Full of Woe : The clues can range from lack of eye contact to wild rage. Many kids in foster care or with neglectful parents suffer ‘attachment disorder.’

The only reason Colorado homemaker Barbara Nolin says she didn’t give her adopted children back was that no one would take them. After two years, she had lost all sympathy for the sisters, former street children who had been named Angel and Crystal for their birth mother’s favorite drugs.

One made repeated false allegations of child abuse. The other had 10-hour tantrums and set a fire that destroyed her house. In years of traditional therapy, they seemed only to become more troubled.

Then last year, Nolin found a new therapist who diagnosed the girls’ condition as “attachment disorder,” an inability to connect, trust or empathize with other people caused in the first years of life. Through intense treatments, the therapist and sometimes Nolin would cradle each girl like an infant and talk about the past. While the younger girl, now 6, has settled down, the older girl, 9, is still being treated.

In the process, Nolin regained her compassion. She recalled one session with the older girl, who never expressed anger or fear. “She was telling this horrible story about how she was molested and there were no tears in her eyes, no emotion at all. . . . We sat there and we cried for Crystal,” said Nolin, who lives in the Denver suburbs. “You cry for the people who can’t cry.”

Such sensational cases of attachment disorder, usually involving adopted or foster children, may be familiar to viewers of daytime talk shows. Some experts believe milder forms--usually the inability to maintain relationships--are also spreading throughout a generation of young people raised by distracted or uncommitted parents with little cultural or social support.

The diagnosis, which can cover behavior from erratic eye contact to substance abuse and violence, is becoming so popular some worry it will become “the ADHD of the ‘90s,” appealing to desperate caretakers and attracting faddish therapies. Indeed the disorder has some similarities to attention deficit hyperactivity disorder, a developmental disability that affects children’s behavior, attention and learning, and has become one of the most common diagnoses in childhood.

The field is in ferment over controversial treatments. Still, some call attachment theory the most significant idea in child psychology in the last 30 years and say research offers great potential for helping solve an apparently overwhelming problem.

“We are turning out kids that as a society we don’t know how to handle,” said Michael Pines, a child psychologist and president of the Dallas-based Assn. for the Treatment and Training in the Attachment of Children (ATTACH). Over the last six years, the umbrella organization of therapists and child placement workers has grown from 30 to 350 members, he said.

Attachment theory originated 30 years ago with the late Dr. John Bowlby, a British psychiatrist, and was elaborated by Dr. Mary Ainsworth, also a psychiatrist and the retired doyenne of attachment theorists who taught at the University of Virginia.

Their common-sensical research, showing that a steady, loving environment for infants provides a foundation for lifelong security, has become increasingly influential in theory and therapy.

Diagnoses have increased dramatically, Pines said, partly because awareness is growing and partly because “there are more families that are disintegrating, more kids being born to drug-affected moms and more children having children.”

Also contributing are rising numbers of children staying in foster care for longer periods of time, shuttling from home to home, awaiting adoption. “As a colleague of mine said, ‘A rolling child gathers no attachments,’ ” Pines said. Others blame the familiar scenario of exhausted, working mothers and fathers forced to place millions of children in mediocre day care or leaving them to raise themselves on TV.

Pines said only 5% of children with attachment disorder are extremely violent. “We usually see kids who have difficulty making or keeping long-term friends, forming trusting relationships with parents and other authority figures, and accepting external controls,” he said.

Critics complain that focusing the attention on children mistakenly shifts attention away from the real problem--the relationship with their parents.

“This isn’t a disease the child has,” said Alan Sroufe, professor of child psychology at the University of Minnesota. Using the medical model of labeling children, sometimes for insurance purposes, oversimplifies what is really a relationship problem, he said. Early attachment problems do not necessarily guarantee lifelong emotional or social problems, he said, because they can be modified by a new environment.

Sroufe also questioned the theoretical foundation of the treatment. “All these attachment centers have sprung up and they don’t understand this research, nor do their views follow from it directly. Often what they’re studying are conduct disordered or oppositional children.” Aside from those like Romanian orphans, raised from birth in institutions, there is no such thing as an “unattached child,” he said, only children with healthy or unhealthy patterns of attachment. “I don’t take kindly to labeling the child and saying it’s inherent in his nature. I don’t take kindly to saying to mothers, ‘It’s your fault.’ ”

Some symptoms of attachment disorder--impulsiveness, withdrawal, clinginess, aggression, distractibility--are similar to conduct disorder or attention deficit hyperactivity disorder, therapists said.

Elias Lefferman, director of outpatient services at the private Vista del Mar family counseling agency in Los Angeles, said some children have been misdiagnosed with ADHD and given prescriptions for drugs when their problem was attachment disorder. One distinction is that children with attachment disorder have a history of multiple losses or divorce, death, abandonment or neglect, he said.

According to attachment theory, the type and amount of trust children develop depends on the warmth and dependability of their caretakers in the first years of life. “The critical window is up to 36 months,” Pines said. “By that time, a child has a good sense of basic trust and is going to see the world as safe and predictable, or unsafe and unpredictable. How they see the world affects how they see themselves.”

Pines said colleagues have seen attachment problems in children whose mothers are deprived or depressed, or those who have been separated from their children due to illness. Some mental health professionals cite the case of Unabomber suspect Theodore Kaczynski. His mother has recalled how Ted, at the age of 9 months, refused to look at her after doctors had separated him from her for a week and tied him to a hospital bed while they photographed a rare case of hives. Pines said he has also seen attachment problems in some firstborn children with extreme colic.

