REACTIVE ATTACHMENT DISORDER
RISK FACTORS
Although it is not fully understood as to why some children develop reactive attachment disorder and others do not, there are some hypotheses surrounding what can increase a child’s risk for RAD including:
- Physical, emotional, or sexual abuse – when a child experiences abuse of any kind from parents or caregivers, often that child will grow to expect rejection and/or hostility. This then makes it difficult to trust others, and fuels social isolation.
- Inconsistent Caregiving – children who have been bounced around to various caregivers (whether due to being in foster care or otherwise) are at an increased risk of developing reactive attachment disorder.
- Chronic Illness – children who have a chronic illness and thus are hospitalized frequently or for long periods of time, are more likely than healthy children to show signs of RAD. This is likely due to the inherent separation from parents/caregivers that occurs when spending much time hospitalized.
- Death or chronic illness of a parent/caregiver – if a child’s parent or caregiver dies, or suffers from chronic illness, it is often very difficult (and in the case of the death of a parent, impossible) for a healthy parent-child attachment style to develop.
- Extreme poverty / financial hardship
SIGNS AND SYMPTOMS
Children with inhibited reactive attachment commonly experience the following symptoms:
- Discomfort or nonresponse when being consoled or soothed
- Avoidant behavior
- A tendency to withdraw from others
- Lack of emotional expression
- Relationship avoidance
While it is the same mental illness, children with the disinhibited type of reactive attachment disorder will present differently. Often these children will:
- Violate social boundaries
- Excessively seek attention from others
- Display incongruent or inappropriate childish behavior
- Form inappropriate attachments to others
- Be extremely selective in choosing attachment figures
COMPLICATIONS
- Anger issues
- Academic problems – delayed learning is often a result of children with RAD experiencing challenges with functioning in an educational environment.
- Slowed physical growth – due to eating issues, which can cause malnutrition
- Low self-esteem
- Addiction – children with RAD commonly develop a drug or alcohol abuse problem as they age into teenagers and young adults.
- Inappropriate sexual behavior –
- Co-occurring disorders – there are numerous conditions seen in children with RAD that are related to neglect including depression, anxiety, attention deficit hyperactive disorder
DIAGNOSIS
If you think your child may suffer from reactive attachment disorder, it is important to meet with a mental health professional, as he or she will be able to screen for symptoms, and assign the proper diagnosis.
Typically a mental health professional (therapist, psychologist, psychiatrist) will ask questions regarding the history of your child’s conduct, and observe his or her behavior, attitude, and style of interaction. The mental health professional will likely also ask about your child’s home life and living situation since birth, and inquire about your parenting/caregiving style and ability.
To be diagnosed with reactive attachment disorder, other psychiatric disorders will need to be ruled out, including:
- Autism spectrum disorder
- Other adjustment disorders
- Depressive disorders
PREPARING FOR THE APPOINTMENT
- Any emotional or behavioral problems/issues you have noticed in your child
- Major stressors or life changes that yourself or your child have endured
- All medications your child takes, including vitamins, supplements, herbal remedies, etc.
- Any initial questions you may have regarding RAD or your child’s behavioral/emotional presentation
Some general questions for your doctor/mental health professional could include:
- What is the possible cause of my child’s behavioral and/or emotional struggles?
- What tests will you administer to my child?
- What is the typical approach used to treat these issues?
- Are there alternative treatments?
- Are there other medical/mental health professionals or specialists that should evaluate my child?
While the answers to these questions can provide a lot of information and insight, it is still a good idea to take any brochures or materials on reactive attachment. The more a parent or caregiver knows about what is affecting his or her child, the more likely it can be managed effectively.
TREATMENT
If your child is diagnosed with RAD, it is vital he or she is provided with appropriate treatment interventions to provide the best chance of symptom management. Treatment typically involves the child and the current caregiver(s). There are various approaches to treating RAD, and depending on which is deemed most effective for your child, the treatment plan may include:
- Psychotherapy
- Family therapy
- Physical therapy
- Caregiver education
TIPS FOR PARENTS
PRACTICE STRESS MANAGEMENT
Learning to control stress levels is essential for any parent, especially those with emotionally or behaviorally difficult children. Thus, incorporating stress-reducing activities (i.e. – yoga, meditation) into your daily routine can be helpful.
TAKE A BREAK
Because of the demanding nature of raising a child with reactive attachment, it is important parents or caregivers get a break. If you can find a family member or trusted friend capable of caring for your child from time to time, it can greatly reduce your chances of becoming exhausted (both physically and mentally) and burning out.
SEEK SUPPORT
Raising a child with RAD can be very stressful. Thus, it is vital for parents/caregivers to take care of themselves and seek their own support. This could be seeking your own psychotherapy, attending support groups, or reaching out to other parents who have experience with a child with reactive attachment disorder.