7 Crucial Insights About Attachment Problems Before Adoption

Are you considering adopting a child? Here are 7 things you must know about attachment issues before you adopt. While this information is important for all adoptions, it’s especially important if you are adopting a child from foster care, a child from another country, or an older child or teen.

The following is not medical advice. Consult a doctor or health care professional.

Risk for Attachment Problems

Any child who has a disruption in the relationship with a primary caregiver or caregivers during the first 3 years of life (and especially in the first months) is at risk for attachment problems.

Attachment issues are on a spectrum or continuum. Some children having minor issues (such as being overly clingy, showing lack of connection, or struggling with healthy boundaries), some having more profound behaviors (lack of remorse, harming themselves or others, problems forming healthy relationships, lying, stealing) to very severe (lack of conscious, lack of ability to connect in any meaningful way).

Attachment Issues, RAD (Reactive Attachment Disorder) and Trauma: 7 Things Adoptive Parents Must Know

Before you adopt, here are 7 important truths about attachment before, during, and after adoption.

1. Your child has a history and a family that don’t include you.

Adoption starts with loss and separation. I have two children who are adopted and it’s hard for me to recognize this painful reality sometimes, but it’s the truth. I also have three biological children and their lives didn’t start with this type of loss. I wish I could have been there from the moment my adoptive children were conceived, but I can’t make this wish a reality.

Your child suffered pain and loss before they came to you, and they have a history that doesn’t include you. That history might be long or it could be shorter, but all children have a history of at least 9 months of pregnancy when you weren’t involved.

If your child is an adoptee who spent time living in another place before coming to you, understand that they have thousands of hours and countless experiences outside of your relationship with them.

Give respect and understanding to the fact that your child’s life includes loss.

2. Your child is at risk for Attachment Issues, Attachment Disorder, or RAD (Reactive Attachment Disorder).

All adopted children are at risk for attachment problems because they are removed from their mother, who is their first and most important figure of attachment. Even if a child is brought into the loving arms of adoptive parents within the first moments of life, the risk of attachment issues is still higher because the baby bonds to the mother during pregnancy.

This does not mean all adoptive children will have attachment problems, in fact most do not. Still, the risk is there and adoptive parents need to engage in attachment parenting right from the start.

Children at high risk for attachment issues include:

• Children in the foster care system. All children in foster care are at a high risk of attachment issues and trauma reactions. If you are adopting any child (baby, toddler, child, or teen) from foster care, assume that there are going to be attachment issues. Here is more information to help foster parents understand RAD.
• Children adopted from other countries. Some children from international adoptions have had multiple caregivers or lack of nurturing. Moving from one country to another, even if done for the most loving reasons, involves trauma and loss of people, culture, language, and familiarity.
• Older children and teens who are adopted. Older children understand loss of relationships and develop an (understandable) lack of trust that adults will take care of them. They may parentify. Parentification means taking on the parent role for themselves or younger siblings.
• Children who have had multiple homes or placements, especially in the first 3 years of life. Anytime a child is moved to another family situation, this causes trauma. Each move places a child at higher risk for attachment disorder.
• Children with severe medical issues in early life. Babies and toddlers experience pain. Medical procedures often involve separation from parents. While these cannot be helped, they are traumatic and increase the risk of attachment problems.
• Children who have been abused or neglected in away way during the first 3 years of life. Any child who has been physically, emotionally, mentally or sexually abused, or witnessed the abuse of a loved one, is at high risk for attachment issues.
• Children whose parents use drugs and alcohol or have severe mental health issues. These situations increase the risk the distance in the parent-infant relationship and create attachment difficulties.

3. Adoption won’t fix it and love is not enough.

Adoption does not fix attachment problems, and loving a child won’t erase their trauma history. Never assume that simply bringing a child into your home is all that is required to bond or create healthy attachment, especially if the child is at a high risk of attachment problems.

Make a plan now to do all you can to help your adopted infant, child, or teen become securely attached to you.

4. Know the warning signs of attachment issues.

When you adopt a child, it’s important that you are aware of the warning signs of attachment issues and what RAD (Reactive Attachment Disorder) can look like. Keep in mind that only a medical professional can diagnose attachment disorder.

Click here for an in-depth RAD checklist with warning signs and symptoms.

Currently, there are two possible attachment disorder diagnosis.

1. Reactive Attachment Disorder (RAD). RAD is characterized as not seeking and responding to comfort from primary caregivers, poor interactions with people, plus fear, sadness, or anger toward primary caregivers. This is often an ambivalent attachment.
2. Disinhibited Social Engagement Disorder (DSED). DSED is diagnosed when a child does not have an appropriate attachment to primary caregivers but instead will attempt to form relationships with strangers. This is an anxious attachment.

Here is a brief overview of some of the possible symptoms of attachment problems for infants and children.

Signs of attachment problems in infants and toddlers

• Lack of eye contact
• Not smiling
• Not reaching out to be picked up
• Won’t calm, soothe, and connect with caregivers
• Is fine, or even better, when left alone
• Non-stop crying or can’t be consoled
• Not vocalizing with baby sounds
• Not following caregiver with eyes
• Not playing with toys
• Rocking or comforting self (this can also be a sign of autism)

Read more about infant attachment theory by Ainsworth and Bowlby here.

