Children with histories of maltreatment, such as physical and psychological neglect, physical abuse, and sexual abuse, are at risk of developing severe psychiatric problems. These children are likely to develop Reactive Attachment Disorder. These children have trauma-attachment problems. The trauma experienced is the result of abuse or neglect, inflicted by a primary caregiver, which disrupts the normal development of secure attachment. This study measured the treatment outcomes for trauma-attachment disordered children using Dyadic Developmental Psychotherapy an attachment-based treatment approach.

Approximately 2% of the population is adopted, and between 50% and 80% of such children have attachment disorder symptoms. Many of these children are violent and aggressive and as adults are at risk of developing a variety of psychological problems and personality disorders, including antisocial personality disorder, narcissistic personality disorder, borderline personality disorder, and psychopathic personality disorder . Neglected children are at risk of social withdrawal, social rejection, and pervasive feelings of incompetence19. Children who have histories of abuse and neglect are at significant risk of developing Post Traumatic Stress Disorder as adults. Children who have been sexually abused are at significant risk of developing anxiety disorders (2.0 times the average), major depressive disorders (3.4 times average), alcohol abuse (2.5 times average), drug abuse (3.8 times average), and antisocial behavior (4.3 times average). The effective treatment of such children is a public health concern.

Trauma-attachment disordered children have internalized a negative working model of the world, adults, relationships, and themselves. The disorganized attachment pattern describes the etiology and psychology of children with trauma-attachment disorders7. Significant early neglect and abuse cause important neurobiological dysfunction , including difficulty regulating affect and an incoherent autobiographical narrative. A child uses the parent’s state of mind to regulate the child’s own mental processes . The child’s developing capacity to regulate emotions and develop a coherent sense of self requires sensitive and responsive parenting. The best predictor of a child’s attachment classification is the state of mind with respect to attachment of the birth mother5. A birth mother’s attachment classification before the birth of her child can predict with 80% accuracy her child’s attachment classification at six years of age . Finally, recent research by Mary Dozier, Ph.D. found that the attachment classification of a foster mother has a profound effect on the attachment classification of the child. She found that the child’s attachment classification becomes similar to that of the foster mother after three months in placement. These findings strongly argue for a non-genetic mechanism for the transmission of attachment patterns across generations and for the beneficial impact of a healing and healthy relationship.

Early interpersonal experiences have a profound impact on the brain because the brain pathways responsible for social perception are the same as those that integrate such functions as the creation of meaning, the regulation of body states, the regulation of emotion, the organization of memory, and the capacity for interpersonal communication and empathy25. Stressful experiences that are overtly traumatizing or chronic cause chronic elevated levels of neuroendocrine hormones25. High levels of these hormones can cause permanent damage to the hippocampus, which is critical for memory . Based on this, we can assume that psychological trauma can impair a person’s ability to create and retain memory and can impede trauma resolution.

These findings strongly suggest that effective treatment requires an affectively attuned relationship. Siegel stated, “As parents reflect with their securely attached children on the mental states that create their shared subjective experience, they are joining with them in an important co-constructive process of understanding how the mind functions. The inherent feature of secure attachment – contingent, collaborative communication – is also a fundamental component in how interpersonal relationships facilitate internal integration in a child” . This has implications for the effective treatment of maltreated children. For example, when in a therapeutic relationship the child is able to reflect upon aspects of traumatic memories and experience the affect associated with those memories without becoming dysregulated, the child develops an expanded capacity to tolerate increasing amounts of affect. The child learns to self-regulate. The attuned resonant relationship between child and therapist and child and parent enables the child to make sense (a left-hemispheric function) out of memories, autobiographical representations, and affect (right hemispheric functions).

Specifically, There are several important implications of treatment that flow from the above description. Dyadic Developmental Psychotherapy is an approach to treating trauma-attachment disordered children that is based on attachment theory , and the previously mentioned processes. This treatment seeks to remediate the negative working model of such children, using experiential methods that have several important and overlapping dimensions: modeling the healthy attachment cycle, reducing shame, safe and nurturing physical contact that is containing, reexperiencing the affect associated with the trauma in order to integrate the experience and not dissociate, and the interpersonal regulation of affect. These dimensions are enacted through the use of eye contact, physical holding, tone of voice, cognitive restructuring, psychodramatic reenactments, and repeated implementations of the first year (needs) and second year (shame) attachment cycles. As a result of treatment, children can affectively internalize their adoptive or foster parent’s love, structuring, and nurturing, resulting in increased ability to tolerate affect without becoming dysregulated or dissociated, a more coherent sense of autobiographical memory, increased trust, and increased self-esteem. Behaviorally, such children exhibit lower levels of aggression, delinquent behaviors, thought disorders, depression, anxiety, and withdrawn behaviors. It is though the healthy internalization of the parent that the child comes to trust the parent and experience a drive to please the parent. This is the beginning of conscience and morality.