FAQs

What is the Attachment & Bonding Center of Atlanta, LLC ?

A team of therapists specially trained to work with attachment resistant children founded the Attachment & Bonding Center of Atlanta, LLC (ABC Atlanta) or ABC. ABC will be a model of excellence in providing therapeutic and humanistic assistance for families, children, and professionals. ABC was formed by Jeff Atkinson, LPC NCC and Cassandra Johnson-Landry, LPC NCC.

Jeff is a nationally certified counselor and has a strong background in the area of family preservation. Cassandra provides therapy using a holistic approach and training to enhance mental health awareness in the African-American community. Both clinicians have specialized training in working with sex offenders. Both clinicians are licensed as professional counselors in the State of Georgia. ABC is a Georgia limited liability company and holds an active business license in Dekalb County. ABC is properly insured in providing direct care for children.

What is our success rate? How is this measured?

We are averaging about a 70% success rate in receiving a positive report from parents that their child significantly benefited form our treatment. We are always working on compiling statistics of our treatment. Effectiveness of treatment can be measured many different ways. The most scientific method would be a controlled study which has never been done on children with RAD (or PTSD as it pertains to attachment therapy). Most centers use outcome measures where they take data compiled from pre and psot treatment measures and see if there is a statistical significance in the difference. We use the Randolph Attachment Disorder Questionannaire (RAD-Q), child behavior checklist (CBCL) and parent satisfaction surveys as our main pre and post treatment measures. The parents are the input source of this data which may not be the most objective source. However, the parents’ satisfaction with their child’s behavior is the best barometer for whether their child needs treatment in the first place.

The remaining 30% of our patients are a diverse group. Some did not finish treatment. Others may have had severe brain issues that prevented them from fully benefiting from treatment. The age of the child, the lack of a parental support group and the child’s criminal and unruly behavior are all big factors in deterring success in treatment.

What is Attachment?
Attachment is one of the fundamental biological processes necessary in most animals for survival of the species like reproduction, care giving, feeding, and environmental awareness. Attachment has been described as operating unnoticed much like the psychological regulators that control our blood pressure and body temperature. The attachment process begins to develop in the first few months of a child’s life. In developing the parent-child bond, the attachment process for the infant is the reciprocal behavior to the adult’s (primarily but not always the mother figure) care-giving process. Simply stated, it is a process that operates to enhance the safety and security of the infant and to aid the infant in getting his or her needs met in humans: touch, eye contact, smiles, motion, and food.
What is Reactive Attachment Disorder?

The pattern of attachment behavior can be influenced greatly by what happens in the child’s environment. Children have the ability to attach on any level, even a traumatic one. Children begin to develop attachment behaviors that are described as either secure or insecure. Insecure attachment behavior is further described as ambivalent, avoidant, or disoriented-disorganized depending on a behavior pattern. The more severe cases of insecure attachment can be categorized as attachment disorder.

Attachment Disorder can be defined as traumatic events can damage a secure base or therapeutic intervention can aid in reducing the damage of an insecure base. While the behaviors must be thought of as operating on a continuum, it is clear that many insecurely attached children have behaviors that can be very destructive to themselves and others. These behaviors are not always apparent at first without the proper knowledge.

What are Possible Causes of attachment disorder?

Prenatal alcohol and drug abuse

Medical problems (i.e., physical illness at birth)

Neglect and abuse issues

Death of a parent

Excessive Transition or changes in mother figure

Unavailable care givers due to the parent/mother’s own attachment issues

What are the Symptoms of Reactive Attachment Disorder (RAD)?

