A parent's worst nightmare

A Colorado child-abuse case highlights the controversial and misunderstood condition of reactive attachment disorder.

Published September 30, 1997 10:19AM (EDT)

According to Renee Polreis, the bruises that blackened her son's body at the
time of his death were self-inflicted. Her adopted son David apparently
suffered from reactive attachment disorder (RAD), a condition marked by
violent fits of rage, inappropriate emotional responses, severe emotional
detachment and an inability to feel pain.

Last week, a Greeley, Colo., judge sentenced her to 22 years in prison for
abuse resulting in David's death. Investigators found a broken, bloody wooden spoon wrapped in a diaper in
the Polreis home; Polreis had called her attorney and her therapist before
calling "911" to report her son's death. U.S. News and World Report reported that Polreis'
defense characterized David's behavior as violent and out of control --
David banged his head on the floor, became rigid and smashed his face on
the ground and tugged his penis until it bled. Despite the defense's focus
on David's uncontrollable behavior, at least two witnesses for the
prosecution testified to the mother's loss of control. According to the New
York Times, one of the Polreis' family's two therapists, Byron Norton,
stated that Renee Polreis called him at 4:30 a.m. on the day David died and
told him that she'd hurt David. "I just lost it," Polreis told Norton.

While casting the national spotlight on reactive attachment disorder, the
Polreis case may have further muddied the waters around a condition that
many have never heard of and few understand. Although recognized by the
American Psychiatric Association as legitimate, attachment
disorder is controversial because of the therapeutic community's
disagreement on the most effective course of treatment. Some doctors advocate
"holding therapy," during which the patient is physically restrained until
he/she can exhibit appropriate emotions, while others advocate more traditional psychotherapy that involves both
parents and children.

Salon recently asked Dr. Alicia Lieberman, director of the Child Trauma Research Project
at San Francisco General Hospital and an expert on attachment disorders, to
discuss the diagnosis, symptoms and treatment of reactive attachment disorder.

What is attachment disorder?

It is a disorder that occurs when children have not had the opportunity to
become emotionally connected to a primary caregiver, particularly in the
absence of a biological or adopted mother figure. It is most notable in
children who have not had a consistent caregiver for the first three years of
life. If the child is not given the opportunity to form a deep emotional
connection with an adult who takes care of him, then it becomes a lifelong
personality disorder that consists of an inability to form intimate
connections with others. Often this manifests itself in a very aggressive,
exploitative pattern of relationships or in a withdrawn, scared, unconnected

How do infants with the disorder act?

"Infant" is defined here as babies ages 0 through 5 years. There
are two major patterns in infants. In one, the child is overly
gregarious, does not seem to see the difference between one person and
another, even between their parent and a stranger. This happens when a
child lives in an orphanage for years and has many, many different
caregivers and then is adopted. The adoptive parents will complain that the
child will follow a stranger who smiles at him. You also see this in
children who were raised in institutions; whatever stranger comes into the
room becomes the novelty, the attractive person, and the child might want to
follow that person out of the room only to turn to the next person they see
and follow them. There is an indiscriminate search for connection without
any emotional preference. It can be very chilling to see.

The second pattern is withdrawal. Children seem to be afraid of the
world. These children are lethargic, apathetic and do not explore or reach
out to anybody and seem uniformly afraid of people.

In the Polreis case, the little boy was apparently abusive to
himself. He apparently banged his head against the wall.

There can also be a component of aggression -- and that includes aggression
toward the self -- but that is much rarer.

Why is there so much controversy around the treatment of attachment

First of all, there is very little controversy over the fact that this
is a real disorder. It is very well documented and nobody who knows
anything about children doubts that it is real.

There is an established approach to treating disorders of attachment
that emphasizes the importance of giving these children precisely what they
have lacked. The research on what makes for a secure attachment and what
makes for a disordered one emphasizes the mother's ability to be responsive
to the child, to be sensitive. The research has shown what really works is
maternal empathy, maternal responsiveness, the ability of the mother to put
herself in the child's position and to be sensitive to the child's signals.

The form of treating attachment disorders that I do is called
infant-parent psychotherapy. It involves understanding the
meaning of the signals a child gives off and helping the mother respond
appropriately. I have done research showing that children
who were treated this way do much better in terms of their social and
emotional functioning, and their mothers become much more competent and
sensitive and less angry and less aggressive.

What does this therapy entail?

We can start the first day of life, prenatally even. The whole point is to
help the mother recognize the meaning of the child's behavior. When a child
is signaling distress, joy or need, we help the mother identify the kinds
of behavior that would meet the child's needs. So essentially what we do is
awaken a sense of nurturance or love for the child. Many of the mothers who
have children with these disorders have been abused or neglected during their own childhoods.
So they are not familiar with the things that you and I might take for
granted -- to go to children when they are crying, to reassure them when
they are scared, to feed them when they are hungry.

It often takes being sensitive to the mother to change the situation
with the child. It is only when the mother feels protected and supported by
us that she in turn can reconnect with her pain, the pain of not having
grown up with this security and caring that she longed for terribly.

What is your opinion of holding therapy?

I've had some mothers call me and say they've gone through it and are
having a hard time. I've heard hearsay about it, but I haven't seen it. One
thing I think is very important to ask is: "What is developmentally appropriate
for children?" One thing we do in our therapy is to try not to exacerbate the
symptoms, not to retraumatize the child. Many of these children not only
have attachment disorder but also post-traumatic stress disorder because of
punishment and loss. We are working with terrified children.

From what I understand, part of the holding therapy is to physically
hold the children down until they "break through," finally
expressing their true emotions.

These children are already having trouble regulating intense emotions.
The best way you can best help them regulate their emotions is to provide
a self-container, where you are the person they can rely on to soften their
emotions, rather than exacerbate them.

The Polreis case highlighted the situation of an adopted child with
attachment disorder. But it sounds like you mostly work with kids and their
natural mothers.

Eighty percent of the women I see are biological mothers.

Why then do we seem to hear only about the cases of attachment
disorder among adopted children, mostly those adopted from the Soviet Union and

I think it's because the parents that adopt them are very articulate in
explaining the difficulties that these children have. But the disorders of
attachment are a rampant problem for infants in our foster-care system.
The disorder occurs often in children who are born to mothers who are
addicted to drugs and therefore cannot provide consistent care, and the children often have a
string of caregivers. Those parents are often not aware of the difficulties
their children are enduring and they feel too guilty to talk about it,
whereas adopted parents don't feel the disorder is their fault
so they seek help. They also have more resources to pay for the help

Is the level of frustration Renee Polreis exhibited something that you
often see in parents who are dealing with this illness?

Yes, I think that there are parents who find themselves unable to get
through to their child, so that their efforts to get the child to obey,
to get the child to mind, to get the child to love them, to be loving and
affectionate with them, seem to go nowhere. That's where I think it is
very important to seek therapy that looks at the meaning of the behavior. I
think it is very important to remember that these behaviors are defenses
that the child engages in. These are children who have no reason to trust
human relations. Every human relation that these children have had have
been disappointing, frightening or confusing. So in a way you have to
say to these children, I am going to give you a totally different experience
from anything you have experienced until now. And I am going to show you
that no matter how much you push me away, how much you make me angry, how
much you defy me, I will not hurt you.

By Lori Leibovich

Lori Leibovich is a contributing editor at Salon and the former editor of the Life section.

MORE FROM Lori Leibovich

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