Frequently Asked Questions  1.   What school professional needs were you looking to meet with writing this book about attachment issues and detached kids? I worked to address three professional areas (1) increase awareness of attachment issues at school;  (2)  increase knowledge about attachment issues; and  (3) increase attachment-issue sensitive and specific tools for interventions. From my consulting at many schools, I believe more awareness about attachment and trauma, as both a primary and underlying issue for students, is needed.  These cases appear to be very "stuck" and struggling, and awareness can be the beginning of very helpful change. In WJSD, I have provided some knowledge about existing research and a useable model for a variety of school professionals, and especially for creating a team approach between the school and parents/caregivers.   2.   What approach do you take to this complex issue that faces students and schools? First, the approach absolutely needs coordinated team work.  Coordination between caregivers at home, home to school, school professionals to home and among each other, and also between school professionals and community therapists must be consistent and clear.  It can be a major challenge to prevent team members from working in different directions, even if inadvertent. Second, you need to assess the attachment, trauma or loss issues with a community-based clinical evaluation, if possible, which can produce some standardized ratings.  WJSD also has functional assessment called the Student Attachment Trauma Rating scale (SATR), a non-standardized needs assessment which ties directly to the areas of  a home-school-community connection, sense of self and safety, thoughts and perceptions, and behaviors and reactions to others.  You can also email me about the complimentary Home Attachment Trauma Rating and the Youth Attachment Trauma Rating at tmottavi@mchsi.com. Last, it is best to bring a broad range of approaches to meet the often broad and varied emotional, safety, relating, social needs of detached students and not just behavior modification or accountability for what is often a high level of defiance and disrespect problems.  3.   What are three basics that school professionals should know about students who are detached? It can be very helpful to know the following:  (A)  Background issues for the child and family which may influence current behavior;  (B) needs or problems that re-cur at different ages tie back to a struggle or setback in one or all of four areas, those being: (i) grief/loss, (ii) trauma or abuse, (iii) attachment insecurities, or (iv) struggles with additional psychiatric issues, such as mood or attention deficit disorders;   and (C) early, attachment-sensitive, parent coordinated, goal-focused interventions can make a big difference.   4.  What are some take-away basics for school professionals?  Basic school professional keys:  (A)  Be informed about the student's background and communicate with parents/caregivers. (B)  Set clear and tight ground rules early in the classroom and be consistent. (C)  Be prepared and goal-directed, yet be flexible to the needs of the day. (D)  Detached students typically have lower levels of social-emotional age, which brings a great variety of behaviors and a need for a broad range of approaches to relationship-building. (E)  Do not try to do everything or go beyond appropriate and qualified roles. (F)  Do not assume very little can be done. (G)  Apply awareness and knowledge and coordinate it with others. (H)  Seek out support for additional stress that comes up professionally from working with children with attachment issues, and  (I)  Work on physical regulation issues.   5.   What is an example of a strategy or activity from Why is Johnny so Detached?  All of the activities have the ability to have a care-provider involved.  A guiding strategy to have close communications with home is so important and often vital to success of behavior discipline interventions or relationship skill building approaches. For students with intense behavior or manipulation, this type of care-prodiver involvement is strongly recommended.  ME AT SCHOOL involves going over a list of behaviors related to the student's functioning (e.g.: acting safe, feeling safe, being responsible, trusting others).  Child and parent talk through and give some ratings on these different issues to see strengths and weaknesses.  This allows for the child's perceptions to be seen, response to adult feedback, and response to key issues to be assessed.  The child's thinking and beliefs about school, school work, adults, and peers starts to come out and can be addressed in a more supportive and strengths-based manner.  There are then follow-up activities to address lying, distrust, using supports, and negative expectations about the school day.   6.   When should school professionals know to refer to outside professionals on these issues? School professionals should trust their instincts and experience about something being missing from the surface explanation of a child having additional struggles at school.  It is best to problem-solve early for concerns with relating, connecting, or just seeming detached from people or school efforts.  ADHD or learning disorders result in social and relationship problems, however, often not as severe as when attachment or trauma issues hare having high levels of interference.   7.   When are some common times of high-level problems or stress for detached students?  What might be some triggers of tantrum or melt-down? Children can vary widely in their responses to stress or change or trauma, which is generally less predictable than in adults.  Despite this variability, some common triggers include:  major changes at home, substitute teachers, new students or routines added to the class, issues with siblings, new expectations from home or school, not earning a reward in a behavioral agreement, hearing stoies of children getting hurt or moving.   These are some examples of possible triggers for fears, insecurities, past anger-hurt resentment and may create problems.  