*Superficially charming and affectionate towards strangers

*Shows developmental delays

*Cruelty to animals and/or people

*Oppositional and Defiant Behaviors

*Steals, Lies, hoards food

*Resistant to parental cuddling/affection

*Preoccupied with fire, blood and violence

*Manipulates and Splits adult caregivers

*Parents may appear hostile and angry

What are the methods for diagnosing RAD?
ABC uses a combination of measures to assess whether the child meets crietria for RAD. First of all they need to meet the diagnosis criteria as set-forth by the Diagnostic and Statistical Manual (DSM IV-TR). Then we observe the child with the parent through two child-parent interactions: A.) the Marshack Interaction Method (MIM) and a B.) parent holding exercise. Lastly there are behavioral measures that help us with determining diagnoses. The Child-behavior Checklist (CBCL) and the Trauma Symptom Checklist (TSCL). To fully determine whether a child has RAD a clinician must evaluate the full array of mental health issues and be ready to make a diagnostic impression. Other diagnoses can perpetuate attachment issues such as PTSD, ADHD, Bi-polar disorder. Further, medical conditions can exaserbate attachment issues as well. These all need to be considered. Hence, an evaluation of attachment should not just solely be to determine whether a child has RAD or not.
Is the RAD-Q a sufficient measure in itself to use as a basis for diagnosing RAD?
No, absolutely not. The RAD-Q or Randolph Attachment Disorder Questionnaire, is a non-standardized test that has been used by a fair amount of clinicians in the attachment field. ABC has used it and still occasional does. However, being that is a behavioral report completed by a parent it should be limited to an impression made by the parent. There are some agencys and therapists that use the RAD-Q and their own checklist to essentially determine whether the child has RAD. This could be a rush to judgement. First of all, the parents emotional intensity needs to be taken into consideration. As some RAD checklists list (such as Nancy Thomas) parents appear hostile. The mother (caretaker) is often getting the brunt of the behavior from a child with attachment issues. Essentially she is getting abused by the child. Now we are asking the “victim” to complete a behavioral form about the perpetrator. There may be some loss of objectivity. None-the-less, the mother’s perspective is highly important and should be a guiding force in treatment. The RAD-Q does not adequately address how long the child has been in the home of the respondent (i.e., adoptive mother) or other factors noted above (i.e., medical conditions). Our agency has concerns about clinicans that would diagnose a child with RAD using primarily the RAD-Q.
What is Holding Therapy? Are there any risks involved?

The most common and possibly most effective modality of treatment for attachment problems is holding therapy. This can also be called cradling therapy or even attachment therapy. Unfortunately, due to a small number of therapists that have attempted to use methods that they called holding therapy (but it was really abuse) the terms “holding therapy”, “attachment therapy” and even the term “attachment” are forever controversial. The fact is there have been children killed by basically crazy therapists and desperate parents under the guise of attachment therapy.

Holding therapy started over thirty years ago and has had many different variations. Early versions of holding therapy used “containment” which was holding the child basically against their will to elicit some type of anger response. Robert Zaslow was probably the pioneer and coined his technique as the Z-process. He worked primarily with infantile autism. The last decade has brought more of a nurturing hold into this process without looking for a rage response. This type of holding therapy is focusing on the engaging the child in a more”emotional” intimacy with the child or parent through eye-contact, proximity (closeness) and lying position (which engages the limbic system of the brain).

ABC has developed its own variation of attachment therapy involving the parents holding their child in a nurturing, non-restraint-like manner. ABC calls this modality Landry-Atkinson Attachment Parenting and Promoting (L.A.P.P.)Therapy. Below is some brief information about the history of holding therapy technique and ABC’s L.A.P.P. therapy

ABC does not use containment or restraint unless the child becomes out of control and needs such structure. ABC uses Landry-Atkinson Attachment Parenting and Promoting (L.A.P.P.)Therapy. This can be therapist-led, but is primarily parent-led. It does not involve containment (holding the child against their will). In therapist-led or parent-led holding therapy, the child is cradled administering therapy to address the various issues that relate to the child’s life. In both styles the child is asked to lay across the parent(s)’ or therapist(s)’ laps in such a way that a child would have a story read to them. There is much focus on the child maintaining eye contact with the therapist or parent through-outthe session. The lying down position (which engages the feeling part of the brain), proximity between child and therapist(s) and the eye contact work together to assist the child in identifying and processing feelings at a much more quick and intensive rate. The child works through the arousal relaxation response in which they are stressed in dealing with the issues of their traumas, etc. and find comfort from the therapists(s). This is called a corrective emotional response. Parent-led holding therapy replaces the therapist (s) with the parent(s). Different therapy techniques are employed depending on who is doing the holding (i.e., EMDR, cognitive-behavioral, narrative, etc).

