In Syndromes & Disorders

The Makings of Reactive Attachment Disorder

reactive attachment disorder

Reactive Attachment Disorder– RAD – in Children and Adults

Definition: RAD definition

The definition of reactive detachment disorder is a lifelong condition beginning in the womb, or in infancy. Newborns and infants with this disorder never develop the required healthy bonding response to primary caregivers or parents. There are two basic clinical patterns and one subset that manifests symptoms of this disorder. The first clinical pattern demonstrates RAD children with symptoms of withdrawal from caregivers, avoiding eye contact, not even responding when they enter the room.

The second pattern, usually separate from the first, is an uninhibited pattern of indiscriminate attempts at socially interacting with strangers having an uninhibited lack boundaries. The reasons behind this condition have not been fully studied but it is known that the effects of the condition are more resistant to treatment and often permanent.

A subset to the RAD disorder includes erratic attachment behaviors, not always withdrawal or attention seeking, but will display attempts to control and manipulate the primary caregiver with no true display of emotional affection or conscience.

Some symptoms are reduced and managed by early intervention and treatment involving the patients, their caregivers and daily routines that are significantly structured with treatment and care. The negative effects of the unfortunate absence of true emotional warmth in the first few years of life disable a child’s entire future, and destroy natural ability to have a healthy love relationship as an adult.

Reactive Attachment Disorder Signs

The key to the diagnosis for RAD is that children never establish normal bonding with their primary caregivers or parents. During developmental milestones these children do not respond with typical human survival behaviors. For example nine month old infants normally begin to develop preference for their primary caregivers or mothers, and fathers, over strangers. They begin to feel anxious when the parent is not in the room or when a stranger comes too close.

Rad children at this age, will respond in one of two distinct ways, they never feel comforted by their primary caregiver or parents, and do not prefer them, to the point of avoiding eye contact. The other uninhibited group will reach for strangers and respond to them indiscriminately, and sometimes in preference to their primary caregivers, with no concern for safety or self-preservation.

Reactive Attachment Disorder Symptoms

According to the Diagnostic and Statistical Manual of Mental Disorders for DSM-IV, RAD studies being conducted to determine whether there is a genetic predisposition for both types: emotionally withdrawn/inhibited patterns and the indiscriminately social pattern subtypes of non-bonding infants. Twin studies are showing a difference in the predisposition of males and females with RAD. Also both social subtypes can exist within the same family.

Children with RAD in either manifestation, appear to have a combination of vulnerability factors that include stress in the womb from drugs taken during pregnancy, prenatal risk factors such as lack of concern of the mother for her health, and post natal social neglect of the newborn. Several factors are present with RAD diagnosis: parental detachment, neglect of child placed in childcare, foster care or institutional care where child is not responded to when initially reaching out for comfort, learning at an early age not to reach out, then begins to ignore human bonding instincts.

The other form of RAD manifests in the opposite result and these children reach out, demand and seek the responses of all others indiscriminately, and inappropriately. The bonding does not occur normally and children never learn affection, attachment to another human and consequently never develops social conscience.

RAD is usually observed by the age of 5 years old, but manifests much earlier and is detected by parents or guardians at infancy. The following symptoms are present in infancy:

  • failure to gain weight
  • detached, unresponsive behavior
  • severe colic and feeding difficulties
  • difficulty in being comforted
  • inhibited, hesitant, and avoids social settings
  • inappropriate familiarity or closeness to strangers

Babies with RAD do not develop patterns of normal behavior like following others in the room with their eyes, they remain calm when left alone, and fail to smile or reach up when picked up. These children have no interest in toys or interactive games like peek-a-boo. They often appear sad, listless and withdrawn. Some babies engage in self-soothing behavior like rocking back and forth and stroking themselves.

As toddlers become more mobile, they develop stronger avoidance behaviors which continue into childhood and adolescence. It is observed that they dismiss or avoid comforting comments or gestures, act aggressively toward peers, fail to ask for support or assistance, and withdraw from others. These kids watch others closely but do not engage in social interaction. They mask their feelings of anger or distress and by adolescence, eventually self-medicate with alcohol or drugs.

Early intervention with RAD children of the inhibited behavior patterns, those that shun relationships and attachments with virtually anyone, will improve symptoms and mediate behaviors with therapy and daily special attention of trained caregivers.

Children with the RAD patterns associated with uninhibited behaviors such as attention seeking from virtually everyone including strangers, preference to strangers, displays inappropriately childish responses, appears overly anxious and needy, constantly requests assistance in tasks – are more resistant to help and less responsive to behavioral treatment, and they tend to show little improvement through-out stage development.

