OF HUMAN BONDING/Attachment disorder is in the news but misunderstood

OF HUMAN BONDING/Attachment disorder is in the news but misunderstood

Author: LESLIE SOWERS; Staff

Article Text:Though it seemed incredible that a toddler could intentionally do serious harm to himself, a Colorado mother said her adopted 2-year-old son could and did.Renee Polreis, on trial for reckless child abuse resulting in death, claimed some of her son's wounds were self-inflicted because he suffered from reactive attachment disorder. The term refers to a range of problems that result when a child fails to bond with a parent.But on Tuesday Polreis was convicted of beating the toddler to death.The Polreis case and a handful of others involving adoptive parents have drawn national attention to attachment disorder and to a controversial technique called holding therapy.The sensational coverage has alarmed one expert who fears the public will use attachment disorder as a buzzword to demonize children who have even mild behavioral problems.Dr. Charles Zeanah, medical director of clinical intervention at the Louisiana State University School of Medicine, also fears a backlash against children with attachment disorder by a public that doesn't understand the crucial importance of bonding in the life of a child.Attachment disorder has become a rallying point for adoptive parents trying to care for children whose disturbed behavior can include sexual abuse of other children in the family, threats toward parents and other violent actions.The disorder is common in children who have been removed from their families as a result of abuse or neglect, or who have spent time in foster care and orphanages. Some cases involve children adopted from Eastern European institutions, including David Polreis.Renee and David Polreis Sr. adopted David Jr., from a Russian orphanage, where he spent his infancy. He died as a result of massive blunt trauma, causing respiratory arrest and brain death.Attachment disorder, or failure to bond, can devastate a child. Such children often have problems at school and with peers. Without help, they may commit criminal offenses as they reach adolescence.But Zeanah cautions against labeling these children as bad seeds."We are really talking about little children and how their world works," Zeanah said. "These are children who have learned through aberrant experiences some unusual rules for things."Attachment disorder should not be viewed as a permanent trait or characteristic, he said, but as a diagnosis subject to change as the child experiences better circumstances.Normally, bonding with parent figures happens naturally, and is even programmed by nature to occur, Zeanah explained. Infants and young children need to form secure relationships through nurture to feel safe in exploring the world.Zeanah said attachment disorder can be reversed if an adoptive family helps the child get past his early experiences. Such efforts may require specialized assistance and may fail. He said little is known about why some children can be reached while others cannot.Zeanah believes the sooner a child is placed in a permanent situation, the easier it is to build a new bond."Every baby needs to feel `I am the most important being in the world,' " Zeanah said. This happens when the child signals a need and the parents meet it. That builds trust and the sense that the world is a fundamentally safe place.Unfortunately, with some children who have missed this experience, the remedy isn't as simple as placing them in a loving home. The underlying rage in children deprived of the bonding experience can make them defiant, violent and unable to respond to the love shown them."Sometimes kids who have been the most severely maltreated elicit the most severe responses," Zeanah said. "They have a way of making other people respond in a punitive way. The things foster and adoptive families struggle with are very tough. The kids who need love and care the most are hardest to love and care for."Therapy is usually required to help children get past these behaviors. Adoptive parents have also formed support groups to help each other cope with children whose behavior can be frightening and dangerous.Sometimes the child's defenses are so steep that traditional talk therapy and play therapy are not successful. This has led to the use of a controversial technique called holding therapy, pioneered at the Attachment Center in Evergreen, Colo.The small group of U.S. therapists who use holding therapy do so with children whose behavior includes rape and physical attack of other children and threatening parents with knives. The children are described as charming and manipulative when engaged in traditional types of supportive therapy.Holding therapy seeks to break through the child's defenses by provoking him verbally or even physically while he is being securely held and eye contact is maintained. Proponents say the child re-experiences the rage that comes from unmet dependency needs and can ask for and receive the care he needs.Critics say holding therapy may create a bond based on fear as well as re-traumatizing the child. Legislative efforts to ban the practice in Texas have been derailed by parents and children who found it was the one thing that worked....Donald Lee Tibbets of Utah was sentenced to up to five years in prison for the 1996 murder of his 3-year-old adopted daughter, Krystal. He testified that she died while he was doing holding therapy, pinning her to the ground and pressing his fist into her abdomen. He ignored another child who told him Krystal was turning blue.Holding therapy was recommended to Tibbets by the Utah family services division. Despite the controversy surrounding it, holding therapy is recommended by some adoption agencies and child welfare services throughout the country.Foster Cline, the psychiatrist most associated with the use of holding therapy at the Evergreen Center, no longer practices the technique. He still believes it is valuable and admires the therapists brave enough to use it despite the controversy, he said. He has moved to Idaho and practices standard marital and family therapy.Cline said it was difficult to defend the practice from those he feels did not understand it. He was reprimanded by the Colorado licensing authority, he said, as the result of a complaint about the work of a therapist he was supervising in training....Mark Wernick, a Houston psychologist who practices holding therapy, said it is not a comfortable experience for the child. It is designed to provoke anxiety to cause the child to make necessary internal changes, a statement he said can also be made of traditional therapy.He said critics of the process often look only at the initial provocation of the child without noting the closeness and softening that takes place between the child and the care-giver. Such success with otherwise hard-to-reach children keeps Wernick working with the technique.Wernick serves on the ethics committee for a national group of therapists who do this work. He said he considers it irresponsible to say that holding therapy killed the Tibbets child. He said the father was not doing authorized therapy, and the child was not currently in therapy with a professional.The technique is not for everyone, he said. It requires an individual who will not react to the child's emotions by getting out of control."Any therapy technique in the wrong hands can be abused and misapplied," he said.He said children with attachment disorder can provoke unresolved emotional issues in even the healthiest of adults. Parents may be too emotionally vulnerable themselves, or they may over-personalize the hostility the child expresses.Wernick said he is concerned that adoption agencies may not be screening parents adequately and educating them about the demands of raising a child with the disorder.He and other therapists who work with attachment-disordered children say society ignores this difficult issue at its peril."Are we just going to let these kids go to prison?" Cline asks. "If these early-life traumas aren't resolved, they are locked in and cause big problems later."He said children need bonding to develop the foundation for conscience, to develop cause-and-effect reasoning and to acquire basic trust in their world."All civilization rests on this," he said. "These three things are developed in the first year of life.Caption:
Drawing: (color)K.B. Sanford / Chronicle

Copyright 1997 Houston Chronicle

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