Reactive Attachment Disorder (RAD)

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Reactive attachment disorder (RAD) is a serious disorder that occurs when an infant or child is unable to form attachments to parents or caregivers. This usually occurs when a baby’s emotional and physical needs are neglected. Children most often at risk for developing RAD may have experienced the following situations: live in a children’s home or facility, frequently changes foster homes or caregivers, have inexperienced parents, have prolonged separation from parents or other caregivers due to hospitalization, have a mother with postpartum depression where she is not actively caring for the child or are a part of an large family where time with the parent or caregiver is rare. It should be stated that not all children in these situations develop RAD. Every child is different and respond differently to these situations.The literature states that RAD is rare and uncommon.

How do I know if my child suffers from RAD?

Reactive attachment disorder (RAD) requires the following criteria from the DSM-5 (Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition).

A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:

  1. The child rarely or minimally seeks comfort when distressed.
  2. The child rarely or minimally responds to comfort when distressed.

B. A persistent social or emotional disturbance characterized by at least two of the following:

  1. Minimal social and emotional responsiveness to others
  2. Limited positive affect
  3. Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adult caregivers.
  4. C. The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following: D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the lack of adequate care in Criterion C).
  5. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caring adults
  6. Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care)
  7. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child to caregiver ratios)

E. The criteria are not met for autism spectrum disorder.

F. The disturbance is evident before age 5 years.

G. The child has a developmental age of at least nine months.

Specify if Persistent: The disorder has been present for more than 12 months.

Specify current severity: Reactive Attachment Disorder is specified as severe when a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.

Diagnosis confirmed. Now what?

Remain calm. Learn as much about parenting, relationships, behavioral skills and reinforcement. Parents will be working on building a trusting relationship. Trust will be based on the perception of the child and not the parent. It’s easier to understand it from the point of view of the child. Children who have been hurt will often find other ways to protect their emotions. It will take time to break down those barriers and establish new ways of relating to caregivers. This will take time. It is important for parents to be patient and consistent.

READ: 10 THINGS YOU DIDN’T KNOW ABOUT REACTIVE ATTACHMENT DISORDER (RAD)

Inconsistency may reinforce the idea that caregivers or parents are not to be trusted. It is important to be consistent and remain consistent in your child’s life. It doesn’t mean you have to be perfect. You should just be consistent and acknowledge when mistakes are made and go back to the established rules.

Parents play a major role in treatment

There are two main approaches to treatment

First, ensure the child is in a safe environment where their emotional and physical needs can be met.

Second, focus on changing the relationship between the child and the caregiver. If the caregiver is the cause of the problem it is recommended that they learn parenting skills to improve the relationship.

​If not treated a client may also develop additional problems including: anxiety, depression, post traumatic stress disorder, substance abuse or other psychological problems.

Professional help

Your child should have a complete physical from a physician to determine if there are other issues going on in relation to any behavior problems. If he recommends mental health counseling he may be able to provide some referrals. He may also refer your child for a psychiatric evaluation to determine if your child suffers from RAD. This evaluation will rule out other issues including: intellectual disabilities, adjustment disorders, autism and depressive disorders which may look like RAD but have different treatment protocol.

Once the diagnosis is confirmed an addition referral may be made for mental health counseling for the child and family.

Consider the following if you are seeking out a competent mental health professional:

  • A therapist who is able to provide treatment for a long period of time. Ideally until the end of treatment.
  • A therapist who has experience working with RAD.
  • A therapist who you feel can “connect” with your child emotionally.

These criteria help establish trust in the relationship and consistency with the child which helps address the issues of abandonment and mistrust.

Working together with a mental health therapist, parents can learn skills to implement at home that help expedite treatment and increase the probability of success.

Children and parents can benefit greatly from using basic skills. The recommended Parenting Skills for RAD are found in the lessons Effective Communication and Preventive Teaching. These parenting skills address negative behaviors and in many ways seeks to prevent them. All the lessons on Smarter Parenting will be beneficial in building and strengthening trust and improved relationships.

Customizing Effective Communication for RAD

This lesson provides a key element that will help improve treatment and your relationships. When it is effectively used it will build trust.

Tips for parents on using this skill for RAD:

  • Practice this skill with your child every day for a few minutes formally and then as a normal part of your communication. Focus on the area of “repeating what is being said” and clarifying it. This helps your child put into words what they mean.
  • Refrain from sharing your perspective or giving counsel during the discussion. Allow your child to express themselves fully without judgment or comment. Addressing those issues can be done later. The point is to allow them to communicate openly and freely and this will allow them to create a better sense of trust for you as a parent.
  • Address concerns at a later time using this skill as a template. Allow for your child to explore and examine your perspective using the reflective listening portion of repeating back what was heard and clarifying.

Customizing Preventive Teaching for RAD

Tips for parents using Preventive Teaching to address RAD:

  • Determine, based on your knowledge, the things that instigate your child’s behaviors. Write them down and begin practicing alternative behaviors in response to those situations.
  • Practice the alternative behaviors at least 3 time and with children of RAD it is helpful to set up an unplanned practice. This means you tell them you will practice it later that day to see if they can remember what to do. Do this for various days. The unplanned practice helps integrate the new behavior into their natural responses. Reward them if they do well.

Implement the other parenting skills and watch the lessons on Smarter Parenting. All these skills will provide you with additional tools to improve your power as a parent and help you raise happy, responsible children.

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