Reactive Attachment Disorder in Teenagers

Older RAD children will begin to exhibit more serious controlling and aggressive behaviors beyond childhood years. Adolescent RAD kids gravitate to delinquent behavior and have trouble relating to peers, often rejected due to persistent childish and inappropriate attention seeking as well as other disorders.

Parents and caregiving adults can benefit from therapy for dealing with these adolescents but only to develop coping skills as there is no cure for RAD. Early childhood developmental damage is irreversible and permanent, the behavioral disorders are a lifelong challenge.

Reactive Attachment Disorder in Adults

The following complications are continued into adulthood and can be a life-long source of loss in quality of living.

  • Inappropriate sexual behavior
  • Poor self-esteem
  • Childish reactions in adulthood
  • Delayed learning or physical growth
  • Delinquent or antisocial behavior
  • Exaggerated Anxiety
  • Academic problems
  • Lack of intimacy or conscience
  • Temper or anger problems
  • Eating problems, which can lead to malnutrition in severe cases
  • Continued cycles of depression
  • Drug and alcohol addiction
  • Constant problems with coworkers or peers
  • Unemployment or frequent job changes
  • Relationship problems
  • Attention seeking behaviors

This is a list of common issues but not an all-inclusive list.

With counseling, supportive family and friends, and a pro-active treatment plan teenagers can break their natural RAD patterns and with work, find satisfaction and safety in healthy relationships. Even as they struggle to maintain good relationships through adolescence, the changes they face while transitioning into young adulthood can disrupt the good work they have achieved. During this crucial time of transition, teens and adults need counseling and support as much as ever.

Keeping structure and consistent, healthy and understanding influences in their lives will sustain them as they develop adult patterns. Professional intervention should be an integrated and acceptable option for RAD patients and their families.

It is important for significant others to not personalize the isolating or disconnected tendencies of a person struggling with RAD symptoms. At the same time, boundaries must be lovingly established for the inappropriate and indiscriminate socialization tendencies in some RAD cases.

Adult symptoms of RAD become more dysfunctional, especially in relationships if they remain untreated. Spouses, significant others and close friends become concerned and confused when RAD adults do not return affection or behave extremely detached. They often avoid and dislike being touched, are resistant and unresponsive to attempts from comforters, and refuse to talk about their feelings. They are extremely inhibited and refuse to acknowledge emotions or act unemotional at inappropriate times.

Reactive Attachment Disorder Treatment

According to Mayo Hospital Research, infants and young children need a stable, caring environment. Consistency is an absolute requirement for normal, basic emotional and physical development of a child. When a baby cries, the need for feeding or a diaper change must be an opportunity for mutual emotional exchange between caregiver and child. This exchange of eye contact, smiling and caressing is the key to normal interactive care.

Children whose needs are ignored, abusively responded to – physically or emotionally, creates the expectation in a young child, that hostility and rejection are normal responses. The child develops distance and distrust in caregivers, dislike for the primary caregiver and avoids any social contact or intimacy.

Early brain development is affected by abnormal emotional contacts with unfeeling or abusive caregivers, creating attachment problems, distorts personality formation and inhibits bonding relationships throughout life.

It is not understood why some children develop RAD and others in the same situations do not. Most children are naturally resilient, even in situations of extreme neglect, abandonment, living in orphanage and institutional environments, multiple foster homes, and having multiple caregivers, still develop healthy relationships and strong bonds.

Some babies are afflicted with RAD in less destructive environments due to inexperienced parenting, prolonged hospitalization of the child, and extreme poverty or post partum depression of the natural mother.

Doctors will watch for signs of RAD in children with living situations like being forcefully removed from parents in neglectful or abusive homes, in the context of physical, sexual or emotional abuse, kids who have parents with mental illness, untreated anger management issues, and alcohol or drug abusers. Without prior RAD effects, most of these children respond to treatment and do not develop the RAD condition.

The American Academy of Child and Adolescent Psychiatry outlines principles of family-focused care, to integrate and sustain a mentally healthy framework within a pediatric/young adult health home. There must be mechanisms to support caregivers and families focused on providing a beneficial care plan for their children with complex mental health needs. Some of the suggestions are ground-breaking.

Intensive availability to the PCP’s or primary care providers have best possible outcomes for RAD adolescents to integrate into a healthy community life. Primary care providers are provided vital collaboration between professionals, the child and adolescent psychiatrists. A care coordination plan is developed for the child and care-givers needs. A triage of appropriate behavioral health treatment, mental health services, and health care team parents are made available.

