The fact that children growing up in environments where adequate care is not provided has difficulties in social relations has attracted the attention of researchers since the middle of the century. However, the development of the diagnosis of reactive attachment disorder is recent.
In the second half of the first year of life, V-XII. Selective loyalties develop between months. Children show this with various emotional and behavioral reactions. V-XII in babies. Stranger anxiety and separation anxiety are seen between months as evidence of selective attachment. Stranger anxiety is a symptom of the relative continuity of mental representations of the mother in the baby. In separation anxiety, the baby feels distressed when separated from the mother and starts looking for her. Because the mother's mental representations are not sufficient to reassure the child until the mother returns. After the age of 3, children can selectively turn to secondary people such as the kindergarten teacher, and the attachment period can continue until the age of 6.
There is a continuous and satisfying relationship between mother and child. If a relationship is not established, we are talking about maternal deprivation. Healthy attachment, which begins at birth, is a determining factor in the future relationship between mother and child. In the first 45-60 minutes following birth, the baby is awake and receptive. Contact with the mother is very critical. The closeness of the mother and the baby in the first three days of the neonatal period is extremely important.
The child's secure attachment may be disrupted for a variety of reasons. These reasons include the following;
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Physical and mental diseases of the child (mental retardation, autism, developmental delays, congenital anomalies, sensory disorders in the form of hearing and vision, language disorders, infectious diseases and metabolic diseases)
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Premature birth and resulting prolonged separations
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Complicated births
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Characteristics of the child (appearance, temperament and temperament)
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Hospitalization of the child
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Sexual and physical abuse of the child
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Early motherhood
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Physical and mental health of the parents and personality structure
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Family living conditions and relationship styles
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Beb Whether the child is wanted or not
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The child grew up in foster care
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Repeated and frequent changes in the primary caregiver during infancy
Reactive attachment disorder is the only psychiatric disorder of childhood with a specific etiology. The factor is unhealthy caregiving. Some children who are suddenly separated from their mother or the adult who is in the mother's place, and some children who are placed in a nursing home, first react with very intense and prolonged crying. Their cries cannot be stopped or soothed. If someone approaches them during a short period of silence, they start crying again. When they become silent, a tired and resentful expression appears on their faces (protest period). Eating gradually decreases, weight loss begins, physical development stops, vomiting and diarrhea occur. After 2-3 weeks, a recession begins. A resentful and sad appearance is evident (depression period). After the second month, the child's emotional reactions gradually decrease and become dull. He becomes indifferent to the environment and those who approach him (period of withdrawal). If the mother returns within three months, the baby will gradually recover and regain its previous condition. If the separation lasts more than three months, there is no reversal or improvement in the situation, and gradually home sickness(hospitalism) develops.
Long-term maternal deprivation or home sickness (hospitalism). strong> It is a syndrome seen in children who are separated from their families at an early age and sent to orphanages or hospitalized for a long time. The only reason here is maternal deprivation. The child, who lacks a one-on-one relationship with the mother or an adult who replaces the mother, also lacks emotional and sensory nutrition. In older ages, these people have difficulty in long-term relationships.
The following are observed in children who are deprived of emotional and sensory nutrition for a long time:
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They are indifferent to the environment, they respond late and difficult to stimuli.
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Swaying, ruminating, head shaking and hitting movements are very common when sitting. These are efforts to stimulate themselves.
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They frequently resort to sources of physical pleasure (such as thumb sucking, rocking).
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Pseudo-retardation is common and usually permanent. Children sent to kindergartens at an early age are 3-4 years old. Even if they return home to work again, their intelligence may not return to normal.
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Although they have good living conditions in terms of nutrition and care, the rates of illness and death are high.
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Walking, talking and toilet training are delayed. Their height and weight are below their chronological age.
The first thing to consider in the treatment of reactive attachment disorder is the child's safety. If the child's environment is harmful, hurtful and dangerous to the child, it is necessary to remove the child. The first decision to be made is whether the child will be hospitalized or treated in his/her environment. Generally, the strategy is determined according to the poor physical and emotional condition of the child, the presence of malnutrition and the severity of pathological care. Generally, if malnutrition is present, hospitalization is required.
In treatment, the child's adaptation efforts are helped, while responsibility for his environment is supported. They are trained to become better-functioning parents.
Achieving change in the child-caregiver relationship may require long-term, intensive therapeutic interventions. It may involve other members of the family as well as the child and parent. There are a wide variety of support programs. These include:
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Home help and advice
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Basic training for parents
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Strengthening the parent's responsibility for the child
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Psychotherapy
Game, family, individual and group therapies can be performed. In play therapy, the aim should be to correct the patient's object relations, enter into an educational relationship, help solve his/her anxiety and fears, and provide emotional release. The aim of family therapy includes reorganizing the relations between the mother and father in a way that does not harm the child, helping the patient's current and future needs to be met appropriately, and ensuring cooperation between the family, the child, and the treatment team. Individual and/or group interviews can be held with the members of the extended family in order to inform the family and support the treatment. The treatment program includes pharmacological treatment for complaints such as enuresis (urinary incontinence) and hyperactivity. It may be considered.
If the family and environment are very pathological and resistant to treatments, placing the child with a relative, giving it to a caregiver, adoption or placement in child care should be considered. If it is unavoidable for young children to be accommodated in kindergartens, necessary precautions should be taken. The number of caregivers should be increased, they should be divided into groups of 5-10 people and cared for under the management of a caregiver mother. They should live in separate small houses instead of large buildings resembling barracks. With all these, the child's daily life should be tried to be similar to the natural family life.
In addition to the care and love provided by the mother to the child, especially in the first years, the quality and continuity of the relationship between the child and the mother is very important. The spouse must also provide adequate support to the mother. In societies that give due importance to the child, countless facilities are provided to the mother. Instead of granting the right to early retirement to a woman aged 40-45 with grown children, the facilities provided to mothers with children in their first years will be an important investment for future generations.
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