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Help! My Child Has Been Diagnosed with Reactive Attachment Disorder

By Meghan Vivo

The first years of a child’s life set the stage for the emotional attachments she’ll have for the rest of her life. Attachment (the development of a strong emotional bond between child and parents or caregivers) is one of the most important developments during this time, affecting the child’s cognitive and social development, the formation of her value and belief system, and the way she relates to the world around her. Healthy attachments help children learn to love and trust others, treat people with compassion and empathy, and develop self-confidence.

Unfortunately, these connections do not form for every child. Many adopted children and those who live in an orphanage, have parents with a mental illness, depression, or drug or alcohol abuse, or experience frequent changes in foster care or caregivers, prolonged hospitalization, extreme poverty, physical, sexual, or emotional abuse, neglect, or family trauma such as death or divorce are at increased risk for developing a complex psychiatric disorder called reactive attachment disorder (RAD).

Understanding the Diagnosis

According to the DSM-IV, reactive attachment disorder is diagnosed when the following criteria are met:

• Presence of markedly disturbed and developmentally inappropriate social interactions, beginning before age 5. For example, the child does not respond to or initiate social interactions in a way that would be developmentally appropriate. Instead, the child is excessively inhibited, hypervigilant, or has highly ambivalent and contradictory responses OR attaches indiscriminately (e.g., excessive familiarity with relative strangers or lack of selectivity in choice of attachment figures).

• The child's inappropriate social interactions are not due exclusively to developmental delay (as in mental retardation) and do not meet the criteria for a pervasive developmental disorder.

• The child has received care in which his basic needs, either emotional or physical, have been disregarded, or in which stable attachments have been prevented (such as when primary caregivers change often).

Usually diagnosed in children younger than age 5, RAD is characterized by the failure to develop healthy bonds to parents or caregivers during infancy and childhood. There are two types of reactive attachment disorder: inhibited and disinhibited. Children with the inhibited form generally don’t initiate or respond appropriately to most social interactions and may respond to comforting with outbursts of anger, crying, or irritability. Children with the disinhibited form of RAD tend to attach easily but indiscriminately, even to strangers or unfamiliar adults.

The course of the disorder, and the child’s response to treatment, are influenced by several factors, including the child’s nature and personality, the severity and duration of the maltreatment, and the nature of the treatment received. Without treatment, the physical, emotional, and social problems associated with RAD may persist – and even worsen – as the child grows older.

Finding Help for Reactive Attachment Disorder

Raising a child with RAD can be immensely challenging. Recognizing the signs as early as possible and accessing appropriate professional resources are two of the most important steps in treating attachment disorders.

Although it has been estimated that only 1 percent of all children under the age of 5 have RAD, diagnosis and treatment are still relatively new and not all therapists have experience treating children and teens with RAD. It is a difficult, time-consuming disorder to treat and it may take time and patience to find the right therapist or treatment program for attachment disorders, but help is available. Talking with parents of adopted children or teens with attachment disorders may be a good place to start, along with your health care provider.

In addition, there are a number of therapeutic boarding schools, residential treatment centers, and wilderness therapy programs that specialize in treating children and teens with RAD. Because traditional therapy isn’t generally effective for children with RAD, these programs employ a variety of therapeutic methods, including role playing and role modeling, parental education, art or play therapy, family therapy, and cognitive behavioral therapy, to help children develop meaningful connections with the world around them.

Treatment is generally a collaborative process between therapist, parents, and child. The primary goals of treatment are creating a safe environment for the child and helping the child develop healthy bonds with parents or caregivers. For parents, therapy is designed to educate them about the nature of the disorder and appropriate self-care, and to develop parenting skills that are effective with RAD children. Once children with RAD (particularly the inhibited form) are placed in a stable, nurturing environment with caring, involved parents, they have shown great improvements in coping and relationship-building skills.

For many of us, our connections with other human beings are one of the single most important parts of life – the part that makes life worth living even when times get tough. Children with RAD need professional help and ongoing support and guidance to have the same opportunity to experience the closeness and meaning found through close interpersonal relationships. With help, your child can learn that when she reaches out for safety and security, she will be met with caring, protection, and love.


 

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