An integration of theory, science and reflective clinical practice in the care and management of attachment-disordered children: A Triple-A approach

The formation of functional attachments is a critical developmental task of infancy and early childhood. Attachments play a significant role in the development of a child’s enduring beliefs about self, other and world (Attachment Representations). Infants become attached to the people who provide physical and emotional care on a continuous and consistent basis. Quality of care and the infant’s early experiences influence the type of attachment the infant develops. When care is grossly deficient and early experiences are characterised by physical and emotional distress, the infant’s attachment to its caregiver is also disturbed. Children who display markedly disturbed and developmentally inappropriate social relatedness in most contexts, and who have experienced grossly deficient care, might accurately be diagnosed with Reactive Attachment Disorder (RAD) or Disinhibited Attachment Disorder (DAD). Attachment-disordered children pose a substantial care and management challenge to all who care for and work with them in the home and educational contexts. Successful management of these children and the remediation of their attachment difficulties are predicated on understanding what function their apparently antisocial and defensive tendencies serve and approaches that support the development of functional attachments. Key roles are attributed to cortical arousal, attachment representations and beliefs about accessibility to needs provision in the diagnosis and remediation of attachment disorders. Drawing from observations of caregiving practices that promote functional attachments in infancy, strategies are presented for the home and classroom that address elevated cortical arousal levels, promote secure attachment representations and reassure the child regarding accessibility to needs provision.