The risk of doing such therapy involves the risk of the child facing past trauma. The child may have an increase in post-traumatic symptoms such as nightmares, bed-wetting, exagerated startle response, etc. However, the crux of attachment therapy is intensely facing the issues of the past that impede upon forming an attachment with the primary care taker and others. Such therapy should not be performed unless there is adequate time for process regarding such memories and adequate support from the care-takers (i.e., parents). Further, the therapist(s) should be highly trained and experienced like those with ABC so that the course of therapy is not too abrupt. The child should also be medically cleared and approved for physical fitness activity.

One has to also ponder the dangers of not having the child deal with these issues. The result of no treatment or ineffective treatment is almost always more dangerous than possible reactions to the treatment itself. If traditional therapy is not working and there is no further treatment, the parent(s) needs to consider where the child is heading in life.

What is Holding Therapy? Are there any risks involved?

The most common and possibly most effective modality of treatment for attachment problems is holding therapy. This can also be called cradling therapy or even attachment therapy. Unfortunately, due to a small number of therapists that have attempted to use methods that they called holding therapy (but it was really abuse) the terms “holding therapy”, “attachment therapy” and even the term “attachment” are forever controversial. The fact is there have been children killed by basically crazy therapists and desperate parents under the guise of attachment therapy.

Holding therapy started over thirty years ago and has had many different variations. Early versions of holding therapy used “containment” which was holding the child basically against their will to elicit some type of anger response. Robert Zaslow was probably the pioneer and coined his technique as the Z-process. He worked primarily with infantile autism. The last decade has brought more of a nurturing hold into this process without looking for a rage response. This type of holding therapy is focusing on the engaging the child in a more”emotional” intimacy with the child or parent through eye-contact, proximity (closeness) and lying position (which engages the limbic system of the brain).

ABC has developed its own variation of attachment therapy involving the parents holding their child in a nurturing, non-restraint-like manner. ABC calls this modality Landry-Atkinson Attachment Parenting and Promoting (L.A.P.P.)Therapy. Below is some brief information about the history of holding therapy technique and ABC’s L.A.P.P. therapy

ABC does not use containment or restraint unless the child becomes out of control and needs such structure. ABC uses Landry-Atkinson Attachment Parenting and Promoting (L.A.P.P.)Therapy. This can be therapist-led, but is primarily parent-led. It does not involve containment (holding the child against their will). In therapist-led or parent-led holding therapy, the child is cradled administering therapy to address the various issues that relate to the child’s life. In both styles the child is asked to lay across the parent(s)’ or therapist(s)’ laps in such a way that a child would have a story read to them. There is much focus on the child maintaining eye contact with the therapist or parent through-outthe session. The lying down position (which engages the feeling part of the brain), proximity between child and therapist(s) and the eye contact work together to assist the child in identifying and processing feelings at a much more quick and intensive rate. The child works through the arousal relaxation response in which they are stressed in dealing with the issues of their traumas, etc. and find comfort from the therapists(s). This is called a corrective emotional response. Parent-led holding therapy replaces the therapist (s) with the parent(s). Different therapy techniques are employed depending on who is doing the holding (i.e., EMDR, cognitive-behavioral, narrative, etc).

The risk of doing such therapy involves the risk of the child facing past trauma. The child may have an increase in post-traumatic symptoms such as nightmares, bed-wetting, exagerated startle response, etc. However, the crux of attachment therapy is intensely facing the issues of the past that impede upon forming an attachment with the primary care taker and others. Such therapy should not be performed unless there is adequate time for process regarding such memories and adequate support from the care-takers (i.e., parents). Further, the therapist(s) should be highly trained and experienced like those with ABC so that the course of therapy is not too abrupt. The child should also be medically cleared and approved for physical fitness activity.

One has to also ponder the dangers of not having the child deal with these issues. The result of no treatment or ineffective treatment is almost always more dangerous than possible reactions to the treatment itself. If traditional therapy is not working and there is no further treatment, the parent(s) needs to consider where the child is heading in life.

What is EMDR?
This stands for eye-movement desensitization and reprocessing. This is a technique developed by Francine Shapiro, Ph.D.. It is a widely used and researched technique used often in dealing with trauma victims. It is non-invasive and can be used with all ages. The ABC therapists have obtained advanced training in using EMDR and logged 100s of hours in its use. The ABC therapists use standard eye-movements, sounds, and tactile stimulation (via a Neurotek machine) to administer EMDR.
What is EEG Biofeedback or Neurofeedback?

