Downloaded from http://ebn.bmj.com/ on November 9, 2014 - Published by group.bmj.com
Evidence-Based Nursing Online First, published on September 2, 2014 as 10.1136/eb-2014-101907 Child health eidetic reduction), the interviews were distilled into 190 ‘significant statements’, which were grouped into meanings and emerging themes.
Phenomenology
Adoptive parents can be unprepared for the challenges in caring for children with reactive attachment disorder 10.1136/eb-2014-101907
Anna T Smyke Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana, USA Correspondence to: Dr Anna T Smyke, Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1430 Tulane Avenue #8055, New Orleans, LA 70112, USA; [email protected]
Commentary on: Follan M, McNamara M. A fragile bond: adoptive parents’ experiences of caring for children with a diagnosis of reactive attachment disorder. J Clin Nurs 2014;23:1076–85.
Implications for practice and research ▪ Adoptive parents experience significant challenges in caring for children diagnosed with reactive attachment disorder. ▪ Informing prospective adoptive parents about attachment issues and providing concrete assistance to develop healthy attachment relationships may decrease some of the frustration experienced by parents and children affected with the disorder. ▪ Future research could address factors contributing to the diagnosis of reactive attachment disorder as well as best practices for ameliorating the disorder.
Context Reactive attachment disorder is a rare and challenging disorder that affects children exposed to markedly poor care giving environments and impacts on the individuals who ultimately assume responsibility for their care. Children who have had multiple placements in foster care are likely to have experienced multiple attachment disruptions and may be reticent to attempt to attach again. Adoptive caregivers may have experienced multiple losses themselves, such as fertility issues or the return of fostered children to their biological parents, but may have hopes and dreams associated with the experience of parenting children. These and other issues impact on the child-parent dyad's ability to develop an attachment relationship.1
Findings Four themes were identified: (1) Being unprepared to care for a child with the diagnosis; (2) Being uncertain of one’s own ability to parent adequately and subsequent insecurity in one’s sense of self; (3) Experiencing many unexpected and overwhelming emotions including anger, guilt, confusion and rejection; (4) Remaining committed to the adopted child despite the challenges. The bonds that developed between parents and their children were fragile and subject to ongoing instability. Although the bond developed at an emotional cost to the parents, they voiced their ongoing commitment to the relationship with their children.
Commentary Follan and McNamara explored the experience of adoptive parents whose children had been diagnosed with reactive attachment disorder. Many questions remain unanswered. For example, although now seen as counterproductive, in the past, individuals either fostered or adopted a child, but not both, contributing to at least one attachment disruption for the child before permanency. To fully understand the parents’ response to the experience of caring for children with reactive attachment disorder, knowing about the child's previous foster care experience as well as the reasons for the initial diagnosis of reactive attachment disorder are important. Although the diagnosis of reactive attachment disorder should only be made when there are specific attachment-related issues, for example the child does not turn to the parent for comfort, at times a diagnosis is made for associated oppositional behaviours rather than for attachment-related issues, per se. Although little is known about the initial diagnosis, thinking on reactive attachment disorder has been refined since the time when these children, many now in their teens, would have been diagnosed.2 Parents’ feelings related to caring for their children were similar to those of their children diagnosed with the disorder in that both felt fear, anger, lack of control, insecurity and sadness. The views of the parents, as reported, contained little empathic appreciation for their children’s experience. Perhaps the authors did not ask about this in their interview, and perhaps the feelings of rejection, anger and stress that had arisen over the years made it difficult to consider the child’s experience; nonetheless, this is an important area for intervention. Attachment is a dyadic process; assisting parents to understand their child’s reluctance to develop another attachment relationship, as well as helping them to find ways to assist their child to establish an attachment relationship would be useful. One study has found that foster parents responded in kind to the child’s attachment behaviour; that is, if the child miscued and appeared to not need the foster parent, the foster parent responded by not offering needed comfort to the child.3 An intervention study focused on assisting caregivers to be mindful of the experience of their school age foster child and to develop empathy for the child’s experience.4 Such interventions would foster a positive parallel process for parents of children with challenging attachment experiences. Competing interests None. References