Signs of attachment problems in children & teens

• Lack of eye contact
• Hyperactivity (this can also be a symptom of ADHD)
• Aggression
• Tempter tantrums beyond what is typical for the age
• Playing alone or parallel play beyond the typical age, lack of friends
• Interest in gore or violence
• Stealing
• Hoarding food
• Lying, especially nonsensical lying
• Lack of boundaries, including with strangers (for example, calling a stranger “Mommy” or hugging her)
• Avoidance or lack of interest in primary caregiver
• Hyper-vigilance
• Bladder and bowel accidents or smearing
• Sexualized behavior
• Lack of concern when others are hurt
• Lack of remorse

5. The first weeks, months, and years are critical for attachment.

The first days that you bring a child into your home are critical to bonding.

How to bond and connect to your adopted baby.

• Hold your baby as much as possible.
• Create skin-to-skin contact as much as possible.
• Do infant massage daily.
• Co-sleep or allow the baby to sleep in your room if you are comfortable with it.
• Wear your baby in a carrier or pouch.
• Use movement like rocking and walking your baby often.
• Sing to your baby and talk to them throughout the day.
• If possible, have one primary caregiver stay home with the baby.
• Hold your baby during feedings and look into their eyes. Do not prop the bottle.
• Manage any feelings of depression and sadness you are experiencing.
• Take care of yourself. As important as these activities are, it’s also important that you rest and take care of yourself so that you can be there for your child.
• If you have concerns about attachment issues, speak to your child’s doctor.

How to bond and connect to your adopted child.

• Connect physically with hugs, lap time reading books, and snuggle on the couch together watching TV if your child feels safe doing so. (Children who have been victims of abuse may not feel safe with this type of physical connection.)
• As much as possible, have most care for your child come from primary caregivers during the early weeks and months.
• Begin attachment therapy. This is different from traditional talk therapy or play therapy and is specific to children with attachment issues. Parent and child attend attachment therapy together.
• Create a highly structured environment with a consistent routine and clear house rules.
• Keep discipline consistent. Click here for more on how to discipline a child with RAD.
• Consider homeschooling for a short period of adjustment time.
• If your child must attend school, be sure the teachers and staff are informed about RAD and attachment issues.
• Supervise the child with line of sight supervision around other children and pets.
• Create a safe home environment. Depending on the child’s needs, this might include additional locks on rooms and cabinets, door alarms, or video cameras.
• Create a safety plan with steps for what will happen if the child engages in behavior that is unsafe to themselves or others.
• Adjust your expectations.
• Continue to offer love and support, even if you don’t receive it in return.

How to bond and connect to your adopted teen.

• Encourage physical touch in ways your teen will allow it. This might include handshakes, pats on the back, hugs, or watching TV together on the couch. Some teens may enjoy having their hair brushed, make-up done, or a manicure or pedicure.
• Begin attachment therapy. This is different from traditional talk therapy or play therapy and is specific to children with attachment issues. Parent and child attend attachment therapy together.
• Don’t try to fix all behaviors at once. Make a plan to work on one small, realistic change at a time.
• Adjust your expectations.
• Have a consistent daily routine.
• Keep firm boundaries in place with clear consequences.
• Create a safe home environment. Medications and sharp knives should be locked. Video cameras may be necessary.
• Supervise with line of sight supervision with other teens, younger children, and pets.
• Create a safety plan with steps for what will happen if the teen engages in behavior that is unsafe to themselves or others.
• Do not expect your adopted teen to trust you. Part of attachment issues is lack of trust.
• Set clear, specific rules for social media, video games, and electronics, including phones.
• Continue to offer love and support, even if you don’t receive it in return.

If a child has severe attachment issues, you can do all the right things for bonding and the child will still have problems. Don’t blame yourself for your child’s attachment insecurities or problems, but also do all you can to promote healing and connection.

6. Treatment is available.

While it can be difficult to find, there is treatment available for attachment issues.

Seek out a qualified attachment therapist and begin attachment therapy. Attachment therapy is different from traditional talk therapy or play therapy and requires a highly skilled therapist who is familiar with children with attachment issues.

The sooner a child begins attachment therapy, the higher the success rate.

Expect to attend therapy with your child. If a child or teen attends therapy alone, they often lie and triangulate the therapist, driving themselves deeper into their attachment problems. (Trust is scary for a child with trauma history, so don’t expect them to willingly participate in therapy.)

Educate yourself with books about attachment and attend training such as Empowered to Connect.

Ideally, a child with attachment issues should stay within the home and community, but there are times when children are not safe to live at home. In those situations, residential therapy may be necessary. Click here for residential programs for kids with RAD and here for a list of 75+ parent reviews of RAD treatment programs.

7. Many children with attachment disruptions have life-long struggles.

Set realistic expectations. Your child’s life started with loss. As much as it’s hard to admit, your adopted child is not the same as a biological child. Your child may have zero attachment problems, but its possible that they will and you need to be prepared for this reality.

If your child is adopted from foster care, internationally, or is older, assume that there will be attachment difficulties and adjust your expectations. Don’t expect your child with a trauma history to be “normal”. While your child can grow and develop healthy connections, those might look different from someone who doesn’t have a history of broken primary attachments.

Trauma and loss never go away. Instead, the goal is to heal, make these challenges part of who we are, and eventually even use these experiences for our greater good and to help others.

Are Attachment Problems Hopeless?

No! There is hope and help for attachment struggles. Your child or teen can heal and connect to you with the proper support and therapy. Adjust your expectations that the relationship might look different from what you had imagined.

Your commitment to your child can have a life-long impact on them becoming a healthy adult who is capable of being a productive member of society.

FAQ Frequently Asked Questions about Attachment & Adoption

Have you adopted a child with attachment issues or are you considering it? Share in the comments below.

Click here for a free PDF printable checklist of the 7 steps to take when your child needs residential treatment.