Sometimes there is a clear connection, however, at other times, there have been an influence from some distorted perceptions and beliefs about self, others, or the school setting that needs to be further explored. There are two activities in Why is Johnny so Detached? that outline ways to obtain good parent input about possible factors influencing fear-based responses or triggers to days of misbehavior or poor functioning.    Also, there is an activity to specifically gather information on ways to help with physical energy or emotional regulation.  This activity level or ability to settle can often be  a barometer to levels of insecurity or coping problems.   8.  What are some important points of awareness for school professionals to have about attachment issues or disorders? Developmental delay in competencies or functioning is the key component of most childhood mental health problems.   Attachmeht issues and disorder often have glaring and impairing gaps in social, emotional, behavioral and relating functioning which tie bakc to early, unmet needs and/or abusive/neglectful environments and care that let the child significantly affected.  Think that in some cases, lack of meeting basic food-care-shelter-nurturing-safety happended hundreds of times over, and the impact that this would have on a small child learning to trust, relate to others, work with their feelings, understand how relationships work, etc.  More severe cases can have lasting neurological traumas which permanently alter abilities to regulate, interact, perceive, and respond in more healthy ways.  (Read more about Complex - PTSD in Youth) It is important to recognize the multiple forms of impact and maltreatment or multiple home placements have had on their development of basic competencies.  It is best to not fall prey to negative views of the child based on some barrages of behavior that may occur.  These intense behaviors are often coming from a child who is unregulated, responding out of fear or desperation, and in past likely got into patterns of agitating, defying and disrupting as a means of self-protection.  Accountability, limits and structure are essential from early on in the classroom.  Teamwork on these at school and home are crucial.  However, we cannot fall into taking the child's behavior personally or get caught up in how challenged and at times, ineffective, we feel with these chidren.   9.  With all the different opinions about attachment issues or attachment disorder, is there some common ground for professional work? There is much debate about how to best approach and work with children and families when there are attachment or trauma issues.  There is generally good agreement about the need to (A) actively engage caregivers and (B) provide support to the families by actively sorting through confusing messages or reports the student may provide.  When there are deficits in trust, there is often much dishonesty and manipulation.  It is helpful to really strengthen the channels of communication and coordination between all involved.  I strongly advise having a broad view on the emotional, relating, behavioral and social issues, much like the model presented in my book.  The 2006 Research Task Force from APSAC believes research evidence supports a focused plan of intervention with goals, objectives and clearly assigned roles for the involved professionals.  Click here for article connection.  10.   What is some background on attachment issues and what is referred to as Reactive Attachment Disorder? The mental health field uses diagnostic definitions from the DSM-IV Manual of the American Psychiatric Association.  The diagnosis of Reactive Attachment Disorder is one of the most disputed and debated in the entire volume. The basic elements are:  (A)  having major disruption in the quality or consistency of basic care between the ages of 0-5 years, and  as a result, have (i) a persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions, as manifested by excessively inhibited, hypervigilant, or highly ambivalent and contradictory responses (e.g.: the child may respond to caregivers with a mixture of approach, avoidance, and resistance to comforting, or may exhibit frozen watchfulness) OR (ii) diffuse attachments as manifested by indiscriminate sociability with marked inability to exhibit appropriate selective attachments (e.g.:  excessive familiarity with relative strangers or lack of selectivity in choice of attachment figures).     (B)  The disturbance in Criterion A is not accounted for solely by developmental delay (as in Mental Retardation) and does not meet criteria for a Pervasive Developmental Disorder.  Reactive Attachment Disorder can be primarily Inhibited (Criterion A(i) dominates) or Disinhibited (Criterion A(ii) dominates).  Professionals in the field have generated lists of symptoms and traits  that have not been officially adopted by the DSM-IV, yet this long list of 25-50 traits and behaviors has been utilized by many in the research and treatment of attachment issues.   A major challenge in treating attachment issues is the variety of behavior in relating, social, emotional issues, and the varied intensity of these behaviors.   11.  What helps detached students increase their readiness to learn and benefit at school? The following all work together to provide a base for progress for detached students: (A)  Having a balance between structure-nurture in the classroom and school programming. (B)  Knowing that home, school and therapy services are coordinated and not allowing the student to push away, control or manipulate stipulations and thus, are safe and to be trusted. (C)  Help to clear away negative beliefs and thinking about school, teachers, peers, friends, etc. (D)  Find ways students can reconnect after misbehaving or acting out and get the underlying issues addressed at school.   Dr. Daniel Hughes, developer of Dyadic Developmental Psychotherapy, emphasizes the great importance of reconnection after a detached child goes into deep shame.  This reconnecting is vital for future healing and better connecting.   The goal is to address school issues in an attachment-sensitive manner, so they do not have a negative impact on home stability.