Karen,

Reactive attachment disorder is a diagnosable mental illness. I think it is
probably fairly rare for premmie babies to be diagnosed with this (in fact
it would not be babies but older children with that history) but that it is
the case that just by their long term hospitalisation and maternal
separation that they are put at risk of attachment issues. The reason why
this is an issue is because babies are wired to expect close contact with a
single caregiver who is able to consistently meet their needs. Clearly
babies who are hospitalised often have mulitple caregivers (exclude places
where 24hr kangarooing is done) and they may have painful medical conditions
that are unable to be relieved (any young child with a painful medical
condition is at risk also). My experience is with adopted children who have
spent time in institutional care not premmies but the same principles apply.
I highly recommend the book Becoming Attached by Robert Karen for a really
good history of the research in this area. I'll paste in below some of a
conference abstract I wrote as a summary of attachment theory.



"It can be argued that the most serious deprivation of institutionalisation
is the lack of a consistent and sensitive caregiver whom the child can trust
and form a healthy attachment to. Development of a secure attachment
normally occurs through interactions in which a primary caregiver meets a
child's needs in an appropriate manner resulting in reduction of discomfort
and in feelings of relief (Levy & Orlans, 2000). This cycle of
arousal-distress-gratification-relief-arousal is ordinarily repeated many
thousands of times in the first years of a child's life but is absent or
greatly reduced in the experience of institutionalised children. Lack of
attachment cycle is extremely damaging and retards emotional, social and
even physical development  (Levy & Orlans, 2000). Behaviours in children
resulting from insecure attachment and trauma include: sleep difficulties,
rejection of mother/fear of intimacy, excessive clinginess, indiscriminate
affection, needing control, resisting being held, not giving eye contact,
self harm (Gribble, 2004b).

Mothers are helped to be responsive to their child by keeping them close.
The physical closeness and associated hormonal influences promote sensitive
care giving (Gribble 2005b). Keeping a baby close goes against Western
cultural beliefs which sees development of early independence as important.
However, what is known about attachment reveals that the base of a secure
attachment, a result of dependence on the mother, is needed in order to
achieve healthy independence (Karen, 1998)."



Karleen Gribble

Australia

> > I am interested in your terminology "Reactive Attachment Disorder".  I
am
> new to this list so may well have missed this previously.  I would be
> grateful if someone can lead me where I can learn more about this.
>
> Karen Palmer
> New Zealand
>

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