Reflections on and Reactions to “Difficulties and Disorders of Attachment and Social Development”

There are a number of DSM disorders that arise from compromised child/care-giver attachments. There is also a healthy amount of research about causes, assessment measures, and treatments for many of these disorders. However, despite all we know there is still a lot unknown. Our lack of information and knowledge about reactive attachment disorder is of particular concern for me given what researchers believe to be the high prevalence of the disorder within foster care communities. In the past almost 34 years, we have not established a universally-accepted measurement for diagnosing this disorder nor have we identified any reliably successful treatments (Landy & Bradley, 2014).

As a social work clinician in training, learning this struck a discordant cord: there exists a population of exceptionally vulnerable children who, by the very nature of the system of which they are part, may develop the symptoms of this disorder but there are no proven tools to combat it. For a brief moment, I was overwhelmed by this realization. It felt like another example of the problem being so big and so nebulous that there was no way to begin to tackle it. And then I recalled that one of the things I am charged with mastering in this program is the toleration of ambiguity within this field. Part of my role in this work is to not only recognize the problems but to add, in my own way, to the body of research that informs our practice and creates more knowledge about what works and what doesn’t. 

The other aspect of this article that struck me was what parents of children with compromised attachments must experience. Parents do the best they can with the tools they possess, and parenting is hard stuff. Many parents of children with attachment and social development disorders have a host of personal issues they’re trying to tackle at any given moment. I say all that to say, it’s incredibly important to skip the judgment and move quickly to partnership in the helping process.

Interestingly enough, my field supervisor and I engaged in a discussion this week involving both these topics—the ambiguity/subjectivity within assessment and our broader work and parenting children with mental health needs. She shared her opinion of diagnosis, which was that the important thing was for clinicians to be speaking the same language and be in the same ballpark when assessing a client. There was much more to this conversation, but my key take-away was that assessment and diagnosis is an ever-evolving process. Similarly, our understanding of mental health and its various contributing factors, such as early attachments, are also constantly evolving. For now, just as many parents do, we’ll do the best we can with the knowledge and EBPs we currently have. And let’s be clear, there are plenty out there.