in-home supportive services, provided by mental
health or family support professionals or paraprofessionals for a
few hours each week, should be available to give parents a re-
spite and enable them to continue providing an intense level of
parenting during the remainder of the week. For such services to
be helpful, however, in-home workers need to function as paren-
tal assistants who reinforce parents' judgments, rules, and au-
thority to the child. They must understand the nature of attach-
ment problems and the interventions that are appropriate. Many
in-home workers are trained to employ traditional behavioral
management techniques. Such techniques, however, are likely to
be ineffective with children w^ho have attachment problems.
If children with attachment problenrs and their adoptive par-
ents are not provided with appropriate services, the risk of adop-
tion disruption increases, as does the possibility that the children
will never achieve the security and support of a permanent adop-
tive family [Keck 1995; Levy & Orlans 1998]. Children with at-
tachment problems are at high risk for frequent moves among
foster homes and other care settings. Under such conditions, the
attachment problems the children have when they enter out-of-
home care are likely to intensify and become more pervasive.
Children who do not achieve secure attachments with significant
caregivers in childhood are likely to manifest various forms of
psychopathology during adolescence and adulthood, and are
likely to have serious problems developing and maintaining at-
tachments with their spouses and children.

Conclusion

A high level of skill and commitment is required when an adop-

tion agency places a child who manifests significant attachment
Daniel A. Hughes 559

problems. Adoptive placements should be carried out in a thor-

ough, professional manner document the nature and severity of
the child's attachment problems. Adoption professionals should
make the prospective adoptive parents fully aware of the child's
problems, the services that the child requires, and the services
that may be needed in the future, as well as the parenting quali-
ties that must be brought to bear to facilitate the child's readiness
and ability to form an attachment. Finally, appropriate treatment
and supportive services must be available to the family.
Neglect and abuse may cause psychological problems that
go far beyond traumatic stress. Chronic neglect, which has been
called the "trauma of absence," can cause significant gaps in the
development of the self. These gaps become evident when a child
has great difficulty in understanding the joy and satisfaction that
comes from a secure attachment with his parents. A child with
attachment problems needs the opportunity to learn how to be-
come attached to good parents who will define for him parental
love and commitment, and show him his own worth and poten-
tial. Such parenting is difficult and should be undertaken only
with full knowledge of and willingness to confront the challenges
involved.

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