Ready access to child and adolescent psychiatric consultations, as needed include “on-demand” (curbside) assistance for primary care providers. Timely and regular Face-to-face consultations with the RAD patients, their families and both patient and families together with an adolescent psychiatric specialist supports members of the home health care unit. There is hope that with time, structures take root and the RAD patient can develop self-control and some insight to know when added support is needed.

Reactive Attachment Disorder Parenting

Parents who think their child is exhibiting symptoms of reactive attachment disorder need to visit their pediatrician to get a referral for a specialist in this diagnostic field to obtain a complete evaluation. The best diagnostician in these cases would be a psychiatrist with experience in the treatment of RAD.

Discuss any of the following observations present in your child:

  • prefers not to be held
  • usually likes to play alone
  • avoids parents or primary care giver
  • doesn’t seek physical contact
  • seems uninterested in primary care giver
  • appears sad, doesn’t seek comforting
  • readily goes to strangers, inappropriate attention seeking

Before seeing the physician or psychiatrist, parent should prepare a list of their questions and concerns they want to discuss. Organize the list from the most important issues with your child to the lesser problems so the doctor can address your most profound concerns fully.

Parents need reasons for their child’s behaviors, some answers may be hard to hear. Some questions may not have answers as yet. Sometimes it will take a couple of visits for the doctor to develop a concise understanding of what symptoms apply and which are unrelated, before the diagnosis is complete.

Testing will usually be an option, treatment modalities will be described and additional mental or physical problems will be examined. Medication may be prescribed to lessen severity of some symptoms. Parental therapy is very helpful for parents trying to understand, adapt and cope with the reality of daily life with a child suffering with RAD.

Provide answers to the psychiatrist’s questions as candidly as possible, even if they are somewhat embarrassing. It’s the best way to get through the issues and help the child.

When did you first notice the child’s behaviors and emotional disorders? Are they continuous or occasional? What is the severity of the behaviors? Do you notice triggers to the child’s behaviors or emotions? Have you found ways to alleviate the behaviors or emotions temporarily?

Most children, but not all, have been exposed to severe disruptions in development of early relationships and bonding responses because of early displacement into a hospital, residential program, foster homes, homeless shelters, orphanage or multiple childcare facilities at a very young age. Many have been physically abused, neglected or emotionally stunted. Never label or diagnose a child with RAD unless a comprehensive psychiatric assessment has been completed and determined it. There are other psychiatric disorders with these signs and symptoms and a trained and experienced psychiatrist is required to evaluate the entire situation.

Parents can learn skills and programs that will help them to apply consistently loving boundaries and attention to behaviors of their RAD youth. With strong support and regular counseling, parents can keep focusing on developing appropriate living skills and coping mechanisms for their child. When the child has downward spirals during development milestone periods, having a support back-up system keeps the family from disconnecting or imploding. Teenagers and young adults are draining and exhausting with normal developmental issues, when the symptoms of either RAD pattern of dysfunction is added, parents must have support and strong leadership to guide them through the minefield.

There are solutions like official support groups sponsored by hospitals, physicians groups and psychiatric facilities that will provide “time-outs” for stressed parents, summer camps for RAD and special needs kids, activities for families experiencing similar problems and solid advice for each new stage the RAD youth are approaching. As families learn to include professionals and knowledge based organizations into their lifestyle, more consistency and trust will develop between the child and parents or guardians.

How Do RAD Parenting Plans Assist?

Parents of RAD diagnosed children are best served by having professional and sponsored assistance through-out their treatment plans. Youngsters with attachment difficulties are very guarded and distrustful, far beyond the level of normal teenager issues. Rad teens cannot receive the love and support naturally offered by their mothers and fathers. Even parents who naturally possess parental common sense and devotional love for their children are out of their element with RAD. The foundational motivation of a RAD kid is safety, at all costs, not love.

The drama that turns the world of a normal suffering teen is love, in every facet and form. This is not a concern or any part of a RAD teen’s world.

RAD kids obsess with strategy and ultimate control over others for the purpose of their own sense of safety. Moms and dads cannot fall into this trap or the battle over control with their child. Control isn’t the real problem. A parent’s job in this instance is to get to the issue of making the home environment to feel safe and secure. Parents need to understand that true safety is never developed by giving in to irrationality.

Support groups illustrate parenting techniques to convert an “unteachable” child into a teachable one. When the process progresses, the teachable child begins to value a parent’s love. Techniques are repetitive and building block steps. A support team helps parents keep their sense of humor and focus on their end result goals.

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