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Some researchers believe that traumatic breaks in the mother-child relationship not only upset the attachment process, but disrupt brain functioning and development. Ken Magid, an attachment expert at Golden Medical Clinic in Golden, Colo., said that as a result of disruption in early attachment, “They will perhaps have more of an emotional response to things, a hair-trigger response, rather than a cognitive one.”

Others said that some children may experience a somatic distress in their bodies and turn to alcohol or other substances to replace the lost attachment. Liz Randolph, an attachment therapist with Evergreen Consultants in Evergreen, Colo., said many children with attachment problems crave sugar and sweets. “Our theory is it’s a replacement for love.”

She said some children are more resilient than others, and inborn temperament plays a role in how a caretaker’s capabilities affect a child. Signs of problems can begin early with a baby who stiffens and pushes away, refuses to make eye contact or refuses to allows caretakers to feed him.

Pines said one symptom of children with attachment problems is that they have trouble maintaining eye contact unless they are angry. Then, he said, “they give you great eye contact. They’ll look at you with what’s been described as shark eyes.”

Christine Hindle, an adoptive mother of abused children in Caney, Kan., said, “It’s almost as if--I know this sounds stupid--as if they were possessed, as if you could see somebody else looking out at you.”

In 1989, social workers told her the children she was adopting were cute and surprisingly untroubled. But soon after the siblings arrived home, the 7-year-old boy kicked her husband in the head and made gory death threats to his sister. The other two set fires inside and outside the house. At 5, the younger boy told a therapist he was going to kill Hindle. They found knives and razor blades stashed under his mattress.

Five years later, Hindle is divorced. Last year, she finally gave up the children as a matter of survival. “People who go into this thinking if I just love them enough, it’ll make up for everything, they just don’t understand,” she said.

As her frustration illustrates, much more is known about the roots of attachment disorder than about how to help the children with subsequent problems.

Some argue that the best course is to provide a secure base for the parent, who then will be able to provide a secure base for the child. But most attachment therapists believe traditional therapies do not work because they require a client’s trust--the key missing ingredient for children with attachment problems. Instead, a community of therapists has evolved that favors a variety of highly controversial therapies, based on work with autistic children, that involve holding, physical restraint and confrontation. Some sessions last for days or weeks; some are parent-led, others are therapist led.

The optimum age for treatment is younger than 7, Pines said. Older than 12, it becomes “exceedingly difficult.”

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Many mainline child therapists believe holding therapy to be abusive. Last year, a 3-year-old child died in Utah after her father suffocated her while using a holding technique he learned at an attachment center in Salt Lake City. Trial for Donald Lee Tibbets of Midvale, her adoptive father, charged with second-degree homicide, is scheduled for later this month.

Fear of litigation or proposed legislation forbidding therapists to touch their clients has driven some, like Randolph, from California to Colorado, a mecca for attachment therapists. She said that about 25 years ago, Robert Zaslow, a San Jose psychologist who developed holding therapy for autistic clients, moved to Colorado to join other pioneers, Foster Cline and Vera Fahlberg.

Randolph said she is convinced holding therapy can work, not only because she has helped clients like Nolin, but also because she has experienced it herself.

She said her mother was ill for the first four months of her life and couldn’t take care of her. As a child, she said she set fires in the field behind her house in Yuba City, received marginal grades, was “very oppositional” and headed for prison by the time she was 14. She turned her life around with the help of a youth club leader but still had problems keeping friends, she said.

After being introduced to holding therapy as a professional, she decided to try it with another therapist, Chris Waldmann at Evergreen Consultants. She said that after three days of therapy in which she was held in his lap with others present, “something clicked in my brain. All of a sudden, it was like I could trust people. And you see it happen when you work with children.”

“Not everybody can do it,” Randolph said. “You have to be willing to tolerate a lot of anger directed toward you by the child. You have to get really loud with a child without being angry yourself. And you have to be able to tolerate stories that would break your heart.”

In the absence of professional standards, therapists must also possess a high professional ethic. Right now, Pines said, anyone could read a book or go to a workshop and set up shop as an attachment therapist. While embarking on a longitudinal research project to determine the effectiveness of holding therapy protocols, ATTACH is also in the process of drawing up a set of standards for therapists, he said.

Meanwhile, others argue the most effective solutions are not therapeutic, but preventive: more parent education, more family friendly workplaces, higher quality day care, or even government funded abortion services.

Pines said there is no cure for attachment disorder. All therapists can do, he said, is help children learn how to “manage their losses and manage the trauma so that over time the intensive behaviors become far less. You don’t cure grief. You manage grief.”

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Signs of Attachment Disorder

Children who have attachment disorder may show some of the following symptoms:

* Superficially charming, always sizing up a situation for their benefit. They will sit in anyone’s lap, go up to strangers and say, “Will you take me home?”

* Engages in power struggles over insignificant things.

* Lies even when it is easier to tell the truth.

* Is preoccupied with blood or fire.

* Appears to be angry all the time and may be cruel to animals or siblings.

* Has trouble making eye contact when adults want him or her to.

* Has tremendous need to have control over everything.

* Demands things, instead of asking for them.

* Doesn’t learn from mistakes and misbehavior.

* Tells others that parent abuses him or her.

* Throws temper tantrums that last for hours.

* Can’t keep friends for more than a week.

* Is very bossy with other children and adults.

* Chatters nonstop, asks repeated questions about things that make no sense, mutters or is hard to understand.

* Prefers to watch violent cartoons and TV shows or horror movies.

Source: Michael Pines, Liz Randolph