Methods Follan and McNamara undertook semistructured interviews with eight adoptive parents to explore their perceptions and experiences of living their lives as caregivers of children diagnosed with reactive attachment disorder. Using Husserl’s phenomenology, the authors sought to determine the ways in which parents had developed a sense of their lifeworlds as they cared for their adoptive children over time. Using three concepts essential to Husserl’s phenomenology (essences, intuiting and
1. Walker J. The use of attachment theory in adoption and fostering. Adoption Fostering 2008;32:49–57. 2. Rutter M, Kreppner J, Sonuga-Barke E. Emanuel Miller Lecture: attachment insecurity, disinhibited attachment, and attachment disorders: where do research findings leave the concepts? J Child Psychol Psychiatry 2009;50:529–43. 3. Stovall-McClough KC, Dozier M. Forming attachments in foster care: infant attachment behaviors during the first 2 months of placement. Dev Psychopathol 2004;16:253–71. 4. Schofield G, Beek M. Providing a secure base: parenting children in long-term foster family care. Attach Hum Dev 2005;7:3–25.
Evid Based Nurs Month 2014 | volume 0 | number 0 |
1
Copyright Article author (or their employer) 2014. Produced by BMJ Publishing Group Ltd (& BCS) under licence.
Downloaded from http://ebn.bmj.com/ on November 9, 2014 - Published by group.bmj.com
Adoptive parents can be unprepared for the challenges in caring for children with reactive attachment disorder Anna T Smyke Evid Based Nurs published online September 2, 2014
Updated information and services can be found at: http://ebn.bmj.com/content/early/2014/09/02/eb-2014-101907
These include:
References Email alerting service
Topic Collections
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Articles on similar topics can be found in the following collections Child health (51) Child and adolescent psychiatry (148) Child and adolescent psychiatry (paedatrics) (148)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Evidence-Based Nursing Online First, published on September 2, 2014 as 10.1136/eb-2014-101907 Child health eidetic reduction), the interviews were distilled into 190 ‘significant statements’, which were grouped into meanings and emerging themes.
Phenomenology
Adoptive parents can be unprepared for the challenges in caring for children with reactive attachment disorder 10.1136/eb-2014-101907
Anna T Smyke Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana, USA Correspondence to: Dr Anna T Smyke, Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1430 Tulane Avenue #8055, New Orleans, LA 70112, USA; [email protected]
Commentary on: Follan M, McNamara M. A fragile bond: adoptive parents’ experiences of caring for children with a diagnosis of reactive attachment disorder. J Clin Nurs 2014;23:1076–85.
Implications for practice and research ▪ Adoptive parents experience significant challenges in caring for children diagnosed with reactive attachment disorder. ▪ Informing prospective adoptive parents about attachment issues and providing concrete assistance to develop healthy attachment relationships may decrease some of the frustration experienced by parents and children affected with the disorder. ▪ Future research could address factors contributing to the diagnosis of reactive attachment disorder as well as best practices for ameliorating the disorder.
Context Reactive attachment disorder is a rare and challenging disorder that affects children exposed to markedly poor care giving environments and impacts on the individuals who ultimately assume responsibility for their care. Children who have had multiple placements in foster care are likely to have experienced multiple attachment disruptions and may be reticent to attempt to attach again. Adoptive caregivers may have experienced multiple losses themselves, such as fertility issues or the return of fostered children to their biological parents, but may have hopes and dreams associated with the experience of parenting children. These and other issues impact on the child-parent dyad's ability to develop an attachment relationship.1
Findings Four themes were identified: (1) Being unprepared to care for a child with the diagnosis; (2) Being uncertain of one’s own ability to parent adequately and subsequent insecurity in one’s sense of self; (3) Experiencing many unexpected and overwhelming emotions including anger, guilt, confusion and rejection; (4) Remaining committed to the adopted child despite the challenges. The bonds that developed between parents and their children were fragile and subject to ongoing instability. Although the bond developed at an emotional cost to the parents, they voiced their ongoing commitment to the relationship with their children.