This is a twenty five-year-old treatment that is gaining favor by attachment therapists. As in other methods of biofeedback, we can use the appropriate device to become more connected with our physical body. In this case our we our training patients to become more in control of their brain. We measure the brain’s response by its brain waves. By receiving auditory and visual feedback via computer games, we can train our brains to produce the appropriate balance of brain waves. This in turn impacts our behavior. For example an anxious person will produce typically an excess of Beta waves. With EEG biofeedback we can work to bring the other brain waves in proper proportion. ABC gets expert recommendations on the specific training protocol to use by taking a Quantitative EEG (qEEG) of the individual and then having it expertly analyzed by Q-Metrx, Inc. Jay Gunkelman, who is considered one of the best in the world at reading QEEG’s, will send us specific recommendations in this report.

ABC has state-of-the art BrainMaster EEG biofeedback equipment. We use this equipment to administer the feedback in office or train parents to use and administer to their child at home.

What is QEEG and how is it used in the Assessment of Mental Health Disorders?

Use of the Quantatative Electroencephalogram or (qEEG) for diagnostic purposes is gaining some momentum. Use of qEEG for such purposes is also unpopular with many traditional psychiatrists and physicians. The proper use of qEEG for assessment is not to determine actual diagnosis, but to identify specific brain system issues that can be addressed medically or with other means (i.e., biofeedback). Further, it is extremely helpful to parents and professionals in determining the actual deficits or potential of a child.

UCLA has pioneered research recently in using qEEG to determine the effectiveness of an anti-depressant within 48 hours rather than waiting the typical 30 days.

Certain mental health disorders tend to show specific characteristics in terms of brain wave activity. RAD for example tends to show a disturbance in the right parietal lobe. This is the area of the brain responsible for understanding social cues. Children who have endured severe neglect tend to have a high level of theta brain waves (associated with focus on inner thoughts or “their own world” ) and usually a deficit of beta brain waves (associated with attention to the here and now).

QEEG is appropriate when a child or individual is chronically not responding to a typical medication regime and/or there is a history of long standing behavior problems. This is aside from the standard neurological reasons for such a test.

Q-Metrx, Inc is the company contracted by ABC to perform the evaluations on qEEG data. They are leaders in the field with Dr. Proler (neurologist) and Jay Gunkleman (EEG specialist) some of the world’s best.

What is the normal length of treatment sessions? How long will my child need to be in therapy with ABC?
An important factor in attachment therapy being effective is allowing for the appropriate amount of therapy time to address treatment issues. One hour a week (such as in traditional therapy… managed care) is not adequate. Our attachment therapy sessions range from 2 to 3 hours per day depending on the issue or the phase of therapy. The initial, intensive phase requires longer sessions daily, often consecutively. Follow-up sessions may be as little as 1.5 hours and be scheduled every other week. Generally therapy may take a total of a year with the following structure: Example: eight days of consecutive therapy, one month of two sessions per week, 2 months of weekly therapy, 3 months of bi-weekly therapy, and 3 months of monthly therapy.
Is there any risk of harm to my child with the treatment techniques provided by ABC?

This has been addressed above in the “holding therapy” question. As with any clinical interventions there are risks associated. These risks should be pre-screened to guard against significant risks. The potential benefits far outweigh any possible negative effects. Children who suffer from RAD or PTSD have ways of defending against further pain (i.e., fighting, violence, defiance, etc). These methods are not healthy for them or accepted in society. In dealing with the pain and hurt associated with their past trauma(s) we are also confronting their unhealthy defenses (which includes pushing people away). This is where the old cliche’ “it gets worse before it gets better” is applicable. How much worse?…Probably not worse than it has ever been. Hold steady, its gets better.

Also in dealing with trauma, a person can experience an abreaction. This is re-experiencing of trauma or an increase in depression type symptoms. Close consult with the child’s psychiatrist is needed, as well as, many necessary follow-up sessions with the attachment therapists to assist the child through this phase of the therapy.

What is difference between Attachment Issues, Attachment Disorder, and Reactive Attachment Disorder?

