Charles H. Zeanah Jr. is a child and adolescent psychiatrist who is a member of the council (Board) of the American Academy of Child and Adolescent Psychiatry (AACAP). [1]
Zeanah is a professor of Psychiatry and Professor of Clinical Pediatrics, Director of Child and Adolescent Psychiatry and vice-chair of the Department of Psychiatry and Neurology at the Tulane University School of Medicine. He is also an executive director of the Institute of Infant and Early Childhood Mental Health.
Zeanah is the editor of the Handbook of Infant Mental Health. His particular field of research is in child psychopathology focussing on infant-parent relationships, attachment and its development in high-risk environments. Zeanah has many scientific papers in peer-reviewed journals and books on these topics. [2]
In 2005 Zeanah was the joint author, with N. Boris, of AACAP's Practice Parameter for the assessment and treatment of reactive attachment disorder. [3] He was also a member of the American Professional Society on the Abuse of Children (APSAC) Taskforce which reported on attachment therapy, reactive attachment disorder, and attachment problems in 2006. [4]
In 1998, Zeanah, together with J.A. Larrieu, devised the New Orleans Intervention, a treatment and prevention program aimed at developmental and health needs of children under the age of five who have been maltreated and placed in foster care, with particular reference to their attachment status and needs. This program is currently in the process of being evaluated. [5] [6] [7] Zeanah directs the Tulane Jefferson Parish Human Services Authority Infant Team, a community-based intervention program for abused and neglected infants and toddlers in the New Orleans area.
In a series of papers from 1996 onwards, Zeanah and N. Boris, building on the earlier work of A.F. Lieberman,[ clarification needed ] proposed new practice parameters for the categorization of attachment disorders, currently categorized as reactive attachment disorder and disinhibited attachment disorder in DSM-IV-TR, the revised fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD-10). The first new category is disorder of attachment, in which a young child has no preferred adult caregiver, parallel to RAD in its inhibited and disinhibited forms, as defined in DSM and ICD. The second is secure base distortion, where the child has a preferred familiar caregiver, but the relationship is such that the child cannot use the adult for safety while gradually exploring the environment. The third is disrupted attachment. Disrupted attachment is not covered under ICD-10 and DSM criteria, and results from an abrupt separation or loss of a familiar caregiver to whom attachment has developed. [8] This form of categorization may demonstrate more clinical accuracy overall than the current DSM and ICD classifications, but further research is required. [9] [10]
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Attachment disorder is a broad term intended to describe disorders of mood, behavior, and social relationships arising from unavailability of normal socializing care and attention from primary caregiving figures in early childhood. Such a failure would result from unusual early experiences of neglect, abuse, abrupt separation from caregivers between three months and three years of age, frequent change or excessive numbers of caregivers, or lack of caregiver responsiveness to child communicative efforts resulting in a lack of basic trust. A problematic history of social relationships occurring after about age three may be distressing to a child, but does not result in attachment disorder.
Reactive attachment disorder (RAD) is described in clinical literature as a severe disorder that can affect children, although these issues do occasionally persist into adulthood. RAD is characterized by markedly disturbed and developmentally inappropriate ways of relating socially in most contexts. It can take the form of a persistent failure to initiate or respond to most social interactions in a developmentally appropriate way—known as the "inhibited form". In the DSM-5, the "disinhibited form" is considered a separate diagnosis named "disinhibited attachment disorder".
An attachment theory is a psychological, evolutionary, and ethological theory concerning relationships between humans. The most important tenet is that young children need to develop a relationship with at least one primary caregiver for their survival, and for them to develop a healthy social and emotional functioning. The theory was formulated by psychiatrist and psychoanalyst John Bowlby (1907–1990).
Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.
Emotional dysregulation is characterized by an inability in flexibly responding to and managing emotional states, resulting in intense and prolonged emotional reactions that deviate from social norms, given the nature of the environmental stimuli encountered. Such reactions not only deviate from accepted social norms but also surpass what is informally deemed appropriate or proportional to the encountered stimuli.