Commentary Follan and McNamara explored the experience of adoptive parents whose children had been diagnosed with reactive attachment disorder. Many questions remain unanswered. For example, although now seen as counterproductive, in the past, individuals either fostered or adopted a child, but not both, contributing to at least one attachment disruption for the child before permanency. To fully understand the parents’ response to the experience of caring for children with reactive attachment disorder, knowing about the child's previous foster care experience as well as the reasons for the initial diagnosis of reactive attachment disorder are important. Although the diagnosis of reactive attachment disorder should only be made when there are specific attachment-related issues, for example the child does not turn to the parent for comfort, at times a diagnosis is made for associated oppositional behaviours rather than for attachment-related issues, per se. Although little is known about the initial diagnosis, thinking on reactive attachment disorder has been refined since the time when these children, many now in their teens, would have been diagnosed.2 Parents’ feelings related to caring for their children were similar to those of their children diagnosed with the disorder in that both felt fear, anger, lack of control, insecurity and sadness. The views of the parents, as reported, contained little empathic appreciation for their children’s experience. Perhaps the authors did not ask about this in their interview, and perhaps the feelings of rejection, anger and stress that had arisen over the years made it difficult to consider the child’s experience; nonetheless, this is an important area for intervention. Attachment is a dyadic process; assisting parents to understand their child’s reluctance to develop another attachment relationship, as well as helping them to find ways to assist their child to establish an attachment relationship would be useful. One study has found that foster parents responded in kind to the child’s attachment behaviour; that is, if the child miscued and appeared to not need the foster parent, the foster parent responded by not offering needed comfort to the child.3 An intervention study focused on assisting caregivers to be mindful of the experience of their school age foster child and to develop empathy for the child’s experience.4 Such interventions would foster a positive parallel process for parents of children with challenging attachment experiences. Competing interests None. References
Methods Follan and McNamara undertook semistructured interviews with eight adoptive parents to explore their perceptions and experiences of living their lives as caregivers of children diagnosed with reactive attachment disorder. Using Husserl’s phenomenology, the authors sought to determine the ways in which parents had developed a sense of their lifeworlds as they cared for their adoptive children over time. Using three concepts essential to Husserl’s phenomenology (essences, intuiting and
1. Walker J. The use of attachment theory in adoption and fostering. Adoption Fostering 2008;32:49–57. 2. Rutter M, Kreppner J, Sonuga-Barke E. Emanuel Miller Lecture: attachment insecurity, disinhibited attachment, and attachment disorders: where do research findings leave the concepts? J Child Psychol Psychiatry 2009;50:529–43. 3. Stovall-McClough KC, Dozier M. Forming attachments in foster care: infant attachment behaviors during the first 2 months of placement. Dev Psychopathol 2004;16:253–71. 4. Schofield G, Beek M. Providing a secure base: parenting children in long-term foster family care. Attach Hum Dev 2005;7:3–25.
Evid Based Nurs Month 2014 | volume 0 | number 0 |
1
Copyright Article author (or their employer) 2014. Produced by BMJ Publishing Group Ltd (& BCS) under licence.
Downloaded from http://ebn.bmj.com/ on November 9, 2014 - Published by group.bmj.com
Adoptive parents can be unprepared for the challenges in caring for children with reactive attachment disorder Anna T Smyke Evid Based Nurs published online September 2, 2014
Updated information and services can be found at: http://ebn.bmj.com/content/early/2014/09/02/eb-2014-101907
These include:
References Email alerting service
Topic Collections
This article cites 5 articles, 1 of which you can access for free at: http://ebn.bmj.com/content/early/2014/09/02/eb-2014-101907#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Child health (51) Child and adolescent psychiatry (148) Child and adolescent psychiatry (paedatrics) (148)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