Attachment problems can be measured on a continuum of severity ranging from mild to severe. Most children who have been adopted have at least some mild attachment issues. The more severe the issues, the more likely it is an attachment disorder. The more severe the disorder, the more likely it is Reactive-Attachment Disorder (RAD). See Elizabeth Randolph, Ph.D. (Evergreen for more information on these distinctions).

If my child has RAD and he/she does not get treatment, what does the future hold for them?

Depending on the severity, the child will grow up into an adult that does not trust others. This leads to sociopathic behaviors which will be most likely criminal and destructive (to themselves and others). If your child does not put significant effort into the treatment process there is cause for grave concern. They will most likely end up with serious legal problems or worse.

What is the typical treatment costs? Does ABC accept insurance? What are the forms of payment that ABC accepts?

Attachment therapy is more costly because you often use two therapists and you spend the time you need to get the job done. Sessions often last three or more hours. ABC charges $180 per hour for the use of two therapists and $90 per hour for one therapist. A RAD assessment is also necessary. The price of this assessment depends upon the type needed. A brief assessment is $375 and a Full is $950.

There are additional costs if qEEG and neurofeedback is needed. QEEG recordings are $250. The report analyses is $325. Neurofeedback sessions are at a cost of $55. A client will need at between 40-60 sessions or more. Packages of neurofeedback sessions are available at a discount (i.e., 20 sessions for $1,000). Training parents to use the equipment and arranging for either rental or purchase of the equipment is available as well.

ABC is on many insurance panels. In most cases you will need to look up Jeff Atkinson, LPC of Tucker, GA as ABC is not listed. ABC takes all forms of payment including VISA, MC, Discover, and AMEX. As stated above ABC also has a program called ACT which is covered by GA Medicaid.

Can an adolescent be too old to benefit from treatment?
It is not the age, but the desire to change that is the greatest factor in treatment efficacy. If the child is 16, 17, or 18 years of age it is important to get a solid commitment from the teenager that they are willing to work hard. They must commit to letting their parents and therapists be the boss. This is after they have accepted responsibility for their behavior and admitted that their life is not going well. This collectively is the contracting part of therapy. Older patients may need to write a letter expressing their desire to improve their life and relationships.
What is the current availability for treatment with ABC?

Due to the intense need and limited availability for such services, ABC cannot guarantee immeadiate service delivery. ABC encourages individuals and families that are seeking our help to keep monthly contact with us. You are welcome to contact us today to be placed directly on our waiting list.

What are some other Resources?

National Resources and Recommended Reading

Adoption Helper 189 Springdale Blvd. Toronto, ON, Canada M4C126

American Adoption Agency 1228 M St.N.W Washington, DC 2005

Attachment Disorder Awareness 8116-187th St.

Edmonton, Alberta, Canada T5T 1K3 Phone and Fax 403 484-9179

Attachment Disorder Parents Networks (ADPN)
P.O.Box 18475
Boulder, CO 80308
303 443-1446

 

List of Parents contacts state by GA state

Georgia Center for Adoptions Resources and Support 1-866-A-Parent

 

Websites

Adoption Information and Support http://www.adoptine.org

Adoption Policy Resource http://www.fpsl.com/adoption/advocats.html

Nancy Thomas www.attachment.org

ATTACh www.attach.org

 

Suggested Readings

Adopting the Hurt Child, Gregory C. Keck Ph.D and Regina M. Kupecky, LSW,Pinon Press, 1995.

Children Who Shock and Surprise, Elizabeth Randolph, RN, Ph.D., RFR Publications, 1994.

Don’t Touch My Heart, Lynda Fianforte Mansfield & Christopher H. Waldmann, MA, LPC, Pinon Press, 1994.

Holding Time, Martha Welch Fireside: New York, NY 1989.

Parenting the Hurt Child, Gregory C. Keck Ph.D and Regina M Kupecky, LSW, Pinon Press, 2002.

Parenting with Love and Logic, Cline, M.D., Foster W.& & Fay, Jim. Nav Press, Colorado Springs, Co 1990.

When Love is Not Enough, Nancy Thomas 1997, Families by Design, P.O. Box 2912, Glenwood Springs, Co 81602.

 

Video(s)

Amazing Talents of The Newborn, Johnson &Johnson, 1-&77-JNJLINK