Dyadic developmental psychotherapy is a psychotherapeutic treatment method for families that have children with symptoms of emotional disorders, including complex trauma and disorders of attachment. It was originally developed by Arthur Becker-Weidman and Daniel Hughes as an intervention for children whose emotional distress resulted from earlier separation from familiar caregivers. Hughes cites attachment theory and particularly the work of John Bowlby as theoretical motivations for dyadic developmental psychotherapy.
Attachment therapy is a pseudoscientific child mental health intervention intended to treat attachment disorders. It is found primarily in the United States, and much of it is centered in about a dozen clinics in Evergreen, Colorado, where Foster Cline, one of the founders, established his clinic in the 1970s.
Advocates for Children in Therapy (ACT) is a U.S. advocacy group founded by Jean Mercer and opposed to attachment therapy and related treatments. The organization opposes a number of psychotherapeutic techniques which are potentially or actually harmful to the children who undergo them. The group's mission is to provide advocacy by "raising general public awareness of the dangers and cruelty" of practices related to attachment therapy. According to the group, "ACT works to mobilize parents, professionals, private and governmental regulators, prosecutors, juries, and legislators to end the physical torture and emotional abuse that is Attachment Therapy."
Child psychotherapy, or mental health interventions for children refers to the psychological treatment of various mental disorders diagnosed in children and adolescents. The therapeutic techniques developed for younger age ranges specialize in prioritizing the relationship between the child and the therapist. The goal of maintaining positive therapist-client relationships is typically achieved using therapeutic conversations and can take place with the client alone, or through engagement with family members.
Child and adolescent psychiatry is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial factors that influence the development and course of psychiatric disorders and treatment responses to various interventions. Child and adolescent psychiatrists primarily use psychotherapy and/or medication to treat mental disorders in the pediatric population.
Traumatic stress is a common term for reactive anxiety and depression, although it is not a medical term and is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The experience of traumatic stress include subtypes of anxiety, depression and disturbance of conduct along with combinations of these symptoms. This may result from events that are less threatening and distressing than those that lead to post-traumatic stress disorder. The fifth edition of the DSM describes in a section titled "Trauma and Stress-Related Disorders" disinhibited social engagement disorder, reactive attachment disorder, acute stress disorder, adjustment disorder, and post-traumatic stress disorder.
Infant mental health is the study of mental health as it applies to infants, toddlers, and their families. The field investigates optimal social and emotional development of infants and their families in the first three years of life. Cognitive development, and the development of motor skills may also be considered part of the infant mental health picture. While the interest in the mental life of infants in the context of their early relationships can be traced back to the work of Anna Freud, John Bowlby, and Donald Winnicott in Great Britain, infant mental health as a movement of public health policy, empirical research, and change in clinical practice paralleled both that of the women's movement and of increased awareness of the prevalence and consequences of child abuse and neglect during the 1960s and 1970s. The vast literature that has emerged since the field's origins has been reviewed in several key texts. Basic principles of infant mental health evaluation and treatment involve consideration of at least three patients: parent(s), child, and their relationship, while keeping in mind the rapid and formative development of the brain and mind in the first years of life.
Disinhibited attachment disorder (DAD) according to the International Classification of Diseases (ICD-10), is defined as:
Attachment-based therapy applies to interventions or approaches based on attachment theory, originated by John Bowlby. These range from individual therapeutic approaches to public health programs to interventions specifically designed for foster carers. Although attachment theory has become a major scientific theory of socioemotional development with one of the broadest, deepest research lines in modern psychology, attachment theory has, until recently, been less clinically applied than theories with far less empirical support. This may be partly due to lack of attention paid to clinical application by Bowlby himself and partly due to broader meanings of the word 'attachment' used amongst practitioners. It may also be partly due to the mistaken association of attachment theory with the pseudo-scientific interventions misleadingly known as attachment therapy. The approaches set out below are examples of recent clinical applications of attachment theory by mainstream attachment theorists and clinicians and are aimed at infants or children who have developed or are at risk of developing less desirable, insecure attachment styles or an attachment disorder.
