We hear so much today about the words “attachment”, “attachment disorder” or, even more frightening, “Reactive Attachment Disorder,” “RAD.” Yet we rarely see a clear explanation of what this is or what consequences it has on an individual’s life. Attachment grows from a secure relationship with a primary caregiver, usually the mother, and is necessary for normal social and emotional development.

First described by the noted British psychoanalyst John Bowlby in the mid- twentieth century, attachment has come to be understood as the connection that enables an individual to feel secure, trust others, develop friendships and find intimacy. Without trust, he will be afraid to take life’s necessary risks, but he will not avoid unnecessary risks, and he will not feel safe. Attachment is extremely important. As parents we need to understand the primacy of attachment so that we can maximize our child’s attachment to us and then to himself and finally the world.

Where does attachment begin? In the womb. Studies have shown that embryos are already bonding when they feel movement, hear voices and other sounds, and have their senses stimulated through smell and taste. Optimally the womb is a good safe first home for a baby about to be born. When a child is born to a mother who is stressed, his first environment is an inhospitable one and he cannot develop optimally. If, after birth, he is removed from that familiar figure the event is traumatic for him, and he suffers all of the consequences of a traumatic event. As unfamiliar as it sounds, even a very young child such as an infant who is separated from his mother, will suffers a loss which he feels in his sub-conscious mind.

At any time during childhood separation from the mother figure is very difficult. Babies who develop in a distressed womb and then are separated from their mothers will find it difficult to overcome these stresses on their own, and they may show some symptoms of posttraumatic stress disorder at birth. For them life is already troubled and they need to secure their equilibrium. Unable to progress smoothly through the stages of development unaided, they will need a blueprint for help through the trouble spots and an intimate understanding of the problem by their parents and other involved adults. If we imagine attachment as a continuum we can see that these children may place anywhere along the continuum from mildly affected to severely affected. At the far end of the continuum is Reactive Attachment Disorder. Depending on how far they are along this line, the road to healthy maturity becomes increasingly more arduous. Once the baby is born, he will need to move through the stages of development with some success. To do this, he must first learn to become attached to and bonded with a trustworthy mother figure. He will learn from that mother and her attentive behavior to trust that his needs will be taken care of. Eventually, he will trust that when she leaves him, she will return, and when he begins exploring, he can trust that she will be there when he returns.

We can all understand the significance of trust. It is the basis of every relationship throughout our lives. It is from our ability to trust first our mothers and what they say and then ourselves that a conscience is born, ethics are developed and a sense of personal identity, an “I am” is achieved. “I am!” “I am smart.” “I am capable.” ‘I am honest.” “I am proud.” This is the child who can control his urges in order to attain his goals. And if he knows who he is and is satisfied with himself he can go on to care for other people’s feelings and learn how to take care of others. He will learn how to do a job well, how to have a sense of competence. He will naturally evolve, in Erik Erikson’s terms, “a sense of industry.” This sense of industry, he asserts, is what develops a lasting basis for cooperative participation in productive adult life. When trust is not attained and developmental goals are not being reached or are interrupted, there is a sense of identity confusion, and an inability to feel any confidence about who one is and how one fits into the world. A crucial aspect of learning how to develop identity, Erikson believes, is settling on an occupation with the accompanying feeling, “This is what I do well, and this is what I have to offer the world.” The inability to settle on an occupational identity is perhaps the most difficult obstacle to maturity for many young people. One of the final achievements in development is the ability for true intimacy with another, which can only come when one is sure of a stable personal identity.

This attainment of intimacy is a feeling of being open to and bonded to another while maintaining a sense of separate self. There are various ways to achieve this goal, but all require long term opportunity for exposure to a lifestyle that promotes the ability to internalize a stable self. Such an opportunity eases the transition into young adulthood. It is our role as adoptive parents to help our children through this journey toward ultimate maturity and a fulfilled life. Below are some suggestions to help your child attach:

• Be attuned to your child’s natural schedule for sleep, feeding and play. There have already been many unpreventable frustrations that this child has encountered, and there will continue to be others. These are children who may not trust that their needs will be met so they have a harder time dealing with disappointments and delays. By focusing on the baby’s needs and wants rather than on the maintenance of an imposed schedule, additional frustrations may be minimized. Therefore, parental responses must be immediate and appropriate.

• Be attuned to your child’s emotions. The child may be grieving over the loss of an earlier caregiver. Allow him time to mourn and be there to help him deal with the loss. It is important at this time that his emotions be soothed. He should be held, cradled and sung to but not denied opportunities to feel his sadness.

• Maximize the time spent with your child. This is not a child who should be left often with babysitters or other surrogates. He needs consistent care from the primary caregiver who must also do all of the feeding, bathing, changing and other activities that facilitate bonding.

• Be consistent with attitude and performance. A child should be able to trust that routines and responses will be consistent. Feeding, napping, bedtime should be on a regular schedule and emotional responses should also be predictable.

• Provide the model for a range of facial expressions such as smiling and frowning and all of the expressions in between. Maintain eye contact when tending your child so that he will mimic your behaviors and maintain a feeling of being connected.

• Maintain close physical contact so that your child feels as if he is almost an extension of you. Hold the child whenever you can, rock him, cuddle him and encourage him to touch your face and hair. If you can’t always hold him, keep him in the same room. This will encourage a sense of security and comfort, especially if he was not held enough before he joined your family. Keep him on a bottle longer than is usual and use the opportunity to hold him even more. Bathe with him. Such activities as hand feeding while holding the child, rather than propping a bottle, rocking, hugging, tickling, singing, massaging and engaging in playful behavior while maintaining eye and physical contact are essential. As he gets older and is toddling and walking around, allow him to be your shadow to maintain that closeness.

• Closely monitor your child’s performance by staying with him or encouraging him to check in frequently with you. As he grows older, it is important to carefully supervise his chores and homework. He needs you to see that work is done and done to some previously established standard. Providing opportunities for success will help build feelings of mastery and accomplishment. Limit opportunities for your child to make poor decisions which affect his sense of security and self-worth and thus jeopardize the attachment. A child who feels good about himself feels connected to others.

• Structure your child’s time during the day so that there are many opportunities to engage in meaningful activities and idle time is minimized.

• Demonstrate affection regardless of your child’s responses to that affection. He needs to be held and kissed and stroked even if he rejects these demonstrations of love.

• Nurture a happy and loving nature through shared play and modeling playful behavior. Happy surprises, mystery activities, silly moments are wonderful for developing this attitude. Toys and objects that encourage attachments should be readily available.

• Be aware of your child’s need to behave as if at a younger age and allow him time to be there. If he wants to talk “baby talk” or crawl when he can walk, allow him opportunities to regress. Conversely, allow opportunities for him to play out more mature roles.

• Articulate your child’s conscience until his sense of morality is strongly developed. Simple conversations about the relationship between cause and effect and the consequences of alternative actions are important for these children.

• Avoid control battles. State what has to be done or what is expected. Don’t be diverted. If discipline is necessary, follow up with a time for affection and reassurance to avoid leaving the child with feelings of shame and worthlessness which will weaken the attachment. Do not isolate your child with “time outs” alone in his room. This will only increase his feelings of separateness. Have him do his thinking time near you so that he will feel safe and the bond will be reinforced even in difficult times.