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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 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 withdrawal symptoms from caregivers, avoiding eye contact, not even responding when they enter the room.
The second pattern, usually separate from the first, is a graphic pattern of indiscriminate attempts at socially interacting with strangers having an uninhibited lack of boundaries. The reasons behind this condition have not been thoroughly studied, but it is known that the effects of the condition are more resistant to treatment and often permanent.
A subset of 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 adverse effects of the unfortunate absence of true emotional warmth in the first few years of life disable a child’s entire future and destroy the natural ability to have a healthy love relationship as an adult.
Reactive Attachment Disorder Signs
The key to the diagnosis of RAD is that children never establish normal bonding with their primary caregivers or parents. These children do not respond to typical human survival behaviors during developmental milestones. For example, nine-month-old infants typically begin to prefer their primary caregivers or mothers and fathers over strangers. They 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 DSM-IV, RAD studies are being conducted to determine whether there is a genetic predisposition for emotionally withdrawn/inhibited patterns and the indiscriminately social pattern subtypes of non-bonding infants. Twin studies show a difference in the predisposition of males and females with RAD. Also, both social subtypes can exist within the same family.
Children with RAD 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 postnatal 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 the child is not responded to when initially reaching out for comfort, learning at an early age not to reach out, then begin 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 usually, and children never learn affection and attachment to another human and consequently never develop a social conscience.
RAD is usually observed by the age of 5 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 normal behaviour patterns 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 more robust avoidance behaviors, which continue into childhood and adolescence. It is observed that they dismiss or avoid lovely 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 with 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 expressive behaviors such as attention-seeking from virtually everyone, including strangers, preference for strangers, displaying inappropriately childish responses, appearing overly anxious and needy, constantly requesting 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 exhibit more severe controlling and aggressive behaviors beyond their 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 and 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; behavioral disorders are a lifelong challenge.
Reactive Attachment Disorder in Adults
The following complications are continued into adulthood and can be a lifelong 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 that 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 proactive 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 essential for significant others not to personalize the isolating or disconnected tendencies of a person struggling with RAD symptoms. At the same time, Who must lovingly establish boundaries 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 highly 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 highly 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 a child’s regular, essential emotional and physical development. 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 standard interactive care.
Children whose needs are ignored and abusively responded to – physically or emotionally- create the expectation that hostility and rejection are normal responses in a young child. The child develops distance and distrust in caregivers, dislikes the primary caregiver, and avoids social contact or intimacy.
Early brain development is affected by abnormal emotional contact with unfeeling or abusive caregivers, creating attachment problems, distorting personality formation and inhibiting 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 extreme neglect, abandonment, an orphanage and institutional environments, multiple foster homes, and multiple caregivers, they still develop healthy relationships and intense bonds.
Some babies are afflicted with RAD in less destructive environments due to inexperienced parenting, prolonged hospitalization of the child, and extreme poverty or postpartum 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 physical, sexual or emotional abuse, kids who have parents with mental illness, untreated anger management issues, and alcohol or drug abusers. Most of these children respond to treatment without prior RAD effects 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 health care plan for their children with complex mental health needs. Some of the suggestions are ground-breaking.
Intensive availability to the PCPs or primary care providers has the best possible outcomes for RAD adolescents to integrate into 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 caregivers’ needs. A triage of appropriate behavioural health treatment, mental health services, and health care team parents are made available.
Ready access to child and adolescent psychiatric consultations, as needed, includes “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, support the home health care unit, members. 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 caregivers
- doesn’t seek physical contact
- seems uninterested in the primary caregiver
- appears sad, doesn’t seek comforting
- readily goes to strangers, inappropriate attention-seeking
Before seeing the physician or psychiatrist, the 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, the doctor will need a couple of visits 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 Who will examine additional mental or physical problems. Who may prescribe medication to lessen the 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 from RAD.
Provide answers to the psychiatrist’s questions as candidly as possible, even if they are somewhat embarrassing. It’sIt’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 the development of early relationships and bonding responses because of early displacement into a hospital, residential program, foster homes, homeless shelters, orphanages 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. 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 apply consistently loving boundaries and attention to the behaviors of their RAD youth. With solid support and regular counseling, parents can keep focusing on developing appropriate living skills and coping mechanisms for their children.
When the child has downward spirals during development milestone periods, having a support backup system keeps the family from disconnecting or imploding. Teenagers and young adults are drained and exhausted with normal developmental issues; when the symptoms of either RAD pattern or dysfunction are 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 of 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 throughout 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 holy 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.
In every facet and form, the drama that turns the world of an average suffering teen is love. This is not a concern or part of a RAD teen’s world.
RAD kids obsess with strategy and ultimate control over others for their sense of safety. Moms and dads cannot fall into this trap or the battle over control with their children. Control isn’t the real problem. In this instance, a parent’s job is to get to the issue of making the home environment feel safe and secure. Parents need to understand that proper 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 result goals.