Daniel S. Schechter is an American and Swiss psychiatrist known for his clinical work and research on intergenerational transmission or "communication" of violent trauma and related psychopathology involving parents and very young children. His published work in this area following the terrorist attacks on the World Trade Center in New York of September 11, 2001 led to a co-edited book entitled "September 11: Trauma and Human Bonds" (2003) and additional original articles with clinical psychologist Susan Coates that were translated into multiple languages and remain among the first accounts of 9/11 related loss and trauma described by mental health professionals who also experienced the attacks and their aftermath Schechter observed that separation anxiety among infants and young children who had either lost or feared loss of their caregivers triggered posttraumatic stress symptoms in the surviving caregivers. These observations validated his prior work on the adverse impact of family violence on the early parent-child relationship, formative social-emotional development and related attachment disturbances involving mutual dysregulation of emotion and arousal. This body of work on trauma and attachment has been cited by prominent authors in the attachment theory, psychological trauma, developmental psychobiology and neuroscience literatures
The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood-Revised is a developmentally based diagnostic manual that provides clinical criteria for categorizing mental health and developmental disorders in infants and toddlers. It is organized into a five-part axis system. The book has been translated into several languages, and its model is utilized for the assessment of children up to five years of age.
Separation anxiety disorder (SAD) is an anxiety disorder in which an individual experiences excessive anxiety regarding separation from home and/or from people to whom the individual has a strong emotional attachment. Separation anxiety is a natural part of the developmental process. It is most common in infants and little children, typically between the ages of six to seven months to three years, although it may pathologically manifest itself in older children, adolescents and adults. Unlike SAD, normal separation anxiety indicates healthy advancements in a child's cognitive maturation and should not be considered a developing behavioral problem.
Trauma focused cognitive behavioral therapy (TF-CBT) is an evidence-based psychotherapy or counselling that aims at addressing the needs of children and adolescents with post traumatic stress disorder (PTSD) and other difficulties related to traumatic life events. This treatment was developed and proposed by Drs. Anthony Mannarino, Judith Cohen, and Esther Deblinger in 2006. The goal of TF-CBT is to provide psychoeducation to both the child and non-offending caregivers, then help them identify, cope, and re-regulate maladaptive emotions, thoughts, and behaviors. Research has shown TF-CBT to be effective in treating childhood PTSD and with children who have experienced or witnessed traumatic events, including but not limited to physical or sexual victimization, child maltreatment, domestic violence, community violence, accidents, natural disasters, and war. More recently, TF-CBT has been applied to and found effective in treating complex posttraumatic stress disorder.
Disinhibited Social Engagement Disorder (DSED), or Disinhibited Attachment Disorder, is an attachment disorder in which a child has little to no fear of unfamiliar adults and may actively approach them. It can significantly impair young children's abilities to relate with adults and peers, according to the Diagnostic and Statistical Manual of Mental Disorders. As well as put them in dangerous and potentially unsafe conditions. Common examples of this include sitting on a person's lap of which they do not know or leaving with a stranger.
The Crowell procedure is a tool used to assess the parent-child relationship. Crowell and Feldman created the assessment tool for use in a study. The tool, which includes seven activities for the parent-child dyad to complete, is used for both preventive and clinical purposes. Crowell and Feldman's 1988 piece introducing the Crowell Method has been cited in over 500 studies. The assessment procedure has also been proven to be a reliable measure in discriminating between clinical and non-clinical dyads. The procedure is also known as the Crowell Parent-Child Interaction Procedure and the Crowell Problem Solving Procedure Rating Scale.
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