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About Reactive Attachment Disorder

By Meghan Vivo

Reactive Attachment Disorder (RAD) is a complex term for a complex psychiatric illness. Also called “attachment disorder” and considered by some a form of post-traumatic stress disorder, children with RAD struggle to forge emotional attachments to others, often because of serious disruptions in their early relationships.

Neglect, physical or emotional abuse, placement outside the home in foster care or an orphanage, and multiple changes in caregiver are frequent causes of reactive attachment disorder. Many adopted and foster children have painful histories. Approximately 2 percent of the population is adopted, and between 50 percent and 80 percent of these children display symptoms of attachment disorder.

Whatever the cause, the RAD child’s basic needs for comfort, affection, nurturing, and stimulation are not met at a young age, making it difficult for the child to trust or bond with others later in life.

Symptoms of Reactive Attachment Disorder

There are two types of reactive attachment disorder: inhibited and disinhibited. In inhibited RAD, children resist affection from others, avoid eye contact and physical contact, and are constantly “on guard.” In the disinhibited type, children form shallow and often inappropriate attachments to virtually everyone, readily seeking comfort from strangers, acting inappropriately childish, and exaggerating the need for help in doing basic tasks. In either case, the child does not form any genuine, trusting bonds.

Children who have been neglected, abused, or moved from caregiver to caregiver sometimes protect themselves from disappointment and rejection by becoming detached. In infants or young children, this detachment manifests in abnormal crying patterns, severe colic and/or feeding difficulties, or failure to gain weight. In older children, RAD may manifest in the following symptoms:

• Low self-esteem
• Inability to cope with stress and adversity
• Depression or apathy
• Obsession with food (refusing to eat, excessive appetite, hording or gorging on food)
• Inability to develop and maintain friendships, trust others, or accept or offer affection
• Alienation from parents or caregivers
• Lack of compassion, remorse, and empathy (sometimes to the extreme of destruction of property or cruelty toward animals)
• Preoccupation with fire, blood, gore, and violence
• Lack of self-control (impulsive behaviors)
• High tolerance to pain
• Lack of understanding of consequences or inability to learn from mistakes
• Speech, language, and learning problems
• Behavioral problems at school
• Oppositional or defiant behavior, or manipulative behavior

Parenting a RAD Child

Normal parenting techniques generally do not work with RAD children. They do not feel the bonds of affection that make most children receptive to parental feedback and anxious to please. As such, parents need extra support and guidance to meet the needs of their child with reactive attachment disorder. The following are a few skills parents will likely learn and practice in therapy:

• Practice Self-Care. Children with RAD can be all-consuming. Parents must learn to first take care of themselves so that they have the energy to consistently and effectively parent their child. Join a RAD support group, participate in family therapy, or find a supportive group of parents with whom you can share your struggles and accomplishments.

• Show Affection. Showing and receiving affection does not come naturally for children with RAD. By regularly offering hugs, pats on the back, and kisses, you set a model for normal, loving human behavior.

• Get Involved in Activities. The more active a child is in extracurricular activities, sports, and family fun time, the more practice she will get interacting with other people in a positive, nonjudgmental setting.

• Create Opportunities to Meet the Child’s Needs. A RAD child needs to learn that you, the parent, are there to consistently meet his basic needs. Make sure your child asks you for assistance and permission with picking out clothes, preparing or eating meals, and other basic daily tasks to help restore the parent-child bond.

• Maintain Structure and Rules. A structured daily schedule and rules around mealtime, homework, bedtime, and use of the computer or television provide consistency and predictability, which helps children feel safe and secure. Also encourage your child to make eye contact with both parents when making requests or engaging in conversation.

It takes time to build trust. Even with the most attentive parents, children only come to trust when their needs are repeatedly and consistently met. For this reason, rebuilding trust is an important component of treating RAD. When children feel valued by their parents, they naturally assume that other people have value as well, which sets the stage for a lifetime of positive social interactions.

Treatment for Reactive Attachment Disorder
 
Traditional therapy is generally ineffective for children with attachment disorders, as building a trusting, open therapeutic relationship is virtually impossible. But there are a number of specialized treatment programs that can help RAD children make great strides. Therapeutic boarding schools, residential treatment centers, and wilderness therapy programs have helped hundreds of children and teens with attachment disorders and their families. With 24-hour supervision, structure, and intensive therapy, combined with academic assistance and a positive network of peers, teens with attachment disorder can develop meaningful connections with the world around them.

In most programs, a variety of therapeutic methods are employed, including role playing and role modeling, Gestalt therapy, family therapy, and general psychotherapy. A structured and nurturing environment is best, where the child is surrounded by a caring team of professionals and learns primarily from the natural consequences of her actions. Early intervention is critical, as RAD can permanently affect a child's social and emotional development and ability to relate to other people.

Parents and caregivers are the single most significant relationship in a child’s life, particularly from birth to age 3. Because children’s early attachment relationships create the blueprints for all their future relationships, the earlier the intervention the better. Give your child the best chance at a lifetime of fulfilling relationships by recognizing any attachment issues and finding help early on.