The impact of reactive attachment disorder on adoptive family

237 Pages·2016·1.33 MB·English

University of Iowa
Iowa Research Online
Theses and Dissertations
Spring 2014
The impact of reactive attachment disorder on
adoptive family functioning
Matthew Lorenzo Vasquez
University of Iowa
Copyright 2014 Matthew Lorenzo Vasquez
This dissertation is available at Iowa Research Online: https://ir.uiowa.edu/etd/4783
Recommended Citation
Vasquez, Matthew Lorenzo. "The impact of reactive attachment disorder on adoptive family functioning." PhD (Doctor of Philosophy)
thesis, University of Iowa, 2014.
https://doi.org/10.17077/etd.xdhcqe8m
Follow this and additional works at:https://ir.uiowa.edu/etd
Part of theClinical and Medical Social Work Commons
THE IMPACT OF REACTIVE ATTACHMENT DISORDER ON ADOPTIVE
FAMILY FUNCTIONING

by
Matthew Lorenzo Vasquez

A thesis submitted in partial fulfillment
of the requirements for the Doctor of
Philosophy degree in Social Work
in the Graduate College of
The University of Iowa

May 2014

Thesis Supervisor: Associate Professor Miriam Landsman
Copyright by
MATTHEW LORENZO VASQUEZ
2014
All Rights Reserved
Graduate College
The University of Iowa
Iowa City, Iowa

CERTIFICATE OF APPROVAL

__________________________

PH.D THESIS

__________

This is to certify that the Ph.D thesis of

Matthew Lorenzo Vasquez

has been approved by the Examining Committee
for the thesis requirement for the Doctor of Philosophy
degree in Social Work at the May 2014 graduation

Thesis Committee: ___________________________________
Miriam Landsman, Thesis Supervisor

___________________________________
Jeanne Saunders

___________________________________
Carol Coohey

___________________________________
Alison Bianchi

___________________________________
Kathryn Whitmore
This dissertation is dedicated to families everywhere who opened their homes to care for
children who had been abused, neglected, and unwanted

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ACKNOWLEDGMENTS

I would like to express my sincere appreciation to my chair, Dr. Miriam
Landsman, for her patience and unyielding guidance in the development and completion
of this dissertation. I want to extend my thanks to Drs. Alison Bianchi and Kathryn
Whitmore for their guidance and unwavering encouragement. I want to extend a heartfelt
thanks to Dr. Jeanne Saunders, who has been a constant support in both the MSW and
PhD programs. She always made time to offer her guidance in the development of my
dissertation, and in many other facets of academia. I also want to give a special thanks to
Dr. Carol Coohey for graciously agreeing to serve on my dissertation committee during
the later part of my program, and for being a point of consistent support during the
doctoral program. Finally, I would like to extend my deepest gratitude to the University
of Iowa School of Social Work for believing in my ability to succeed and for its constant
support.
I would like to acknowledge the support from Four Oaks, Inc., IowaKids.net, and
Bruce Buchanan, for providing me the opportunity to advertise my study. I express my
deepest gratitude to those families who opened their homes to me and revealed many of
their hopes, fears, and struggles. I also want to acknowledge and thank the Schneekloth
family who were the inspiration for me engaging in this study. For their financial
support, I thank the University of Iowa School of Social Work, The University of Iowa
Graduate College, and the Executive Council of Graduate and Professional Studies.
Finally, I express my deepest gratitude to my wife, Emily for her unwavering support and
encouragement. I also thank Elle Victoria, Zevi Borroughs, Jim Burroughs, and Larry
and Roxanne Rustand for their unyielding support and encouragement throughout my
studies.
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ABSTRACT
Adopted children with special needs can experience a multitude of
developmental, emotional, and behavioral issues as a result of pre-adoption maltreatment.
On rare occasions, maltreated children can display behaviors severe enough to fit the
criteria of reactive attachment disorder (RAD). Children with RAD are known to engage
in self-destructive behavior, talk of killing others or themselves, verbal and physical
aggression toward peers and adults, and lack discernment between parental figures and
strangers. Given the uniqueness of these behaviors, the rarity of the disorder, and the
lack of research in this area, further exploration is warranted. Therefore, the purpose of
this study is to explore the effects adopted children with reactive attachment disorder
(RAD) have on family functioning.
Due to there being little research on RAD in the context of families, an
exploratory approach was determined to be the best for this study. Kathy Charmaz’s
constructivist grounded theory guided this qualitative inquiry. Her approach, coupled
with the use of semi-structured interviews, allowed for rich, descriptive information to be
obtained, while allowing the researcher to include aspects of his experience in working
with children with RAD. The data collected included five families from the Midwest, and
consisted of a total of 28 participants, with 14 adults and 14 children. The adopted
children’s mental health assessments, individual education plans, and the researcher’s
field notes were also included. Data analysis consisted of the constant comparative
method.
RAD behaviors were found to manifest themselves on a developmental
continuum, with two dominant forms of thinking and behaviors identified. These
behaviors are characterized as control-based, and are often perpetuated by high levels of
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anxiety. When this anxiety becomes unmanageable for the child, it is released in the form
of rages toward those caregivers who are deemed as safe and for whom the child has the
strongest relational bond. Traditional child therapies and behavior modification
techniques were found to do little to change the course of these behaviors. Since children
with RAD had no physical sign of a disorder, this commonly led the public to perceive
their behaviors as being the result of parental incompetency. Parents who continually
experienced public criticism found themselves purposefully withdrawing from society.
This withdrawal was related to an increased sense of isolation, which was related to
increased levels of stress, somatic complaints, and marital discord. Possible
neurobiological factors involved in the development of RAD are discussed, along with
practice and policy implications for families who adopt children with RAD.

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TABLE OF CONTENTS
LIST OF FIGURES ........................................................................................................... xi

CHAPTER I. INTRODUCTION ........................................................................................1

Statement of the Problem .........................................................................................1
Purpose and Research Questions .............................................................................4
Significance of the Study ........................................................................................6
Summary of Chapters .............................................................................................8
CHAPTER II. LITERATURE REVIEW .........................................................................10

Special Needs Adoption .........................................................................................10
Definition and Prevalence ...............................................................................10
The Decision to Adopt ....................................................................................11
Issues Facing Special Needs Children ............................................................12
Pre-adoption supports ...............................................................................14
Post-adoption supports ..............................................................................14
Difficulties with attachment ......................................................................15
Adoptions and Institutionalized Children .......................................................16
Reactive Attachment Disorder ..............................................................................20
Diagnostic Definition ......................................................................................20
Inhibited subtype ........................................................................................21
Disinhibited subtype .................................................................................22
Prevalence Rates .............................................................................................23
Pathogenic Care ..............................................................................................24
Child neglect .............................................................................................24
Child abuse.................................................................................................25
Additional Risk Factors ..................................................................................26
Attachment Theory ...............................................................................................28
Function of Attachment ..................................................................................29
Personality Development ................................................................................30
Disrupted Attachments ....................................................................................31
Attachment Theory and RAD .........................................................................32
Conceptual Framework .........................................................................................33
Normal Family Processes ...............................................................................33
General Systems Theory .................................................................................35
Stress Theory ..................................................................................................38

CHAPTER III. METHOD ...............................................................................................42

Methodology ..........................................................................................................42
Constructivism and Qualitative Research .........................................................42
Grounded Theory .............................................................................................43
Method ...................................................................................................................45
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Interviews, Field Notes, and Documents .........................................................45
Semi-structured interviews ........................................................................45
Perceived benefits .........................................................................46
Interviewing adults ....................................................................................46
Interviewing children .................................................................................47
Interviewing families .................................................................................51
Field notes ..................................................................................................51
Mental health assessments .........................................................................52
Individual education plans .........................................................................53
Study Design .........................................................................................................53
Pre-interview Protocol .....................................................................................53
Interview Structure...........................................................................................54
Sampling ..........................................................................................................56
Selection criteria .......................................................................................56
Sampling procedures .................................................................................59
Sample characteristics ...............................................................................59
Protection of Human Subjects .........................................................................60
Pilot Study .......................................................................................................60
Data Collection Procedures .............................................................................61
Data Analysis ..................................................................................................62
My approach .............................................................................................63
Autobiography of Researcher ................................................................................65
Subjective Biases ............................................................................................67

CHAPTER IV. PORTRAITS OF NEGLECT ...................................................................69

My Research Goal..................................................................................................69
Meeting Travis: A Real Son .................................................................................70
My First Encounter .........................................................................................70
Raised in a Car Seat ........................................................................................71
A Dynamic Family ..........................................................................................71
Yin and Yang ..................................................................................................75
A shared history .........................................................................................76
Meeting Marie: A Little Mama .............................................................................77
My First Encounter ........................................................................................77
Friend Family ................................................................................................78
A Second Round of Parenting .......................................................................80
No Special Needs—No Problem ...................................................................80
A Love but Mostly Hate Relationship ...........................................................82
Meeting Hailey: A Child of Trauma .....................................................................84
My First Encounter ........................................................................................84
“I Don’t Want A Child With Mental Illness” ................................................86
A Tale of Two Sisters ....................................................................................87
One stays, one goes ...................................................................................87
The quiet one emerges ..............................................................................88
Misinformation ..............................................................................................88
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